As vacinas contra a covid-19 em plataformas de vídeos curtos no Brasil: o caso do Kwai / Covid-19 vaccines on short video platforms in Brazil: the case of Kwai / Las vacunas contra la covid-19 en plataformas de videos cortos en Brasil: el caso del Kwai

Neste artigo, analisamos as temáticas, os posicionamentos, as formas expressivas, os atores legitimados e os recursos visuais e sonoros empregados na produção de 482 vídeos sobre vacinas, publicados de 2020 a 2022 na plataforma de vídeos curtos Kwai. A partir de análise temática e de análise de conteúdo, identificamos que os vídeos apresentaram, em sua maioria, posicionamento favorável ou neutro em relação às vacinas e que ressaltaram as experiências pessoais com a vacinação. Não obstante, utilizaram sobretudo um tom hu-morístico no tratamento do assunto, com potencial desinformativo quanto aos efeitos colaterais das vacinas. Concluímos assim que, por um lado, o Kwai tem sido utilizado para expressão de experiências positivas com a vacinação, que podem estimular a adesão aos imunizantes, mas, por outro, tem sido também espaço para a circulação de percepções negativas e temores que podem suscitar dúvidas quanto à segurança das vacinas.

In this article, we analyze the themes, positions, expressive forms, legitimized actors, and both visual and sound resources used in the production of 482 videos about vaccines, published from 2020 to 2022 on the short video platform Kwai. Based on thematic analysis and content analysis, we identified that the videos predominantly presented a favorable or neutral stance toward vaccines and that they highlighted personal experiences with immunization. However, they mainly used a humorous tone when dealing with the subject, thereby potentially disseminating misinformation regarding the adverse effects of vaccines. We thus conclude that, on the one hand, Kwai has been used to express positive experiences with vaccination, which can stimulate adherence to vaccinations, but, on the other hand, it has also been a space for the circulation of negative perceptions and fears that can raise doubts regarding the safety of vaccines.

En este artículo, analizamos los temas, posiciones, formas expresivas, actores legitimados y recursos visuales y sonoros utilizados en la producción de 482 videos sobre vacunas publicados de 2020 a 2022 en la plataforma de videos cortos Kwai. A partir del análisis temático y de contenido, identificamos que los videos presentaban, en su mayoría, una posición favorable o neutral con relación a las vacunas y que destacaban experiencias per-sonales con la vacunación. Sin embargo, al abordar el tema, utilizaron, principalmente, un tono humorístico, con potencial desinformativo sobre los efectos secundarios de las vacunas. De ese modo, concluimos que, por un lado, el Kwai tiene sido utilizado para expresar experiencias positivas con la vacunación que pueden estimular la adhesión a las vacunas, pero, por otro lado, también tiene sido un espacio para la circulación de percepciones negativas y miedos que pueden plantear dudas sobre la seguridad de las vacunas.

Estruturação do plano de imunização no combate a covid-19: (des)ordem nos acordos entre os poderes / Structuring the immunization plan to fight covid-19: (dis)order in agreements between the powers / Estructura del plan de inmunización para combatir el covid-19: (des)orden en acuerdos entre potencias

Objetivo: Fomentar o debate acerca da ordenação do plano de vacinação nacional, considerando os aspectos organizacionais entre união, estados e municípios. Métodos: Revisão de literatura, tendo como base os periódicos Cientific Electronic Library Online (SCIELO), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) e Biblioteca Virtual de Saúde (BVS), usando como descritores: Pandemia, Vacina e Plano de Imunização. Com essa busca foram encontradas, inicialmente, 48 publicações. Após a realização da análise, foram incluídos 11 artigos científicos na revisão. Os textos foram submetidos à análise de conteúdo semântica. Resultados: Foram levantadas duas categorias: estratégias de combate a pandemia do covid-19 no Brasil, e a manipulação da sociedade civil e a desordem da cobertura vacinal. Conclusão: as reflexões aqui apresentadas podem contribuir para que os profissionais de enfermagem desenvolvam uma postura reflexiva frente a demanda vacinal, processo de planejamento e percepções da sociedade civil, podendo desencadear uma melhora na preparação para a educação em saúde. (AU)

Objective: To encourage the debate about the ordering of the national vaccination plan, considering the organizational aspects between the union, states and municipalities. Methods: Literature review, based on scientific journals Electronic Library Online (SCIELO), Coordination for the Improvement of Higher Education Personnel (CAPES) and Virtual Health Library (VHL), using as descriptors: Pandemia, Vaccine and Immunization Plan. With this search, 48 publications were initially found. After the analysis, 11 scientific articles were included in the review. The texts were subjected to semantic content analysis. Results: Two categories were raised: strategies to combat the covid-19 pandemic in Brazil, and the manipulation of civil society and the disorder of vaccination coverage. Conclusion: The reflections presented here can contribute for nursing professionals to develop a reflexive posture in face of the vaccine demand, planning process and civil society perceptions, which can trigger an improvement in the preparation for health education. (AU)

Objetivo: Fomentar el debate sobre la ordenación del plan nacional de vacunación, considerando los aspectos organizativos entre sindicato, estados y municipios. Métodos: Revisión de la literatura, con base en revistas científicas Biblioteca Electrónica en Línea (SCIELO), Coordinación para el Perfeccionamiento del Personal de Educación Superior (CAPES) y Biblioteca Virtual en Salud (BVS), utilizando como descriptores: Pandemia, Vacuna y Plan de Inmunización. Con esta búsqueda se encontraron inicialmente 48 publicaciones. Después del análisis, se incluyeron 11 artículos científicos en la revisión. Los textos fueron sometidos a análisis de contenido semántico. Resultados: Se plantearon dos categorías: estrategias para combatir la pandemia de covid-19 en Brasil y la manipulación de la sociedad civil y el desorden de la cobertura de vacunación. Conclusión: Las reflexiones aquí presentadas pueden contribuir para que los profesionales de enfermería desarrollen una postura reflexiva ante la demanda de vacunas, el proceso de planificación y las percepciones de la sociedad civil, lo que puede desencadenar una mejora en la preparación para la educación en salud. (AU)

Adherencia de adultos de la compañía Chauria para la vacunación contra la COVID-19

Introducción: La pandemia del COVID-19 ha provocado cambios que afectan a los sistemas sanitarios y al enfoque de las enfermedades infecciosas en todo el mundo. La demanda de vacunas contra el COVID-19 se encuadra en un espectro que va desde el rechazo hasta la demanda, con una aceptación pasiva en el medio. Objetivo: Determinar la adherencia de los adultos a la vacunación contra la COVID-19. Chauria-Caballero, Paraguay 2022. Metodología: Estudio observacional, descriptivo, de corte transversal, con enfoque cuantitativo. El muestreo fue no probabilístico por conveniencia. La muestra estuvo conformada por un total de 225 adultos; los datos fueron recabados por medio de una encuesta elaborada por la investigadora, los datos fueron procesados con el software EPI INFO. Resultados: La mayoría de los sujetos de estudio se vacunaron, y hubo adherencia de la población a la vacuna contra la COVID-19 en un 93 %; diversos factores influyeron en las decisiones de estos; el porcentaje de adultos no vacunados mencionan como motivos su desconfianza (69 %) y el miedo/temor a la vacunación (31 %). Discusión: El estudio encontró una alta adherencia en general, la gran mayoría de los participantes vacunados contra COVID-19, porcentajes significativos se reportaron en Chile, China y Catar, cifras muy altas con relación a la aceptación de la vacuna a nivel país, teniendo una cobertura con un porcentaje mayor a la mitad con al menos una dosis.

Introduction: The coronavirus disease (COVID-19) pandemic has caused changes that affect health systems and the approach to infectious diseases worldwide. The demand for COVID-19 vaccines falls on a spectrum from rejection to demand, with passive acceptance in between. Objective: To determine the adherence of adults to vaccination against COVID-19. Chauria-Caballero, Paraguay 2022. Methods: This was an observational, descriptive, cross-sectional study using a quantitative approach. For convenience, the sampling was non-probabilistic. The sample comprised of 225 adults. The data were collected through a survey elaborated by the researcher, and the data were processed using EPI INFO software. Results: The majority of the study subjects were vaccinated, and there was 93% adherence of the population to the COVID-19 vaccine. Various factors influenced their decisions; the percentage of unvaccinated adults mentioned their distrust (69%) and fear of vaccination (31%). Discussion: The study found high adherence in general, the vast majority of participants were vaccinated against COVID-19, with significant percentages reported in Chile, China, and Qatar, very high figures in relation to the acceptance of the vaccine at the country level, with coverage of more than half with at least one dose.

Dengue en paciente de 32 días de vida. Reporte de un caso poco habitual / Dengue fever in a 32-day-old patient. A rare case report

El dengue es una enfermedad viral transmitida por la picadura del mosquito Aedes aegypti. El comportamiento del dengue en Argentina es epidémico; la mayoría de los casos se observan en los meses de mayor temperatura. Hasta la semana epidemiológica (SE) 20/2023, se registraron en Argentina 106 672 casos; se vieron afectadas 18 de las 24 provincias que conforman el país. Dentro de los principales grupos de riesgo, se incluyen los menores de 2 años. Reconocer los signos, síntomas e identificar los factores de riesgo es fundamental para el manejo de casos con mayor riesgo de gravedad. Presentamos el caso de una paciente de 32 días de vida que se internó por síndrome febril sin foco, con diagnósticos diferenciales de meningitis viral y sepsis, evolucionó con leucocitosis, plaquetopenia, hipoalbuminemia, asociado a exantema y edemas. Se llegó al diagnóstico de dengue por la clínica, epidemiologia e IgM positiva.

Dengue fever is a viral disease transmitted by the Aedes aegypti mosquitoes. In Argentina, dengue fever is an epidemic disease; most cases are reported during the hot months.Until epidemiological week (EW) 20/2023, 106 672 cases were reported across 18 of the 24 provinces of Argentina. Children younger than 2 years are among the main groups at risk. Recognizing signs and symptoms and identifying risk factors is fundamental for the management of cases at a higher risk of severity. Here we describe the case of a 32-day-old female patient who was hospitalized due to febrile syndrome without a source, who had a differential diagnosis of viral meningitis and sepsis and progressed to leukocytosis, thrombocytopenia, hypoalbuminemia in association with rash and edema. The diagnosis of dengue fever was established based on clinical, epidemiological, and positive IgM data.

Production of dendritic cell vaccines using different methods with equivalent results: Implications for emerging centers

Introduction Dendritic cell (DC) vaccines have demonstrated good efficacy in preventing relapse and in increasing survival of patients affected by a variety of both solid and hematological tumors. Most protocols used to generate these cells involve the automated separation of peripheral blood monocytes from patients. This approach requires specialized equipment, which elevates the cost of this type of therapy, potentially limiting the widespread access to patients. Method: In this study, we compare the yield and quality of dendritic cells generated from monocytes and isolated by an automated method or by manual methods using gradient centrifugation. Results The results demonstrate the equivalence of the 3 methods in relation to the yield and final quality of the product, however with considerable differences between the costs of these procedures. In addition, this study also demonstrates the feasibility of the antigenic pulse with autologous tumor cell lysates, constituting a source of antigens, not only easily obtained and manipulated, but also specific to the patient's tumor. Conclusion These findings may have important implications for emerging centers interested in using this medical approach and potentially increase the access of a greater number of patients to this therapeutic option.

Trichostatin A-modified vaccine provides superior protection against ovarian cancer formation and development

More attention has been paid to immunotherapy for ovarian cancer and the development of tumor vaccines. We developed a trichostatin A (TSA)-modified tumor vaccine with potent immunomodulating activities that can inhibit the growth of ovarian cancer in rats and stimulate immune cell response in vivo. TSA-treated Nutu-19 cells inactivated by X-ray radiation were used as a tumor vaccine in rat ovarian cancer models. Prophylactic and therapeutic experiments were performed with TSA-modified tumor vaccine in rats. Flow cytometry and ELISpot assays were conducted to assess immune response. Immune cell expression in the spleen and thymus were detected by immunohistochemical staining. GM-CSF, IL-7, IL-17, LIF, LIX, KC, MCP-1, MIP-2, M-CSF, IP-10/CXCL10, MIG/CXCL9, RANTES, IL-4, IFN-γ, and VEGF expressions were detected with Milliplex Map Magnetic Bead Panel immunoassay. TSA vaccination in therapeutic and prophylactic models could effectively stimulate innate immunity and boost the adaptive humoral and cell-mediated immune responses to inhibit the growth and tumorigenesis of ovarian cancer. This vaccine stimulated the thymus into reactivating status and enhanced infiltrating lymphocytes in tumor-bearing rats. The expression of key immunoregulatory factors were upregulated in the vaccine group. The intensities of infiltrating CD4+ and CD8+ T cells and NK cells were significantly increased in the vaccine group compared to the control group (P<0.05). This protection was mainly dependent on the IFN-γ pathway and, to a much lesser extent, by the IL-4 pathway. The tumor cells only irradiated by X-ray as the control group still showed a slight immune effect, indicating that irradiated cells may also cause certain immune antigen exposure, but the efficacy was not as significant as that of the TSA-modified tumor vaccine. Our study revealed the potential application of the TSA-modified tumor vaccine as a novel tumor vaccine against tumor refractoriness and growth. These findings offer a better understanding of the immunomodulatory effects of the vaccine against latent tumorigenesis and progression. This tumor vaccine therapy may increase antigen exposure, synergistically activate the immune system, and ultimately improve remission rates. A vaccine strategy designed to induce effective tumor immune response is being considered for cancer immunotherapy.

Egg allergy and yellow fever vaccination

Abstract Objective Evaluate biomarkers capable of safely guiding Yellow fever vaccine (YFV) vaccination among individuals suspicious of hen's egg allergy, and identify factors associated with a higher risk for adverse events after immunization (AEAI). Methods Patients underwent skin prick test (SPT) for standardized allergens: whole egg, egg white, egg yolk; YFV (1:10 dilution; Biomanguinhos-Fiocruz), and intradermal test (IDT; YFV 0.02 mL, 1:100 dilution) and positive and negative controls. Serum levels of specific IgE (sIgE) for a whole egg, egg white, egg yolk, egg albumin, ovomucoid, lysozyme, and conalbumin (ImmunoCap®; ThermoFisher®) were obtained. Patients sensitized to YFV were submitted to YFV desensitization, and those negatives received YFV (0.5mL) and remained under surveillance for at least one hour. Results 103 patients were enrolled, 95% under 12 years old. 71% (81/103) of patients had reactions: 80% immediate, 11% mixed, and 9% delayed. There was an association between positive skin test results with YFV and the severity of the reaction (OR:7.64; 95%CI:1.61-36.32; p =0,011). Only the presence of sIgE to ovomucoid was associated with clinical symptoms (p =0,025). Thirty patients underwent the YFV desensitization protocol. Conclusion There is a relationship between the positivity of the egg's components and the severity of the clinical reaction. Furthermore, the relationship between the positivity of the tests with the YFV and egg's components may show a tendency to look at ovomucoid and conalbumin, but it is not a certainty. Therefore, further studies are needed to confirm these associations, and for now, the authors still recommend using the vaccine for testing when necessary.

The decline of measles antibody titers in previously vaccinated adults: a cross-sectional analysis

ABSTRACT The global reemergence of measles in 2018-2019 reinforces the relevance of high-coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun®) and chemiluminescence (LIASON®). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose.

Transferência de tecnologia para vacina contra COVID-19 no Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz / Transferencia de tecnología para vacuna contra la COVID-19 en el Instituto de Tecnología en Inmunobiológicos (Bio-Manguinhos), Fundación Oswaldo Cruz / Technology transfer for COVID-19 vaccine in the Institute of Technology in Immunobiologicals (Bio-Manguinhos), Oswaldo Cruz Foundation

Resumo: A inovação é um elemento fundamental para o desenvolvimento e crescimento, mas constituída por um processo demorado de acúmulo de conhecimento. Uma das formas de acelerar tal processo é por meio da transferência de tecnologia. Este artigo mapeou as particularidades da transferência de tecnologia para a vacina contra COVID-19, celebrado entre a AstraZeneca e o Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz, bem como reconheceu os seus facilitadores, seus entraves e suas lacunas. Para tanto, foi realizada uma análise desde a etapa da seleção do parceiro mais adequado até a incorporação da nova tecnologia. A metodologia utilizada se baseou em uma ampla revisão bibliográfica sobre o tema, aliada ao estudo de caso. Os resultados apontaram que, apesar de muitas ações ainda precisarem ser realizadas para que os ganhos de capacidade tecnológica sejam potencializados, as lições aprendidas com o processo de transferência de tecnologia servirão de aprendizado e serão utilizadas nos acordos futuros e em andamento.

Resumen: La innovación es un elemento fundamental para el desarrollo y el crecimiento, pero consiste en un proceso de acumulación de conocimiento que requiere mucho tiempo. Una de las formas de acelerar este proceso es mediante la transferencia de tecnología. Este artículo mapeó las particularidades del proceso de transferencia de tecnología para la vacuna contra la COVID-19, celebrado entre AstraZeneca y el Instituto de Tecnología en Inmunobiológicos (Bio-Manguinhos), Fundación Oswaldo Cruz, además de reconocer los facilitadores, obstáculos y brechas. Para ello se realizó un análisis, desde la etapa de selección del socio más adecuado hasta la incorporación de la nueva tecnología. La metodología utilizada se basó en una amplia revisión bibliográfica sobre el tema, combinada con el estudio de caso. Los resultados mostraron que, si bien aún es necesario llevar a cabo muchas acciones para maximizar las ganancias de capacidad tecnológica, las lecciones aprendidas del proceso de transferencia de tecnología servirán como lecciones y se utilizarán en acuerdos futuros y en curso.

Abstract: Innovation is an essential element for development and growth, but it consists of a long process of knowledge accumulation, so technology transfer is used to accelerate this process. This study mapped the particularities of the technology transfer process for the COVID-19 vaccine between AstraZeneca and the Institute of Technology in Immunobiologicals (Bio-Manguinhos), Oswaldo Cruz Foundation, and identified enablers, obstacles, and gaps. Our analysis investigated the process from selection of the most suitable partner to incorporation of the new technology based on a comprehensive literature review on this topic, combined with a case study. The results showed that, although many actions still have to be performed to maximize technology capacity gains, the lessons learned from the technology transfer process will be used in future and ongoing agreements.

Efeitos da campanha de vacinação nas internações e mortalidade relacionados ao sarampo no Brasil na última década / Effects of the vaccination campaign on hospitalization and mortality linked to measles in Brazil in the last decade

Resumo O sarampo é uma das principais causas de morbidade e mortalidade na população pediátrica e pode ser prevenido com 100% de eficácia pela vacinação. No entanto, a doença permanece ativa no território brasileiro. O objetivo do artigo é avaliar a adesão da população à vacinação e a possível relação com hospitalização e mortalidade em relação ao sarampo no Brasil. Trata-se de um estudo ecológico realizado a partir de dados secundários de mortalidade e internações acerca do sarampo e da cobertura vacinal contra a doença no Brasil nos anos de 2013 a 2022. O ápice de adesão ao calendário vacinal contra o sarampo se deu nos três anos que precederam a erradicação da doença no país, ocorrida em 2016. Nesse intervalo, tem-se as menores taxas de internação, com a mortalidade zerada de 2014 a 2017. Em contrapartida, verifica-se, desde então, queda na taxas de vacinação, acentuadas a partir de 2019, quando a doença reaparece no Brasil. Concomitantemente, as taxas de internação e mortalidade atingem os valores mais altos registrados. A adesão populacional ao calendário vacinal completo contra o sarampo, essencial ao controle da doença e dos óbitos relacionados, está insuficiente, o que se reflete nas taxas de internações e mortalidade.

Abstract Measles is one of the main causes of morbidity and mortality in the pediatric population and it can be prevented with 100% effectiveness by vaccination. However, the disease remains active in throughout Brazil. The scope of this article is to evaluate the population's adherence to vaccination and the potential connection with hospitalizations and mortality in relation to measles in Brazil. This is an ecological study based on secondary data on mortality and hospitalizations due to measles and vaccination coverage against the disease in Brazil from 2013 to 2022. The peak of adherence to the measles vaccination schedule occurred in the 3 years that preceded the eradication of the disease in the country, which occurred in 2016. In this interval, there are the lowest hospitalization rates, with zero mortality from 2014 to 2017. On the other hand, there has been a marked drop in vaccination rates since 2019, when the disease resurfaced in Brazil. Concomitantly, hospitalization and mortality rates reach the highest recorded values. Population adherence to the complete measles vaccination schedule, which is essential to control the disease and related deaths, is insufficient, which is reflected in hospitalization and mortality rates.

In silico identification of drug targets and vaccine candidates against Bartonella quintana: a subtractive proteomics approach

BACKGROUND The availability of genes and protein sequences for parasites has provided valuable information for drug target identification and vaccine development. One such parasite is Bartonella quintana, a Gram-negative, intracellular pathogen that causes bartonellosis in mammalian hosts. OBJECTIVE Despite progress in understanding its pathogenesis, limited knowledge exists about the virulence factors and regulatory mechanisms specific to B. quintana. METHODS AND FINDINGS To explore these aspects, we have adopted a subtractive proteomics approach to analyse the proteome of B. quintana. By subtractive proteins between the host and parasite proteome, a set of proteins that are likely unique to the parasite but absent in the host were identified. This analysis revealed that out of the 1197 protein sequences of the parasite, 660 proteins are non-homologous to the human host. Further analysis using the Database of Essential Genes predicted 159 essential proteins, with 28 of these being unique to the pathogen and predicted as potential putative targets. Subcellular localisation of the predicted targets revealed 13 cytoplasmic, eight membranes, one periplasmic, and multiple location proteins. The three-dimensional structure and B cell epitopes of the six membrane antigenic protein were predicted. Four B cell epitopes in KdtA and mraY proteins, three in lpxB and BQ09550, whereas the ftsl and yidC proteins were located with eleven and six B cell epitopes, respectively. MAINS CONCLUSIONS This insight prioritises such proteins as novel putative targets for further investigations on their potential as drug and vaccine candidates.

Increased risk of bladder cancer recurrence due to bacillus Calmette-Guérin shortage in Brazil

SUMMARY OBJECTIVE: Our study aimed to evaluate the impact of bacillus Calmette-Guérin shortage on recurrence and progression in patients with non-muscle invasive bladder cancer in a Brazilian cohort. METHODS: We retrospectively reviewed the clinicopathological data of 409 patients who had their first transurethral resection of the bladder tumor for intermediate or high-risk non-muscle invasive bladder cancer between June 2014 and May 2021 in a tertiary public hospital in Brazil. Patients included had non-muscle-invasive urothelial carcinoma of the bladder resected completely for the first time, regardless of bacillus Calmette-Guérin use. Low-risk disease patients were excluded from the analysis. Demographic, clinicopathological, and bacillus Calmette-Guérin use data were collected from our database. Recurrence and progression data were obtained from patient records or through telephone interviews. Recurrence-free survival and progression-free survival were calculated from the date of transurethral resection of the bladder tumor until the events of recurrence, progression, last office visit, or phone interview. RESULTS: Within a median follow-up period of 26.7 months, 168 (41.1%) patients experienced a recurrence in a median time of 27 months (95%CI 16.1-38). Bacillus Calmette-Guérin was administered to 57 (13.9%) individuals after transurethral resection of the bladder tumor. Patients with ≥3 lesions (p<0.001), those with lesions >3 cm (p=0.02), and those without bacillus Calmette-Guérin treatment (p<0.001) had shorter recurrence-free survival. According to a Cox multivariate regression model, bacillus Calmette-Guérin use was independently associated with a reduced recurrence rate, with an HR of 0.43 (95%CI 0.25-0.72). Out of the patients studied, 26 (6.4%) experienced progression. T1 stage (p<0.001) and high-grade (p<0.001) were associated with shorter progression-free survival. Bacillus Calmette-Guérin did not influence bladder cancer progression. In the Cox multivariate analysis, high-risk disease was independently associated with progression (p<0.001). CONCLUSION: Our study confirms that non-muscle invasive bladder cancer exhibits a high recurrence rate. The use of adjuvant bacillus Calmette-Guérin in intermediate and high-risk patients significantly reduces this rate. Furthermore, the bacillus Calmette-Guérin shortage could have negatively impacted these patients.

Immunogenicity of COVID-19 adsorbed inactivated vaccine (CoronaVac) and additional doses of mRNA BNT162b2 vaccine in immunocompromised adults compared with immunocompetent persons

ABSTRACT Inactivated COVID-19 vaccines data in immunocompromised individuals are scarce. This trial assessed the immunogenicity of two CoronaVac doses and additional BNT162b2 mRNA vaccine doses in immunocompromised (IC) and immunocompetent (H) individuals. Adults with solid organ transplant (SOT), hematopoietic stem cell transplant, cancer, inborn immunity errors or rheumatic diseases were included in the IC group. Immunocompetent adults were used as control group for comparison. Participants received two CoronaVac doses within a 28-day interval. IC received two additional BNT162b2 doses and H received a third BNT162b2 dose (booster). Blood samples were collected at baseline, 28 days after each dose, pre-booster and at the trial end. We used three serological tests to detect antibodies to SARS-CoV-2 nucleocapsid (N), trimeric spike (S), and receptor binding domain (RBD). Outcomes included seroconversion rates (SCR), geometric mean titers (GMT) and GMT ratio (GMTR). A total of 241 IC and 100 H adults participated in the study. After two CoronaVac doses, IC had lower SCR than H: anti-N, 33.3% vs 79%; anti-S, 33.8% vs 86%, and anti-RBD, 48.5% vs 85%, respectively. IC also showed lower GMT than H: anti-N, 2.3 vs 15.1; anti-S, 58.8 vs 213.2 BAU/mL; and anti-RBD, 22.4 vs 168.0 U/mL, respectively. After the 3rd and 4th BNT162b2 doses, IC had significant anti-S and anti-RBD seroconversion, but still lower than H after the 3rd dose. After boosting, GMT increased in IC, but remained lower than in the H group. CoronaVac two-dose schedule immunogenicity was lower in IC than in H. BNT162b2 heterologous booster enhanced immune response in both groups.

Geography and public health: analysis of the epidemiological dynamics of meningitis in Brazil, between 2010 and 2019 / Geografia e saúde coletiva: análise da dinâmica epidemiológica das meningites no Brasil, entre os anos de 2010 e 2019

ABSTRACT Objective: To analyze the spatiotemporal epidemiological dynamics of meningitis in Brazil, between 2010 and 2019. Methods: Descriptive ecological study with cases and deaths due to meningitis in Brazil (2010-2019) in the National Notifiable Diseases Information System (Sistema de Informações de Agravos de Notificação - SINAN). The following analyses were performed: (I) frequency analyses of cases and deaths, prevalence rates, mortality, lethality, Fisher's exact test, and chi-square test; (II) Prais-Winstein regression; and (III) Global, Local Moran's index, and Kernel density. Results: 182,126 cases of meningitis were reported in Brazil, of which 16,866 (9.26%) resulted in death, with prevalence rates of 9.03/100,000 inhabitants, mortality of 0.84/100,000 inhabitants, and lethality of 9.26%. There was a noted trend of decreasing prevalence rates (−9.5%, 95% confidence interval — 95%CI −13.92; −4.96, p<0.01) and mortality (−11.74%, 95%CI −13.92; −9.48, p<0.01), while lethality remained stable (−2.08%, 95%CI −4.9; 0.8; p<0.1941). The majority of cases were viral meningitis (45.7%), among 1-9 years old (32.2%), while the highest proportion of deaths was due to bacterial meningitis (68%), among 40-59 years old (26.3%). In the Moran and Kernel maps of prevalence and mortality rates, municipalities in the South, Southeast, and the capital of Pernambuco in the Northeast stood out with high rates; as for lethality, the North, Northeast, and Southeast coastal areas were highlighted. Conclusion: A decrease in meningitis cases and deaths was found in this study; however, the lethality rate was higher in areas with lower prevalence, emphasizing the need to enhance actions for identifying, monitoring, and providing health care for cases, as well as expanding vaccination coverage.

RESUMO Objetivo: Analisar a dinâmica epidemiológica espaçotemporal das meningites no Brasil, entre os anos de 2010 e 2019. Métodos: Estudo ecológico descritivo com os casos e óbitos por meningites no Brasil (2010-2019) no Sistema de Informações de Agravos de Notificação. Realizaram-se (I) análises de frequências dos casos e óbitos, taxas de prevalência, mortalidade, letalidade, testes de exato de Fisher e qui-quadrado; (II) regressão de Prais-Winsten; e (III) índice de Moran global, local e densidade de Kernel. Resultados: Notificaram-se 182.126 casos de meningites no Brasil, dos quais 16.866 (9,26%) evoluíram para óbito, com taxas de prevalência de 9,03/100.000/habitantes, mortalidade de 0,84/100.000/habitantes e letalidade de 9,26%. Destaca-se a tendência de decrescimento das taxas de prevalência (−9,5%, intervalo de confiança de 95% — IC95% −13,92; −4,96, p<0,01) e mortalidade (−11,74%, IC95% −13,92; −9,48, p<01,01), enquanto a letalidade se manteve estacionária (−2,08%, IC95% −4,9; 0,8; p<0,1941). A maioria dos casos foi de meningites virais (45,7%), entre 1 e 9 anos (32,2%), enquanto a maior parcela dos óbitos foi por meningites bacterianas (68%), entre 40 e 59 anos (26,3%). Nos mapas de Moran e Kernel das taxas de prevalência e mortalidade, destacaram-se com altas taxas os municípios do sul, sudeste e a capital de Pernambuco, no nordeste; já na letalidade, evidenciaram-se o norte, o nordeste e o litoral do sudeste. Conclusão: Encontrou-se decréscimo dos casos e óbitos por meningites neste estudo, entretanto a taxa de letalidade foi maior em áreas com menor prevalência, reforçando a necessidade do aprimoramento das ações de identificação, vigilância e assistência em saúde dos casos, bem como da ampliação da cobertura vacinal.

Strategies for expanding childhood vaccination in the Americas following the COVID-19 pandemic / Estrategias para ampliar la vacunación infantil en la Región de las Américas después de la pandemia de COVID-19 / Estratégias para ampliar a vacinação infantil nas Américas depois da pandemia de COVID-19

ABSTRACT Objective. To provide an overview of the status of the childhood vaccination schedule in the Americas, outline program structures, and identify updated implementation strategies to improve vaccination coverage following the COVID-19 pandemic. Methods. A group of experts in pediatrics, epidemiology, vaccines, and global and public health discussed the current status of the childhood vaccination schedule in the Americas, describing the program structure and identifying new implementation strategies that have the potential to improve vaccination coverage in the post-pandemic context, after the challenges COVID-19 presented for more than two years. Results. The Americas currently face a high risk of resurgence of diseases that were previously controlled or eliminated. Therefore, it is important to find new strategies to educate citizens on the risks associated with lower vaccination rates, especially in children. Conclusions. New strategies along with strong mobilization of the population and advocacy by citizens are necessary to prevent antivaccination groups from gaining a stronger presence in the region and jeopardizing the credibility of the Expanded Program on Immunization.

RESUMEN Objetivo. Presentar un panorama general de la situación del calendario de vacunación infantil en la Región de las Américas, describir la estructura de los programas y encontrar estrategias actualizadas para su ejecución a fin de mejorar la cobertura de vacunación después de la pandemia de COVID-19. Métodos. Un grupo de expertos en pediatría, epidemiología, vacunas y salud pública y mundial analizó la situación actual del calendario de vacunación infantil en la Región de las Américas, mediante la descripción de la estructura de los programas y la búsqueda de nuevas estrategias de ejecución capaces de mejorar la cobertura de vacunación en el contexto posterior a la pandemia de COVID-19, una vez superados los desafíos planteados por esta durante más de dos años. Resultados. En este momento, en la Región de las Américas hay un riesgo alto de reaparición de enfermedades previamente controladas o eliminadas. En consecuencia, es importante contar con nuevas estrategias para la educación de salud de la ciudadanía sobre los riesgos asociados a las tasas bajas de vacunación, especialmente en la población infantil. Conclusiones. Es necesario contar con nuevas estrategias, acompañadas de una fuerte movilización de la población y una promoción por parte de la ciudadanía, para evitar que los grupos que generan mensajes antivacunas aumenten su presencia en la Región y pongan en peligro la credibilidad del Programa Ampliado de Inmunización.

RESUMO Objetivo. Apresentar um panorama da situação do calendário de vacinação infantil nas Américas, definir a estrutura do programa e identificar estratégias de implementação atualizadas para melhorar a cobertura vacinal depois da pandemia de COVID-19. Métodos. Um grupo de especialistas em pediatria, epidemiologia, vacinas e saúde pública e global discutiu a situação atual do calendário de vacinação infantil nas Américas, descrevendo a estrutura dos programas e identificando novas estratégias de implementação que poderiam melhorar a cobertura vacinal no contexto pós-pandemia, na sequência dos desafios impostos pela COVID-19 durante mais de dois anos. Resultados. Atualmente, as Américas enfrentam um grande risco de ressurgimento de doenças já controladas ou eliminadas. Desse modo, é importante identificar novas estratégias para conscientizar os cidadãos sobre os riscos decorrentes da queda das taxas de vacinação, sobretudo em crianças. Conclusões. É necessário adotar novas estratégias, aliadas a uma forte mobilização da população e promoção da causa pelos cidadãos, a fim de impedir que os grupos antivacinas fortaleçam sua presença na região e coloquem em risco a credibilidade do Programa Ampliado de Imunização.

Efficacy of current vaccines against recently isolated foot and mouth disease virus type A South America (Venezuela) in Egypt 2022

Foot and mouth disease is a highly contagious viral disease that poses a significant economic threat to cloven-hoofed animals, including cattle and sheep. The emergence of a novel foot and mouth disease virus-A isolate, FMDV-A-Egy-AHRI-RL385-Ven-2022, in Egypt in 2022 has raised concerns about its potential impact on existing vaccination programs. Given that vaccination is a key strategy for foot and mouth disease virus control, the present study was aimed to assess the cross-protective efficacy of both local and imported inactivated vaccines against this new threat. Through challenge experiments and serum neutralization tests, we observed limited effectiveness of both vaccine types. The calculated r1-values at 28 days post-vaccination indicated a minimal immune response to FMDV-A-Egy-AHRI-RL385-Ven-2022 (0.176 and 0.175 for local and imported vaccines, respectively). Challenge experiments further confirmed these findings, revealing 0percent protection from the local vaccine and only 20percent rotection from imported vaccines by day 7 post-challenge. These results underscore the urgent need to update existing foot and mouth disease virus vaccines in Egypt by incorporating the newly circulating FMDV-A-Egy-AHRI-RL385-Ven-2022 strain. This proactive measure is crucial to prevent future outbreaks and ensure effective disease control(AU)

La fiebre aftosa es una enfermedad vírica muy contagiosa que supone una importante amenaza económica para los animales biungulados, entre ellos el ganado vacuno y ovino. La aparición de un nuevo aislado del virus A de la fiebre aftosa, el FMDV-A-Egy-AHRI-RL385-Ven-2022, en Egipto en 2022 ha suscitado preocupación por su posible impacto en los programas de vacunación existentes. Dado que la vacunación es una estrategia clave para el control del virus de la fiebre aftosa, el objetivo del presente estudio fue evaluar la eficacia protectora cruzada de las vacunas inactivadas locales e importadas frente a esta nueva amenaza. Mediante experimentos de desafío y pruebas de seroneutralización, observamos una eficacia limitada de ambos tipos de vacuna. Los valores r1 calculados a los 28 días posvacunación indicaron una respuesta inmunitaria mínima frente a FMDV-A-Egy-AHRI-RL385-Ven-2022 (0,176 y 0,175 para las vacunas local e importada, respectivamente). Los experimentos de provocación confirmaron aún más estos resultados, revelando un 0 por ciento de protección de la vacuna local y sólo un 20 por ciento de protección de las vacunas importadas al séptimo día después de la provocación. Estos resultados subrayan la urgente necesidad de actualizar las vacunas existentes contra el virus de la fiebre aftosa en Egipto incorporando la nueva cepa circulante FMDV-A-Egy-AHRI-RL385-Ven-2022. Esta medida proactiva es crucial para prevenir futuros brotes y garantizar un control eficaz de la enfermedad(AU)

Psychometric properties and reliability of the Brazilian version of Parent Attitudes about Childhood Vaccine (PACV-BR) / Propriedades psicométricas e confiabilidade da versão brasileira do Parent Attitudes about Childhood Vaccine (PACV-BR)

ABSTRACT Objective: To evaluate the psychometric properties and reliability of the Brazilian version of the tool Parent Attitudes about Childhood Vaccine (PACV-BR). Methods: The sample included 110 parents of children up to two years old served by Family Health Basic Units. The tool's internal consistency and factor validity were respectively assessed by Cronbach's alpha and exploratory factor analysis (EFA). The test-retest reliability was assessed by the intraclass correlation coefficient (ICC). Results: The EFA results indicated a proper structural adequacy of the PACV-BR (15 items and two factors). The reliability generated Cronbach's alpha values between 0.715 and 0.854 for the items, of 0.918 for the tool as a whole, of 0.877 for factor 1 and of 0.825 for factor 2, in addition to an ICC of 0.984. Conclusions: The PACV-BR showed evidence of construct validity and reliability.

RESUMO Objetivo: Avaliar as propriedades psicométricas e a confiabilidade da versão brasileira do instrumento Parent Attitudes about Childhood Vaccine (PACV-BR). Métodos: A amostra incluiu 110 pais de crianças de até dois anos atendidas em Unidades Básicas de Saúde da Família. A consistência interna e a validade fatorial do instrumento foram avaliadas, respectivamente, pelo alfa de Cronbach e pela análise fatorial exploratória (EFA). A confiabilidade teste-reteste foi avaliada pelo coeficiente de correlação intraclasse (ICC). Resultados: Os resultados da AFE indicaram adequação estrutural do PACV-BR (15 itens e dois fatores). A confiabilidade indicou valores de alfa de Cronbach entre 0,715 e 0,854 para os itens, de 0,918 para o instrumento como um todo, de 0,877 para o fator 1 e de 0,825 para o fator 2, além de ICC de 0,984. Conclusões: O PACV-BR apresentou evidências de validade de construto e confiabilidade.

Safety of the yellow fever vaccine in people living with HIV: a longitudinal study exploring post-vaccination viremia and hematological and liver kinetics

ABSTRACT Background: Safety data on the yellow fever vaccine 17DD in People Living with HIV (PLWH) are limited. This study explored the occurrence of post-vaccination 17DD viremia and the kinetics of hematological and liver laboratorial parameters in PLWH and HIV-uninfected participants [HIV(-) controls]. Methods: We conducted a secondary analysis of a longitudinal interventional trial (NCT03132311) study that enrolled PLWH and HIV(-) controls to receive a single 17DD dose and were followed at 5, 30 and 365 days after vaccination in Rio de Janeiro, Brazil. 17DD viremia (obtained throughreal-time PCR and plaque forming units' assays), hematological (neutrophils, lymphocytes and platelets counts) and liver enzymes (ALT and AST) results were assessed at baseline and Days 5 and 30 post-vaccination. Logistic regression models explored factors associated with the odds of having positive 17DD viremia. Linear regression models explored variables associated with hematological and liver enzymes results at Day 5. Results: A total of 202 PLWH with CD4 > 200 cells/μL and 68 HIV(-) controls were included in the analyses. 17DD viremia was found in 20.0 % of the participants and was twice more frequent in PLWH than in HIV(-) controls (22.8% vs. 11.8 %, p-value < 0.001). Neutrophils, lymphocytes and platelets counts dropped at Day 5 and returned to baseline values at Day 30. 17DD viremia was associated with lower nadir of lymphocytes and platelets at Day 5. ALT levels did not increase post-vaccination and were not associated with 17DD viremia. Conclusions: 17DD was safe and well-tolerated in PLWH with CD4 > 200 cells/μL. Post-vaccination viremia was more frequent in PLWH than in controls. Transient and self-limited decreases in lymphocytes and neutrophils occurred early after vaccination. 17DD viremia was associated with lower lymphocytes and platelets nadir after vaccination. We did not observe elevations in ALT after 17DD vaccination.

Importancia de la vigilancia poscomercialización en las vacunas contra SARS-CoV-2 / Importance of post-marketing surveillance of SARS-CoV-2 vaccines

Introducción: La vacunación ha sido una de las intervenciones sanitarias más costo-efectivas, por su impacto en el control de las enfermedades inmunoprevenibles. La pandemia ocasionada por SARS-CoV-2 condujo al desarrollo mundial de más de doscientas vacunas en diferentes fases de investigación con diversas plataformas. Objetivo: Caracterizar la evaluación del control de calidad de las vacunas contra SARS-CoV-2 y los eventos adversos de las aprobadas contra otros agentes patógenos en las diferentes etapas del ensayo preclínico y clínico. Métodos: Se realizó una búsqueda en Google Académico y PubMed/Medline de artículos publicados entre 1969 y marzo de 2021. Se seleccionaron los de mayor relevancia. Desarrollo: Las vacunas se desarrollaron en un corto tiempo ante la pandemia de COVID-19, sin comprometer el adecuado control de los ensayos clínicos. Aunque resultan seguras, no están exentas de eventos adversos; por ello se debe vigilar su seguridad durante el proceso de poscomercialización. Muchas de ellas han comprometido su seguridad. Conclusiones: Las vacunas deben poseer inmunogenicidad, eficacia y seguridad comprobadas. Los eventos adversos pueden surgir en cualquier etapa de la investigación; por tanto, resulta fundamental la vigilancia en la fase de poscomercialización(AU)

Introduction: Vaccination has been one of the most cost-effective health interventions, due to its impact on the control of immunopreventable diseases. The pandemic caused by SARS-CoV-2 led to the worldwide development of more than two hundred vaccines in different phases of research with diverse platforms. Objective: To characterize the quality control assessment of vaccines against SARS-CoV-2 and adverse events of those approved against other pathogens at different stages of preclinical and clinical trials. Methods: We searched Google Scholar and PubMed/Medline for articles published between 1969 and March 2021. The most relevant articles were selected. Development: Vaccines were developed in a short time in the face of the COVID-19 pandemic, without compromising the adequate control of clinical trials. Although they are safe, they are not free of adverse events; therefore, their safety should be monitored during the post-marketing process. Many of them have compromised their safety. Conclusions: Vaccines should possess proven immunogenicity, efficacy and safety. Adverse events can arise at any stage of research; therefore, post-marketing surveillance is essential(AU)

COVID-19 vaccine hesitancy in KwaZulu-Natal, South Africa: A survey of unvaccinated adults

Background: Concerns and misconceptions surrounding coronavirus disease 2019 (COVID-19) vaccines may account for vaccine hesitancy and low uptake. Aim: To determine prevalence of COVID-19 vaccine hesitancy, vaccine-related misconceptions, and predictors of vaccine hesitancy among South Africans. Setting: Community setting in five districts in KwaZulu- Natal province. Methods: Between August 20, 2021, and September 27, 2021, we conducted a cross-sectional survey, interviewing 300 unvaccinated adults amid the national vaccination campaign. Predictors of hesitancy were identified through multivariable logistic regression analysis. Results: Participants had a median age of 29 years (IQR: 23­39), 86.7% were Black African, 63.2% were male, 53.3% resided in rural communities, and 59.3% (95% CI: 53.8% ­ 64.9%) were classified as vaccine hesitant. The primary reason for not vaccinating was a lack of trust in the vaccine (62.1%). Factors associated with reduced vaccine hesitancy included age (participants aged 35­49 years: OR: 0.28, 95% CI: 0.18­0.64, p = 0.003; participants over 50 years: OR: 0.18, 95% CI: 0.07­0.47, p = 0.0004), previous COVID-19 infection (OR: 0.31, 95% CI: 0.11­0.87, p = 0.03), and receiving vaccine information from healthcare workers (OR: 0.32, 95% CI: 0.10­1.0, p = 0.05). Unemployed (OR: 2.14, 95% CI: 1.1­4.2, p = 0.03) and self-employed individuals (OR: 2.98, 95% CI: 1.27­7.02, p = 0.01) were more likely to be vaccine hesitant. Conclusion: COVID-19 vaccine hesitancy rates are high in KwaZulu-Natal. Uptake could be enhanced by healthcare workers leading information campaigns with messages targeting younger individuals, the unemployed, and the self-employed. Contribution: This survey provides evidence to improve COVID-19 vaccination uptake in South Africa.