Covid-19 en trabajadores de la Salud: Experiencia en la Residencia de Pediatría de un hospital de La Plata, Argentina / Covid-19 in health workers: Experience in the Pediatric Residence of a hospital in La Plata, Argentina

Introducción: Los trabajadores de la salud (TS) poseen la mayor exposición laboral al contagio SARS-CoV-2. Los residentes forman parte fundamental de los servicios de salud por lo que no se encuentran exentos del impacto físico, psíquico, social y económico negativo producido por la pandemia por COVID-19. Objetivo: : Describir el impacto epidemiológico de la enfermedad profesional por COVID-19 en médicos residentes de pediatría. Material y métodos: Estudio descriptivo de corte transversal en médicos residentes de pediatría del H.I.A.E.P "Sor María Ludovica". El período comprendido en el estudio fue del 01/10/2020 al 30/09/2021. Se evaluaron los siguientes datos: género, edad, antecedentes personales, vacunación, cuadro clínico, métodos diagnósticos, aislamientos epidemiológicos, evolución y licencias tramitadas. Los datos fueron registrados por la jefatura de residentes. Resultados: 143 casos sospechosos de COVID-19, de ellos 30 resultaron confirmados de COVID-19. La edad media de los enfermos fue de 31 años (26-46 años) de los cuales 14 (47%) no estaban vacunados contra SARS COV-2, 11 (36%) estaban completamente inmunizados y 5 (17%) tenían calendario incompleto. 2 casos (6,6%) reportaron comorbilidad previa. Se realizaron pruebas de laboratorio en 130 de los 143 casos. 13 casos se descartaron por criterio clínico. La tasa de positividad fue 23,1%. 26 casos fueron confirmados por laboratorio y 4 casos mediante criterio clínico epidemiológico. Todos los casos fueron leves y evolucionaron favorablemente. Fueron gestionadas 326 licencias relacionadas a la pandemia por COVID-19 que significaron la pérdida de 2.830 días laborales. Conclusión: En el presente estudio se evidenció una alta tasa de incidencia de COVID-19 en residentes de pediatría en un año: 23,1%

Introduction: Health workers (HCWs) have the highest occupational exposure to SARS-CoV-2 contagion. Residents are a fundamental part of health services, so they are not exempt from the negative physical, psychological, social and economic impact caused by the COVID-19 pandemic. Objectives: To describe the epidemiological impact of the occupational disease by COVID-19 in resident pediatricians. Material and methods: Descriptive cross-sectional study in pediatric residents of the H.I.A.E.P "Sor María Ludovica". The period covered by the study was from 10/01/2020 to 09/30/2021. The following data were evaluated: gender, age, personal history, vaccination, clinical picture, diagnostic methods, epidemiological isolates, evolution and licenses processed. The data was recorded by the head of residents. Results: 143 suspected cases of COVID-19, of which 30 were confirmed to be COVID-19. The mean age of the patients was 31 years (26-46 years), of which 14 (47%) were not vaccinated against SARS COV.-2, 11 (36%) were fully immunized and 5 (17%) had an incomplete schedule. 2 cases (6.6%) reported previous comorbidity. Laboratory tests were performed in 130 of the 143 cases. 13 cases were ruled out based on clinical criteria. The positivity rate was 23.1%. 26 cases were confirmed by laboratory and 4 cases by clinical epidemiological criteria. All cases were mild and evolved favorably. 326 licenses related to the COVID-19 pandemic were managed, which meant the loss of 2,830 working days. Conclusion: In the present study, a high rate of incidence of COVID-19 was evidenced in pediatric residents in one year: 23.1%

Avaliação da cobertura vacinal da poliomielite nos estados da região sul, com foco no município de Pato Branco, entre os anos de 2009-2019 / Assessment of polio vaccination coverage in the southern states, focusing on the municipality of Pato Branco, from 2009-2019 / Evaluación de la cobertura de vacunación contra la poliomielitis en los estados de la región sur, con enfoque en el municipio de Pato Branco, entre los años 2009-2019

Objetivo: Analisar a taxa de cobertura vacinal da poliomielite em relação às metas de vacinação de 95% da população-alvo, estabelecidas pelo Ministério da Saúde, com base nos registros de imunização do DATASUS nos estados do Paraná, Santa Catarina e Rio Grande do Sul, que compõem a região sul do Brasil, e na cidade de Pato Branco, PR. Métodos: Estudo descritivo de abordagem quantitativa referente à cobertura vacinal da Poliomielite nos estados da região sul e no município de Pato Branco, PR com resultados da cobertura avaliados quanto ao alcance das metas estabelecidas pelo Ministério da Saúde e comparado o desempenho entre os estados e o município no período de 2009 a 2019. Os dados foram recolhidos da seção de Imunizações do DATASUS, o departamento de informática do Sistema Único de Saúde do Brasil. Resultados: No período analisado, o município de Pato Branco se manteve com uma taxa satisfatória em relação à meta estabelecida pelo Ministério da Saúde, exceto nos anos de 2017 e 2018, onde ficou abaixo da meta em cerca de 3% e 11%, respectivamente. Em relação aos estados do sul, o estado do Paraná mostrou-se abaixo da meta de cobertura vacinal recomendada na maioria dos anos estudados, com a menor cobertura ocorrendo em 2017, ficando 15% abaixo do esperado; o estado de Santa Catarina, apesar de apresentar queda desde o ano de 2014, apresentou os melhores índices de cobertura vacinal, com a maior taxa de queda de cobertura no ano de 2018 com cerca de 7%; e o estado do Rio Grande do Sul se apresentou como o estado com o pior desempenho na região, demonstrando quedas significativas da cobertura desde 2010, com menor taxa de vacinação em 2017, ficando 18% abaixo do esperado. Conclusões: Pode-se observar uma queda nos valores da cobertura vacinal entre os anos de 2009 a 2019, tanto no município de Pato Branco, PR, quanto nos estados do Paraná, Santa Catarina e Rio Grande do Sul, algo que é motivo de crescente preocupação pelos serviços de saúde do país devido à possibilidade de reintrodução da doença no território nacional. Ressalta-se, então, a necessidade de criação de estratégias eficazes para o combate das quedas das taxas de cobertura vacinal no país.

Objective: To analyze the rate of polio vaccination coverage in relation to the vaccination goals of 95% of the target population, set by the Ministry of Health, based on DATASUS immunization records in the states of Paraná, Santa Catarina, and Rio Grande do Sul, which make up the southern region of Brazil, and in the city of Pato Branco, PR. Methods: A descriptive study of quantitative approach regarding the vaccination coverage of Poliomyelitis in the states of the southern region and in the municipality of Pato Branco, PR with coverage results evaluated as to the achievement of the goals set by the Ministry of Health and compared performance between the states and the municipality in the period from 2009 to 2019. The data were collected from the Immunizations section of DATASUS, the computer department of the Brazilian Unified Health System. Results: In the period analyzed, the municipality of Pato Branco remained with a satisfactory rate in relation to the target set by the Ministry of Health, except in the years 2017 and 2018, where it was below the target by about 3% and 11%, respectively. Regarding the southern states, the state of Paraná showed below the recommended vaccine coverage target in most of the years studied, with the lowest coverage occurring in 2017, being 15% below expected; the state of Santa Catarina, despite showing a drop since the year 2014, showed the best rates of vaccine coverage, with the highest rate of drop in coverage in the year 2018 with about 7%; and the state of Rio Grande do Sul presented itself as the state with the worst performance in the region, showing significant drops in coverage since 2010, with the lowest rate of vaccination in 2017, being 18% below expectations. Conclusions: A drop in vaccination coverage values can be observed between the years 2009 and 2019, both in the municipality of Pato Branco, PR, and in the states of Paraná, Santa Catarina, and Rio Grande do Sul, something that is a cause of growing concern for the country's health services due to the possibility of reintroduction of the disease in the national territory. Therefore, the need to create effective strategies to combat the declines in vaccination coverage rates in the country is highlighted.

Objetivo: Analizar la tasa de cobertura de vacunación antipoliomielítica en relación con las metas de vacunación del 95% de la población objetivo, establecidas por el Ministerio de Salud, a partir de los registros de inmunización DATASUS en los estados de Paraná, Santa Catarina y Rio Grande do Sul, que conforman la región sur de Brasil, y en la ciudad de Pato Branco, PR. Métodos: Estudio descriptivo de abordaje cuantitativo referente a la cobertura vacunal de la Poliomielitis en los estados de la región sur y en el municipio de Pato Branco, PR con resultados de la cobertura evaluados en cuanto al alcance de las metas establecidas por el Ministerio de Salud y comparado el rendimiento entre los estados y el municipio en el período de 2009 a 2019. Los datos se recogieron de la sección de Inmunizaciones de DATASUS, el departamento de informática del Sistema Único de Salud de Brasil. Resultados: En el período analizado, el municipio de Pato Branco se mantuvo con una tasa satisfactoria en relación a la meta establecida por el Ministerio de Salud, excepto en los años 2017 y 2018, donde estuvo por debajo de la meta en cerca de 3% y 11%, respectivamente. En lo que respecta a los estados del sur, el estado de Paraná se mostró por debajo de la meta de cobertura vacunal recomendada en la mayoría de los años estudiados, siendo la cobertura más baja la que se produjo en el año 2017, estando un 15% por debajo de lo esperado; el estado de Santa Catarina, a pesar de mostrar una caída desde el año 2014, mostró los mejores índices de cobertura vacunal, siendo la mayor tasa de caída de la cobertura en el año 2018 con cerca de un 7%; y el estado de Río Grande do Sul se presentó como el estado con peor desempeño en la región, demostrando caídas significativas en la cobertura desde 2010, con la tasa de vacunación más baja en 2017, siendo un 18% por debajo de lo esperado. Conclusiones: Se observa una caída en los valores de las coberturas de vacunación entre los años 2009 y 2019, tanto en el municipio de Pato Branco, PR, como en los estados de Paraná, Santa Catarina y Rio Grande do Sul, algo que es motivo de creciente preocupación para los servicios de salud del país debido a la posibilidad de reintroducción de la enfermedad en el territorio nacional. Por lo tanto, se destaca la necesidad de crear estrategias eficaces para combatir el descenso de las tasas de cobertura de vacunación en el país.

Estratégias para aumentar a cobertura vacinal: overview de revisões sistemáticas / Strategies to increase vaccination coverage: overview of systematic reviews

A vacinação é a principal ferramenta de prevenção primária de doenças e uma das medidas mais bem-sucedidas em saúde pública, com melhor custo-efetividade (ABBAS et al , 2006; WHO, 2021a). Além disso, a imunização evita incapacidades e cerca de 2 a 3 milhões de mortes, em todo o mundo, a cada ano (UE, 2020; PAHO, 2022; WATSON et al., 2022). Não obstante os esforços implementados por organizações internacionais e locais, dados da OMS apontam que a cobertura vacinal global caiu de 86% em 2019 para 81% em 2021, o que significa que cerca de 25 milhões de crianças menores de 1 ano não receberam as vacinas básicas (WHO, 2021a). Já no Brasil (Figura 1), a cobertura manteve-se estável de 1999 a 2015 e em contrapartida, em 2016 e no último triênio, apresenta tendência de queda (BRASIL, 2022b). Diante dessa realidade, objetivou-se investigar as estratégias utilizadas para ampliar a vacinação, e assim, subsidiar a formulação e tomada de decisão em políticas públicas para mitigar a baixa cobertura vacinal

Vaccination is the main tool for primary disease prevention and one of the most successful and cost-effective public health measures (ABBAS et al , 2006; WHO, 2021a). In addition, immunization prevents disability and an estimated 2 to 3 million deaths worldwide each year (EU, 2020; PAHO, 2022; WATSON et al., 2022). Notwithstanding the efforts implemented by international and local organizations, WHO data indicate that global vaccination coverage dropped from 86% in 2019 to 81% in 2021, which means that about 25 million children under 1 year of age do not received the basic vaccines (WHO, 2021a). In Brazil (Figure 1), coverage remained stable from 1999 to 2015 and, on the other hand, in 2016 and in the last three years, it shows a downward trend (BRASIL, 2022b). Faced with this reality, the objective was to investigate the strategies used to expand vaccination, and thus subsidize the formulation and decision-making in public policies to mitigate the low vaccination coverage

Situação vacinal de crianças cadastradas em equipes de saúde da família / Vaccine situation of children registered in family health teams / Situación de vacunas de niños matriculados en los equipos de salud familiar

Objetivo: analisar a situação vacinal de crianças menores de três anos, cadastradas em Equipes de Saúde da Família. Método: estudo transversal, realizado em Unidades de Saúde da Família de João Pessoa, Paraíba, Brasil, com 424 cadernetas de crianças menores de três anos. Os dados foram coletados entre maio e novembro de 2019, com o auxílio de um instrumento elaborado conforme Caderneta da Criança, e analisados por estatística descritiva e inferencial. Resultados: 295 (69,6%) cadernetas estavam atualizadas conforme idade da criança, com maior porcentagem de atraso 58 (40%) nas cadernetas de crianças entre 12 e 23 meses. As vacinas mais registradas foram BCG e Hepatite B. Crianças do sexo masculino e entre 12 e 23 meses apresentaram associação significante com atualização vacinal. Conclusão: a cobertura vacinal está abaixo do recomendado, sendo necessárias campanhas de orientação a população para melhor adesão as vacinas e busca ativa de crianças com atraso vacinal.

Objective: to analyze the vaccination status of children under three years old, registered in Family Health Teams. Method: cross-sectional study carried out in Family Health Units in João Pessoa, Paraíba, Brazil, with 424 booklets for children under three years of age. Data were collected between May and November 2019, with the help of an instrument prepared according to the Child Handbook, and analyzed using descriptive and inferential statistics. Results: 295 (69,6%) booklets were updated according to the child's age, with a higher percentage of delay 58 (40%) in the booklets of children between 12 and 23 months. The most registered vaccines were BCG and Hepatitis B. Male children aged between 12 and 23 months showed a significant association with vaccination update. Conclusion: vaccination coverage is below what is recommended, and campaigns are needed to guide the population for better adherence to vaccines and an active search for children with delayed vaccinations.

Objetivo: analizar el estado de vacunación de los niños menores de tres años, registrados en los Equipos de Salud de la Familia. Método: estudio transversal realizado en Unidades de Salud de la Familia en João Pessoa, Paraíba, Brasil, con 424 folletos para niños menores de tres años. Los datos fueron recolectados entre mayo y noviembre de 2019, con la ayuda de un instrumento elaborado según el Manual del Niño, y analizados mediante estadística descriptiva e inferencial. Resultados: 295 (69,6%) cuadernillos se actualizaron según la edad del niño, con mayor porcentaje de atraso 58 (40%) en los cuadernillos de niños entre 12 y 23 meses. Las vacunas más registradas fueron BCG y Hepatitis B. Los niños varones de entre 12 y 23 meses mostraron una asociación significativa con la actualización de la vacunación. Conclusión: la cobertura de vacunación está por debajo de lo recomendado, y se necesitan campañas que orienten a la población para una mejor adherencia a las vacunas y una búsqueda activa de niños con vacunación tardía.

Incidência de erros de imunização em Minas Gerais: estudo transversal, 2015-2019 / La incidencia de los errores de inmunización en Minas Gerais, Brasil: estudio transversal, 2015-2019 / Incidence of immunization errors in the state of Minas Gerais, Brazil: a cross-sectional study, 2015-2019

Objetivo: Avaliar a incidência do erro de imunização no serviço público de saúde do estado de Minas Gerais, Brasil. Métodos: Estudo transversal, a partir dos erros notificados no Sistema de Informação do Programa Nacional de Imunização entre 2015 e 2019. Realizaram-se análise descritiva e cálculo da incidência para as macrorregiões de saúde do estado. Resultados: Foram analisadas 3.829 notificações. Crianças menores de 1 ano foram as mais acometidas (39,1%) e a via intramuscular foi responsável por 29,4% dos erros. O erro mais frequente foi a administração de vacina fora da idade recomendada (37,7%). Observou-se maior incidência de erros nas macrorregiões Vale do Aço (26,5/100 mil) e Triângulo do Norte (22,6/100 mil). Conclusão: Os erros de imunização apresentaram incidência heterogênea entre as macrorregiões de Minas Gerais, no período 2015-2019, e a administração de vacinas fora da idade recomendada foi o erro mais notificado.

Objetivo: Evaluar la incidencia de errores de inmunización en el servicio público de salud del estado de Minas Gerais, Brasil. Métodos: Estudio transversal basado en errores notificados en el Sistema de Información del Programa Nacional de Vacunación entre 2015 y 2019. Se realizó un análisis descriptivo y cálculo de la incidencia para las macrorregiones de salud del estado. Resultados: Se analizaron un total de 3.829 notificaciones. Los niños menores de 1 año fueron los más afectados (39,1%) y la vía intramuscular fue responsable del 29,4% de los errores. El error más frecuente fue la administración de la vacuna fuera de la edad recomendada (37,7%). Se observó una mayor incidencia en las macrorregiones Vale do Aço (26,5/100.000) y Triângulo do Norte (22,6/100.000). Conclusión: Los errores de inmunización mostraron una incidencia heterogénea entre las macrorregiones del estado de Minas Gerais de 2015 a 2019 y la administración de vacunas fuera de la edad recomendada fue el error más reportado.

Objective: To evaluate the incidence of immunization errors in the public health service of the state of Minas Gerais, Brazil. Methods: This was a cross-sectional study, based on errors reported on the National Immunization Program Information System between 2015 and 2019. A descriptive analysis and calculation of the incidence for the state's health macro-regions were performed. Results: A total of 3,829 notifications were analyzed. Children younger than 1 year old were the most affected (39.1%) and the intramuscular route accounted for 29.4% of the errors. The most frequently reported error was administration of vaccines outside minimum and maximum recommended ages (37.7%). There was a higher incidence of errors in Vale do Aço (26.5/100,000) and Triângulo do Norte (22.6/100,000) macro-regions. Conclusion: Immunization errors showed a heterogeneous incidence among the macro-regions of the state of Minas Gerais, between 2015-2019, and the administration of vaccines outside minimum and maximum recommended ages was the most frequently reported error.

Factores socio-laborales asociados a la posibilidad de vacunación contra la COVID-19 si el trabajo se los exige, Perú / Socio-occupational factors associated with the possibility of vaccination against COVID-19 if required by work, Peru

En el contexto de la llegada de las vacunas contra la COVID-19 al Perú, es importante conocer que rubros son los más dispuestos a realizarlo. El objetivo de este estudio fue determinar los factores socio-laborales asociados a la posibilidad de vacunación contra la COVID-19 si el trabajo se los exige. Estudio transversal analítico, que tuvo como pregunta principal si es que se vacunarían si es que es requisito para el trabajo, esto se comparó según el rubro laboral, el sexo y el grupo etario; se obtuvo estadística descriptiva y analítica. De los 6628 trabajadores encuestados, el 34% y 35% se vacunarían si es que el trabajo se los pide según el que aún no se enfermaran o que ya lo hubiesen hecho, respectivamente. En el análisis multivariado, hubo mayor frecuencia de estar de acuerdo con el vacunarse entre los que están en el sector de minería (RPa: 1,33; IC95%: 1,05-1,69; valor p=0,019), los que hacen labores domésticas (RPa: 1,14; IC95%: 1,01-1,29; valor p=0,036) y los hombres (RPa: 1,07; IC95%. 1,01-1,14; valor p=0,029); en cambio, a comparación de los más jóvenes, los del rango etario de 40-49 años (RPa: 0,82; IC95%: 0,71-0,95; valor p=0,010) los que pensaban en vacunarse menor frecuencia. Hubo una baja percepción a la posibilidad de vacunarse si es que el trabajo se los pide, siendo los principales factores asociados a la posibilidad de vacunarse el no haberse contagiado previamente de COVID-19, pertenecer al sector minería, realizar labores domésticas y ser hombre(AU)

In the context of the arrival of vaccines against COVID-19 in Peru, it is important to know which sectors are the most willing to be vaccinated. The objective of this study was to determine the socio-labor factors associated with the possibility of vaccination against COVID-19 if required by work. Analytical cross-sectional study, which had as its main question whether they would be vaccinated if it was a job requirement, this was compared according to work category, sex and age group; descriptive and analytical statistics were obtained. Of the 6628 workers surveyed, 34% and 35% would get vaccinated if required to do so by their job, based on whether they had not yet been sick or had already been sick, respectively. In the multivariate analysis, there was a higher frequency of agreement to be vaccinated among those in the mining sector (aPR: 1.33; 95%CI: 1.05-1.69; p-value=0.019), those doing domestic work (aPR: 1.14; 95%CI: 1.01-1.29; p-value=0.036) and men (aPR: 1.07; 95%CI. 1.01-1.14; p-value=0.029); in contrast, those in the younger age range 40-49 years (aPR: 0.82; 95%CI: 0.71-0.95; p-value=0.010) were less likely to be vaccinated than those in the younger age range (aPR: 0.82; 95%CI: 0.71-0.95; p-value=0.010). There was a low perception of the possibility of getting vaccinated if asked to do so at work, the main factors associated with the possibility of getting vaccinated being not having been previously infected with COVID-19, belonging to the mining sector, performing domestic work and being male(AU)

Vacunación programática 2020 en Chile en tiempos de pandemia por SARS-CoV-2 / Routine immunization 2020 in Chile during the SARS-CoV-2 pandemic

Resumen En marzo de 2020, la Organización Mundial de la Salud (OMS) hizo un llamado a mantener la vacunación programática siempre que se pudieran garantizar condiciones seguras frente a la circulación de SARS-CoV-2. Asimismo, advirtió sobre el riesgo de interrupción de la vacunación programática secundaria a la pandemia por SARS-CoV-2. La interrupción de la vacunación genera un aumento en el número de personas susceptibles a las enfermedades que se busca prevenir y, así, de la probabilidad de uno o más brotes epidémicos. Estos, junto con incrementar la morbilidad y mortalidad en los grupos de riesgo, significarían una carga adicional al ya demandado sistema de salud por COVID-19. En agosto 2020, la OMS reportó interrupción de los servicios de salud esenciales en distintos países a raíz de la pandemia de SARS-CoV-2, afectando con mayor frecuencia a la vacunación de rutina y extramural. En Chile, la vacunación programática durante el 2020 disminuyó respecto del promedio del período 2015-2019, con la menor caída en la vacunación de los 2 meses de edad con hexavalente (0,39%) y la mayor a los 18 meses también con hexavalente (12,02%). La excepción fue la vacunación antineumocócica del adulto, con un incremento de 0,8% respecto del período 2015-2019.

Abstract In March 2020, the World Health Organization (WHO) recommended that vaccination not be interrupted as long as countries could safely maintain this service in the context of the SARS-CoV-2 pandemic. WHO also warned about the risk of interruption of programmatic vaccination that generates an increase in the number of people susceptible to infections that are sought to be prevented with the use of vaccines and, therefore, an increase in the probability of disease outbreak. Along with increased morbidity and mortality in risk groups, vaccine-preventable disease outbreaks would put additional demand on the health system already burdened by COVID-19. In August 2020, WHO reported the interruption of essential health services in different countries as a result of the SARS-CoV-2 pandemic, which mainly affected routine and extramural vaccination. In Chile, routine vaccination coverage decreased during 2020 compared to the average coverage for the 2015-2019 period. The smallest decline was 0.39% for the hexavalent vaccine at 2 months of age and the largest decrease was 12.02% at 18 months for the same vaccine. The exception to the fall in coverage in 2020 was adult pneumococcal vaccination, which showed an increase of 0.8% compared to 2015-2019.

Antecedente de inmunización contra influenza en pacientes con COVID-19: impacto en la mortalidad / History of influenza immunization in COVID-19 patients: impact on mortality

Resumen Introducción: En el contexto de la pandemia de COVID-19 existe inquietud en cuanto al impacto de la temporada de influenza. Objetivo: Analizar el impacto del antecedente de inmunización contra influenza en pacientes con infección por SARS-CoV-2. Métodos: Se incluyeron pacientes mayores de 18 años con COVID-19, registrados entre marzo y agosto de 2020. Los datos fueron analizados mediante las pruebas exacta de Fisher y t de Student. Para evaluar el impacto en la mortalidad se utilizó un modelo de regresión logística; la relación entre el porcentaje de pacientes a quienes se aplicó la vacuna contra la influenza y la mortalidad fue determinada con el coeficiente de correlación de Pearson. Resultados: Se incluyeron 16 879 participantes; 17 % tuvo antecedente de vacunación contra influenza. La mortalidad fue menor en el grupo con historia de vacunación (3.5 % versus 7 %, p < 0.0001). El porcentaje de vacunación presentó una relación inversa con el porcentaje de mortalidad (r de Pearson –0.922, p = 0.026). Conclusiones: La inmunización contra la influenza fue un factor protector independiente de mortalidad en pacientes con COVID-19. Aunque son necesarios más estudios para determinar la relación causal, será razonable incrementar la inmunización contra influenza en la población general.

Abstract Introduction: In the context of the COVID-19 pandemic, there is concern regarding the impact of the influenza season. Objective: To analyze the impact of influenza immunization history on patients with SARS-CoV-2 infection. Methods: Patients older than 18 years with COVID-19, registered between March and August 2020, were included. Data were analyzed using Fisher’s exact test and Student’s t-test. To evaluate the impact on mortality, a logistic regression model was used; the relationship between the percentage of patients who received the influenza vaccine and mortality was determined with Pearson’s correlation coefficient. Results: 16,879 participants were included; 17 % had a history of influenza vaccination. Mortality was lower in the group with a history of vaccination (3.5 % vs. 7 %, p < 0.0001). The vaccination rate had an inverse relationship with the mortality rate (Pearson’s r: -0.922, p = 0.026). Conclusions: Previous influenza immunization was an independent protective factor for mortality in patients with COVID-19. Although further studies are needed to determine a causal relationship, it would be reasonable to increase influenza immunization in the general population.

Estudio de la vacunación contra el COVID-19 a nivel de América / Study on COVID-19 vaccination in the Americas

Introducción: una de las expectativas que tenemos actualmente es colocar vacunas seguras y efectivas para suministrar a la población. Con estas vacunas se intenta conseguir la inmunidad colectiva que permita quebrar la cadena de transmisión. Hay que tener estrategias de vacunación frente al COVID-19 teniendo en cuenta la disponibilidad progresiva de dosis, es necesario realizar un ejercicio de priorización atendiendo a principios éticos y criterios de riesgo. Objetivo: comparar si hay diferencias en los promedios de vacunación por cada 100 personas para COVID-19 entre los diferentes países de América. Materiales y métodos: se utilizó la base de datos de la vacunación con la información acumulada al 7 de mayo 2021. Se realizó a partir del análisis estadístico de los datos aplicando el análisis de varianza, se utilizó el paquete estadístico SPSS v.25. Resultados: a partir del análisis estadístico de los datos aplicando el análisis de varianza el p-valor de la prueba para la variable de vacunación es de 0,000, en este caso es menor a α =0.05, de esta manera se rechaza Ho, es decir la prueba de análisis de varianza nos indica que hay diferencias significativas entre la vacunación contra COVID-19 para los diferentes países de América. Conclusiones: el panorama ante la vacunación contra el COVID-19 a nivel de América es bastante preocupante, pues hay varios países con un bajísimo nivel de vacunación, esto se puede deber a que no sea una prioridad para todos los países, especialmente para los que tienen una baja densidad de población y no se estén presentando un gran número de contagios y muertes.

Introduction: one of our current expectations is to supply safe and effective vaccines to be administered to the population. The endpoint is achieving herd immunity through vaccination in order to break the chain of transmission. COVID 19 vaccination strategies expanding access to vaccine doses are necessary. Prioritization on the basis of ethical principles and risk criteria is required. Objective: to compare whether there are differences in COVID 19 vaccination rates per 100 people among the different countries of the Americas. Materials and methods: the vaccination database with the information collected to May 7 2021 was used. An analysis of variance test was applied using the SPSS v.25 statistical package. Results:the p-value obtained in the statistical analysis of variance test for the vaccination variable was 0.000, which is less than α=0.05, therefore, the hypothesis (Ho) is rejected, which means, the analysis of variance test indicates there are significant differences in COVID-19 vaccination in the different countries of America. Conclusions: the outlook for COVID-19 vaccination in the Americas is quite worrying, as there are several countries with very low vaccination rates, maybe due to the fact vaccination is not a priority for all countries, especially for those with low population density, who are not experiencing high COVID 19 infection and death rates.

Factors associated with adults' actions to confirm their own rubella immune status in Japan's drive toward rubella elimination: Cross-sectional online survey of non-healthcare workers in their 20s to 40s

BACKGROUND@#Rubella outbreaks occurred among adults in Japan in 2013-2014 and 2018-2019 due to immunity gaps. In response and aiming at rubella elimination by 2020, the government introduced countermeasures comprising supplementary immunization activities for voluntary testing of adult non-healthcare-related workers and vaccination of susceptible individuals. However, as of October 2020, rubella immunity testing and vaccination rates remained low. This study was conducted to identify factors associated with adults voluntarily confirming their rubella immune status, to help develop effective promotion activities for hard-to-reach and left-behind populations.@*METHODS@#In this cross-sectional study, a general population sample of non-healthcare workers aged 20-49 years in Japan completed an online survey in November 2020. Univariate analysis was performed to examine associations of specific actions taken to confirm rubella immune status with social background characteristics, knowledge of rubella, and attitude to testing and vaccination. Log binomial regression analysis was performed to explore the associations following adjustment for social background characteristics.@*RESULTS@#Among 1,854 respondents (927 men, 927 women), only 23.4% of men and 39.4% of women in their 20s to 40s have taken some action related to rubella prevention. Three major factors were associated with the targeted population having taken voluntary action: (1) knowing about testing for confirmation of immunity status (adjusted odds ratio [AOR] 4.29 men, 2.89 women), the rubella outbreak in 2013 among men in their 20s to 40s (AOR 2.79 men, 1.64 women), and congenital rubella syndrome (AOR 1.89 men, 3.10 women); (2) having acquaintances who were vaccinated against or tested for rubella (AOR 2.98 men, 1.95 women); and (3) having a positive attitude toward influenza vaccination (AOR 2.48 men, 1.83 women). Marriage, desire for pregnancy, and having children were weakly associated with taking action.@*CONCLUSIONS@#Currently, insufficient voluntary action is being taken by high-risk adult populations to close the identified immunity gaps. In this last mile to rubella elimination, our findings and suggested potential interventions via annual health check-ups and occupational health and public health initiatives could prove helpful in developing further countermeasures that actively promote and implement supplementary immunization activities targeting all adult generations.

Cobertura da vacina papilomavírus humano (HPV) no Brasil: heterogeneidade espacial e entre coortes etárias / Human papillomavirus (HPV) vaccination coverage in Brazil: spatial and age cohort heterogeneity

RESUMO: Objetivo: Estimar a cobertura da primeira e da segunda dose da vacina papilomavírus humano (HPV) no Brasil, conforme a microrregião, comparando-se as coortes de meninas com 14, 15 e 16 anos em 2017, e investigar a associação da heterogeneidade espacial na cobertura vacinal com variáveis sociodemográficas. Métodos: A informação sobre doses aplicadas nos anos de 2013 a 2017 por idade foi obtida do Programa Nacional de Imunizações. O número de meninas residentes com sete, oito e nove anos em 2010, em cada microrregião, é oriundo do censo brasileiro de 2010. Para a análise, a cobertura vacinal acumulada por microrregião (n = 558) foi categorizada em baixa (< 80%) e adequada (≥ 80%), e um modelo logístico com intercepto aleatório foi ajustado, tendo cobertura vacinal adequada como desfecho. O efeito aleatório (unidade da federação) foi incluído para captar a correlação entre microrregiões que pertencem ao mesmo estado. Resultados: O percentual de microrregiões que alcançou a cobertura vacinal adequada foi significativamente maior para a primeira dose (entre 91,8 e 159,2%), independentemente da coorte. Observou-se menor cobertura da segunda dose (entre 7 e 79,9%), com heterogeneidade associada ao grau de urbanização e à presença de domicílios com banheiro de uso próprio no município. O efeito aleatório mostrou forte poder explicativo, sugerindo importantes diferenças entre os estados brasileiros no alcance da cobertura vacinal. Conclusão: Apesar de a vacina HPV estar disponível no Programa de Imunização, os achados do presente estudo apontam para uma dificuldade do alcance da cobertura vacinal adequada.

ABSTRACT: Objective: To estimate the coverage of the first and second dose of the human papillomavirus (HPV) vaccine in Brazil according to microregion, comparing cohorts of girls aged 14, 15, and 16 years in 2017, and investigate the association between spatial heterogeneity in vaccination coverage and sociodemographic variables. Methods: Information about the doses administered from 2013 to 2017 by age was gathered from the National Immunization Program. The number of girls aged seven, eight, and nine years living in each microregion in 2010 was obtained from the 2010 Brazilian Census. For the analysis, the cumulated vaccination coverage per microregion (n = 558) was categorized as low (< 80%) and adequate (≥ 80%), and a random intercept logistic model was adjusted, with adequate vaccination coverage as the outcome. The random effect (federative unit) was included to identify the correlation between microregions that belong to the same state. Results: The percentage of microregions with adequate vaccination coverage was significantly higher in the first dose (between 91.8 and 159.2%), regardless of the cohort. The coverage of the second dose was lower (between 7 and 79.9%), with heterogeneity associated with the degree of urbanization and households with private bathrooms in the municipality. The random effect showed a strong explanatory power, suggesting important differences among Brazilian states as to the outreach of vaccination coverage. Conclusion: Although the HPV vaccine is available through the Immunization Program, the findings of the present study point to a difficulty in achieving adequate vaccination coverage.

Prevalence of neutralizing antibodies against poliovirus 1, 2, and 3 in healthcare professionals aged 20-50 years / Prevalência de anticorpos neutralizantes contra poliovírus 1, 2 e 3 em profissionais de saúde de 20 a 50 anos de idade

ABSTRACT Objective: To describe the prevalence of neutralizing antibodies against poliovirus (PV1, PV2, and PV3) in blood samples of healthcare professionals aged 20 to 50 years. Methods: Health professionals who serve children at Darcy Vargas Children's Hospital and the Department of Pediatrics of Irmandade da Santa Casa de São Paulo. The sample size was calculated at 323 participants. The Mantel-Haenszel chi-square was used to verify differences between groups. The neutralization reaction detected human poliovirus antibodies. For susceptible individuals, vaccination with the inactivated+triple acellular polio vaccine was performed, and neutralizing antibodies were re-dosed after one week. Results: 333 professionals were studied - 92.8% were immune to poliovirus 1, 86.5% to poliovirus 2, and 63.3% to poliovirus 3; 37% had titers less than 1:8 for any serotype, 5;1% had titers below 1:8 for all three. Vaccination with inactivated polio vaccine was performed for susceptible participants, and neutralizing antibodies were dosed after one week, showing increased titers for all polioviruses. Conclusions: Despite the detection of a significant percentage of individuals with low poliovirus antibody titer, the challenge with vaccination demonstrated immune response compatible with poliovirus immunity.

RESUMO Objetivo: Descrever a prevalência de anticorpos neutralizantes contra poliovírus (tipos 1, 2 e 3) em amostra de sangue de profissionais de saúde com idade de 20 a 50 anos. Métodos: Profissionais de saúde que atendem crianças do Hospital Infantil Darcy Vargas e do Departamento de Pediatria da Irmandade da Santa Casa de São Paulo. O tamanho da amostra foi de 323 participantes. Os anticorpos contra poliovírus humanos foram detectados pela reação de neutralização. Para os indivíduos suscetíveis, foram administradas vacina para poliomielite inativada+tríplice e nova dosagem de anticorpos neutralizantes após uma semana. Utilizou-se o teste do qui-quadrado de Mantel-Haenszel para verificar as diferenças entre os grupos. Resultados: Foram estudados 333 profissionais - 92,8% eram imunes ao poliovírus 1; 86,5%, ao poliovírus 2; 63,57%, ao poliovírus 3; 37% apresentaram títulos inferiores a 1:8 para qualquer sorotipo; 5,1% tinham títulos abaixo de 1:8 para os três. Após a vacinação dos suscetíveis, houve elevação dos títulos para todos os poliovírus. Conclusões: Apesar da detecção de percentual significativo de indivíduos com baixo título de anticorpos para poliovírus, o desafio da vacinação demonstrou resposta imune robusta compatível.

Reasons for non-vaccination against influenza among older adults with hypertension in Brazil: a cross-sectional study

ABSTRACT The aim of this study was to estimate the prevalence of non-vaccination against influenza among Brazilian older adults with systemic arterial hypertension and determine the main reasons for non-adherence. A cross-sectional study was conducted using data from older adults (≥ 60 years of age) with hypertension who participated in the 2013 National Health Survey and reported not having been vaccinated against flu over the previous 12 months (n = 1,295). The analyses were performed using the Stata 14.0 software. The data were weighted because of the sampling design. An estimated 3,026,080 older adults with hypertension had not received a flu vaccine over the 12 months prior to the survey (22.6%). No significant associations were found with sex, age group or schooling. The prevalence of unvaccinated older adults was lower in the southern and southeastern regions of Brazil than in the northern and northeastern regions, even after adjusting for age. The prevalence was higher among individuals without private health insurance. The main reasons for non-vaccination were fear of a reaction, rarely having the flu and not believing in the protection of the vaccine. The present findings underscore the need for healthcare professionals to explain to the population the benefits of the vaccine for preventing severe influenza (protective effect and possible reactions) and for secondary prevention of cardiovascular events. Increasing the prevalence of vaccination in older adults with hypertension and other cardiovascular diseases is of fundamental importance within the realm of public health as a strategy for reducing occurrences of complications and deaths associated with influenza.

Recordatorio a través de múltiples cartas para vacunación contra influenza / Multiple mail reminders to increase adherence to influenza vaccination

INTRODUCCIÓN: Distintas intervenciones han sido propuestas para reforzar el uso de la vacuna contra la influenza. El uso de recordatorios, ya sea a través de cartas, llamadas telefónicas, panfletos o aplicaciones tecnológicas, entre otras, ha destacado dentro de aquellas orientadas a incrementar la adherencia al tratamiento. Sin embargo, su efectividad no está clara. En este resumen, que forma parte de una serie de evaluaciones de recordatorios, se abordará el envío de múltiples recordatorios enviados por correo. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta-análisis y prepara-mos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyeron 35 estudios primarios, de los cuales cuatro corresponden a ensayos aleatorizados que analizan el uso de múltiples recordatorios enviados por correo. Concluimos que más de un recordatorio enviado por correo probablemente aumenta la adherencia a vacunación contra influenza en pacientes mayores de 60 años, mien-tras que podría resultar en poca o nula diferencia en menores de 6 años, pero la certeza de la evidencia es baja.

INTRODUCTION: Different interventions have been proposed to reinforce the use of the influenza vaccine. The use of reminders, whether through letters, phone calls, pamphlets or technological applications, among others, has stood out among those aimed at increasing ad-herence to treatment. However, its effectiveness is not clear. In this summary, which is part of a series of reminder evaluations, we assess the use of multiple mail reminders. METHODS: We conducted a search in Epistemonikos, the largest database of systematic health reviews, which is maintained by screening multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. We extracted the data from the identified reviews, analyzed the data from the primary studies, performed a meta-analysis and prepared a summary table of the results using the GRADE method. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including 35 primary studies, of which four analyze the use of more than one letter as a reminder. We conclude that the use of multiple mail reminders probably increase adherence to influenza vaccination in patients over 60; while it may make little or no difference in children under 6 years, but the certainty of the evidence is low.

Vacunación canina y felina masiva en México: pobre rectoría y fallo de mercado / Massive canine and feline vaccination in Mexico: poor governance and market failure

Resume: Objetivo: Analizar la rectoría y los mecanismos de procuración de insumos en el contexto del Programa de Acción Específico de Prevención y Control de la Rabia Humana y la Semana Nacional de Vacunación Antirrábica canina y felina en México (SNVA-C). Material y métodos: La información se obtuvo mediante solicitudes al Instituto Nacional de Transparencia, Acceso a la Información y Protección de Datos Personales. Resultados: De 2009 a 2017 se aplicaron 158.9 millones de dosis de vacuna antirrábica canina y felina (VAR-CF) por un monto de compra aproximado de 1 915 MDP. Se documentó una débil rectoría que permite prácticas monopólicas y compras fragmentadas y directas. Las adquisiciones se han fincado con precios que varían entre entidades federativas y son significativamente más altos que los precios internacionales. Conclusión: Después de 30 años de operación de la SNVA-C en México, persisten pagos excesivos para la VAR-CF, los cuales son indicativos de una falla importante del mercado, caracterizada por nula competencia, información asimétrica y estructuras de incentivos desalineadas que impiden obtener un precio competitivo.

Abstract: Objective: To analyze decision-making concerning stewardship and procurement mechanisms in the context of the Program for Prevention and Control of Human Rabies and the National Canine and Feline Vaccination Week in Mexico. Materials and methods: The information was obtained through requests to the National Institute of Transparency, Access to Information and Protection of Personal Data. Results: From 2009 to 2017, 158.9 million doses of canine rabies vaccine (VAR-CF) were applied with an estimated budget of 1 915 million pesos. Our findings suggest weak stewardship and ineffective governance that allows monopolistic practices and fragmented and direct purchases. Prices for the same product vary discretionally between states and are significantly higher than those offered at international level. Conclusions: After 30 years of operation of the SNVA-C in Mexico, high prices of the VAR-CF persist, which are indicative of a significant market failure, characterized by zero competition, asymmetric information and misaligned incentive structures that precluded favorable price negotiation.

Bolsa família program and incomplete childhood vaccination in two Brazilian cohorts / Programa bolsa família e vacinação infantil incompleta em duas coortes brasileiras

ABSTRACT OBJECTIVE: To estimate the effect of being a beneficiary of the Bolsa Família Program (BFP) in the vaccination of children aged 13 to 35 months. METHODS: Our study was based on all birth records of residents of Ribeirão Preto (SP) and probabilistic sampling with 1/3 of the births of residents of São Luís (MA), selecting low-income children, born in 2010, belonging to the cohorts Brazilian Ribeirão Preto and São Luís Birth Cohort Studies and eligible for the Bolsa Família program. The information of Cadastro Único (CadÚnico - Single Registry) was used to categorize the receipt of benefit from the BFP (yes or no). The final sample consisted of 532 children in Ribeirão Preto and 1,229 in São Luís. The outcome variable was a childhood vaccine regimen, constructed with BCG, tetravalent, triple viral, hepatitis B, poliomyelitis, rotavirus and yellow fever vaccines. The adjustment variables were: economic class, mother's schooling and mother's skin color. Children with monthly per capita family income of up to R$ 280.00 and/or economic class D/E were considered eligible for the benefit of the BFP. A theoretical model was constructed using a directed acyclic graph to estimate the effect of being a beneficiary of the BFP in the vaccination of low-income children. In the statistical analyses, weighing was used by the inverse of the probability of exposure and pairing by propensity score. RESULTS: Considering a monthly per capita family income of up to R$ 280.00, being a beneficiary of the BFP had no effect on the childhood vaccination schedule, according to weighing by the inverse of the probability of exposure (SL-coefficient: −0.01; 95%CI −0.07 to 0.04; p = 0.725 and RP-coefficient: 0.04; 95%CI −0.02 to 0.10; p = 0.244) and pairing by propensity score (SL-coefficient: −0.01; 95%CI −0.07 to 0.05; p = 0.744 and RP-coefficient: 0.04; 95%CI −0.02 to 0.10; p = 0.231). CONCLUSIONS: The receipt of the benefit of the BFP did not influence childhood vaccination, which is one of the conditionalities of the program. This may indicate that this conditionality is not being adequately monitored.

RESUMEN OBJETIVO: Estimar o efeito de ser beneficiário do Programa Bolsa Família (PBF) na vacinação de crianças de 13 a 35 meses. MÉTODOS: Partiu-se de todos os registros de nascimentos de residentes de Ribeirão Preto (SP) e de amostragem probabilística com ⅓ dos nascimentos de residentes de São Luís (MA), selecionando-se crianças de baixa renda, nascidas em 2010, pertencentes às coortes Brazilian Ribeirão Preto and São Luís Birth Cohort Studies e elegíveis ao PBF. As informações do Cadastro Único (CadÚnico) foram utilizadas para categorizar o recebimento de benefício do PBF (sim ou não). A amostra final foi de 532 crianças em Ribeirão Preto e 1.229 em São Luís. A variável-desfecho foi esquema vacinal infantil, construída com as vacinas BCG, tetravalente, tríplice viral, hepatite B, poliomielite, rotavírus e febre amarela. As variáveis de ajuste foram: classe econômica, escolaridade da mãe e cor de pele da mãe. Consideraram-se elegíveis ao benefício do PBF crianças com renda familiar per capita mensal de até R$ 280,00 e/ou da classe econômica D/E. Para estimar o efeito de ser beneficiário do PBF na vacinação de crianças de baixa renda, construiu-se um modelo teórico por meio de gráfico acíclico direcionado. Nas análises estatísticas, foi usada ponderação pelo inverso da probabilidade de exposição e pareamento por escore de propensão. RESULTADOS: Considerando renda familiar per capita mensal de até R$ 280,00, ser beneficiário do PBF não teve efeito no esquema vacinal infantil, segundo ponderação pelo inverso da probabilidade de exposição (SL-coeficiente: −0,01; IC95% −0,07 a 0,04; p = 0,725 e RP-coeficiente: 0,04; IC95% −0,02 a 0,10; p = 0,244) e pareamento pelo escore de propensão (SL-coeficiente: −0,01; IC95% −0,07 a 0,05; p = 0,744 e RP-coeficiente: 0,04; IC95% −0,02 a 0,10; p = 0,231). CONCLUSÕES: O recebimento do benefício do PBF não exerceu influência sobre a vacinação infantil, que é uma das condicionalidades do programa. Isso pode indicar que essa condicionalidade não está sendo adequadamente acompanhada.

Covid-19 and its impact on immunization programs: reflections from Brazil

ABSTRACT Due to social distancing guidelines and the displacement of both human and material resources to fight the covid-19 pandemic, individuals seeking healthcare services face certain challenges. Immunization programs have already been a worrisome topic for health authorities due to declines in vaccine uptake rates and are now especially affected by the covid-19 pandemic. Disbelief in science, dissemination of fake news about vaccines, socioeconomic vulnerability and social inequality are some of the challenges faced. This commentary article discusses the impacts of the covid-19 pandemic on immunization programs in Brazil. In light of advances (and notability) of Brazil's national immunization program, established in the 1970s, the programs face challenges, such as the recent drop in vaccine uptake rates. In addition to this health crisis, there is also Brazil's current political crisis, which will undoubtedly require assistance from researchers, policymakers and society to be fixed.

Áreas com queda da cobertura vacinal para BCG, poliomielite e tríplice viral no Brasil (2006-2016): mapas da heterogeneidade regional / Areas with declining vaccination coverage for BCG, poliomyelitis, and MMR in Brazil (2006-2016): maps of regional heterogeneity / Áreas con una caída de la cobertura de vacunación para BCG, poliomielitis y triple vírica en Brasil (2006-2016): mapas de la heterogeneidad regional

A imunização é reconhecida como uma das intervenções mais bem-sucedidas e custo-efetivas, resultando na erradicação e no controle de diversas doenças em todo o mundo. Todavia, uma preocupante redução na cobertura vacinal tem sido observada no Brasil, trazendo o recrudescimento de algumas doenças até então superadas. Dessa forma, no intuito de realizar um diagnóstico situacional que pondere as diferentes regiões do país e a tendência temporal de cobertura vacinal, o presente estudo teve o objetivo de evidenciar áreas com queda da cobertura vacinal de BCG, poliomielite e tríplice viral no Brasil por meio de um estudo ecológico que coletou informações acerca do número crianças de até um ano de idade imunizadas para essas três vacinas, no período entre 2006 e 2016, por município brasileiro. Os dados foram adquiridos por meio do Departamento de Informática do SUS. Foi realizada uma varredura espacial, analisando as variações espaciais nas tendências temporais de cobertura vacinal. Foi observada uma tendência de redução no número de imunizações no Brasil, com quedas de 0,9%, 1,3% e 2,7% ao ano para BCG, poliomielite e tríplice viral, respectivamente. Ademais, aglomerados significativos com tendências temporais de redução da cobertura vacinal foram verificados em todas as cinco regiões brasileiras. O estudo evidencia uma importante redução na cobertura vacinal nos últimos anos, constatando heterogeneidades consideráveis entre os municípios. Dessa forma, uma atenção singular e planejamento estratégico condizente com as características de cada localidade são necessários para o controle tanto da redução de cobertura vacinal como do reaparecimento de doenças no Brasil.

Immunization is known to be one of the most successful and cost-effective health interventions, resulting in the eradication and control of various diseases in the world. However, Brazil has experienced a worrisome drop in vaccination coverage, associated with the resurgence of various previously controlled or eradicated diseases. This study thus conducted a situational diagnosis weighing Brazil's different regions and time trends in vaccination coverage in order to identify areas with reduction in vaccination coverage for BCG, poliomyelitis, and MMR. This ecological study collected data on the number of children up to one year of age who had been vaccinated with these three vaccines from 2006 to 2016, according to municipality (county). Data were obtained from the Brazilian Health Informatics Department. A spatial scan was performed, analyzing spatial variations in the time trends for vaccination coverage. Downward trends were seen in the number of immunizations in Brazil, with reductions of 0.9%, 1.3%, and 2.7% per year for BCG, poliomyelitis, and MMR, respectively. Significant decreases were also seen in all five major geographic regions with time trends in the reduction of vaccination coverage. The study evidenced an important reduction in vaccination coverage in recent years, with major heterogeneity between municipalities. Thus, focused attention and strategic planning in keeping with each local area's characteristics are necessary to address both the reduction of vaccination coverage and the resurgence of vaccine-preventable diseases in Brazil.

La inmunización está reconocida como una de las intervenciones más exitosas y costo-eficientes, consiguiendo la erradicación y control de diversas enfermedades en todo el mundo. Sin embargo, se ha observado una preocupante reducción en la cobertura de la vacunación en Brasil, conllevando el recrudecimiento de algunas enfermedades hasta entonces superadas. De esta forma, con el fin de realizar un diagnóstico situacional, que pondere las diferentes regiones del país y la tendencia temporal de cobertura vacunación, el presente estudio tuvo como objetivo evidenciar áreas con una caída de la cobertura vacunación respecto a BCG, poliomielitis y triple vírica en Brasil. Se trata de un estudio ecológico, que recabó información acerca del número de niños de hasta un año de edad inmunizados con estas tres vacunas, durante el período entre 2006 y 2016, por municipios brasileños. Los datos se consiguieron a través del Departamento de Informática del SUS. Se realizó un barrido espacial, analizando las variaciones espaciales en las tendencias temporales de cobertura de vacunación. Se observó una tendencia de reducción en el número de inmunizaciones en Brasil, con caídas de 0,9%, 1,3% y 2,7% al año, en el caso de BCG, poliomielitis y triple vírica, respectivamente. Además, se verificaron aglomerados significativos con tendencias temporales de reducción en la cobertura de vacunación dentro de las cinco regiones brasileñas. El estudio evidencia una importante reducción en la cobertura de vacunación durante los últimos años, constatando heterogeneidades considerables entre los municipios. De esta forma, una atención singular y planificación estratégica, acorde con las características de cada localidad, son necesarias para el control, tanto de la reducción de la cobertura de vacunación, como del resurgimiento de enfermedades en Brasil.