Adverse event following immunization or vaccination in children in Minas Gerais: 2015 to 2020.

OBJECTIVE: To describe adverse event following immunization or vaccination in children in Minas Gerais: 2015 to 2020, resulting from immunization errors in children from zero to nine years old. METHODS: An ecological, descriptive study with a quantitative approach, based on event notifications available in the National Immunization Program Information System. RESULTS: Among the 39,903,277 doses of immunobiologicals in children aged zero to nine, administered in the state of MG, 3,259 events of types of immunization errors were recorded, around 0.008% of the total and, of these, 91.86% did not result in adverse events and 56.02% were children under one year of age. The most frequent diagnosis was application outside the recommended age (29.12%). Among the manifestations, 71.91% were local and systemic, with fever being the most common (40.85%). CONCLUSION: The study demonstrated that immunization errors were rare and that most of them were not associated with adverse events, which reinforces the safety of the immunization process. This undoubtedly raises reflection on the need and relevance of continuing education for health professionals.

[Transmission risk classification for vaccine-preventable diseases in Minas Gerais, Brazil: two years since the onset of the COVID-19 pandemic]. / Classificação de risco para transmissão de doenças imunopreveníveis em Minas Gerais, Brasil: dois anos desde o início da pandemia de COVID-19.

The scope of this study is to analyze the risk classification of transmission of vaccine-preventable diseases (VPDs) in the 853 municipalities in the state of Minas Gerais (MG) two years after the onset of the COVID-19 pandemic. It is an epidemiological study with secondary data on vaccination coverage and dropout rate of ten immuno-biologicals recommended for under 2-year-old children in 2021 in MG. With respect to the dropout rate, this indicator was only evaluated for the multidose vaccines. After calculating all the indicators, the municipalities of the state were classified according to the transmission risk of VPDs into five categories: very low, low, medium, high, and very high risk. Minas Gerais had 80.9% of municipalities classified as high transmission risk for VPDs. Regarding the homogeneity of vaccination coverage (HCV), large municipalities had the highest percentage of HCV classified as very low, and 100% of these municipalities were classified as high or very high risk for transmission of VPDs, with statistical significance. The use of immunization indicators by municipality is effective for the classification of the scenario of each territory and the proposal of public policies seeking to increase vaccination coverage.

O objetivo é analisar a classificação de risco de transmissão de doenças imunopreveníveis nos 853 municípios de Minas Gerais (MG) após dois anos de início da pandemia de COVID-19. Estudo epidemiológico com dados secundários da cobertura vacinal e taxa de abandono de dez imunobiológicos recomendados para crianças menores de 2 anos, no ano de 2021, em MG. Em relação à taxa de abandono, este indicador foi avaliado somente para as vacinas multidoses. Após o cálculo de todos os indicadores, os municípios do estado foram classificados de acordo com o risco de transmissão de doenças imunopreveníveis em cinco estratos. Minas Gerais apresentou 80,9% dos municípios classificados como alto risco para transmissão de doenças imunopreveníveis. Em relação à homogeneidade das coberturas vacinais (HCV), os municípios de grande porte apresentaram a maior porcentagem de HCV classificada como muito baixa e 100% desses municípios foram classificados como de alto ou muito alto risco para transmissão de doenças imunopreveníveis, com significância estatística. A utilização de indicadores de imunização por município é efetiva para o delineamento do cenário de cada território e a proposição de políticas públicas em saúde visando o aumento das coberturas vacinais.

Classificação de risco para transmissão de doenças imunopreveníveis em Minas Gerais, Brasil: dois anos desde o início da pandemia de COVID-19 / Transmission risk classification for vaccine-preventable diseases in Minas Gerais, Brazil: two years since the onset of the COVID-19 pandemic

Resumo O objetivo é analisar a classificação de risco de transmissão de doenças imunopreveníveis nos 853 municípios de Minas Gerais (MG) após dois anos de início da pandemia de COVID-19. Estudo epidemiológico com dados secundários da cobertura vacinal e taxa de abandono de dez imunobiológicos recomendados para crianças menores de 2 anos, no ano de 2021, em MG. Em relação à taxa de abandono, este indicador foi avaliado somente para as vacinas multidoses. Após o cálculo de todos os indicadores, os municípios do estado foram classificados de acordo com o risco de transmissão de doenças imunopreveníveis em cinco estratos. Minas Gerais apresentou 80,9% dos municípios classificados como alto risco para transmissão de doenças imunopreveníveis. Em relação à homogeneidade das coberturas vacinais (HCV), os municípios de grande porte apresentaram a maior porcentagem de HCV classificada como muito baixa e 100% desses municípios foram classificados como de alto ou muito alto risco para transmissão de doenças imunopreveníveis, com significância estatística. A utilização de indicadores de imunização por município é efetiva para o delineamento do cenário de cada território e a proposição de políticas públicas em saúde visando o aumento das coberturas vacinais.

Abstract The scope of this study is to analyze the risk classification of transmission of vaccine-preventable diseases (VPDs) in the 853 municipalities in the state of Minas Gerais (MG) two years after the onset of the COVID-19 pandemic. It is an epidemiological study with secondary data on vaccination coverage and dropout rate of ten immuno-biologicals recommended for under 2-year-old children in 2021 in MG. With respect to the dropout rate, this indicator was only evaluated for the multidose vaccines. After calculating all the indicators, the municipalities of the state were classified according to the transmission risk of VPDs into five categories: very low, low, medium, high, and very high risk. Minas Gerais had 80.9% of municipalities classified as high transmission risk for VPDs. Regarding the homogeneity of vaccination coverage (HCV), large municipalities had the highest percentage of HCV classified as very low, and 100% of these municipalities were classified as high or very high risk for transmission of VPDs, with statistical significance. The use of immunization indicators by municipality is effective for the classification of the scenario of each territory and the proposal of public policies seeking to increase vaccination coverage.

Blood count reference intervals for the Brazilian adult population: National Health Survey / Intervalos de referência de hemograma da população adulta brasileira: Pesquisa Nacional de Saúde

Objective: to estimate the reference intervals (RIs) of complete blood count parameters in the Brazilian adult population. Methods: Cross-sectional study, with data from the National Health Survey (PNS), between 2014-2015. The final sample consisted of 2,803 adults. The final sample consisted of 2,803 adults. To establish the RI, exclusion criteria were applied, outliers were removed and partitions were made by sex, age and race/skin color. The non-parametric method was adopted. Differences were assessed using the Mann Withney and Kruskal Wallis tests (p≤0.05). Results: There were statistically significant differences for the following hematological parameters based on sex, red blood cells, hemoglobin, hematocrit, MCH, MCHC, eosinophils and absolute monocytes, neutrophils and platelets (p≤0.05). When analyzed by age, the RIs were statistically different in females for hematocrit, MCV, white blood cells and RDW and in males for red blood cells, white blood cells, eosinophils, mean platelet volume, MCV, RDW and MCH(p≤0.05). For race/color there were differences in the RIs for parameters of hemoglobin, MCH, MCHC, white blood cells and mean platelet volume, neutrophils and absolute eosinophils (p ≤ 0.05). Conclusion: The differences found in the RIs of some in blood count parameters in Brazilian adults reaffirm the importance of having their own laboratory reference standards. The results can support a more accurate interpretation of tests, adequate identification and disease prevention in Brazil.

Objetivo: estimar os intervalos de referência (IR) de parâmetros de hemograma completo na população adulta brasileira. Métodos: Estudo transversal, com dados da Pesquisa Nacional de Saúde (PNS), entre 2014-2015. A amostra final constitui-se de 2.803 adultos. Para estabelecer os IR, aplicou-se critérios de exclusão, removeram-se outliers e feito particionamentos por sexo, idade e raça/cor da pele. Adotou-se o método não paramétrico.  As diferenças foram avaliadas pelos testes Mann Withney e Kruskal Wallis (p≤0,05). Resultados: houve diferenças estatisticamente significativas nos IR segundo sexo para glóbulos vermelhos, hemoglobina, hematócrito, HCM, CHCM, eosinófilos, monócitos, neutrófilos absolutos e plaquetas (p≤0,05). Quando analisados por idade,  houve diferenças nos IR de mulheres para hematócrito, VCM, glóbulos brancos e RDW e nos homens de glóbulos vermelhos, glóbulos brancos, eosinófilos, volume plaquetário médios, VCM, RDW e HCM (p≤0,05). Para raça/cor houve diferenças nos IR de hemoglobina, HCM, CHMC, glóbulos brancos e volume plaquetário médio, neutrófilos e eosinófilos absolutos (p ≤ 0,05). Conclusão: As diferenças encontradas nos IR de alguns em parâmetros de hemograma em adultos brasileiros  reafirmam a importância de se ter padrões de referência laborarias próprios. Os resultados podem subsidiar a interpretação mais precisa dos exames, identificação adequada e a prevenção de doenças no Brasil.

Adverse event following immunization or vaccination in children in Minas Gerais: 2015 to 2020 / Eventos supostamente atribuíveis à imunização ou vacinação em crianças de Minas Gerais: de 2015 a 2020

ABSTRACT Objective: To describe adverse event following immunization or vaccination in children in Minas Gerais: 2015 to 2020, resulting from immunization errors in children from zero to nine years old. Methods: An ecological, descriptive study with a quantitative approach, based on event notifications available in the National Immunization Program Information System. Results: Among the 39,903,277 doses of immunobiologicals in children aged zero to nine, administered in the state of MG, 3,259 events of types of immunization errors were recorded, around 0.008% of the total and, of these, 91.86% did not result in adverse events and 56.02% were children under one year of age. The most frequent diagnosis was application outside the recommended age (29.12%). Among the manifestations, 71.91% were local and systemic, with fever being the most common (40.85%). Conclusion: The study demonstrated that immunization errors were rare and that most of them were not associated with adverse events, which reinforces the safety of the immunization process. This undoubtedly raises reflection on the need and relevance of continuing education for health professionals.

RESUMO Objetivo: Descrever os eventos supostamente atribuíveis à imunização ou vacinação em crianças de Minas Gerais, de 2015 a 2020, decorrentes dos erros de imunização em crianças de 0 a 9 anos. Métodos: Estudo ecológico, descritivo, de abordagem quantitativa, fundamentado nas notificações de eventos disponíveis no Sistema de Informações do Programa Nacional de Imunizações. Resultados: Dentre os 39.903.277 de doses de imunobiológicos administrados em crianças de 0 a 9 anos, no estado de Minas Gerais, registraram-se 3.259 eventos do tipo erros de imunizaçõo, cerca de 0,008% do total e, destes, 91,86% não acarretaram eventos adversos e 56,02% ocorreram em crianças menores de 1 ano. O diagnóstico mais frequente foi a aplicação fora da idade recomendada (29,12%). Dentre as manifestações, 71,91% foram locais e, em relação às sistêmicas, a mais comum foi a febre (40,85%). Conclusão: O estudo demonstrou que os erros de imunização foram raros e a maioria deles não se associou aos eventos adversos, o que reitera a segurança no processo de imunização. Isso suscita, indubitavelmente, a reflexão sobre a necessidade e a relevância de educação permanente dos profissionais da saúde.

Blood count reference intervals for the Brazilian adult population: National Health Survey / Intervalos de referência de hemograma da população adulta brasileira: Pesquisa Nacional de Saúde

ABSTRACT Objective: To estimate the reference intervals (RIs) of complete blood count parameters in the Brazilian adult population. Methods: Cross-sectional study, with data from the National Health Survey (Pesquisa Nacional de Saúde - PNS), between 2014-2015. The final sample consisted of 2,803 adults. To establish the RIs, exclusion criteria were applied, outliers were removed and partitions were made by gender, age, and race/skin color. The non-parametric method was adopted. Differences were assessed using the Mann Whitney and Kruskal Wallis tests (p≤0.05). Results: There were statistically significant differences for the following hematological parameters based on gender, red blood cells, hemoglobin, hematocrit, MCH, MCHC, eosinophils and absolute monocytes, neutrophils and platelets (p≤0.05). When analyzed by age, the RIs were statistically different in females for hematocrit, MCV, white blood cells and RDW and in males for red blood cells, white blood cells, eosinophils, mean platelet volume, MCV, RDW, and MCH (p≤0.05). For race/color, there were differences in the RIs for parameters of hemoglobin, MCH, MCHC, white blood cells and mean platelet volume, neutrophils and absolute eosinophils (p≤0.05). Conclusion: The differences found in the RIs of some in blood count parameters in Brazilian adults reaffirm the importance of having their own laboratory reference standards. The results can support a more accurate interpretation of tests, adequate identification and disease prevention in Brazil.

RESUMO Objetivo: Estimar os intervalos de referência (IR) de parâmetros de hemograma completo na população adulta brasileira. Métodos: Estudo transversal, com dados da Pesquisa Nacional de Saúde (PNS), entre 2014-2015. A amostra final constitui-se de 2.803 adultos. Para estabelecer os IR, aplicou-se critérios de exclusão, removeram-se outliers e foram feitos particionamentos por sexo, idade e raça/cor da pele. Adotou-se o método não paramétrico. As diferenças foram avaliadas pelos testes Mann Withney e Kruskal Wallis (p≤0,05). Resultados: Houve diferenças estatisticamente significativas nos IR segundo sexo para glóbulos vermelhos, hemoglobina, hematócrito, HCM, CHCM, eosinófilos, monócitos, neutrófilos absolutos e plaquetas (p≤0,05). Quando analisados por idade, houve diferenças nos IR de mulheres para hematócrito, VCM, glóbulos brancos e RDW, e nos homens em glóbulos vermelhos, glóbulos brancos, eosinófilos, volume plaquetário médios, VCM, RDW e HCM (p≤0,05). Para raça/cor, houve diferenças nos IR de hemoglobina, HCM, CHMC, glóbulos brancos e volume plaquetário médio, neutrófilos e eosinófilos absolutos (p≤0,05). Conclusão: As diferenças encontradas nos IR de alguns parâmetros de hemograma nos adultos brasileiros, reafirmam a importância de se ter padrões laboratoriais próprios de referência. Os resultados podem subsidiar a interpretação mais precisa dos exames, identificação adequada e a prevenção de doenças no Brasil.

Environmental factors associated with human papillomavirus vaccine coverage in adolescents: 2016-2020 analysis.

OBJECTIVE: to analyze the association between the factors of the social environment and the coverage rates of the human papillomavirus (HPV) vaccine in adolescents, in the State of Minas Gerais, Brazil. METHOD: this is an epidemiological, ecological study, with panel and trend analysis from 2016 to 2020. The population consisted of adolescents aged 9 to 13 years. The environmental variables were coverage rates, the municipal index of human development, income, education, and longevity; and the rate of violence. The Prais-Winsten autoregression and the panel regression model were used, in addition to the estimate of the mean annual percentage variation. RESULTS: the vaccination coverage rates are below the goals recommended by the Ministry of Health for all regions analyzed. Moreover, these rates are associated with factors related to the application of the first dose and to aspects inherent to the social environment, such as the rate of violence. CONCLUSION: our findings showed that, although tenuous, aspects of the environment, in addition to individual characteristics, provide relevant information to understand the occurrence of health outcomes, since this vaccination campaign presents a strong influence of the environment and age as factors associated with the low rates. HIGHLIGHTS: (1) The coverage of human papillomavirus vaccination is below the target in Minas Gerais.(2) The rates are associated with aspects inherent to the social environment, such as violence.(3) The environment provides relevant information for understanding health outcomes.

Vaccination against human papillomavirus in Brazilian schoolchildren: National Survey of School Health, 2019.

OBJECTIVE: to analyze the prevalence of schoolchildren vaccinated against human papillomavirus (HPV) and the reasons related to non-vaccination. METHOD: cross-sectional study, with data from the 2019 National Survey of School Health. The sample consisted of 160,721 students aged 13 to 17 years. The prevalence and confidence intervals (95%CI) of vaccinated adolescents were estimated according to location, sex, and administrative dependence of the school. The differences between the strata were evaluated with the Chi-square test. Adjusted prevalence ratios (aPR) and 95%CI were estimated with the Poisson regression model. RESULTS: most of the students were vaccinated (62.9%), and the prevalence of girls (76.1%) was higher than that of boys (49.1%). The most prevalent reason for not vaccinating was "did not know they had to take" (46.8%), with the highest aPR in public schoolchildren in Brazil (1.6; 95%CI 1.5;1.7), from the Northeast region (1.2; 95%CI 1.1;1.2), and in students from private schools in the Northeast regions (1.1; 95%CI 1.1;1.2) and North (1.3; 95%CI 1.2;1.4). CONCLUSION: one out of every two Brazilian schoolchildren was vaccinated against HPV. Misinformation was a recurring reason for non-vaccination. The North and Northeast regions had the highest prevalence of non-vaccinated people, observed mainly in adolescents from public schools. HIGHLIGHTS: (1) 63% of Brazilian schoolchildren reported having been vaccinated against human papillomavirus (HPV).(2) In Brazil, in 2019, the prevalence of immunized girls was higher than that of boys.(3) Misinformation and fear are reasons for hesitating vaccination.(4) Social and health inequalities may reflect upon HPV vaccination.(5) Achieving the goal of 80% in HPV vaccination coverage is a challenge in Brazil.

Cobertura vacinal em crianças menores de um ano no estado de Minas Gerais, Brasil / Vaccination coverage in children under one year of age in Minas Gerais state, Brazil

Resumo O objetivo deste artigo é analisar as taxas de coberturas vacinais em crianças menores de um ano durante o período de 2015 a 2020 no estado de Minas Gerais (MG). Estudo ecológico, de série temporal, sobre as coberturas vacinais em crianças menores de 1 ano, considerando-se como unidade de análise as 28 Gerências/Superintendências Regionais de Saúde (GRS/SRS) de MG. Analisaram-se as coberturas vacinais dos seguintes imunobiológicos vacinas: contra o Bacilo de Calmette e Guérin (BCG), contra rotavírus humano, contra pneumococo 10, pentavalente, contra meningococo C, contra febre amarela e contra a poliomielite. Empregou-se o modelo autorregressivo de Prais-Winsten para análise de tendência. Destaca-se o ano de 2020, que apresentou a menor proporção de GRS e SRS que alcançaram as metas preconizadas de cobertura vacinal para os imunobiológicos analisados. Quanto à análise de tendência da cobertura, 8 das 28 GRS/SRS apresentaram tendência decrescente de, pelo menos, 5 dos 7 imunobiológicos avaliados. Observou-se tendência decrescente na cobertura vacinal de pelo menos cinco imunobiológicos em oito das GRS /SRS, com destaque para a vacina Pentavalente, que apresentou tendência decrescente de cobertura vacinal em 60,71% das GRS e SRS.

Abstract The scope of this article is to analyze vaccination coverage rates in children under one year of age during the period from 2015 to 2020 in the state of Minas Gerais (MG). It involved an ecological, time-series study on vaccination coverage in children under 1 year of age, considering the 28 Regional Health Management/Superintendencies (GRS/SRS) of MG as the unit of analysis. The following immunobiological vaccine coverage was analyzed: Bacillus Calmette and Guérin, human rotavirus, pneumococcal 10, pentavalent, meningococcus C, yellow fever, and polio vaccines. The Prais-Winsten autoregressive model was employed for trend analysis. The year 2020 stands out, as it presented the lowest proportion of GRS and SRS that reached the recommended vaccine coverage goals for the immunobiologicals analyzed. Regarding the analysis of the coverage trend, 8 of the 28 GRS/SRS showed a decreasing trend for at least 5 of the 7 immunobiologicals evaluated. We observed a downward trend in the vaccination coverage of at least five immunobiologicals in eight of the GRS/SRS, with emphasis on the Pentavalent vaccine, which showed a downward trend in vaccination coverage in 60.71% of the GRS and SRS.

[Vaccination coverage in children under one year of age in Minas Gerais state, Brazil]. / Cobertura vacinal em crianças menores de um ano no estado de Minas Gerais, Brasil.

The scope of this article is to analyze vaccination coverage rates in children under one year of age during the period from 2015 to 2020 in the state of Minas Gerais (MG). It involved an ecological, time-series study on vaccination coverage in children under 1 year of age, considering the 28 Regional Health Management/Superintendencies (GRS/SRS) of MG as the unit of analysis. The following immunobiological vaccine coverage was analyzed: Bacillus Calmette and Guérin, human rotavirus, pneumococcal 10, pentavalent, meningococcus C, yellow fever, and polio vaccines. The Prais-Winsten autoregressive model was employed for trend analysis. The year 2020 stands out, as it presented the lowest proportion of GRS and SRS that reached the recommended vaccine coverage goals for the immunobiologicals analyzed. Regarding the analysis of the coverage trend, 8 of the 28 GRS/SRS showed a decreasing trend for at least 5 of the 7 immunobiologicals evaluated. We observed a downward trend in the vaccination coverage of at least five immunobiologicals in eight of the GRS/SRS, with emphasis on the Pentavalent vaccine, which showed a downward trend in vaccination coverage in 60.71% of the GRS and SRS.

O objetivo deste artigo é analisar as taxas de coberturas vacinais em crianças menores de um ano durante o período de 2015 a 2020 no estado de Minas Gerais (MG). Estudo ecológico, de série temporal, sobre as coberturas vacinais em crianças menores de 1 ano, considerando-se como unidade de análise as 28 Gerências/Superintendências Regionais de Saúde (GRS/SRS) de MG. Analisaram-se as coberturas vacinais dos seguintes imunobiológicos vacinas: contra o Bacilo de Calmette e Guérin (BCG), contra rotavírus humano, contra pneumococo 10, pentavalente, contra meningococo C, contra febre amarela e contra a poliomielite. Empregou-se o modelo autorregressivo de Prais-Winsten para análise de tendência. Destaca-se o ano de 2020, que apresentou a menor proporção de GRS e SRS que alcançaram as metas preconizadas de cobertura vacinal para os imunobiológicos analisados. Quanto à análise de tendência da cobertura, 8 das 28 GRS/SRS apresentaram tendência decrescente de, pelo menos, 5 dos 7 imunobiológicos avaliados. Observou-se tendência decrescente na cobertura vacinal de pelo menos cinco imunobiológicos em oito das GRS /SRS, com destaque para a vacina Pentavalente, que apresentou tendência decrescente de cobertura vacinal em 60,71% das GRS e SRS.

Diagnóstico e tratamento da sífilis em gestantes nos serviços de Atenção Básica / Diagnosis and treatment of syphilis in pregnant women at the services of Primary Care

Resumo O objetivo deste artigo é avaliar as condições dos serviços de Atenção Básica (AB) brasileiros quanto a disponibilidade de testes rápidos (TR) para o diagnóstico precoce e de Benzilpenicilina (BZP) para o tratamento das gestantes com sífilis. Estudo transversal com dados dos serviços de AB que participaram do Programa de Melhoria da Qualidade da Atenção Básica. Os serviços que não dispunham de TR sempre disponível ou não dispunham de BZP em quantidade suficiente foram categorizados como "inadequados" e aqueles que dispunham de TR sempre disponível e de BZP em quantidade suficiente, como "adequados". Foi realizada análise bivariada e estimados os Odds ratios com seus respectivos Intervalos de Confiança de 95%. A amostra incluiu 20.286 serviços de AB de todas as regiões do país. A prevalência de serviços com condições inadequadas para diagnóstico e tratamento da sífilis foi de 47,7%. A região Centro-Oeste e as cidades que não eram capitais apresentaram maiores prevalências de serviços de AB com condições inadequadas para diagnóstico e tratamento da sífilis em gestantes (p<0,05). Diferenças regionais e de localização dos serviços de AB impactam na disponibilidade de TR e de BZP.

Abstract The aim of this article is to evaluate the conditions of Primary Care (PC) services in Brazil as regards the availability of quick tests (QTs) for early diagnoses and of Benzylpenicillin (BZP) for the treatment of pregnant women with syphilis. This was a cross-sectional study, conducted with data from PC services that participated in the National Program for Access and Quality Improvement in Primary Care (PMAQ-AB, in Portuguese). The services where QTs were not readily available or where BZP was not available in a sufficient quantity were categorized as "inadequate", while those where the QTs were readily available and BZP was found in sufficient quantities were categorized as "adequate". A bivariate analysis and Odds Ratio (OR) estimates, together with their respective 95% confidence intervals (CI), were performed. The sample included 20,286 PC services from regions throughout the country. The prevalence of services with inadequate conditions for the diagnosis and treatment of syphilis was 47.7%. The Midwest region and non-capital cities presented the highest prevalence rates for PC services with inadequate conditions for the diagnosis and treatment of syphilis in pregnant women (p<0.05). Differences in the regions and locations of the PC services impact the availability of QTs and BZP.

Diagnosis and treatment of syphilis in pregnant women at the services of Primary Care. / Diagnóstico e tratamento da sífilis em gestantes nos serviços de Atenção Básica.

The aim of this article is to evaluate the conditions of Primary Care (PC) services in Brazil as regards the availability of quick tests (QTs) for early diagnoses and of Benzylpenicillin (BZP) for the treatment of pregnant women with syphilis. This was a cross-sectional study, conducted with data from PC services that participated in the National Program for Access and Quality Improvement in Primary Care (PMAQ-AB, in Portuguese). The services where QTs were not readily available or where BZP was not available in a sufficient quantity were categorized as "inadequate", while those where the QTs were readily available and BZP was found in sufficient quantities were categorized as "adequate". A bivariate analysis and Odds Ratio (OR) estimates, together with their respective 95% confidence intervals (CI), were performed. The sample included 20,286 PC services from regions throughout the country. The prevalence of services with inadequate conditions for the diagnosis and treatment of syphilis was 47.7%. The Midwest region and non-capital cities presented the highest prevalence rates for PC services with inadequate conditions for the diagnosis and treatment of syphilis in pregnant women (p<0.05). Differences in the regions and locations of the PC services impact the availability of QTs and BZP.

O objetivo deste artigo é avaliar as condições dos serviços de Atenção Básica (AB) brasileiros quanto a disponibilidade de testes rápidos (TR) para o diagnóstico precoce e de Benzilpenicilina (BZP) para o tratamento das gestantes com sífilis. Estudo transversal com dados dos serviços de AB que participaram do Programa de Melhoria da Qualidade da Atenção Básica. Os serviços que não dispunham de TR sempre disponível ou não dispunham de BZP em quantidade suficiente foram categorizados como "inadequados" e aqueles que dispunham de TR sempre disponível e de BZP em quantidade suficiente, como "adequados". Foi realizada análise bivariada e estimados os Odds ratios com seus respectivos Intervalos de Confiança de 95%. A amostra incluiu 20.286 serviços de AB de todas as regiões do país. A prevalência de serviços com condições inadequadas para diagnóstico e tratamento da sífilis foi de 47,7%. A região Centro-Oeste e as cidades que não eram capitais apresentaram maiores prevalências de serviços de AB com condições inadequadas para diagnóstico e tratamento da sífilis em gestantes (p<0,05). Diferenças regionais e de localização dos serviços de AB impactam na disponibilidade de TR e de BZP.

Covid-19 pandemic impacts on follow-up of child growth and development.

OBJECTIVE: To analyze the impact of the covid-19 pandemic on the use of primary health care services to follow-up the child growth and development in Brazil. METHOD: A total of 7.9 million consultations of children (0-2 years old) across Brazil between March 2017 and May 2020 were studied. Differences between medians were analyzed using non-parametric tests, the Global Moran Index (IGM) and the Local Indicators of Spatial Association. RESULTS: During the initial period of the pandemic, the median number of consultations was significantly lower than the same period in previous years, reducing more than 50%. The drop in 2020, compared to 2019, ranged from 49% to 62.2% across all regions of the country, except the South. The percentage reduction registered in 2019-2020 showed significant spatial autocorrelation (IGM = 0.20; p = 0.04), with the presence of low-low (states with reduction between 29% and 51%) and high-high (states with reduction between 55% and 69%) spatial clusters. CONCLUSION: The covid-19 pandemic impacted the follow-up of child growth and development in primary health care services in Brazil, with a geographically uneven reduction.

Yellow fever vaccination before and during the covid-19 pandemic in Brazil.

OBJECTIVE: To analyze the number of yellow fever vaccine doses administered before and during the covid-19 pandemic in Brazil. METHODS: This is an ecological, time series study based on data from the National Immunization Program. Differences between the median number of yellow fever vaccine doses administered in Brazil and in its regions before (from April/2019 to March/2020) and after (from April/2020 to March/2021) the implementation of social distancing measures in the country were assessed via the Mann-Whitney test. Prais-Winsten regression models were used for time series analyses. RESULTS: We found a reduction in the median number of yellow fever vaccine doses administered in Brazil and in its regions: North (-34.71%), Midwest (-21.72%), South (-63.50%), and Southeast (-34.42%) (p < 0.05). Series showed stationary behavior in Brazil and in its five regions during the covid-19 pandemic (p > 0.05). Brazilian states also showed stationary trends, except for two states which recorded an increasing trend in the number of administered yellow fever vaccine doses, namely: Alagoas State (before: ß = 64, p = 0.081; after: ß = 897, p = 0.039), which became a yellow fever vaccine recommendation zone, and Roraima State (before: ß = 68, p = 0.724; after: ß = 150, p = 0.000), which intensified yellow fever vaccinations due to a yellow fever case confirmation in a Venezuelan State in 2020. CONCLUSION: The reduced number of yellow fever vaccine doses administered during the covid-19 pandemic in Brazil may favor the reemergence of urban yellow fever cases in the country.

Self-reported diabetes and factors associated with it in the Brazilian adult population: National Health Survey, 2019. / Diabetes autorreferido e fatores associados na população adulta brasileira: Pesquisa Nacional de Saúde, 2019.

This study aims to analyze the prevalence of self-reported diabetes and its associated factors in the Brazilian adult population. It is a cross-sectional study using the 2019 National Health Survey. Prevalence and crude prevalence ratios (PRc) and adjusted prevalence ratios (PRa) of self-reported diabetes were estimated, with confidence intervals (95% CI), using Poisson regression. In the 82,349 adults, the prevalence of self-reported diabetes was 7.7%. Positively associated factors were: advanced age with greater association after 60 years (PRa 24.87; 95%CI 15.78-39.18); living in the Northeast (PRa 1.16; 95%CI 1.04-1.29), Southeast (PRa 1.27; 95% CI 1.14-1.43), South (PRa 1.18; 95%CI 1, 05-1.34), and Midwest (PRa 1.21; 95%CI 1.06-1.38); being a former smoker (PRa 1.17; 95%CI 1.09-1.27); self-assessment of regular health (PRa 2.41; 95%CI 2.21-2.64), bad/very bad (PRa 3.45; 95%CI 3.06-3.88); having heart disease (PRa 1.81; 95%CI 1.64-2.00), hypertension (PRa 2.84; 95%CI 2.60-3.69), high cholesterol (PRa 2.22; 95%CI 2.05-2.41), overweight (PRa 1.49; 95%CI 1.36-1.64), and obesity (PRa 2.25; 95%CI 2.05-2.47). It could be concluded that diabetes in Brazilian adults is associated with sociodemographic factors, aging, lifestyle, and morbidities. These results can guide public policies for the prevention and control of disease in Brazil.

O estudo analisa a prevalência de diabetes autorreferido e fatores associados na população adulta brasileira. Estudo transversal usando a Pesquisa Nacional de Saúde 2019. Estimaram-se as prevalências e razões de prevalência brutas (RPb) e ajustadas (RPa) de diabetes autorreferido, com intervalos de confiança (IC95%), empregando-se regressão de Poisson. Nos 82.349 adultos, a prevalência de diabetes autorreferido foi de 7,7%. Associaram-se positivamente: idade avançada, sendo maior após 60 anos (RPa 24,87; IC95%: 15,78-39,18); residir nas regiões Nordeste (RPa 1,16; IC95%: 1,04-1,29), Sudeste (RPa 1,27; IC95%: 1,14-1,43), Sul (RPa 1,18; IC95%: 1,05-1,34) e Centro-Oeste (RPa 1,21; IC95%: 1,06-1,38), ser ex-fumante (RPa 1,17; IC95%: 1,09-1,27), autoavaliação de saúde regular (RPa 2,41; IC95%: 2,21-2,64), ruim/muito ruim (RPa 3,45; IC95%: 3,06-3,88), ter doença cardíaca (RPa 1,81; IC95%: 1,64-2,00), hipertensão (RPa 2,84; IC95%: 2,60-3,69), colesterol elevado (RPa 2,22; IC95%: 2,05-2,41), sobrepeso (RPa 1,49; IC95%: 1,36-1,64) e obesidade (RPa 2,25; IC95%: 2,05- 2,47). Conclui-se que o diabetes nos adultos brasileiros se associa a fatores sociodemográficos, envelhecimento, estilos de vida e morbidades. Esses resultados podem orientar políticas públicas para prevenção e controle da doença no Brasil.

Impact of the COVID-19 Pandemic on Human Papillomavirus Vaccination in Brazil.

Objective: To analyze the number of applied HPV vaccine doses before (from April 2019 to March 2020) and after (from April 2020 to September 2020) social distancing measures in response to the COVID-19 pandemic in states and regions of Brazil. Methods: Ecological time-series study, using data from the Brazilian National Immunization Program (PNI). Using the Mann-Whitney test, we evaluated the difference between the median number of applied doses during the periods April 2019 to March 2020 and from April 2020 to September 2020. Spatial analysis identified clusters with a high or low percentage reduction in the median applied doses. Prais-Winsten regression models identified temporal trends in the applieddoses from both periods. Results: There was a significant reduction in the median HPV vaccine doses applied, formation of spatial clusters and, after a sharp drop in the number of applieddoses during the months following social distancing. There was a tendency to increase the applied vaccines doses. Conclusion: The COVID-19 pandemic resulted in reduction of the number of HPV vaccine doses applied as a possible effect of restrictive measures caused by the pandemic.

Estado nutricional e clínico de pacientes submetidos à cirurgia bariátrica / Estado nutricional y clínico de los pacientes sometidos a cirugía bariátrica / Nutritional and clinical status of patients submitted to bariatric surgery

RESUMO Objetivo: analisar o estado clínico e nutricional de pacientes submetidos à cirurgia bariátrica. Métodos: trata-se de estudo epidemiológico observacional, com delineamento transversal, norteado pela ferramenta STROBE. Foi realizado entre 2015 e 2016, com dados de pacientes submetidos à cirurgia bariátrica em Y de Roux nos anos de 2012 a 2014, em um hospital privado de Minas Gerais. A coleta de dados ocorreu por meio de questionário semiestruturado, elaborado pelos pesquisadores. Para verificar a existência da associação entre as variáveis do estado nutricional e clínico e o tempo pós-cirúrgico, utilizou-se o teste qui-quadrado de Pearson ou exato de Fisher para as variáveis categóricas. E para as contínuas, os testes Kruskal-Wallis ou Mann-Whitney. Resultados: verificou-se significância estatística para as variáveis: "enfraquecimento de unhas" (p=0,002), "êmese" (p=0,018), "frequência de consumo alcoólico" (p=0,018) e "número de refeições diárias" (p=0,028) no grupo feminino. Conclusão: este estudo revelou alterações no componente clínico e nutricional das pacientes submetidos à cirurgia bariátrica. Houve associações estatisticamente significativas no grupo feminino, incluindo mudanças no perfil clínico de maior episódio de êmese e maior frequência no consumo de álcool. Em relação ao perfil nutricional, pacientes do sexo feminino apresentaram maiores proporções no número de refeições e mais enfraquecimento nas unhas após o procedimento cirúrgico. Reforça-se a importância do acompanhamento e da orientação nutricional e psicológica contínuas, pré e pós-cirúrgicas, minimizando os impactos negativos deste resultado na saúde dos indivíduos.

RESUMEN Objetivo: analizar el estado clínico y nutricional de los pacientes sometidos a cirugía bariátrica. Métodos: se trata de un estudio epidemiológico observacional, con un diseño transversal, guiado por la herramienta STROBE. Se realizó entre 2015 y 2016, con datos de pacientes sometidos a cirugía bariátrica en Roux-en-Y en los años 2012 a 2014, en un hospital privado de Minas Gerais. La recolección de datos se realizó a través de un cuestionario semiestructurado desarrollado por los investigadores. Para verificar la existencia de asociación entre las variables de estado nutricional, clínico y tiempo posquirúrgico se utilizó la prueba qui cuadrado de Pearson o la prueba exacta de Fisher para las variables categóricas. Y para las continuas, las pruebas de Kruskal-Wallis o Mann-Whitney. Resultados: hubo significancia estadística para las variables: "debilitamiento de las uñas" (p = 0,002), "emesis" (p = 0,018), "frecuencia de consumo de alcohol" (p = 0,018) y "número de comidas diarias" (p = 0,028) en el grupo de mujeres. Conclusión: este estudio reveló cambios en el componente clínico y nutricional de los pacientes sometidos a cirugía bariátrica. Hubo asociaciones estadísticamente significativas en el grupo femenino, incluyendo cambios en el perfil clínico de mayor episodio de emesis y mayor frecuencia de consumo de alcohol. En cuanto al perfil nutricional, las pacientes del sexo femenino presentaron mayores proporciones en el número de comidas y mayor debilitamiento de las uñas tras el procedimiento quirúrgico. Se refuerza la importancia del seguimiento continuo y la orientación nutricional y psicológica, pre y posquirúrgica, minimizando los impactos negativos de este resultado en la salud de las personas.

ABSTRACT Objective: to analyze the clinical and nutritional status of patients submitted to bariatric surgery. Methods: this is an observational epidemiological study, with a cross-sectional design, guided by the STROBE tool. It was carried out between 2015 and 2016, with data from patients undergoing Roux-en-Y bariatric surgery in the years 2012 to 2014, in a private hospital in Minas Gerais. Data collection took place through a semi-structured questionnaire developed by the researchers. To verify the existence of an association between the variables of nutritional and clinical status and the time after surgery, Pearson's chi-square test or Fisher's exact test was used for categorical variables. And for continuous ones, the Kruskal-Wallis or Mann-Whitney tests. Results: there was statistical significance for the variables: 'weakening of nails' (p=0.002), 'emesis' (p=0.018), 'frequency of alcohol consumption' (p=0.018) and 'number of daily meals' (p=0.028) in the female group. Conclusion: this study revealed changes in the clinical and nutritional component of patients undergoing bariatric surgery. There were statistically significant associations in the female group, including changes in the clinical profile of greater episode of emesis and greater frequency of alcohol consumption. Regarding the nutritional profile, female patients had higher proportions in the number of meals and more weakening of the nails after the surgical procedure. The importance of monitoring and continuous nutritional and psychological guidance, pre- and post-surgical, is reinforced, minimizing the negative impacts of this result on the health of individuals.

Eventos adversos após a vacina papilomavírus humano em adolescentes no estado de Minas Gerais / Eventos adversos después de la vacunación contra el virus del papiloma humano, en adolescentes en el estado de Minas Gerais / Adverse events following human papillomavirus vaccine in adolescents in the state of Minas Gerais

RESUMO Objetivo: investigar as notificações dos eventos adversos pós-vacinação papilomavírus humano no estado de Minas Gerais, de acordo com a localidade de notificação, a causalidade, a gravidade e a evolução dos casos. Métodos: estudo epidemiológico realizado com os dados de 2015-2019, notificados no Sistema de Informação de Vigilância de Eventos Adversos. Os dados foram analisados e apresentados em proporções, segundo as macrorregiões de saúde e os anos do estudo. Resultados: em 2015, foram notificados 26,41% eventos adversos, sendo o ano com maior notificação. Na análise das macrorregiões de saúde, Vale do Jequitinhonha apresentou a menor prevalência de registro (0,43%), e a Centro a maior prevalência de notificação (30,95%). Os eventos adversos locais mais prevalentes foram: dor (56,48%) e edema (38,89%). Já quanto aos eventos sistêmicos, a cefaleia (29,69%) e a gastroenterite (29,69%) tiveram os maiores registros de casos. Os eventos classificados como adversos não graves (59,82%) foram os mais prevalentes, e quanto à causa, 35,94% deles foram atribuídos aos erros de imunização. Conclusão: este estudo reforça que os eventos adversos pós-vacina de HPV foram, em sua maioria, eventos não graves, demonstrando, portanto, a segurança da vacina HPV para o público adolescente, contribuindo para o aumento das taxas de cobertura vacinal.

RESUMEN Objetivo: investigar las notificaciones de eventos adversos de papilomavirus humano en el Estado de Minas Gerais, según la localidad de notificación, la causalidad, la gravedad y la evolución de los casos. Métodos: estudio epidemiológico realizado con datos de 2015-2019, notificados en el Sistema de Información de Vigilancia de Eventos Adversos. Los datos fueron analizados y presentados en proporciones, según las macrorregiones sanitarias y los años del estudio. Resultados: en 2015 se notificaron un 26,41% de eventos adversos, siendo el año con mayor notificación. Al analizar las macrorregiones sanitarias, el Valle de Jequitinhonha tuvo la menor prevalencia de registro, con un 0,43%, y el Centro tuvo la mayor prevalencia de notificación (30,95%). Los efectos adversos locales más frecuentes fueron el dolor (56,48%) y el edema (38,89%). En cuanto a los eventos sistémicos, la cefalea (29,69%) y la gastroenteritis (29,69%) presentaron el mayor número de casos. Los eventos clasificados como adversos no graves (59,82%) fueron los más prevalentes y, en cuanto a la causa, el 35,94% de ellos se atribuyeron a los errores de inmunización. Conclusión: este estudio refuerza que los eventos adversos posteriores a la vacuna contra el VPH fueron en su mayoría eventos no graves, demostrando así la seguridad de la vacuna contra el VPH para el público adolescente y contribuyendo al aumento de las tasas de cobertura de vacunación.

ABSTRACT Objective: to investigate reports of adverse events following human papillomavirus vaccination in the state of Minas Gerais, according to the location of notification, causality, severity, and evolution of cases. Methods: epidemiological study carried out with data from 2015-2019, reported in the Adverse Event Surveillance Information System. Data were analyzed and presented in proportions, according to health macro-regions and years of study. Results: in 2015, 26.41% of adverse events were reported, being the year with the highest number of notifications. In the analysis of health macro-regions, Vale do Jequitinhonha had the lowest prevalence of registration (0.43%), and the Center had the highest prevalence of notification (30.95%). The most prevalent local adverse events were pain (56.48%) and edema (38.89%). As for systemic events, headache (29.69%) and gastroenteritis (29.69%) had the highest number of cases. Events classified as non-serious adverse events (59.82%) were the most prevalent, and regarding the cause, 35.94% of them were attributed to immunization errors. Conclusion: this study reinforces that adverse events following HPV vaccination were, for the most part, non-serious events, thus demonstrating the safety of the HPV vaccine for the adolescent public, contributing to the increase in vaccine coverage rates.

Cobertura vacinal contra influenza em gestantes da região Sudeste do Brasil: análise de 2010­2020 / Influenza vaccination coverage in pregnant women in the Southeast region of Brazil: analysis from 2010 to 2020

Objetivo: Analisar a cobertura vacinal contra a influenza em gestantes na região Sudeste do Brasil, nos anos de 2010 a 2020. Métodos:Estudo ecológico, de série temporal, realizado com dados do Sistema de Informação do Programa Nacional de Imunizações (SI-PNI), referentes aos registros de doses da vacina contra influenza em gestantes no estado de Minas Gerais. Resultados: A cobertura vacinal adequada foi alcançada em apenas quatro dos 11 anos estudados, variando de 49,75% em 2011 a 88,5% em 2015. No ano de 2020 foi alcançado 80,82%. Possíveis determinantes são discutidos em uma perspectiva ampliada, que pode subsidiar planejamento de ações em todo o país. Conclusão: A cobertura vacinal contra Influenza nas gestantes apresentou, em sua maior parte, uma tendência estacionária, apontando para a possível necessidade de educação permanente dos profissionais de saúde envolvidos no pré-natal, qualificação de suas ações na área de educação em saúde para esclarecer dúvidas das gestantes sobre a temática.

Objective: To analyze the influenza vaccination coverage in pregnant women in the Southeast region of Brazil between years 2010 and 2020. Methods: An ecological, time series study conducted with data from the National Immunization Program Information System (SI-PNI) referring to records of doses of influenza vaccine in pregnant women in the state of Minas Gerais. Results:Adequate vaccination coverage was achieved in only four out of the 11 years studied, ranging from 49.75% in 2011 to 88.5% in 2015. In 2020, the rate of 80.82% was reached. Possible determinants are discussed in an expanded perspective that can support the planning of actions across the country. Conclusion: Influenza vaccination coverage in pregnant women showed a stagnation trend for the most part, pointing to the possible need for continuing education of health professionals involved in antenatal care and qualification of their actions in the area of health education to clarify pregnant women's doubts on the subject.

Diabetes autorreferido e fatores associados na população adulta brasileira: Pesquisa Nacional de Saúde, 2019 / Self-reported diabetes and factors associated with it in the Brazilian adult population: National Health Survey, 2019

Resumo O estudo analisa a prevalência de diabetes autorreferido e fatores associados na população adulta brasileira. Estudo transversal usando a Pesquisa Nacional de Saúde 2019. Estimaram-se as prevalências e razões de prevalência brutas (RPb) e ajustadas (RPa) de diabetes autorreferido, com intervalos de confiança (IC95%), empregando-se regressão de Poisson. Nos 82.349 adultos, a prevalência de diabetes autorreferido foi de 7,7%. Associaram-se positivamente: idade avançada, sendo maior após 60 anos (RPa 24,87; IC95%: 15,78-39,18); residir nas regiões Nordeste (RPa 1,16; IC95%: 1,04-1,29), Sudeste (RPa 1,27; IC95%: 1,14-1,43), Sul (RPa 1,18; IC95%: 1,05-1,34) e Centro-Oeste (RPa 1,21; IC95%: 1,06-1,38), ser ex-fumante (RPa 1,17; IC95%: 1,09-1,27), autoavaliação de saúde regular (RPa 2,41; IC95%: 2,21-2,64), ruim/muito ruim (RPa 3,45; IC95%: 3,06-3,88), ter doença cardíaca (RPa 1,81; IC95%: 1,64-2,00), hipertensão (RPa 2,84; IC95%: 2,60-3,69), colesterol elevado (RPa 2,22; IC95%: 2,05-2,41), sobrepeso (RPa 1,49; IC95%: 1,36-1,64) e obesidade (RPa 2,25; IC95%: 2,05- 2,47). Conclui-se que o diabetes nos adultos brasileiros se associa a fatores sociodemográficos, envelhecimento, estilos de vida e morbidades. Esses resultados podem orientar políticas públicas para prevenção e controle da doença no Brasil.

Abstract This study aims to analyze the prevalence of self-reported diabetes and its associated factors in the Brazilian adult population. It is a cross-sectional study using the 2019 National Health Survey. Prevalence and crude prevalence ratios (PRc) and adjusted prevalence ratios (PRa) of self-reported diabetes were estimated, with confidence intervals (95% CI), using Poisson regression. In the 82,349 adults, the prevalence of self-reported diabetes was 7.7%. Positively associated factors were: advanced age with greater association after 60 years (PRa 24.87; 95%CI 15.78-39.18); living in the Northeast (PRa 1.16; 95%CI 1.04-1.29), Southeast (PRa 1.27; 95% CI 1.14-1.43), South (PRa 1.18; 95%CI 1, 05-1.34), and Midwest (PRa 1.21; 95%CI 1.06-1.38); being a former smoker (PRa 1.17; 95%CI 1.09-1.27); self-assessment of regular health (PRa 2.41; 95%CI 2.21-2.64), bad/very bad (PRa 3.45; 95%CI 3.06-3.88); having heart disease (PRa 1.81; 95%CI 1.64-2.00), hypertension (PRa 2.84; 95%CI 2.60-3.69), high cholesterol (PRa 2.22; 95%CI 2.05-2.41), overweight (PRa 1.49; 95%CI 1.36-1.64), and obesity (PRa 2.25; 95%CI 2.05-2.47). It could be concluded that diabetes in Brazilian adults is associated with sociodemographic factors, aging, lifestyle, and morbidities. These results can guide public policies for the prevention and control of disease in Brazil.