Vaccination coverage in children in the period before and during the COVID-19 pandemic in Brazil: a time series analysis and literature review

Abstract Objective: To evaluate the behavior of VCR and VCH, per municipality and per vaccines offered at the NVC, to identify priority areas for intervention. Methods: Descriptive study of a time series, using secondary data and accompanied by a narrative review of the literature evaluating VCR and VCH. Vaccines offered to children under one year and to those aged one year in the pre-pandemic period of COVID-19 (2015 to 2019) were selected and compared to those offered during the pandemic period (2020 and 2021 ). Results and discussions: The decrease in VCR and VCH is a process that precedes the COVID-19 pandemic but was intensified during this period. In 2021, the VCR was around 70% for most vaccines. This phenomenon encompasses the entire country; however, it is more intense in the states/municipalities located in the north and northeast regions, suggesting greater difficulty in accessing health services. Conclusion: Low and heterogeneous VCR requires the adoption of practices that were previously implemented, establishing partnerships with governmental and non-governmental institutions, with adequate communication, active search for non-compliance and non-adherence to the regular vaccination program, adopting intra- and extramural vaccination strategies, to reverse the current situation and reduce the risk of recurrence of diseases that have been already controlled and eliminated.

Hesitação Vacinal em Ambulatório-Escola / Vaccine Hesitation in a School Outpatient Clinic

Introdução: Hesitação vacinal é o atraso em aceitar ou a recusa das vacinas recomendadas. A Organização Mundial da Saúde recomenda uma cobertura vacinal por volta de 95% para garantir os benefícios da vacinação. Apesar disso, a hesitação em vacinar é crescente, o que deixa parte da população suscetível a doenças imunopreveníveis e favorece o ressurgimento de enfermidades já erradicadas. O objetivo do estudo foi identificar a hesitação vacinal e fatores associados a esta em um ambulatório-escola no sul de Santa Catarina. Métodos: Estudo observacional transversal realizado em ambulatório-escola no período de outubro a dezembro de 2019. Resultados: O estudo foi composto por 221 responsáveis por crianças e adolescentes até 16 anos. Apesar de todos os responsáveis exporem que vacinam os seus filhos, 84,2% estavam com a carteira de vacinação atualizada. A prevalência de hesitação vacinal foi de 20,09%, e os principais motivos destacados foram a preocupação com os efeitos adversos e a falta de segurança em realizá-las. Em relação à intensidade da hesitação, 52,77% deixaram de aplicar somente uma vacina recomendada, e 41,66% vacinaram, mesmo hesitando. Entre aqueles que já hesitaram, 65,62% não imunizaram seus filhos contra o vírus Influenza. Conclusão: Apesar de a maioria vacinar seus filhos, a taxa de hesitação encontrada não pode ser ignorada, devendo ser revertida. Para isso, se faz necessário o desenvolvimento de programas e campanhas informativas para o esclarecimento da população local frente à importância e aos benefícios da vacinação.

Introduction: Vaccine hesitancy is the delay in acceptance or refusal of recommended vaccines. The World Health Organization recommends around 95% vaccination coverage to ensure the benefits of vaccination. Despite this, hesitancy to vaccinate is increasing, leaving part of the population susceptible to immunopreventable diseases and favoring the resurgence of already eradicated diseases. This study aimed to identify vaccine hesitancy and associated factors in a school outpatient clinic in southern Santa Catarina. Methods: The study carried out a cross-sectional observational study in a school outpatient clinic from October to December 2019. Results: The 221 guardians of children and adolescents up to 16 years composed the research. Although all guardians exposed that they vaccinate their children, 84.2% were with the vaccination cards updated. The prevalence of vaccine hesitancy was 20.09%, and the main reasons highlighted were concern about adverse effects and lack of safety when vaccinating. Concerning the intensity of hesitancy, 52.77% failed to apply only one recommended vaccine, and 41.66% were vaccinated even though they hesitated. Among those who hesitated, 65.62% did not immunize their children against the influenza virus. Conclusions: Although the majority vaccinate their children, the hesitancy rate found cannot be ignored and should be reversed. For this, it is necessary to develop informative programs and campaigns to educate the local population about the importance and benefits of vaccination.

COVID-19 vaccination: The greater Manila experience 2021 / The Health Sciences Journal

INTRODUCTION@#Almost half of adult Filipinos were unwilling to receive the COVID-19 vaccination in early 2021. This study aimed to describe the COVID-19 vaccination experience in the Greater Manila Area. @*METHODS@#An analytical cross-sectional study design was done where Filipinos aged 18-60 years old residing in the Greater Manila Area answered an online survey. Fisher’s exact test was used to compute p-values for the association between participants’ willingness or refusal to get vaccinated and their sociodemographic and clinical characteristics.@*RESULTS@#Among 1,248 respondents, 97.92% were willing to get vaccinated against COVID-19. The majority who refused strongly agreed that the vaccine could cause serious side effects (46.2%). Being a college graduate (OR = 3.03, p = 0.006) and high income (OR = 5.06, p = 0.003) had a statistically significant positive association with willingness to get vaccinated.@*CONCLUSION@#There are more individuals willing to get vaccinated and there is a statistically significant association between educational attainment and monthly income with vaccine willingness or refusal.

Rechazo de los padres a la vacunación obligatoria en Chile. Desafíos éticos y jurídicos / Parental refusal to mandatory vaccination in Chile. Ethical and legal challenges

Resumen: Este artículo se presenta como una reflexión ética y jurídica acerca de la tendencia actual de los pa dres a rechazar la vacunación de sus hijos en un régimen jurídico que establece la obligatoriedad de determinadas vacunas. Se analizan los principales argumentos que los padres usan para rechazar las vacunaciones obligatorias, y, en concreto: el temor a los efectos negativos que la vacunación pueda provocar en el menor; la violación del "derecho a la autonomía"; las creencias religiosas o pseudo- filosóficas; la resistencia a la intervención del Estado en asuntos personales o familiares. De esto, nace un necesario análisis ético sobre la vacunación infantil. Finalmente, se discute la responsabilidad de los padres y del Estado (autoridad sanitaria) en el cuidado de los menores de edad. La vacunación es un beneficio tanto para el inoculado como para la comunidad, la mejor política preventiva. Al mismo tiempo, se configura como un caso complejo que demanda un debate profundo, cuyo fin debe ser el tránsito desde un aparente conflicto entre los padres y el Estado, a una convergencia por el cuidado de los menores de edad. En otros términos, se recalca el hecho de que los padres, más allá del cum plimiento de un deber normativo heterogéneo, deben actuar motivados por la adhesión voluntaria al bien del hijo y de la comunidad.

Abstract: This article is an ethical and legal reflection about the current trend of parents to refuse vaccination of their children under a legal regime that establishes mandatory use of certain vaccines. We analyze the main arguments used by parents to refuse obligatory vaccination, i.e., the fear of the negative effects that vaccination may have on the child; the violation of the "right to autonomy"; religious or pseudo-philosophical beliefs; and the resistance to the State intervention in personal or family mat ters. Therefore, this statement implies a necessary ethical analysis of childhood vaccination. Finally, it will be discussed the responsibility of parents and the State -the health authority- in the care of mi nors. Vaccination is a benefit for both the inoculated and the community, the best preventive policy. At the same time, it is considered a complex case that demands a profound debate, whose purpose should be the transition from an apparent conflict between parents and the State, to convergence for the care of minors. In other words, it is emphasized the fact that parents, beyond the fulfillment of a heterogeneous normative duty, must act motivated by voluntary adherence to the best interest of the child and the community.

Vaccine refusal - what we need to know / Recusa vacinal - que é preciso saber

Abstract Objective: Opposition to vaccines is not a new event, and appeared soon after the introduction of the smallpox vaccine in the late 18th century. The purpose of this review is to educate healthcare professionals about vaccine hesitancy and refusal, its causes and consequences, and make suggestions to address this challenge. Source of data: A comprehensive and non-systematic search was carried out in the PubMed, LILACS, and ScieLo databases from 1980 to the present day, using the terms "vaccine refusal," "vaccine hesitancy," and "vaccine confidence." The publications considered as the most relevant by the author were critically selected. Synthesis of data: The beliefs and arguments of the anti-vaccine movements have remained unchanged in the past two centuries, but new social media has facilitated the dissemination of information against vaccines. Studies on the subject have intensified after 2010, but the author did not retrieve any published studies to quantify this behavior in Brazil. The nomenclature on the subject (vaccine hesitancy) was standardized by the World Health Organization in 2012. Discussions have been carried out on the possible causes of vaccine hesitancy and refusal, as well as on the behavior of families and health professionals. Proposals for interventions to decrease public doubts, clarify myths, and improve confidence in vaccines have been made. Guides for the health care professional to face the problem are emerging. Conclusions: The healthcare professional is a key element to transmit information, resolve doubts and increase confidence in vaccines. They must be prepared to face this new challenge.

Resumo Objetivo: Oposição às vacinas não é evento novo e surgiu logo após a introdução da vacina contra varíola no fim do século XVIII. O objetivo desta revisão é esclarecer os profissionais de saúde sobre hesitação e recusa vacinal, suas causas e consequências e fazer sugestões para enfrentar esse desafio. Fonte dos dados: Foi feita busca abrangente e não sistemática nas bases de dados PubMed, Lilacs e Scielo desde 1980 até o presente, com os termos "recusa vacinal", "hesitação vacinal" e "confiança nas vacinas". Foram selecionadas de forma crítica as publicações avaliadas como mais relevantes pela autora. Síntese dos dados: As crenças e os argumentos dos movimentos antivacinas mantiveram-se inalterados nos dois últimos séculos, mas as novas mídias sociais facilitaram a disseminação das informações contra as vacinas. Os estudos sobre o assunto se intensificaram depois de 2010, mas não foram identificados estudos publicados que permitam quantificar esse comportamento no Brasil. A nomenclatura sobre o tema (hesitação vacinal) foi uniformizada pela Organização Mundial de Saúde em 2012. Pesquisas têm sido feitas sobre as possíveis causas da hesitação e recusa vacinal, e também sobre o comportamento das famílias e dos profissionais da saúde. Propostas de intervenções para diminuir as dúvidas da população, esclarecer mitos e melhorar a confiança nas vacinas têm sido feitas. Guias para o profissional de saúde enfrentar o problema estão surgindo. Conclusões: O profissional de saúde é elemento fundamental para transmitir informações, combater as dúvidas e fortalecer a confiança nas vacinas. Eles devem se preparar para enfrentar esse novo desafio.