Nota Técnica N. 3/2023 - SES/GVEDT: Nota técnica de Síndrome Gripal (SG) e Síndrome Respiratória Aguda Grave (SRAG) pelo vírus influenza / Technical Note N. 3/2023 - SES/GVEDT: Technical Note on Influenza Syndrome (SG) and Severe Acute Respiratory Syndrome (SARS) due to the influenza virus

A vigilância d influenza no Brasil é composta pela vigilância sentinela de Síndrome Gripal (SG), Síndrome Respiratória Grave (SRAG) em pacientes hospitalizados ou óbitos e em surtos de SG em instituições e de longa permanência. As unidade sentinelas de Síndrome Gripal têm como objetivo monitorar a circulação dos vírus respiratórios com ênfase em influenza e Sars-CoV-2, identificar as variações sazonais por faixa etária, prover cepas virais para formulação de vacinas de influenza, vigilância genômica do coronavírus, e identificar situações inusitadas

Influenza surveillance in Brazil is composed of sentinel surveillance of Influenza Syndrome (SG), Severe Respiratory Syndrome (SARS) in hospitalized or deceased patients and in SG outbreaks in institutions and long-term care facilities. The flu syndrome sentinel units aim to monitor the circulation of respiratory viruses with emphasis on influenza and Sars-CoV-2, identify seasonal variations by age group, provide viral strains for the formulation of influenza vaccines, genomic surveillance of the coronavirus, and identify unusual situations

Vacunación antigripal en personal de salud que trabaja con niños en un prestador privado de salud: años 2019 y 2020 / Flu vaccine administered to health care personnel working with children at a private health provider (2019-2020) / Vacina contra influenza administrada a profissionais de saúde que trabalham com crianças numa operadora de saúde privada (2019-2020)

Introducción: la infección por el virus de la gripe genera morbimortalidad. El personal de salud es uno de los grupos prioritarios para ser vacunado. Objetivo: conocer cobertura vacunal contra la gripe del personal de salud que trabaja con niños en CASMU en 2019 y 2020, y las razones por las que se vacunaron o no. Material y método: estudio observacional, descriptivo, transversal. Recolección de datos en 2020 a través de un cuestionario anónimo. Se registraron las siguientes variables: edad, lugar de trabajo (urgencias, internación o policlínica), función, riesgo de enfermedad grave, aplicación o no de vacuna en 2019 y en 2020, y motivos de vacunación o de no vacunación. Resultados: completaron la encuesta 204 trabajadores. En 2019, se vacunó el 73 % y, en 2020, el 77,5 % (p >0,05). El personal de salud de urgencias de Montevideo presentó mayor vacunación (en 2019, el 90,7 %; en 2020, el 93 %), seguido por el personal de salud de urgencias de Ciudad de la Costa e internación. Según la ocupación, para los médicos se registró una vacunación mayor al 95 % (2019 y 2020); para las licenciadas y auxiliares de enfermería, el 68,6 % en 2019 y el 75,7 % en 2020; para el personal no clínico, el 33 % en 2019 y el 41 % en 2020. El aumento de vacunados en 2020 no fue significativo en ninguna de las ocupaciones. El 21 % de los encuestados presentaba riesgo de enfermedad grave; el 65 % de estos se vacunó en 2019 y el 74,4 % en 2020. La totalidad de las embarazadas de la muestra se vacunó. Motivos más frecuentes mencionados de vacunación (2019 y 2020): prevención (50,5 %) y ser personal de salud (36 %). El de quienes no se vacunaron fue "Nunca enfermo" (19 %). Quienes no se administraron la vacuna en 2019, pero sí en 2020, mencionaron más frecuentemente la pandemia como motivo. Conclusión: en CASMU, el porcentaje de trabajadores de la salud en contacto con niños que se adhirió a la vacunación antigripal en 2019 y 2020 fue mayor al 70 %. No se registró aumento significativo por la pandemia. Se debe mejorar la cobertura en policlínicas y del personal de salud no médico, en particular del personal de salud con factores de riesgo de enfermedad grave.

Introduction: the influenza virus infection causes morbidity and mortality. Health care personnel (HCP) is one of the priority groups to be vaccinated. Objective: to learn about HCP's vaccination coverage against influenza of those workers working with children at CASMU in 2019 and 2020, and the reasons why they received vaccination or did not. Material and Methods: observational, descriptive, crosssectional study. Data collection in 2020: anon ymous survey. Variables: age, place of work (emer gency, hospital or clinic), function, risk of serious illness, vaccination received (or not received) in 2019 and 2020 and reasons. Results: 204 workers completed the survey; influenza vaccination: 73% in 2019 and 77.5% in 2020 (p>0.05). Montevideo's Emergency Department presented the highest level of vaccination and hospitalization (2019-90.7%; 2020-93%) followed by the Ciudad de la Costa's Emergency Department. By occupational level: doctors: vaccination> 95% (2019 and 2020); graduates and nursing assistants: 2019-68.6%; 2020- 75.7%; administrative, kitchen, cleaning and gate house staff: 2019-33%, 2020-41%. The increase in vaccinated personnel in 2020 was not significant for any of the occupations. 21% of those surveyed had a risk of serious illness; 65% were vaccinated in 2019 and 74.4% in 2020. All the sampled pregnant women were vaccinated. The most frequent reasons mentioned for vaccination (2019 and 2020): "prevention" (50.5%), being PS (36%). Those who were not vaccinated stated that were "never ill" (19%). Those who had not received the vaccine in 2019, but received in 2020, mostly mentioned the "pandemic" as a reason. Conclusion: in CASMU, the percentage of health workers in contact with children who adhered to the flu vaccination in 2019 and 2020 was higher than 70%. There was no significant increase after to the pandemic. Coverage in polyclinics and nonmedical HCP, in particular those HCP with risk factors for serious diseases, should be improved.

Introdução: a infecção pelo vírus influenza gera morbimortalidade. O pessoal de saúde (PS) é um dos grupos prioritários a ser vacinado. Objetivo: conhecer a cobertura vacinal contra influenza do PS que atende crianças no CASMU em 2019 e 2020, e os motivos pelos quais foram vacinados ou não. Material e Métodos: estudo observacional, descritivo e transversal. Coleta de dados em 2020: questionário anônimo. Variáveis: idade, local de trabalho (emergência, internação ou policlínica), função, anos de trabalho, risco de doença grave, aplicação ou não da vacinação em 2019 e 2020 e motivos. Resultados: 204 trabalhadores responderam à pesquisa; vacinação contra influenza: 73% em 2019 e 77,5% em 2020 (p> 0,05). O pronto socorro de Montevidéu apresentou o maior nível de vacinação (2019-90,7%; 2020-93%) seguido pelo pronto socorro de Ciudad de la Costa e internação. Ocupação: médicos: vacinação> 95% (2019 e 2020); graduados e auxiliares de enfermagem: 2019-68,6%; 2020-75,7%; Pessoal administrativo, cozinha, limpeza e porteiros: 2019-33%, 2020-41%. O aumento de vacinados em 2020 não foi significativo em nenhuma das ocupações. 21% dos entrevistados corriam risco de doenças graves; 65% deles foram vacinados em 2019 e 74,4% em 2020. Todas as gestantes da amostra foram vacinadas. Motivos mais citados para a vacinação (2019 e 2020): "prevenção" (50,5%), sendo PS (36%). Aqueles que não foram vacinados disseram que eles "nunca ficavam doentes" (19%). Os que não receberam a vacina em 2019, mas sim em 2020, citaram com mais frequência a "pandemia" como motivo. Conclusão: no CASMU, a percentagem de profissionais de saúde em contato com crianças que aderiram à vacinação contra gripe em 2019 e 2020 foi superior a 70%. Não houve aumento significativo após a pandemia. A cobertura em policlínicas e profissionais de saúde não médicos e, em particular, profissionais de saúde com fatores de risco para doenças graves, deve ser melhorada.

Consideration on the usage of full-dose influenza vaccine for the infants aged 6-35 months old / 中华预防医学杂志

Seasonal influenza has a high disease burden, and children infected with influenza are prone to multiple complications. Influenza vaccination is effective in preventing infection and reducing risks of severe diseases and complications. Influenza vaccines are trivalent and quadrivalent, depending on the components of the vaccine. According to the hemagglutinin content, it can be divided into full dose and half dose of influenza vaccine for children. The findings from clinical trials and real-world studies suggested, the full-dose influenza vaccine as in adults has the same safety profile and higher immunogenicity in children aged 6 to 35 months. The application of full-dose influenza vaccine in children aged 6 to 35 months can greatly improve the flexibility and convenience of vaccination, and help reduce the workload in the process.

Research progress of influenza vaccination, pneumococcal vaccination and COVID-19 vaccination among cancer patients / 中华预防医学杂志

This article reviews the relevant studies on the efficacy and safety of influenza, pneumococcal and COVID-19 vaccination among tumor patients worldwide in recent years. By combing and analyzing the retrieved literature, the results show that influenza and pneumococcal vaccination can significantly reduce the morbidity and hospitalization rate of infectious diseases in tumor patients, reduce the risk of cardiovascular events and death, and significantly improve survival prognosis. COVID-19 vaccination can also protect tumor patients, especially those who have completed full dose vaccination. Authoritative guidelines and consensuses worldwide all recommend that tumor patients receive influenza, pneumococcal and COVID-19 vaccines. We should carry out relevant researches, as well as take effective measures to strengthen patient education, so that tumor patients can fully experience the health protection brought by the vaccine to this specific group.

Assessing the impact of educational methods on influenza vaccine uptake and patient knowledge and attitudes: a randomised controlled trial

INTRODUCTION@#Although influenza vaccination reduces rates of pneumonia, hospitalisation and mortality, influenza vaccination uptake remains low in older patients. The primary aim was to compare individualised counselling with educational pamphlets alone in improving influenza vaccination uptake. The secondary aims were to evaluate knowledge and attitudes towards influenza vaccination and factors influencing uptake.@*METHODS@#A randomised controlled study was conducted in two government polyclinics with 160 participants per arm. Patients aged 65 years and above attending for doctor consultation were recruited. All participants received an educational pamphlet on influenza vaccination. The intervention group received additional face-to-face counselling. Participants filled a pre- and postintervention questionnaire assessing knowledge of influenza and attitudes towards the vaccine. Follow-up calls and verification of electronic records was done at three months to determine actual vaccine uptake.@*RESULTS@#At three months, 16 (10%) patients in the intervention group and 20 (12.5%) patients in the control group had completed influenza vaccination (P = 0.48). Factors positively associated with vaccine uptake were willingness to receive vaccination immediately after intervention (adjusted odds ratio [OR] 12.15, 95% confidence interval [CI] 4.42-33.38), and male gender (adjusted OR 2.96, 95% CI 1.23-7.12). Individualised counselling was more effective in improving knowledge (P < 0.01). Overall knowledge scores did not influence actual vaccine uptake rates. (adjusted OR 1.10 [0.90-1.3]).@*CONCLUSION@#Both arms of patient education increased uptake of influenza vaccination. Individualised counselling was not superior to pamphlets alone in improving uptake. Performing vaccination at the initial point of contact improves actual uptake rates.

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

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

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

A broadly neutralizing human monoclonal antibody against the hemagglutinin of avian influenza virus H7N9 / 中华医学杂志(英文版)

BACKGROUND@#The new emerging avian influenza A H7N9 virus, causing severe human infection with a mortality rate of around 41%. This study aims to provide a novel treatment option for the prevention and control of H7N9.@*METHODS@#H7 hemagglutinin (HA)-specific B cells were isolated from peripheral blood plasma cells of the patients previously infected by H7N9 in Jiangsu Province, China. The human monoclonal antibodies (mAbs) were generated by amplification and cloning of these HA-specific B cells. First, all human mAbs were screened for binding activity by enzyme-linked immunosorbent assay. Then, those mAbs, exhibiting potent affinity to recognize H7 HAs were further evaluated by hemagglutination-inhibiting (HAI) and microneutralization in vitro assays. Finally, the lead mAb candidate was selected and tested against the lethal challenge of the H7N9 virus using murine models.@*RESULTS@#The mAb 6-137 was able to recognize a panel of H7 HAs with high affinity but not HA of other subtypes, including H1N1 and H3N2. The mAb 6-137 can efficiently inhibit the HA activity in the inactivated H7N9 virus and neutralize 100 tissue culture infectious dose 50 (TCID50) of H7N9 virus (influenza A/Nanjing/1/2013) in vitro, with neutralizing activity as low as 78 ng/mL. In addition, the mAb 6-137 protected the mice against the lethal challenge of H7N9 prophylactically and therapeutically.@*CONCLUSION@#The mAb 6-137 could be an effective antibody as a prophylactic or therapeutic biological treatment for the H7N9 exposure or infection.

Progress in research of safety, efficiency and vaccination status of influenza vaccine in populations at high risk / 中华流行病学杂志

This paper reviews the domestic and foreign studies published in 2020 on the application of influenza vaccine in populations at high risk. The importance of influenza vaccination in population at high risk has been proved by larger sample, multicentre, high-quality evidence-based studies. Influenza vaccination is the most cost-effective measure to prevent influenza. However, the coverage rate of influenza vaccine is very low in China, it is necessary to strengthen the health education to promote influenza vaccination in different populations. It is recommended to give influenza vaccination to the population in whom influenza vaccination has been proven safe and effective before influenza season. Research of the safety, efficiency and cost-effectiveness of influenza vaccine should be accelerated for the populations in whom such data are lacking or insufficient.

Analysis on vaccination willingness and related factors of influenza, pneumonia, and herpes zoster vaccine among people over 50 years old in Minhang district of Shanghai / 中华预防医学杂志

Objective: To determine the knowledge of influenza, pneumonia, herpes zoster and related vaccines, willingness to vaccinate under multiple payment scenarios, and corresponding risk factors among people over 50 years old in Minhang District of Shanghai. Methods: A total of 1 672 respondents aged 50-69 from 13 communities/towns in Minhang district of Shanghai were included in this study using a stratified random sampling strategy on December 2020. The knowledge of influenza, pneumonia, herpes zoster and vaccines was investigated using a questionnaire, and the differences in the willingness under multiple payment scenarios were determined using chi-square test. The consistency in the willingness under multiple payment scenarios was compared using Cohen's Kappa and the risk factors of the willingness was determined using ordinal logistic regression. Results: The average age of 1 672 respondents was (60.48±5.96) years old, including 777 (46.47%) males and 895 (53.53%) females. A total of 1 350 subjects (80.74%) had local household registration in Shanghai. The proportion of the willingness to vaccinate for themselves, spouses, and parents under any payment scenario was determined to be 80.6% (influenza vaccine), 81.5% (pneumonia vaccine), and 74.0% (herpes zoster vaccine). The willingness to vaccinate against influenza and pneumonia under multiple payment scenarios remained stable (Kappa value ≥0.6), while that against herpes zoster infection was inconsistent (Kappa value ≤0.35). Logistic regression analysis showed that respondents who had higher knowledge of influenza and influenza vaccine [OR (95%CI): 1.111 (1.054-1.170), 1.182 (1.126-1.240), respectively], aged 50-59 [1.305 (1.085-1.531)] and local household registration in Shanghai [1.372 (1.079-1.721)] had higher willingness to vaccinate against influenza, while males had lower willingness [0.733 (0.551-0.910)]. Respondents who had higher knowledge of pneumonia and pneumonia vaccine [OR (95%CI): 1.837 (1.152-2.517), 2.217 (1.541-2.893), respectively] had higher willingness to receive pneumonia vaccine. Respondents aged 50-59 [1.327 (1.059-1.537)] and with local household registration in Shanghai [2.497 (1.417-4.400)] were more likely to be vaccinated against herpes zoster, while those with middle school degree or below [0.664 (0.396-0.992)] and high school degree [0.559 (0.324-0.964)] were less likely to be vaccinated. Conclusion: Among people aged over 50 years old in Minhang district of Shanghai, the willingness to vaccinate for themselves, spouses, and parents against influenza, pneumonia and herpes zoster infection is quite different under multiple payment scenarios, especially for herpes zoster vaccine.

Consideration on implementation of co-administration of Seasonal Influenza and COVID-19 vaccines during pandemic in China / 中华预防医学杂志

Influenza is an infectious respiratory disease caused by the influenza viruses. Older people, infants and people with underlying medical conditions could have a higher risk of severe influenza symptoms and complications. The co-infection of Coronavirus Diseases 2019 (COVID-19) with influenza viruses could lead to the complication of prevention, diagnosis, control, treatment, and recovery of COVID-19. Influenza vaccine and COVID-19 vaccine overlapped in target populations, vaccination time, and inoculation units. Although there was insufficient evidence on the immunogenicity and safety of co-administration of influenza vaccine and COVID-19 vaccine, World Health Organization and some countries recommended co-administration of inactivated influenza vaccine and COVID-19 vaccine. This review summarized domestic and international vaccination policies and research progress, and put forward corresponding suggestions in order to provide scientific support for the formulation of vaccination strategy on seasonal influenza vaccine and COVID-19 vaccine.

Trend analysis of influenza vaccination among hospitalized elderly people in Beijing, 2013-2019 / 北京大学学报(医学版)

OBJECTIVE@#To analyze the influenza vaccination trend of hospitalized elderly people (≥ 60 years old) in Beijing from 2013 to 2019.@*METHODS@#The influenza vaccination status and hospitalization information of elderly people were extracted from the Beijing Elderly Influenza Vaccination database (2013-2019) and the Beijing Urban Employee Basic Medical Insurance database (2013-2019), se-parately. The influenza vaccine coverage rates and annual percentage change were calculated to compare the vaccination trends of elderly people hospitalized due to different diseases. The subjects in 2018-2019 influenza season were divided into different groups according to demographic status, health conditions and hospitalization outcomes to describe and compare the distribution of influenza vaccination rates.@*RESULTS@#The influenza vaccine coverage rates among the elderly people hospitalized due to cardiovascular diseases, cerebrovascular diseases, respiratory diseases or diabetes mellitus were 14.6%, 13.4%, 13.4% and 11.8%, respectively. The influenza vaccination rate among those hospitalized for cardiovascular diseases remained the highest across six influenza seasons and those hospitalized for diabetes mellitus remained the lowest. The largest annual decline of influenza vaccine coverage rate was observed among the hospitalized elderly due to diabetes mellitus (-7.85%). The distribution of vaccinated population was significantly associated with age, gender, hospitalization outcome and comorbidities among the hospitalized elderly people with specific diseases in 2018-2019. Among the elderly people hospitalized due to four different diseases, the vaccination rate of the patients aged 70-79 years was higher than that of the other age groups and that of the patients aged 60-69 years was the lowest. Among the elderly people hospitalized due to respiratory diseases, the vaccination rate of men was higher than that of women, while the situation reversed among the elderly people hospitalized due to cardiovascular diseases and diabetes mellitus. Vaccination rates decreased among the older adults with poor hospitalization outcomes. Among the elderly people hospitalized due to diabetes mellitus, those with 0 comorbidity had the lowest vaccination rate (7.9%).@*CONCLUSION@#The trend of influenza vaccine coverage rates among the elderly people in Beijing from 2013 to 2019 was downward. We should pay more attention to influenza vaccination in elderly people with diabetes mellitus and aged 60-69 years, and carry out more research on the protective effects of influenza vaccine to promote influenza vaccine coverage among people with chronic diseases.

Motivos para vacinação contra influenza em idosos em 2019 e 2020 / Motivos para la vacunación contra la influenza en adultos mayores en 2019 y 2020 / Reasons for influenza vaccination in older adults in 2019 and 2020

Resumo Objetivo Avaliar a cobertura vacinal para influenza e os motivos para vacinação ou não em idosos, nas campanhas dos anos de 2019 e 2020. Métodos Estudo quantitativo e longitudinal, realizado em Três Lagoas (MS). Participaram idosos cadastrados em serviços de saúde ou de convivência. No primeiro trimestre de 2020, foram avaliados presencialmente 172 idosos, dos quais 86 foram reentrevistados entre agosto e outubro de 2020 por meio de contato telefônico. Na primeira entrevista, questionou-se sobre a vacinação contra a gripe em 2019 e os motivos para vacinação ou não. Na segunda, as questões foram sobre a vacinação em 2020 e os motivos. As coberturas vacinais de 2019 e 2020 foram comparadas pelo teste de McNemar. Resultados Houve predomínio de mulheres, com média de 69,1 anos de idade. A cobertura vacinal em 2019 foi de 90,7%. A maioria tomou a vacina por acreditar que era importante se vacinar. Como motivos para a não vacinação, destacaram-se as reações anteriores e o fato de não ficar gripado. Em 2020, a cobertura foi de 86,0%. A maioria dos idosos se vacinou pelo fato de a vacina estar disponível no Sistema Único de Saúde. Os motivos para não vacinação foram medo de sair de casa devido à pandemia e falta de orientação profissional. Não houve diferença significativa na cobertura vacinal em 2019 e 2020 (p=0,388). Conclusão A cobertura vacinal diminuiu no ano da pandemia, sem diferença significativa. Informações confiáveis de profissionais de saúde e da mídia são essenciais para a manutenção de altas coberturas vacinais.

Resumen Objetivo Evaluar la cobertura vacunal de la influenza y los motivos para la vacunación o no de adultos mayores en las campañas de los años de 2019 y de 2020. Métodos Estudio cuantitativo y longitudinal, realizado en Três Lagoas (Mato Grosso do Sul). Participaron adultos mayores registrados en servicios de salud o de convivencia. En el primer trimestre de 2020, 172 adultos mayores fueron evaluados presencialmente de los que 86 fueron entrevistados nuevamente entre agosto y octubre de 2020 por medio de contacto telefónico. En la primera entrevista, se preguntó sobre la vacunación contra la gripe en el 2019 y los motivos para vacunarse o no vacunarse. En la segunda, las preguntas fueron sobre la vacunación en el 2020 y los motivos. Las coberturas vacunales de 2019 y de 2020 fueron comparadas por la prueba de McNemar. Resultados Hubo un predominio de mujeres, con un promedio de 69,1 años de edad. La cobertura vacunal en el 2019 fue del 90,7 %. La mayoría tomó la vacuna por considerar que era importante vacunarse. Como motivos para la no vacunación, se destacaron las reacciones anteriores y el hecho de no quedarse engripado. En el 2020, la cobertura fue del 86,0 %. La mayoría de los adultos mayores se vacunó por el hecho de que la vacuna está disponible en el Sistema Único de Salud. Los motivos para la no vacunación fueron el miedo de salir de casa en función de la pandemia y la falta de orientación profesional. No hubo diferencia significante en la cobertura vacunal en el 2019 y el 2020 (p=0,388). Conclusión La cobertura vacunal disminuyó el año de la pandemia, sin significante diferencia. Informaciones confiables de profesionales de salud y de los medios son esenciales para el mantenimiento de altas coberturas vacunales.

Abstract Objective To assess influenza vaccination coverage and reasons for vaccination or not in older adults, in the campaigns of 2019 and 2020. Methods This is a quantitative and longitudinal study, carried out in Três Lagoas (MS). Older adults registered in health care or social services participated. In the first quarter of 2020, 172 older adults were assessed in person, of whom 86 were re-interviewed between August and October 2020 through telephone contact. In the first interview, questions were asked about the flu vaccination in 2019 and the reasons for vaccination or not. In the second, the questions were about vaccination in 2020 and why. Vaccination coverage for 2019 and 2020 was compared using the McNemar test. Results There was a predominance of women, with an average age of 69.1 years. Vaccination coverage in 2019 was 90.7%. Most of them took the vaccine because they believed it was important. As reasons for non-vaccination, the previous reactions and the fact that they did not have the flu were highlighted. In 2020, coverage was 86.0%. Most older adults were vaccinated because the vaccine was available in the Unified Health System (Sistema Único de Saúde). The reasons for non-vaccination were fear of leaving home due to the pandemic and lack of professional guidance. There was no significant difference in vaccination coverage in 2019 and 2020 (p=0.388). Conclusion Vaccination coverage decreased in the year of the pandemic, with no significant difference. Reliable information from healthcare professionals and the media is essential for maintaining high vaccination coverage.

Barriers and facilitators to influenza vaccination observed by officers of national immunization programs in South America countries with contrasting coverage rates / Barreras y facilitadores de la vacuna contra la gripe observados por funcionarios de los programas nacionales de inmunización en países de Suramérica con niveles de cobertura contrastantes / Barreiras e facilitadores da vacinação contra influenza observados por funcionários dos programas nacionais de imunização em países Sul-Americanos com diferentes níveis de cobertura

Influenza is a severe, vaccine-preventable disease. Vaccination programs across Latin American countries show contrasting coverage rates, from 29% in Paraguay to 89% in Brazil. This study explores how national influenza vaccination programs in the chosen South American countries address vaccine confidence and convenience, as well as complacency toward the disease. Barriers and facilitators to influenza vaccination programs in their relation to vaccine hesitancy were observed by documentary analysis and interviews with 38 national immunization program officers in high- (Brazil and Chile) and low-performing (Paraguay, Peru, and Uruguay) countries. Influenza vaccination policies, financing, purchasing, coordination, and accessibility are considered good or acceptable. National communication strategies focus on vaccine availability during campaigns. In Chile, Paraguay, and Uruguay, anti-vaccine propaganda was mentioned as a problem. Programming and implementation face human resource shortages across most countries. Statistical information, health information systems, and nominal risk-group records are available, with limitations in Peru and Paraguay. Health promotion, supervision, monitoring, and evaluation are perceived as opportunities to address confidence and complacency. Influenza vaccination programs identify and act on most barriers and facilitators affecting influenza vaccine hesitancy via supply-side strategies which mostly address vaccine convenience. Confidence and complacency are insufficiently addressed, except for Uruguay. Programs have the opportunity to develop integral supply and demand-side approaches.

La gripe es una enfermedad grave, prevenible mediante vacunas con sus correspondientes programas en países latinoamericanos, informando sobre tasas contrastadas de cobertura, desde el 29% en Paraguay al 89% en Brasil. Este artículo investiga cómo los programas nacionales contra la gripe en países seleccionados de Suramérica abordan la confianza en la vacuna y su conveniencia, así como también la complacencia hacia la enfermedad. Las barreras y facilitadores del programa de vacunación de la gripe, en su relación con la vacilación hacia la vacuna, se observaron mediante análisis documental y entrevistas a 38 a cargo de los programas nacionales de inmunización en países con alto (Brasil y Chile) y bajo desempeño (Paraguay, Perú y Uruguay). Políticas de vacunación contra la gripe, financiamiento, compras coordinación y accesibilidad fueron consideradas como buenas o aceptables. Las estrategias nacionales de comunicación se centran en la disponibilidad de la vacuna durante las campañas. En Chile, Paraguay y Uruguay la propaganda antivacunas fue mencionada como un problema. La planificación e implementación enfrentan escasez de recursos humanos en la mayoría de países a través de la mayoría de países. Los sistemas de información en salud, estadísticas y registros nominales por grupos de riesgo se encuentran disponibles con limitaciones en Perú y Paraguay. La promoción de la salud, supervisión, monitoreo y evaluación son percibidos como oportunidades para abordar la confianza y complacencia. Los programas de vacunación contra la gripe actúan principalmente sobre las barreras y facilitadores que afectan la vacilación a vacunarse mediante estrategias del lado de la demanda, las cuales en su mayor parte van dirigidas a contrarestar la conveniencia. La confianza y complacencia son insuficientemente abordadas en todos los países, excepto en Uruguay. Los programas tienen la oportunidad de desarrollar estrategias que aborden tanto el lado de la oferta como de la demanda.

A influenza é uma doença grave, imunoprevenível, para a qual os programas de vacinação nos países latino-americanos apresentam taxas de cobertura contrastantes, desde 29% no Paraguai até 89% no Brasil. O artigo explora de que maneira os programas nacionais de influenza em países selecionados da América do Sul lidam com a confiança e a conveniência da vacina, assim como, a acomodação em relação à doença. As barreiras e facilitadores dos programas de vacinação contra influenza foram observados em relação à hesitação vacinal, através de análise documental e entrevistas com 38 autoridades de programas nacionais de imunização em países com desempenho alto (Brasil e Chile) e baixo (Paraguai, Peru e Uruguai). As políticas de vacinação contra influenza, financiamento da compra de vacinas, coordenação e acessibilidade são consideradas boas ou aceitáveis. As estratégias nacionais de comunicação estão concentradas na disponibilidade durante campanhas. No Chile, Paraguai e Uruguay, a propaganda antivacina foi mencionada enquanto problema. A programação e a implementação enfrentam escassez de recursos humanos na maioria dos países. Dados estatísticos, sistemas de informação em saúde e registros nominais de grupos de risco estão disponíveis, com limitações no Peru e no Paraguai. A promoção da saúde, supervisão, monitoramento e avaliação foram percebidas como oportunidades para tratar da confiança e da acomodação. Os programas de vacinação contra influenza identificam e agem sobre a maioria das barreiras e facilitadores que afetam a hesitação vacinal através de estratégias do lado da oferta, tratando principalmente da conveniência da vacina. A confiança e a acomodação não são tratadas de maneira suficiente, com exceção notável do Uruguai. Os programas têm a oportunidade de desenvolver abordagens que integram os lados da oferta e da procura.

Covid-19 y gripe de 1918-1919: paralelos históricos, preguntas y respuestas / Covid-19 and the 1918-1919 influenza: historical parallels, questions and answers

Resumen El desarrollo de la pandemia de la covid-19 ha motivado un renovado interés por la gripe de 1918-1919 para buscar elementos que facilitaran la comprensión de la experiencia presente, pero también como oportunidad para reevaluar la grave crisis sanitaria del siglo XX a la luz de lo que estamos viviendo. En este contexto y con ese objetivo se inserta esta reflexión histórica sobre estos dos fenómenos pandémicos, que muestra los paralelismos existentes y la necesidad de una toma de conciencia de que nuestro modelo de sociedad está en crisis y se requiere una transformación profunda.

Abstract The rise of the covid-19 pandemic has led to renewed interest in the 1918-1919 influenza in search of aspects that might help us understand the current situation, but also as an opportunity to re-evaluate the serious twentieth-century health crisis in light of what we are experiencing now. In this context and with that goal, this historical reflection shows the parallels that exist and the need for a realization that our model of society is undergoing a crisis and requires profound transformation.

Vacinação para influenza em idosos na pandemia COVID-19: estudo de base populacional em 133 cidades brasileiras / Influenza vaccination in older adults during the COVID-19 pandemic: a population-based study in 133 Brazilian cities

Resumo Imunizações de rotina durante pandemias podem ser prejudicadas. Este estudo estimou a cobertura vacinal para influenza em idosos durante a COVID-19 através do EPICOVID-19, inquérito populacional realizado em 133 cidades sentinelas dos 26 estados brasileiros e Distrito Federal. Selecionou-se 25 setores censitários por cidade, amostragem proporcional ao tamanho, dez domicílios por setor e uma pessoa por domicílio, aleatoriamente. O quantitativo de 8.265 idosos (≥ 60 anos) foram entrevistados e responderam se haviam sido vacinados contra gripe em 2020. A cobertura foi 82,3% (IC95% 80,1; 84,2), sem diferenças por sexo, idade ou região. Maiores coberturas ocorreram nos mais ricos (84,7% versus 80,1% nos mais pobres) e nos mais escolarizados (87,3% versus 83,2% nos menos escolarizados). Menor cobertura nos indígenas (56,9% versus coberturas superiores a 80% nos demais grupos étnicos). Houve associação positiva com número de comorbidades entre homens, mas não entre mulheres. A maioria vacinou-se na rede pública (97,5%), sendo a rede privada mais utilizada na região Sul, pelos mais escolarizados e mais ricos. Conclui-se que a cobertura vacinal ficou sete pontos percentuais abaixo da meta governamental (90%), e que desigualdades devem ser revertidas em futuras campanhas.

Abstract Routine immunization during pandemics can be harmed. This study estimated the influenza vaccination coverage in older adults during the COVID-19 through the EPICOVID-19, a population-based study conducted in 133 cities from the 26 Brazilian states and Federal District. We selected 25 census tracts per city, with probability proportional to the tract's size, ten households by census tract, and one random individual interviewed. A total of 8,265 older adults (≥60 years old) were interviewed and asked whether they had been vaccinated against flu in 2020. Vaccination coverage was 82.3% (95% CI: 80.1-84.2) with no difference by gender, age, and region; higher vaccination coverage was observed among the wealthiest (84.7% versus 80.1% in the poorest) and among the more educated (87.3% versus 83.2% less educated); lower coverage among indigenous (56.9% versus > 80% among other ethnic groups). A positive association was identified with the number of comorbidities among men but not among women. Most of the population was vaccinated (97.5%) in the public health system. The private network was chosen mainly in the South by the wealthiest and more educated. Vaccination coverage was seven percentage points lower than the government target (90%), and inequalities should be reversed in future campaigns.

Campaña influenza 2020 en contexto de pandemia por SARS-CoV-2: una experiencia inédita de salud pública en Chile / Seasonal influenza campaign 2020 in the context of SARS-CoV-2 pandemic: an unprecedented public health experience in Chile

Resumen Desde 1982, cada año el Departamento de Inmunizaciones del Ministerio de Salud de Chile lleva a cabo la campaña de vacunación contra influenza junto con las Secretarías Regionales Ministeriales-SEREMI, Servicios de Salud y centros de atención primaria de salud. Con los objetivos de prevenir mortalidad y morbilidad grave en grupos de mayor riesgo y de preservar la integridad de los servicios de salud, hasta el 2020 las campañas de vacunación contra influenza serían las más grandes implementadas en Chile, para dar paso, el 2021, a la vacunación contra SARS-CoV-2. Obedeciendo a cambios demográficos y epidemiológicos locales y acogiendo los avances científicos sobre seguridad e inmunogenicidad de la vacuna, el incremento de las vacunas influenza disponibles en Chile forma parte de la planificación anual de la campaña. El 2020, sin embargo, la Campaña Influenza tuvo que ser re-planificada en curso como consecuencia de la incorporación de nuevos grupos a vacunar según dispuso la modificación de la alerta sanitaria por brote de SARS-CoV-2 del 6 de marzo de 2020. Así, de 6.799.800 de dosis, el Departamento de Inmunizaciones logró en menos de dos meses aumentar la disponibilidad a 8.480.325, y cumplir con el compromiso de garantizar el acceso de los grupos de riesgo al beneficio de la vacunación estatal gratuita.

Abstract In Chile, the Immunization Department of the Ministry of Health has carried out the seasonal influenza vaccination campaign annually since 1982 in collaboration with the national health services, regional health offices, and primary health care centres. With the aim of preventing deaths and serious morbidity in high-risk groups and preserving the integrity of health services, the seasonal influenza campaign had been the largest implemented in Chile until 2020, since in 2021 the vaccination campaign against SARS-CoV-2 is expected to become the largest ever implemented. In response to local demographic and epidemiological changes, and taking into account the new scientific evidence on the safety and immunogenicity of vaccines, the influenza vaccines available in Chile would increase annually as a result of campaign planning. In 2020, the influenza campaign had to be re-planned while in progress due to the addition of new high-risk groups to be vaccinated in accordance with the SARS-CoV-2 pandemic health alert modification of March 6th, 2020. Over the course of three weeks, the Immunization Department managed to increase the doses of available influenza vaccines from 6,799,800 previously agreed upon to 8,480,325 and thus serve high-risk groups, guaranteeing their access to state funded influenza vaccination.

Influenza vaccination coverage in elderly and high-risk adults: characterization of associated factors / Cobertura vacinal de influenza em idosos e adultos de alto risco: caracterização dos fatores associados

ABSTRACT Objective To evaluate the prevalence and factors associated with non-vaccination against influenza in the risk group. Methods A cross-sectional, population-based study, carried out in the city of Rio Grande (RS). The outcome was defined as belonging to risk groups and not having been vaccinated in the last 12 months. Demographic, socioeconomic, behavioral variables, and access for health services were analyzed. Results In this study, 680 individuals participated. The prevalence was 46.0% (95%CI: 41.8-50.3), ranging from 27.9% (elderly) to 81.8% (pregnant women). Young adults, single, intermediate socioeconomic bracket, smoker, with depressive symptoms, who did not perform physical activity and did not consult a physician in the last year, had a higher prevalence of non-vaccination. Conclusion Half of the sample was not vaccinated in the period. Due to the similarity of influenza-like illness and the coronavirus 2019 disease (COVID-19), increasing vaccination would minimize mortality and use of hospital beds due to influenza, optimizing the response of hospital capacity.

RESUMO Objetivo Avaliar a prevalência e os fatores associados à não vacinação contra influenza em grupos de risco. Métodos Estudo transversal, de base populacional, realizado em Rio Grande (RS). O desfecho foi definido como pertencer aos grupos de risco e não ter se vacinado nos últimos 12 meses. Foram analisadas variáveis demográficas, socioeconômicas, comportamentais e de acesso a serviços de saúde. Resultados Participaram 680 indivíduos. A prevalência foi de 46,0% (IC95%: 41,8-50,3), variando de 27,9% (idosos) a 81,8% (gestantes). Adultos jovens, solteiros, de nível econômico intermediário, tabagistas, com sintomas depressivos, que não praticavam atividade física e não consultaram um médico no último ano tiveram maior prevalência de não vacinação. Conclusão Metade da amostra não foi vacinada no período. Pela semelhança da síndrome gripal com a doença pelo coronavírus 2019 (COVID-19), aumentar a vacinação minimizaria a mortalidade e a utilização de leitos hospitalares devido à influenza, otimizando a resposta da capacidade hospitalar.

Vacinação contra influenza no enfrentamento da COVID-19: integração ensino-serviço para formação em enfermagem e saúde / Vaccination against influenza in the face of COVID-19: teaching-service integration for training in nursing and health / Vacunación contra influenza en el enfrentamiento de la COVID-19: integración enseñanza-servicio para formación en enfermería y salud

Objetivo: descrever a experiência de integração ensino-serviço durante a primeira etapa da 22ª Campanha Nacional de Vacinação contra a Influenza na emergência da COVID-19. Método: relato de experiência sobre a parceria de um curso de enfermagem de uma das instituições de ensino superior de Ribeirão Preto-SP, Brasil, com serviços da Atenção Primária à Saúde na referida campanha, no período de março a abril de 2020. Resultados: essa parceria mobilizou diversos voluntários para implementar 35 postos volantes de vacinação, incluindo um drive-thru. Nessa primeira etapa, foram aplicadas 91.697 doses do imunobiológico em idosos, de um total de 98.189, que correspondeu a 83,3%, valor muito próximo da cobertura vacinal de 90% esperada para esse grupo populacional. Com a parceria, o número total de doses aplicadas em idosos ao final da 22a campanha, na cidade, superou em 42,6% a média dos últimos cinco anos. Conclusão e implicações para a prática: atribui-se esse percentual ao trabalho coletivo e multiprofissional e ao compromisso social das instituições envolvidas com a proteção da saúde, a preservação da vida e o fortalecimento do Sistema Único de Saúde.

Objective: to describe the experience of teaching-service integration during the first stage of the 22nd Brazilian National Influenza Vaccination Campaign in the emergence of COVID-19. Method: this is an experience report on the partnership of a nursing course from one of the higher education institutions in Ribeirão Preto-SP, Brazil, with Primary Health Care services in that campaign, from March to April 2020. Results: this partnership mobilized several volunteers to implement 35 vaccination stations, including a drive-thru. In this first stage, 91,697 doses of the immunobiological agent were applied to older adults, from a total of 98,189, which corresponded to 83.3%, a value very close to the 90% vaccination coverage expected for this population group. With the partnership, the total number of doses applied to older adults at the end of the 22nd campaign in the city exceeded the average of the last five years by 42.6%. Conclusion and implications for practice: this percentage is attributed to the collective and multiprofessional work and the social commitment of the institutions involved with protection of health, preservation of life and strengthening of the Unified Health System.

Objetivo: describir la experiencia de integración enseñanza-servicio durante la primera etapa de la 22ª Campaña Nacional de Vacunación contra el Influenza en la emergencia de la covid-19. Método: un relato de experiencia de la asociación de un curso de enfermería de una institución de enseñanza superior de Ribeirão Preto-SP, Brasil con servicios de la atención primaria a la salud en la referida campaña, en el período de marzo a abril de 2020. Resultados: esta asociación movilizó a varios voluntarios para implementar 35 estaciones de vacunación, incluyendo un drive-thru. En esa primera etapa, fueron aplicadas 91.697 dosis del inmunobiológico en ancianos, de un total de 98.189, que correspondió a 83,3%, valor muy próximo de la cobertura vacunal de 90% esperada para ese grupo poblacional. Con la asociación, el número total de dosis aplicadas en ancianos al final de la 22a campaña en la ciudad superó en 42,6% el promedio de los últimos cinco años. Conclusión e implicaciones para la práctica: este porcentaje se atribuye al trabajo colectivo e interprofesional y al compromiso social de las instituciones involucradas con la protección de la salud, la preservación de la vida y el fortalecimiento del Sistema Único de Salud.

Willingness to vaccinate against influenza A (H1N1)pdm09 among Brazilian civil servants: Pró-Saúde cohort study / Disposição para vacinar contra influenza A (H1N1)pdm09 entre funcionários técnico-administrativos universitários: estudo de coorte Pró-Saúde

ABSTRACT: Objective: To investigate sociodemographic factors associated with the willingness to take the pandemic influenza vaccine. Methods: This is a cross-sectional study of Brazilian civil servants participating in the fourth wave (2012-2013) of the longitudinal Pró-Saúde Study. Associations were expressed as odds ratios (OR) and 95% confidence intervals (95%CI), estimated by multivariate logistic regression models. Results: Among 2,828 participants, 15.9% would not be willing to vaccinate in the future if the Brazilian Ministry of Health promoted a new vaccination campaign against pandemic influenza. Not willing to vaccinate in the future was strongly associated with not taking the pandemic influenza vaccine in 2010 (OR = 9.0, 95%CI 6.9 - 11.6). Among the unvaccinated, females, those aged > 60 years, and non-health care workers were less willing to vaccinate in the future. Again, in the vaccinated group, females were less willing to vaccinate. Conclusion: Multidisciplinary efforts should be encouraged in order to identify reasons for refusing vaccination, focusing on the individual and group perceptions of susceptibility, severity, benefits, and barriers to vaccination. Such information is needed to identify target groups for the delivery of customized interventions towards preventing emerging pandemics, such as avian influenza and COVID-19.

RESUMO: Objetivo: Investigar fatores sociodemográficos associados à disposição em adotar a vacina contra influenza pandêmica. Métodos: Estudo transversal entre servidores técnico-administrativos participantes da quarta onda (2012-2013) do estudo longitudinal Pró-Saúde. Associações foram expressas como razões de chances (RC) e intervalos de confiança de 95% (IC 95%), estimados mediante modelos de regressão logística multivariada. Resultados: Entre os 2.828 participantes, 15,9% não estariam dispostos a serem vacinados no futuro se o Ministério da Saúde do Brasil promovesse uma nova campanha de vacinação contra influenza pandêmica. Não estar disposto a ser vacinado no futuro foi fortemente associado a não receber a vacina contra influenza pandêmica em 2010 (RC = 9,0, IC95% 6,9 - 11,6). Entre os não vacinados, mulheres, maiores de 60 anos e profissionais de outras áreas que não a saúde estavam menos dispostos a serem vacinados no futuro. Novamente, para aqueles vacinados, as mulheres estavam menos dispostas a serem vacinadas. Conclusão: Abordagens multidisciplinares devem ser estimuladas para identificar as razões para recusa vacinal, com foco nas percepções individual e coletivas sobre suscetibilidade, gravidade, benefícios e barreiras à vacinação. Essas informações são necessárias para identificar grupos-alvo para a oferta de intervenções particularizadas para a prevenção de pandemias emergentes, como a de influenza aviária e de covid-19.