Estimated COVID-19 severe cases and deaths averted in the first year of the vaccination campaign in Brazil: A retrospective observational study.

Background: A nationwide Severe Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination campaign was initiated in Brazil in January 2021 with CoronaVac (Sinovac Biotech) and ChAdOx1 nCoV-19 (AstraZeneca) followed by BNT162b2 mRNA (Pfizer-BioNTech) and Ad26.COV2.S (Johnson & Johnson-Janssen) vaccines. Here we provide estimates of the number of severe cases and deaths due to coronavirus disease (COVID-19) averted during the first year of the mass vaccination campaign in Brazil. Methods: Data on COVID-19 vaccination and COVID-19-related illness and death were obtained from the Brazilian Ministry of Health and used to estimate the direct effects of the vaccination campaign on the number of severe cases and deaths due to COVID-19 occurring between January 17, 2021 and January 31, 2022. To this end, we compared the daily age-specific rates between the unvaccinated population and the "at least partly vaccinated" population (received at least one dose of a two-dose vaccine), as well as other two vaccination subgroups, "fully vaccinated" (completed the one- or two-dose vaccine schedule), and "boosted-vaccinated" (fully vaccinated and recipients of booster dose) populations. Findings: We estimated that 74% (n = 875,846; 95% confidence interval, CI 843,383-915,709) of total expected cases of severe COVID-19 and 82% (n = 303,129; 95% CI 284,019-321,681) of total expected deaths due to COVID-19 were averted in the first year of the national vaccination campaign. The averted burden was heterogeneous between age groups and higher in the more populous states. However, outcome rate differences between vaccinated and unvaccinated groups were higher in the less populated states. Interpretation: The first year of the COVID-19 vaccination program in Brazil saved the lives of at least 303,129 adults. The results highlight the need for future vaccination campaigns, including those required in the current pandemic, to rapidly achieve high uptake, particularly among the elderly and residents of the least populous regions. Funding: Ministry of Health (Brazil).

Covid-19 Fiocruz Observatory - an analysis of the evolution of the pandemic from February 2020 to April 2022. / Observatório Covid-19 Fiocruz - uma análise da evolução da pandemia de fevereiro de 2020 a abril de 2022.

The COVID-19 pandemic had a significant impact on the living and working conditions of the entire population of Brazil, having a different and more intense effect on groups considered to be vulnerable. The objective of this article is to present an overview of the evolution of the pandemic in the country according to the bulletins of the Covid-19 Fiocruz Observatory in the period between the declarations of the beginning and end of the Public Health Emergency of National Concern (ESPIN, in Portuguese), February 2020 to April 2022. Several of the indicators adopted in the 69 bulletins published for the analysis of the pandemic were used, such as cases and deaths due to SARIs and COVID-19, age groups, % of occupancy of ICU beds, and vaccination, among others. The evolution analysis was organized between years and phases of the pandemic, seeking to highlight what characterized each moment. The closing statement of ESPIN in Brazil coincides with the discussions on the transition from a pandemic to an endemic scenario, without this representing the elimination of the virus, infections, and disease, posing the challenges of advances in vaccination processes in Brazil and around the world, as well as living with scenarios that may require the adoption of temporary protection measures in epidemic periods and periods of greater risk for vulnerable groups.

A pandemia de COVID-19 teve um imenso impacto nas condições de vida e trabalho de toda a população do país, impactando de modo diferenciado e mais intenso os grupos considerados vulneráveis. O objetivo deste artigo é apresentar um panorama da evolução da pandemia no país segundo os boletins do Observatório Covid-19 Fiocruz, no período entre as declarações de início e de encerramento da Emergência em Saúde Pública de Importância Nacional (ESPIN), fevereiro de 2020 a abril de 2022. Foram utilizados diversos dos indicadores adotados nos 69 boletins publicados para a análise da pandemia, como casos e óbitos por SRAGs e COVID-19, grupos etários, taxas de ocupação de leitos UTI e vacinação, entre outros. A análise da evolução foi organizada entre anos e fases da pandemia, procurando destacar o que caracterizou cada momento. A declaração de encerramento da ESPIN no Brasil coincide com as discussões acerca da transição de pandemia para a endemia, sem que isso represente a eliminação do vírus, das infecções e da doença, colocando-se os desafios de avanços nos processos de vacinação no Brasil e no mundo e da convivência com cenários que poderão exigir a adoção de medidas de proteção temporárias em períodos epidêmicos e de maior risco para grupos vulneráveis.

The effectiveness of COVID-19 vaccines against severe cases and deaths in Brazil from 2021 to 2022: a registry-based study.

Background: Brazil started the COVID-19 mass vaccination in January 2021 with CoronaVac and ChAdOx1, followed by BNT162b2 and Ad26.COV2.S vaccines. By the end of 2021, more than 317 million vaccine doses were administered in the adult population. This study aimed at estimating the effectiveness of the primary series of COVID-19 vaccination and booster shots in protecting against severe cases and deaths in Brazil during the first year of vaccination. Methods: A cohort dataset of over 158 million vaccination and severe cases records linked from official national registries was analyzed via a mixed-effects Poisson model, adjusted for age, state of residence, time after immunization, and calendar time to estimate the absolute vaccine effectiveness of the primary series of vaccination and the relative effectiveness of the booster. The method permitted analysis of effectiveness against hospitalizations and deaths, including in the periods of variant dominance. Findings: Vaccine effectiveness against severe cases and deaths remained over 25% and 50%, respectively, after 19 weeks from primary vaccination of BNT162b2, ChAdOx1, or CoronaVac vaccines. The boosters conferred greater protection than the primary series of vaccination, with heterologous boosters providing marginally greater protection than homologous. The effectiveness against hospitalization during the Omicron dominance in the 60+ years old population started at 61.7% (95% CI, 26.1-86.2) for ChAdOx1, 95.6% (95% CI, 82.4-99.9) for CoronaVac, and 72.3% (95% CI, 51.4-87.4) for the BNT162b2 vaccine. Interpretation: This study provides real-world evidence of the effectiveness of COVID-19 vaccination in Brazil, including during the Omicron wave, demonstrating protection even after waning effectiveness. Comparisons of the effectiveness among different vaccines require caution due to potential bias effects related to age groups, periods in the pandemic, and eventual behavioural changes. Funding: Fundação Oswaldo Cruz (FIOCRUZ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ), Pan American Health Organization (PAHO), Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde do Ministério da Saúde do Brasil (DECIT/SCTIE/MS).

Timeline kinetics of protective immunity to SARS-CoV-2 upon primary vaccination and humoral response to variants after booster dose.

New variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have emerged, imposing the need for periodic booster doses. However, whether booster doses should be applied to the entire population or groups, and the booster doses interval, remains unclear. In this study, we evaluated humoral reactivity kinetics from before the first dose to 180 days after the third booster dose in different schedules in a well-controlled health worker cohort. Among the 2,506 employees, the first 500 vaccinated health workers were invited to participate. The third booster dose was administered 8 months after the first dose. Among the invited participants, 470 were included in the study; 258 received inactivated vaccine CoronaVac (VAC group) and 212 received viral vector vaccine ChAdOx1 (AZV group). The groups were homogeneous in terms of age and sex. 347 participants were followed up after the booster dose with AZV or BNT162b2 (Pfizer, BNT group): 63 with VAC/AZV, 117 with VAC/BNT, 72 with the AZV/AZV and 95 with AZV/BNT schedules. Blood samples were collected immediately before, 28 days after each dose and 180 days after the primary vaccination and booster dose. Anti-SARS-CoV-2 antibodies were measured by chemiluminescence and plaque reduction neutralization test (PRNT). Plasma immune mediators were quantified using a multiplex immunoassay. Geometric mean of antibodies increased 28 days after the second dose with 100 % seroconversion rate in both groups and decreased 180 days after the first dose. In the baseline-seropositive VAC group, the levels of plasma immune mediators increased after the second dose. Booster dose was applied at 4-6 months after the primary vaccination. Heterologous booster in VAC or AZV primary vaccinees were effective maintaining the titers of anti-SARS-CoV-2 antibodies even after 6 months of follow-up. The heterologous schedule induced higher and stable antibody reactivity, even after 180 days, protecting to ancestral (Wuhan), Delta, and Omicron variants.

Occurrence of yellow fever outbreaks in a partially vaccinated population: An analysis of the effective reproduction number.

BACKGROUND: Yellow fever is endemic in Africa and the Americas, occurring in urban or sylvatic environments. The infection presents varying symptoms, with high case-fatality among severe cases. In 2016, Brazil had sylvatic yellow fever outbreaks with more than 11 thousand cases, predominantly affecting the country's Southeast region. The state of Minas Gerais accounted for 30% of cases, even after the vaccine had been included in the immunization calendar for at least 30 years. METHODOLOGY AND PRINCIPAL FINDINGS: We applied parameters described in the literature from yellow fever disease into a compartmental model of vector-borne diseases, using namely generation time intervals, vital host and vector parameters, and force of infection, using macroregions as the spatial unit and epidemiological weeks as the time interval. The model permits obtaining the reproduction number, which we analyzed from reported cases of yellow fever from 2016 to 2018 in residents of the state of Minas Gerais, Brazil. Minas Gerais recorded two outbreak periods, starting in EW 51/2016 and EW 51/2017. Of all the reported cases (3,304), 57% were men 30 to 59 years of age. Approximately 27% of cases (905) were confirmed, and 22% (202) of these individuals died. The estimated effective reproduction number varied from 2.7 (95% CI: 2.0-3.6) to 7.2 (95% CI: 4.4-10.9], found in the Oeste and Nordeste regions, respectively. Vaccination coverage in children under one year of age showed heterogeneity among the municipalities comprising the macroregions. CONCLUSION: The outbreaks in multiple parts of the state and the estimated Re values raise concern since the state population was partially vaccinated. Heterogeneity in vaccination coverage may have been associated with the occurrence of outbreaks in the first period, while the subsequent intense vaccination campaign may have determined lower Re values in the second period.

Effectiveness, safety, and immunogenicity of half dose ChAdOx1 nCoV-19 COVID-19 Vaccine: Viana project.

Fractional dose is an important strategy to increase access to vaccines. This study evaluated the effectiveness, safety, and immunogenicity of half dose of ChAdOx1 nCoV-19 vaccine. A non-inferiority non-randomized controlled trial compared a half dose of ChAdOx1 nCoV-19 with the full dose, with an interval of 8 to 10 weeks, in individuals aged 18-49 years. The primary endpoints were the incidence rate of new cases/1,000 person-year at 90 days after 14 days of the second dose, confirmed by RT-PCR and new cases registered at SUS National Health Surveillance Database (e-SUS VS). The anti-SARS-CoV-2 spike (S) protein receptor binding domain (RBD) by chemiluminescence and the neutralizing antibodies by plaque reduction neutralization test (PRNT) were titrated. The soluble biomarkers were quantified with a multiplex immunoassay. Follow-up was 90 days after 14 days of the second dose. A total of 29,598 individuals were vaccinated. After exclusion, 16,570 individuals who received half a dose and 6,402 who received full doses were analyzed. The incidence of new cases confirmed by RT-PCR of half dose was non-inferior to full dose (23.7 vs. 25.7 cases per 1,000 persons-year [coefficient group -0.09 CI95%(-0.49 to 0.31)], even after adjusting for age and sex. There were no deaths or hospitalization after immunization of either group. Immunogenicity was evaluated in a subsample (N=558) compared to 154 healthcare workers who received a full dose. The seroconversion rate in seronegative individuals at baseline half dose was 99.8%, similar to that of the full dose (100%). Geometric mean concentration (95% CI; BAU/mL) were half dose = 188 (163-217) and full dose = 529 (423-663) (p < 0.001). In seropositive subjects at baseline (pre-immune individuals), the first dose induced very high and similar IgG-S in half dose 1,359 (1,245-1,483) and full dose 1,354 (1,048-1,749) BAU/mL. A half dose induced a high increase in plasma chemokines, pro-inflammatory/regulatory cytokines, and growth factors. The frequency of adverse events was similar. No serious adverse events or deaths were reported. A half dose of ChAdOx1 nCoV-19 is as effective, safe, and immunogenic as the full dose. The immune response in pre-immune (seropositive in the baseline) individuals indicates that the half dose may be a booster dose schedule.

Household crowding hampers mitigating the transmission of SARS-CoV-2.

INTRODUCTION: Household crowding deserves attention when evaluating the transmission intensity of SARS-CoV-2 in Brazil. We aimed to evaluate the association between household crowding and COVID-19 incidence. METHODS: Linear and Poisson regression analyses were used to assess the associations between indices of household crowding (high, average, low) and COVID-19 incidence estimates. RESULTS: Cities with a high index of household crowding were linked with a significantly higher COVID-19 incidence estimate (excess of 461 per 100,000; 95% confidence interval: 371-558 per 100,000). CONCLUSIONS: Crowding typically promotes virus transmission. Considering urban and housing structures is essential in designing mitigation strategies during a pandemic.

[Sociodemographic and clinical factors associated with time to treatment for colorectal cancer in Brazil, 2006-2015]. / Fatores sociodemográficos e clínicos associados ao tempo para o início do tratamento de câncer de cólon e reto no Brasil, 2006-2015.

Colorectal cancer presents high incidence worldwide, but case-fatality is higher in developing countries. The study's objective was to analyze sociodemographic and clinical factors associated with delay in the initiation of treatment for colorectal cancer in hospitals in Brazil. This is a retrospective study of data from hospital cancer registries in Brazil from 2006 to 2015. The target variable is time to initiation of treatment for colorectal cancer and possible associations between sociodemographic variables and clinical factors. The analysis revealed disparities in time to treatment according to sociodemographic strata and geographic regions. Higher odds of treatment delay were associated with age over 50 years, black race/color (OR = 1.50; 95%CI: 1.21-1.84) and brown race/color (OR = 1.28; 95%CI: 1.17-1.42), illiteracy or low schooling (OR = 1.50; 95%CI: 1.19-1.90), and treatment in a city far from the patient's residence (OR = 1.25; 95%CI: 1.14-1.38). For rectal cancer, higher odds of treatment delay were associated with age over 50 years, black (OR = 1.44; 95%CI: 1.20-1.72) or brown race/color (OR = 1.29; 95%CI: 1.19-1.39), illiteracy or low schooling (OR = 1.71; 95%CI: 1.40-2.09), and treatment in a city far from the patient's residence (OR = 1.35; 95%CI: 1.25-1.47). In conclusion, greater attention should be given to reducing the time to initiation of treatment in underprivileged regions and in social strata identified with barriers to timely treatment access.

O câncer de cólon e reto apresenta alta incidência mundialmente, porém a letalidade da doença é maior em países em desenvolvimento. O objetivo deste estudo é analisar fatores sociodemográficos e clínicos associados ao atraso para o início de tratamento de câncer de cólon e reto em hospitais no Brasil. Trata-se de estudo retrospectivo com dados dos registros hospitalares de câncer no Brasil de 2006 a 2015. O desfecho analisado é o tempo para início do tratamento de câncer de cólon e reto e possíveis associações entre variáveis sociodemográficas e referentes a fatores clínicos. Observaram-se disparidades no tempo para início do tratamento de acordo com estratos sociodemográficos e regiões geográficas. Há maior chance de atraso para o início do tratamento de câncer de cólon em pacientes com idade acima de 50 anos, de raça/cor de pele preta (OR = 1,50; IC95%: 1,21-1,84) e parda (OR = 1,28; IC95%: 1,17-1,42), analfabetos (OR = 1.50; IC95%: 1,19-1,90) ou com baixa escolaridade e cujo tratamento ocorreu em um município distinto de sua residência (OR = 1,25; IC95%: 1,14-1,38). Em pacientes com câncer de reto, há maior chance de atraso para o início do tratamento entre os casos com idade acima de 50 anos, de raça/cor de pele preta (OR = 1,44; IC95%: 1,20-1,72) e parda (OR = 1,29; IC95%: 1,19-1,39), analfabetos (OR = 1,71; IC95%: 1,40-2,09) ou com baixa escolaridade e cujo tratamento ocorreu em um município distinto de sua residência (OR = 1,35; IC95%: 1,25-1,47). Como conclusão, maior atenção deve ser destinada a reduzir o tempo para iniciar o tratamento nas regiões desfavorecidas e nos estratos identificados com barreiras de acesso ao tratamento em tempo oportuno.

El cáncer de colon y recto presenta una alta incidencia mundialmente, pese a que la letalidad de la enfermedad es mayor en países en desarrollo. El objetivo de este estudio fue analizar los factores sociodemográficos y clínicos, asociados al retraso para el inicio del tratamiento de cáncer de colon y recto en hospitales en Brasil. Se trata de un estudio retrospectivo con datos de registros hospitalarios de cáncer en Brasil de 2006 a 2015. El resultado analizado es el tiempo para el inicio del tratamiento de cáncer de colon y recto, así como las posibles asociaciones entre variables sociodemográficas y las relacionadas con factores clínicos. Se observó disparidades en el tiempo para el inicio del tratamiento, según estratos sociodemográficas y regiones geográficas. Existe una mayor oportunidad de retraso para el inicio del tratamiento de cáncer de colon en pacientes con una edad por encima de 50 años, de raza/afrodescendiente (OR = 1,50; IC95%: 1,21-1,84) y mulata/mestiza (OR = 1,28; IC95%: 1,17-1,42), analfabetos (OR = 1,50; IC95%: 1,19-1,90) o con baja escolaridad, y cuyo tratamiento se produjo en un municipio distinto al de su residencia (OR = 1,25; IC95%: 1,14-1,38). En pacientes con cáncer de recto existe una mayor oportunidad de atraso para el inicio del tratamiento entre los casos con una edad por encima de 50 años, de raza/afrodescendiente (OR = 1,44; IC95%: 1,20-1,72) y mulata/mestiza (OR = 1,29; IC95%: 1,19-1,39), analfabetos (OR = 1,71; IC95%: 1,40-2,09) o con baja escolaridad, y cuyo tratamiento se produjo en un municipio distinto al de su residencia (OR = 1,35; IC95%: 1,25-1,47). Como conclusión, se debe prestar mayor atención a la reducción del tiempo para comenzar el tratamiento en las regiones desfavorecidas y en estratos identificados con barreras de acceso al tratamiento en el tiempo adecuado.

Identification of priority groups for COVID-19 vaccination in Brazil. / Identificação de grupos prioritários para a vacinação contra COVID-19 no Brasil.

In a context of community transmission and shortage of vaccines, COVID-19 vaccination should focus on directly reducing the morbidity and mortality caused by the disease. It was thus essential to define priority groups for vaccination by the Brazilian National Immunization Program (PNI in Portuguese), based on the risk of hospitalization and death from the disease. We calculated overrisk according to sex, age group, and comorbidities using hospitalization and death records from severe acute respiratory illness with confirmation of COVID-19 (SARI-COVID) in all of Brazil in the first 6 months of the epidemic. Higher overrisk was associated with male sex (hospitalization = 1.1 and death = 1.2), age over 45 years for hospitalization (OvRag ranging from 1.1 to 8.5), and age over 55 year for death (OvRag ranging from 1.5 to 18.3). In the groups with comorbidities, chronic kidney disease, diabetes mellitus, cardiovascular disease, and chronic lung disease were associated with overrisk, while there was no such evidence for asthma. Chronic kidney disease or diabetes and age over 60 showed an even stronger association, reaching overrisk of death 14 and 10 times greater than in the general population, respectively. For all the comorbidities, there was higher overrisk at older ages, with a downward gradient in the oldest age groups. This pattern was reversed when examining overrisk in the general population, for both hospitalization and death. The current study provided evidence of overrisk of hospitalization and death from SARI-COVID, assisting the definition of priority groups for COVID-19 vaccination.

Em um contexto de transmissão comunitária e escassez de vacinas, a vacinação contra a COVID-19 deve focar na redução direta da morbidade e da mortalidade causadas pela doença. Portanto, é fundamental a definição de grupos prioritários para a vacinação pelo Programa Nacional de Imunizações (PNI), baseada no risco de hospitalização e óbito pela doença. Para tal, calculamos o sobrerrisco por sexo, faixa etária e comorbidades por meio dos registros de hospitalização e óbito por síndrome respiratória aguda grave com confirmação de COVID-19 (SRAG-COVID) em todo o Brasil nos primeiros seis meses de epidemia. Apresentaram maior sobrerrisco pessoas do sexo masculino (hospitalização = 1,1 e óbito = 1,2), pessoas acima de 45 anos para hospitalização (SRfe variando de 1,1 a 8,5) e pessoas acima de 55 anos para óbitos (SRfe variando de 1,5 a 18,3). Nos grupos de comorbidades, doença renal crônica, diabetes mellitus, doença cardiovascular e pneumopatia crônica conferiram sobrerrisco, enquanto para asma não houve evidência. Ter doença renal crônica ou diabetes mellitus e 60 anos ou mais mostrou-se um fator ainda mais forte, alcançando sobrerrisco de óbito 14 e 10 vezes maior do que na população geral, respectivamente. Para todas as comorbidades, houve um sobrerrisco mais alto em idades maiores, com um gradiente de diminuição em faixas mais altas. Esse padrão se inverteu quando consideramos o sobrerrisco em relação à população geral, tanto para hospitalização quanto para óbito. O presente estudo forneceu evidências a respeito do sobrerrisco de hospitalização e óbito por SRAG-COVID, auxiliando na definição de grupos prioritários para a vacinação contra a COVID-19.

En un contexto de transmisión comunitaria y escasez de vacunas, la vacunación contra la COVID-19 debe enfocarse en la reducción directa de la morbilidad y de la mortalidad causadas por la enfermedad. Por lo tanto, es fundamental la definición de grupos prioritarios para la vacunación por el Programa Nacional de Inmunizaciones (PNI), basada en el riesgo de hospitalización y óbito por la enfermedad. Para tal fin, calculamos el sobrerriesgo por sexo, franja de edad y comorbilidades mediante los registros de hospitalización y óbito por síndrome respiratorio agudo grave con confirmación de COVID-19 (SRAG-COVID) en todo Brasil, durante los primeros seis meses de epidemia. Presentaron mayor sobrerriesgo personas del sexo masculino (hospitalización = 1,1 y óbito = 1,2), personas por encima de 45 años para hospitalización (SRfe variando de 1,1 a 8,5) y personas por encima de 55 años para óbitos (SRfe variando de 1,5 a 18,3). En los grupos de comorbilidades, enfermedad renal crónica, diabetes mellitus, enfermedad cardiovascular y neumopatía crónica ofrecieron sobrerriesgo, mientras que para el asma no hubo evidencia. Sufrir una enfermedad renal crónica o diabetes mellitus y tener 60 años o más mostró un factor todavía más fuerte, alcanzando sobrerriesgo de enfermedad 14 y 10 veces mayor que en la población general, respectivamente. Para todas las comorbilidades, hubo un sobrerriesgo más alto en edades mayores, con un gradiente de disminución en franjas más altas. Este patrón se invirtió cuando consideramos el sobrerriesgo en relación con la población general, tanto para hospitalización como para óbito. El presente estudio proporcionó evidencias respecto al sobrerriesgo de hospitalización y óbito por SRAG-COVID, ayudando en la definición de grupos prioritarios para la vacunación contra la COVID-19.

Women who have undergone abortion in the city of Rio de Janeiro, Brazil: application of a Bayesian hierarchical model. / Mulheres que fizeram aborto no Município do Rio de Janeiro, Brasil: aplicação de um modelo hierárquico bayesiano.

Estimates of number of women who have undergone induced abortion in jurisdictions with restrictive abortion laws are still scarce in the scientific literature, and the disparate estimates from currently used methods call for the application of innovative estimation techniques such as new indirect methods. This need is especially acute in more densely populated areas, such as Brazil's state capitals, given the magnitude of unsafe abortions and the resulting risks and harms. The article aims to estimate the number of women who had induced abortions in the city of Rio de Janeiro in 2011, based on a Bayesian hierarchical model. The model was applied to data from a household survey that supported the use of the network scale-up method in the city of Rio de Janeiro, a Bayesian hierarchical model using indirect information based on the contact networks of randomly selected participants from the general population. Among the 1,758,145 women 15-49 years of age living in the city of Rio de Janeiro, 13,025 women (95%CrI: 10,635; 15,748) had induced abortions in 2011, resulting in a mean cumulative incidence of 7.41 (95%CrI: 6.05; 8.96) for every 1,000 women 15-49 years of age. The model's self-validation process identified patterns of underestimation in stigmatized subpopulations with low social visibility, such as women who have undergone induced abortion. Induced abortion is a common practice among women in the city of Rio de Janeiro. New indirect estimation methods can contribute to more precise measurement of this event, considering the context of illegality, and thereby contribute to appropriate health policies.

Estimativas de mulheres que fizeram aborto provocado em localidades cujas leis são restritivas ainda são escassas na literatura científica, e a não coincidência de estimativas oriundas dos métodos hoje em uso clama pela aplicação de métodos inovadores, como novos métodos indiretos. Tal necessidade é especialmente aguda nas áreas mais densamente povoadas, como as capitais brasileiras, dada a magnitude do fenômeno e os danos e riscos daí decorrentes. O artigo objetiva estimar o número de mulheres que fez aborto provocado no Município do Rio de Janeiro, Brasil, em 2011, por meio de um modelo hierárquico bayesiano. Ele foi aplicado aos dados de um inquérito domiciliar que subsidiou a utilização do método network scale-up, no Município do Rio de Janeiro, um modelo hierárquico bayesiano utilizando as informações indiretas baseadas na rede de contatos dos participantes selecionados de forma aleatória da população. Das 1.758.145 mulheres de 15-49 anos residentes no Município do Rio de Janeiro (13.025; ICr95%: 10.635; 15.748) mulheres fizeram aborto provocado em 2011, resultando numa incidência acumulada média de 7,41 (ICr95%: 6,05; 8,96) para cada 1.000 mulheres de 15-49 anos. O estudo de autovalidação do modelo permitiu identificar padrões de subestimação em subpopulações estigmatizadas com baixa visibilidade social, como mulheres fizeram aborto provocado. O abortamento provocado é uma prática recorrente entre as mulheres no Município do Rio de Janeiro. Novos métodos de estimação indireta podem contribuir para a apreensão mais precisa do evento, considerando o contexto de ilegalidade, e contribuir para formulação de políticas de saúde.

Las estimaciones de mujeres que tuvieron un aborto provocado en localidades cuyas leyes son restrictivas todavía son escasas en la literatura científica, y la no coincidencia de las estimaciones procedentes de los métodos hoy en uso reclama urgentemente la aplicación de métodos innovadores, como los nuevos métodos indirectos. Tal necesidad es especialmente acuciante en las áreas más densamente pobladas, como las capitales brasileñas, dada la magnitud del fenómeno y los daños y riesgos derivados de allí. El artículo tiene como objetivo estimar el número de mujeres que realizaron un aborto provocado en el Municipio de Río de Janeiro, Brasil, en 2011, a partir de un modelo jerárquico bayesiano. Este se aplicó a los datos de una encuesta domiciliaria que fomentó la utilización del método network scale-up, en el Municipio de Río de Janeiro, un modelo jerárquico bayesiano utilizando información indirecta, basada en la red de contactos de los participantes seleccionados de forma aleatoria en la población. De las 1.758.145 mujeres de 15-49 años, residentes en el Municipio de Río de Janeiro, 13.025 (ICr95%: 10.635; 15.748) mujeres tuvieron un aborto provocado en 2011, resultando en una incidencia acumulada media de 7,41 (ICr95%: 6,05; 8,96) para cada 1.000 mujeres de 15-49 años. El estudio de autovalidación del modelo permitió identificar patrones de subestimación en subpoblaciones estigmatizadas con baja visibilidad social, como las mujeres que tuvieron un aborto provocado. El aborto provocado es una práctica recurrente entre mujeres en el municipio de Río de Janeiro. Nuevos métodos de estimación indirecta pueden contribuir a la aprehensión más precisa de este evento, considerando el contexto de ilegalidad, y contribuir a la formulación de políticas de salud.

Description and comparison of demographic characteristics and comorbidities in SARI from COVID-19, SARI from influenza, and the Brazilian general population. / SRAG por COVID-19 no Brasil: descrição e comparação de características demográficas e comorbidades com SRAG por influenza e com a população geral.

The study aims to describe patients hospitalized for severe acute respiratory illness (SARI) due to COVID-19 (SARI-COVID) in Brazil according to demographic characteristics and comorbidities up to the 21st Epidemiological Week of 2020. The study aimed to compare these characteristics with those of patients hospitalized for SARI due to influenza in 2019/2020 (SARI-FLU) and with the Brazilian general population. The proportions of demographic characteristics, comorbidities, and pregnant and postpartum women among patients hospitalized for SARI-COVID and SARI-FLU were obtained from the SIVEP-Gripe database, and the estimates for the Brazilian population were obtained from the population projections performed by Brazilian Institute of Geography and Statistics, Information System on Live Birth data, and nationwide surveys. Compared to the Brazilian population, patients hospitalized for SARI-COVID showed a higher proportion of males, elderly individuals and those aged 40 to 59 years, comorbidities (diabetes mellitus, cardiovascular disease, chronic kidney disease, and chronic lung diseases), and pregnant/postpartum women. Compared to the general population, Brazilians hospitalized for SARI-FLU showed higher prevalence rates of ages 0 to 4 years or over 60 years, white race/color, comorbidities (diabetes, chronic kidney disease, asthma, and other chronic lung diseases), and pregnant/postpartum women. The data suggest that these groups are evolving to more serious forms of the disease, so that longitudinal studies are extremely relevant for investigating this hypothesis and supporting appropriate public health policies.

Factors associated with death in patients with tuberculosis in Brazil: Competing risks analysis.

OBJECTIVES: This study aimed to analyze the factors associated with likely TB deaths, likely TB-related deaths and deaths from other causes. Understanding the factors associated with mortality could help the strategy to End TB, especially the goal of reducing TB deaths by 95% between 2015 and 2035. METHODS: A retrospective, population-based cohort study of the causes of death was performed using a competing risk model in patients receiving treatment for TB. Patients had started TB treatment in Brazil 2008-2013 with any death certificates dated in the same period. We used three categories of deaths, according to ICD-10 codes: i) probable TB deaths; ii) TB-related deaths; iii) deaths from other causes. RESULTS: In this cohort, 39,997 individuals (14.1%) died, out of a total of 283,508 individuals. Of these, 8,936 were probable TB deaths (22.4%) and 3,365 TB-related deaths (8.4%), illustrating high mortality rates. 27,696 deaths (69.2%) were from other causes. From our analysis, factors strongly associated with probable TB deaths were male gender (sHR = 1.33, 95% CI: 1.26-1.40), age over 60 years (sHR = 9.29, 95% CI: 8.15-10.60), illiterate schooling (sHR = 2.33, 95% CI: 2.09-2.59), black (sHR = 1.33, 95% CI: 1.26-1.40) and brown (sHR = 13, 95% CI: 1.07-1.19) color/race, from the Southern region (sHR = 1.19, 95% CI: 1.10-1.28), clinical mixed forms (sHR = 1.91, 95% CI: 1.73-2.11) and alcoholism (sHR = 1.90, 95% CI: 1.81-2.00). Also, HIV positive serology was strongly associated with probable TB deaths (sHR = 62.78; 95% CI: 55.01-71.63). CONCLUSIONS: In conclusion, specific strategies for active surveillance and early case detection can reduce mortality among patients with tuberculosis, leading to more timely detection and treatment.

Should I stay or should I go? Movement of adult Triatoma sordida within the peridomestic area of a typical Brazilian Cerrado rural household.

BACKGROUND: Chagas disease, or American trypanosomiasis, is an important neglected tropical illness caused by the flagellate protozoan Trypanosoma cruzi, which is primarily transmitted to humans by hematophagous insects of the subfamily Triatominae. Although knowledge on triatomine movement capabilities at the micro-geographical scale is of fundamental importance concerning the development of effective vector control strategies, it remains a poorly understood subject. Furthermore, survival rates and size estimates of natural populations are important topics to consider when evaluating transmission intensity. RESULTS: The movement of adult Triatoma sordida within the peridomestic area of a rural Brazilian household was evaluated via mark-release-recapture assays. A total of 210 insects had their pronota marked with fluorescent dyes and were released at different distances from the chicken coop (two, five, ten and 20 m), and from the horse corral (27, 32, 35, 46 and 56 m). Recaptures occurred in three consecutive 15-day intervals. Specimens were successfully recaptured at all distances up to 32 m. Bayesian models were used to estimate recapture probability, survival rates (males vs females) and population size. Although recapture probability was inversely proportional to distance for both sexes, females were more affected by increased distance. On the other hand, no significant difference was detected in the survival rates between males and females in a 15-day period. Fisher-Ford and Bayesian models gave more accurate population size estimates than Lincoln method. CONCLUSIONS: Triatoma sordida adults were able to cover a distance of 32 m in 45 days. Recapture data modelling reveals that male dispersal was more effective suggesting that T. sordida males are more likely to contribute as potential colonizers of the peridomestic environment. Increasing the distance between the peridomestic structures and the sylvatic environment as much as possible appears to be a simple and feasible recommendation to reduce the contact rate between humans and infected bugs and ultimately Chagas disease transmission.

Observatório Covid-19 Fiocruz - uma análise da evolução da pandemia de fevereiro de 2020 a abril de 2022 / Covid-19 Fiocruz Observatory - an analysis of the evolution of the pandemic from February 2020 to April 2022

Resumo A pandemia de COVID-19 teve um imenso impacto nas condições de vida e trabalho de toda a população do país, impactando de modo diferenciado e mais intenso os grupos considerados vulneráveis. O objetivo deste artigo é apresentar um panorama da evolução da pandemia no país segundo os boletins do Observatório Covid-19 Fiocruz, no período entre as declarações de início e de encerramento da Emergência em Saúde Pública de Importância Nacional (ESPIN), fevereiro de 2020 a abril de 2022. Foram utilizados diversos dos indicadores adotados nos 69 boletins publicados para a análise da pandemia, como casos e óbitos por SRAGs e COVID-19, grupos etários, taxas de ocupação de leitos UTI e vacinação, entre outros. A análise da evolução foi organizada entre anos e fases da pandemia, procurando destacar o que caracterizou cada momento. A declaração de encerramento da ESPIN no Brasil coincide com as discussões acerca da transição de pandemia para a endemia, sem que isso represente a eliminação do vírus, das infecções e da doença, colocando-se os desafios de avanços nos processos de vacinação no Brasil e no mundo e da convivência com cenários que poderão exigir a adoção de medidas de proteção temporárias em períodos epidêmicos e de maior risco para grupos vulneráveis.

Abstract The COVID-19 pandemic had a significant impact on the living and working conditions of the entire population of Brazil, having a different and more intense effect on groups considered to be vulnerable. The objective of this article is to present an overview of the evolution of the pandemic in the country according to the bulletins of the Covid-19 Fiocruz Observatory in the period between the declarations of the beginning and end of the Public Health Emergency of National Concern (ESPIN, in Portuguese), February 2020 to April 2022. Several of the indicators adopted in the 69 bulletins published for the analysis of the pandemic were used, such as cases and deaths due to SARIs and COVID-19, age groups, % of occupancy of ICU beds, and vaccination, among others. The evolution analysis was organized between years and phases of the pandemic, seeking to highlight what characterized each moment. The closing statement of ESPIN in Brazil coincides with the discussions on the transition from a pandemic to an endemic scenario, without this representing the elimination of the virus, infections, and disease, posing the challenges of advances in vaccination processes in Brazil and around the world, as well as living with scenarios that may require the adoption of temporary protection measures in epidemic periods and periods of greater risk for vulnerable groups.

Novel inference models for estimation of abundance, survivorship and recruitment in mosquito populations using mark-release-recapture data.

BACKGROUND: Experiments involving mosquito mark-release-recapture (MRR) design are helpful to determine abundance, survival and even recruitment of mosquito populations in the field. Obstacles in mosquito MRR protocols include marking limitations due to small individual size, short lifespan, low efficiency in capturing devices such as traps, and individual removal upon capture. These limitations usually make MRR analysis restricted to only abundance estimation or a combination of abundance and survivorship, and often generate a great degree of uncertainty about the estimations. METHODOLOGY/PRINCIPAL FINDINGS: We present a set of Bayesian biodemographic models designed to fit data from most common mosquito recapture experiments. Using both field data and simulations, we consider model features such as capture efficiency, survival rates, removal of individuals due to capturing, and collection of pupae. These models permit estimation of abundance, survivorship of both marked and unmarked mosquitoes, if different, and recruitment rate. We analyze the accuracy of estimates by varying the number of released individuals, abundance, survivorship, and capture efficiency in multiple simulations. These methods can stand capture efficiencies as low as usually reported but their accuracy depends on the number of released mosquitoes, abundance and survivorship. We also show that gathering pupal counts allows estimating differences in survivorship between released mosquitoes and the unmarked population. CONCLUSION/SIGNIFICANCE: These models are important both to reduce uncertainty in evaluating MMR experiments and also to help planning future MRR studies.

How does competition among wild type mosquitoes influence the performance of Aedes aegypti and dissemination of Wolbachia pipientis?

BACKGROUND: Wolbachia has been deployed in several countries to reduce transmission of dengue, Zika and chikungunya viruses. During releases, Wolbachia-infected females are likely to lay their eggs in local available breeding sites, which might already be colonized by local Aedes sp. mosquitoes. Therefore, there is an urgent need to estimate the deleterious effects of intra and interspecific larval competition on mosquito life history traits, especially on the duration of larval development time, larval mortality and adult size. METHODOLOGY/PRINCIPAL FINDINGS: Three different mosquito populations were used: Ae. aegypti infected with Wolbachia (wMelBr strain), wild Ae. aegypti and wild Ae. albopictus. A total of 21 treatments explored intra and interspecific larval competition with varying larval densities, species proportions and food levels. Each treatment had eight replicates with two distinct food levels: 0.25 or 0.50 g of Chitosan and fallen avocado leaves. Overall, overcrowding reduced fitness correlates of the three populations. Ae. albopictus larvae presented lower larval mortality, shorter development time to adult and smaller wing sizes than Ae. aegypti. The presence of Wolbachia had a slight positive effect on larval biology, since infected individuals had higher survivorship than uninfected Ae. aegypti larvae. CONCLUSIONS/SIGNIFICANCE: In all treatments, Ae. albopictus outperformed both wild Ae. aegypti and the Wolbachia-infected group in larval competition, irrespective of larval density and the amount of food resources. The major force that can slow down Wolbachia invasion is the population density of wild mosquitoes. Given that Ae. aegypti currently dominates in Rio, in comparison with Ae. albopictus frequency, additional attention must be given to the population density of Ae. aegypti during releases to increase the likelihood of Wolbachia invasion.

Household crowding hampers mitigating the transmission of SARS-CoV-2

Abstract INTRODUCTION: Household crowding deserves attention when evaluating the transmission intensity of SARS-CoV-2 in Brazil. We aimed to evaluate the association between household crowding and COVID-19 incidence. METHODS: Linear and Poisson regression analyses were used to assess the associations between indices of household crowding (high, average, low) and COVID-19 incidence estimates. RESULTS: Cities with a high index of household crowding were linked with a significantly higher COVID-19 incidence estimate (excess of 461 per 100,000; 95% confidence interval: 371-558 per 100,000). CONCLUSIONS: Crowding typically promotes virus transmission. Considering urban and housing structures is essential in designing mitigation strategies during a pandemic.

Fatores sociodemográficos e clínicos associados ao tempo para o início do tratamento de câncer de cólon e reto no Brasil, 2006-2015 / Sociodemographic and clinical factors associated with time to treatment for colorectal cancer in Brazil, 2006-2015 / Factores sociodemográficos y clínicos relacionados con el tiempo para el inicio del tratamiento de cáncer de colon y recto en Brasil, 2006-2015

O câncer de cólon e reto apresenta alta incidência mundialmente, porém a letalidade da doença é maior em países em desenvolvimento. O objetivo deste estudo é analisar fatores sociodemográficos e clínicos associados ao atraso para o início de tratamento de câncer de cólon e reto em hospitais no Brasil. Trata-se de estudo retrospectivo com dados dos registros hospitalares de câncer no Brasil de 2006 a 2015. O desfecho analisado é o tempo para início do tratamento de câncer de cólon e reto e possíveis associações entre variáveis sociodemográficas e referentes a fatores clínicos. Observaram-se disparidades no tempo para início do tratamento de acordo com estratos sociodemográficos e regiões geográficas. Há maior chance de atraso para o início do tratamento de câncer de cólon em pacientes com idade acima de 50 anos, de raça/cor de pele preta (OR = 1,50; IC95%: 1,21-1,84) e parda (OR = 1,28; IC95%: 1,17-1,42), analfabetos (OR = 1.50; IC95%: 1,19-1,90) ou com baixa escolaridade e cujo tratamento ocorreu em um município distinto de sua residência (OR = 1,25; IC95%: 1,14-1,38). Em pacientes com câncer de reto, há maior chance de atraso para o início do tratamento entre os casos com idade acima de 50 anos, de raça/cor de pele preta (OR = 1,44; IC95%: 1,20-1,72) e parda (OR = 1,29; IC95%: 1,19-1,39), analfabetos (OR = 1,71; IC95%: 1,40-2,09) ou com baixa escolaridade e cujo tratamento ocorreu em um município distinto de sua residência (OR = 1,35; IC95%: 1,25-1,47). Como conclusão, maior atenção deve ser destinada a reduzir o tempo para iniciar o tratamento nas regiões desfavorecidas e nos estratos identificados com barreiras de acesso ao tratamento em tempo oportuno.

Colorectal cancer presents high incidence worldwide, but case-fatality is higher in developing countries. The study's objective was to analyze sociodemographic and clinical factors associated with delay in the initiation of treatment for colorectal cancer in hospitals in Brazil. This is a retrospective study of data from hospital cancer registries in Brazil from 2006 to 2015. The target variable is time to initiation of treatment for colorectal cancer and possible associations between sociodemographic variables and clinical factors. The analysis revealed disparities in time to treatment according to sociodemographic strata and geographic regions. Higher odds of treatment delay were associated with age over 50 years, black race/color (OR = 1.50; 95%CI: 1.21-1.84) and brown race/color (OR = 1.28; 95%CI: 1.17-1.42), illiteracy or low schooling (OR = 1.50; 95%CI: 1.19-1.90), and treatment in a city far from the patient's residence (OR = 1.25; 95%CI: 1.14-1.38). For rectal cancer, higher odds of treatment delay were associated with age over 50 years, black (OR = 1.44; 95%CI: 1.20-1.72) or brown race/color (OR = 1.29; 95%CI: 1.19-1.39), illiteracy or low schooling (OR = 1.71; 95%CI: 1.40-2.09), and treatment in a city far from the patient's residence (OR = 1.35; 95%CI: 1.25-1.47). In conclusion, greater attention should be given to reducing the time to initiation of treatment in underprivileged regions and in social strata identified with barriers to timely treatment access.

El cáncer de colon y recto presenta una alta incidencia mundialmente, pese a que la letalidad de la enfermedad es mayor en países en desarrollo. El objetivo de este estudio fue analizar los factores sociodemográficos y clínicos, asociados al retraso para el inicio del tratamiento de cáncer de colon y recto en hospitales en Brasil. Se trata de un estudio retrospectivo con datos de registros hospitalarios de cáncer en Brasil de 2006 a 2015. El resultado analizado es el tiempo para el inicio del tratamiento de cáncer de colon y recto, así como las posibles asociaciones entre variables sociodemográficas y las relacionadas con factores clínicos. Se observó disparidades en el tiempo para el inicio del tratamiento, según estratos sociodemográficas y regiones geográficas. Existe una mayor oportunidad de retraso para el inicio del tratamiento de cáncer de colon en pacientes con una edad por encima de 50 años, de raza/afrodescendiente (OR = 1,50; IC95%: 1,21-1,84) y mulata/mestiza (OR = 1,28; IC95%: 1,17-1,42), analfabetos (OR = 1,50; IC95%: 1,19-1,90) o con baja escolaridad, y cuyo tratamiento se produjo en un municipio distinto al de su residencia (OR = 1,25; IC95%: 1,14-1,38). En pacientes con cáncer de recto existe una mayor oportunidad de atraso para el inicio del tratamiento entre los casos con una edad por encima de 50 años, de raza/afrodescendiente (OR = 1,44; IC95%: 1,20-1,72) y mulata/mestiza (OR = 1,29; IC95%: 1,19-1,39), analfabetos (OR = 1,71; IC95%: 1,40-2,09) o con baja escolaridad, y cuyo tratamiento se produjo en un municipio distinto al de su residencia (OR = 1,35; IC95%: 1,25-1,47). Como conclusión, se debe prestar mayor atención a la reducción del tiempo para comenzar el tratamiento en las regiones desfavorecidas y en estratos identificados con barreras de acceso al tratamiento en el tiempo adecuado.