Brazilian National Immunization Research Articles

Low vaccine coverage and varicella outbreaks in Brazil − 2019-2022

The persistence of varicella outbreaks in Brazil has underscored the high concern with the low vaccine coverage in the last 4 years.Using publicly available data from the Brazilian Health System (SUS), this study analyzed varicella vaccine coverage and incidence trends from 2019 to 2022 in Brazilian States. Vaccine coverage decreased nationally in 2020, possibly influenced by the COVID-19 pandemic’s initial phase.In Bahia State, we have the persistence of varicella with an incidence rate of 3.0 cases per 100,000 inhabitants (higher incidence compared to other States) in 2023. Under 15 months children and young children (4–6 Years old) faced the highest risk, urging the importance of vaccination. Despite a monovalent varicella vaccine being available through Brazil’s National Immunization Program (NIP), Bahia fell short of achieving the ≥95 % disease control target for coverage.The study highlight the importance of vaccines to prevent some infectious diseases, as varicella, in poor tropical regions. Addressing vaccine hesitancy and misinformation, and augmenting awareness campaigns, are important to achieve and sustain high vaccine coverage over 80% as WHO guidelines to obtain a safe rate of protection for Brazilian population (Brazil's national immunization program has a target of 95% coverage).

Strategies to increase vaccine coverage in brazilian territory

The Brazilian National Immunization Program (PNI), created in 1973, is a comprehensive and successful vaccination program, providing vaccines free of charge to all citizens, regardless of age, income, or place of residence. It maintains a vaccination schedule aimed at achieving high immunization rates against various diseases. However, it faces challenges such as misinformation, anti-vaccine movements, distrust in health authorities, difficulties in access, and interruptions in vaccine distribution, which have led to a decline in vaccination rates. To reverse this trend, several strategies can be adopted, adapted to the local context. This includes knowledge of the territory, vaccination campaigns, vaccination units, home visits and active patient outreach, Health Education in the school environment, public-private partnerships, effective communication, electronic records, ongoing education for healthcare professionals, identification of high-risk groups, and awareness campaigns. These strategies should be implemented in coordination, taking into account the characteristics of each territory. Collaboration between the government, healthcare professionals, schools, and the community is essential to ensure the protection of the population against infectious diseases. Strengthening vaccination is crucial for promoting public health and preventing outbreaks of preventable diseases in Brazil.

Carriage of oropharyngeal bacteria among children in a vulnerable rural population living in a tropical region in São Paulo, Brazil

This study aimed to detect the carriage of _Streptococcus pneumoniae_, _Haemophilus influenza_, and _Moraxella catarrhalis_ in the oropharynx and a possible association for airway infections in children of a vulnerable population living in a tropical rural settlement, São Paulo, Brazil. Demographic data were collected through standard questionnaires. Oropharyngeal samples were cultured and examined using the multiplex polymerase chain reaction. The molecular method had higher sensitivity and revealed a high rate of colonization by _S. pneumoniae _and _M. catarrhalis_. _H. influenza_ was not detected, highlighting the strength of Brazil's national immunization program. Low income was reported by 61.4% of participants. Carriage of _S. pneumoniae _was positively associated with being female (_P_=0.004) and being brown color (_P= _0.042). We identified risk factors for respiratory infections and vulnerabilities that may be widely applicable to other rural communities in Brazil and other settings of developing countries.

Incidence of vaccine-related anaphylaxis from Brazil's National Immunization Program

Incidence of vaccine-related anaphylaxis from Brazil's National Immunization Program

The impact of strategies for increasing vaccination coverage in children: A community clinical trial

The Brazilian National Immunization Program (PNI) has been consolidating itself as one of the most relevant interventions in public health. Paradoxically, great challenges arise for the PNI. The phenomenon of falling vaccine coverage is observed not only in Brazil, but in several countries. In the year 2021, faced with the unfavorable scenario of a drop in vaccination coverage, the State Department of Health, and the Federal University of Minas Gerais joined forces to implement a research-intervention project. This study aimed to evaluate the impact of this intervention on vaccination coverage in children under 2 years of age and on indicators of immunization work processes. This is a community clinical trial carried out in 212 municipalities in the state. Workshops were held and Municipal Action Plans were created. Vaccination coverage data were obtained from the National Immunization Program Information System (SIPNI) and evaluated using the Mann-Whitney U Test and the McNemar Test. Work process indicators were evaluated using the Friedman and Wilcoxon tests. The results demonstrate an important improvement for most of the indicators in the three analyzed times, with statistical significance and an increase in medians and interquartile ranges. Among the indicators that showed the best performance, it is possible to mention those related to the active search by the Community Health Agent. Regarding vaccine coverage, for all immunobiologicals analyzed, there was an increase in the percentage of municipalities that reached targets when comparing the years 2022 and 2021, except for hepatitis A. The intervention research had a positive impact on vaccine coverage of children under 2 years of age and on indicators of immunization work processes in municipalities in the state of Minas Gerais, Brazil.

Pertussis antibodies and vaccination coverage among healthcare professionals in Brazil is inadequate: A cross-sectional serological study

IntroductionWorldwide, tetanus-diphtheria-acellular pertussis (Tdap) vaccination coverage of healthcare professionals (HCPs) is below 40%, but this data is not available for Brazil. We hypothesize that a high number of HCPs are not immune to pertussis in Brazil. Main objective was to determine the seroprevalence of anti-pertussis toxin (anti-PT IgG) among HCPs. Secondary objectives were to evaluate Tdap vaccination coverage, to assess predictive factors associated with anti-PT IgG, and to estimate the decay of anti-PT IgG and time to Tdap vaccination. MethodsObservational cross-sectional serological study in 352 HCPs who worked at São Paulo Hospital - Federal University of São Paulo (UNIFESP) in 2020, approved by UNIFESP Ethics Committee. Data collected included sociodemographics, knowledge about Tdap, and vaccination status. Anti-PT IgG were quantified by ELISA: <10 IU/mL seronegative and ≥ 10–1000 IU/mL seropositive. Titers ≥ 10–50 IU/mL were classified low positivity, indicating no recent B. pertussis infection or Tdap vaccination; >50 IU/mL high positivity, indicating recent B. pertussis infection or Tdap vaccination, and > 100 IU/mL as acute B. pertussis infection or Tdap vaccination in the previous year. Comparisons were done by Chi-square test, multivariable logistic regression, and Pearsońs correlation, at 5% p-level. Results331/352 HCPs were not aware the Brazilian National Immunization Program recommends Tdap for all HCPs and pregnant women. 68/339 HCPs received Tdap (mean 3.1 ± 2.0 years). 55/352 were seronegative for pertussis, all unvaccinated. 56/271 with no history of Tdap vaccination had high positivity. The probability of anti-PT IgG > 50 IU/mL was 11.5 times higher in Tdap vaccinated HCPs than in non-vaccinated (p < 0.001). There was a weak but significant correlation between anti-PT IgG and interval of Tdap vaccination (r = 0.404; p = 0.001). Anti-PT IgG dropped 5 IU/mL/year (p = 0.001). ConclusionBetter education of HCPs on needs and benefits of Tdap vaccination is critical. Goals must be to improve HCPs vaccination coverage.

Trends in Pneumococcal and Bacterial Meningitis in Brazil from 2007 to 2019.

The pneumococcal conjugate vaccination (PCV) was introduced into the Brazilian Childhood National Immunization Program in 2010; however, universal pneumococcal vaccination for older adults has not been implemented yet. Our aim is to evaluate the trends in pneumococcal meningitis incidence and case fatality rate (CFR) across all age groups from 2007 to 2019 using data from the National Surveillance System. The pre-PCV (2007-2009) and post-PCV (2011-2019) periods were compared; changes in incidence and CFR were assessed by joinpoint regression. Additional analyses of bacterial meningitis were performed to compare the patterns and trends. Over the 13-year period, 81,203 and 13,837 cases were classified as bacterial and pneumococcal meningitis, respectively. S. pneumoniae was the main etiological agent of bacterial meningitis in adults aged ≥50 years and the most lethal in all age groups. In the post-PCV period, a 56.5% reduction in the average incidence was seen in pneumococcal meningitis in the pediatric population. In contrast, there was an increasing trend among adults. The CFR for pneumococcal and bacterial meningitis remained stable in most age groups during the study period. These findings highlight the value of expanding pneumococcal vaccination policies, including vaccines that provide better indirect protection from children to adults and broadening vaccination to older adults.

Spatial analysis of vaccine coverage in children under the age of 1 year by mesoregions in Paraíba a northeastern Brazilian state.

Immunization is one of the most effective measures in public health, and it is responsible for the reduction of vaccine-preventable diseases. In the present study, vaccine coverage (VC) and the spatial dynamics of homogeneity of VC (HVC) were compared and analyzed in the terms of the immunobiologicals administered to children aged < 1 year in a state in Paraíba, Brazil. This is a mixed ecological study that used public-domain secondary data from the years 2016 and 2017 from the Information System of the Brazilian National Immunization Program (SI-PNI) and the Brazilian National Information System of Live Births (SINASC). VC rates were calculated by dividing the number of administered doses by the number of live births. Then, VC was classified into four categories. The Municipal HVC was considered adequate when the overall VC exceeds 75%. The study included a descriptive analysis and a spatial autocorrelation analysis for HVC using global and local Moran's statistics. The stratified VC analysis revealed a significant number of municipalities in each of the state's mesoregions with low or very low VC rates for all immunobiologicals, with the Mata Paraibana mesoregion having the worst percentages in both years studied. The spatial analysis of HVC revealed several clusters of inadequate homogeneity, with Mata Paraibana being the worst mesoregion in 2016. The analysis of spatial dynamics and spatial statistics techniques allows the precise identification of vulnerable areas, "vaccination pockets," making it possible to develop plans aimed at meeting the targets of the PNI.

Prevalence, capsular types, antimicrobial resistance and risk factors associated with pneumococcal carriage among children after long-term 10-valent pneumococcal conjugate vaccine use in Brazil.

The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced for childhood vaccination in Brazil's National Immunization Program in 2010. After nine years of PCV10 use, we investigated the carriage prevalence, capsular types, antimicrobial resistance and risk factors among children living in Niterói city, RJ, Brazil. Between September and December 2019, we conducted a cross-sectional study and recruited children under 6years of age. Antimicrobial susceptibility was evaluated by the disk-diffusion method and MICs to beta-lactams and macrolides were determined by E-test®. Capsular types were deduced by multiplex PCR. Logistic regression was used to predict risk factors for pneumococcal carriage. Seventy-five (17.4%) of the 430 children were pneumococcal carriers. The most frequent capsular types were 6C/D (14.7%), 11A/D (13.3%), and 23B (9.3%). PCV10 serotypes represented 5.3%. All isolates were susceptible to levofloxacin, linezolid, rifampicin, and vancomycin. Penicillin non-susceptible pneumococci (PNSP) made up 37.3%, with penicillin and ceftriaxone MICs ranging from 0.12 to 4.0μg/ml and 0.064-4.0μg/ml, respectively. Of the 19 (25.3%) erythromycin-resistant (ERY-R) isolates (macrolide MICs of 6 to>256μg/ml), most had the cMLSB phenotype (84.2%) and carried the erm(B) gene (73.7%). We detected 17 (22.6%) multidrug-resistant (MDR) isolates, strongly associated with serotype 6C/D. Presence of any symptoms, chronic diseases, childcare center attendance, living with young siblings, slum residence, and unstable income were predictors of pneumococcal carriage. Long-term universal childhood use of PCV10 has nearly eliminated carriage with PCV10 serotypes, but the high frequency of MDR isolates, especially associated with serotype 6C/D, remains a concern. Replacing PCV10 with PCV13 should reduce the proportion of ERY-R isolates and PNSP by at least 14% and 18%, respectively.

Persistence of immunity against hepatitis A in Brazilian children vaccinated with a single dose of inactivated virus vaccine.

In 2014, the Brazilian National Immunization Program implemented the universal vaccination against the hepatitis A virus (HAV) for children aged 12 months and older, applying a single dose of the inactivated virus vaccine. It is essential to carry out follow-up studies in this population, aiming to verify the longevity of HAV immunological memory. This study evaluated the humoral and cellular immune response of a cohort of children vaccinated between 2014 and 2015, and further investigated between 2015 and 2016, and who had their initial antibody response assessed after the single dose. A second evaluation took place in January 2022. We examined 109 children out of the 252 that took part in the initial cohort. Seventy (64.2%) of them had anti-HAV IgG antibodies. Cellular immune response assays were performed in 37 anti-HAV-negative and 30 anti-HAV-positive children. Production of interferon-gamma (IFN-y) stimulated with the VP1 antigen was demonstrated in 34.3% of these 67 samples. Of the 37 negative anti-HAV samples, 12 (32.4%) produced IFN-y. Among the 30 anti-HAV-positive, 11 (36.7%) produced IFN-y. In total, 82 (76.6%) children presented some type of immune response against HAV. These findings demonstrate the persistence of immunological memory against HAV in the majority of children vaccinated between 6 and 7 years with a single dose of the inactivated virus vaccine.

Measles, mumps and rubella vaccine 12 months after hematopoietic stem cell transplantation.

The measles, mumps and rubella (MMR) vaccine is usually recommended from 24 months after a hematopoietic stem cell transplant (HSCT). Some authors have demonstrated that the MMR vaccination can be safe from 12 months post-HSCT in non-immunosuppressed patients, as recommended by the Brazilian National Immunization Program/Ministry of Health, since 2006. The objectives of this study were to evaluate when patients received MMR vaccine after an HSCT in our care service and if there were reports of any side effects. We retrospectively reviewed the records of HSCT recipients who received at least one MMR dose in our care service, a quaternary teaching hospital in Sao Paulo city, Brazil, from 2017 to 2021. We identified 82 patients: 75.6% (90.1% in the autologous group and 45.1% in the allogeneic group) were vaccinated before 23 months post-transplantation. None reported side effects following the vaccination. Our data support that the MMR vaccination is safe from 12 to 23 months after HSCT.

50 years of the Brazilian National Immunization Program and the Immunization Agenda 2030

50 years of the Brazilian National Immunization Program and the Immunization Agenda 2030

2183. Population-based Mortality Rate Trends of Potential Pneumococcal Pneumonia in Brazil from 2006-2019

Abstract Background Pneumococcal Disease is an important public health problem. In 2010, childhood pneumococcal vaccination with the 10-valent conjugate vaccine (PCV-10) was introduced in the Brazilian national immunization program. No public universal program is currently available for older adults; selected populations at risk are eligible to receive pneumococcal vaccine in few public centers across the country. The objective of this study was to assess trends in mortality rate (MR) due to potential pneumococcal pneumonia (PPP) from 2006-2019 in Brazil. Methods Death data were obtained from the Mortality Information System (SIM) and population data from the Brazilian Institute of Geography and Statistics (IBGE). ICD-10 codes included J13-J18. Yearly MR were calculated per 100,000 people. The percentage of change was calculated using average rate in the pre-(2006-2009) and post-PCV10 (2011-2019) vaccine introduction periods. Joinpoint regression was performed to assess changes in rates per 100,000 people and annual percentage changes (APCs) for each line segment and 95% confidence interval were estimated. Results During 2006-2019, 887,304 deaths by PPP occurred in all-age groups. Most cases were reported as unspecific pneumonia (99.8%). Mean MRs decreased in children &amp;lt; 5 years in post-PCV10 period, in contrast to increasing rates in adults ≥ 50 years (Table 1 and Figure 1). Among children less than 18 years, significant decreasing trends in MR by 5.5%, 2.9%, and 1.6% per year were observed in &amp;lt; 1year, 1-4 years, and 5-17 years, respectively, between 2006-2019 (Table 2). Although significantly decreasing trends were observed in 60-64 years and ≥65 years age groups during 2015-2019, the average APC increased by 1.0% (95%CI;0.3%;1.8%) and 1.4% (95%CI;0.5%;2.2%) in the post-PCV-10, respectively (Table 2). Table 1.Mean mortality rates by age groups for potential pneumococcal pneumonia in the pre-vaccination period (2006-2009) and post-vaccination period (2011-2019) , BrazilFigure 1.Mortality rate of pneumonia by age group in parallel with infant vaccination coverage, 2006-2019Table 2.Jointpoint analysis for mortality rate trends of potential pneumococcal pneumonia by age groups, Brazil, 2006-2019 Conclusion In post-PCV10 period, mortality rate of PPP declined mostly for infants. For older adults, the mortality trends have been consistently higher compared to &amp;lt; 18 age groups, being unable to demonstrate indirect effects of childhood vaccination. These findings inform decision makers about needs related to pneumococcal disease prevention and interventions among older adults. Disclosures Cintia I. Parellada, MD, PhD, MSD Brazil: Employee of MSD Brazil, a subsidiary of Merck &amp; Co., Inc.,|MSD Brazil: Stocks/Bonds Ana Luiza Bierrenbach, MD, PhD, Merck &amp; Co., Inc.: Advisor/Consultant Carolina Zampirolli, Msc, Merck &amp; Co., Inc.: Advisor/Consultant|Merck &amp; Co., Inc.: Employee of IQVIA who received funding to execute this study Ariane Abreu, Msc, Merck &amp; Co., Inc.: Advisor/Consultant|Merck &amp; Co., Inc.: Employee of IQVIA who received funding to execute this study Guilherme Julian, Msc, Merck &amp; Co., Inc.: Advisor/Consultant|Merck &amp; Co., Inc.: Employee of IQVIA who received funding to execute this study Thais Moreira, MD, MSc, MSD Brazil: Employee of MSD Brazil, a subsidiary of Merck &amp; Co., Inc.,|MSD Brazil: Stocks/Bonds Licieri Figueiredo, MD, Merck &amp; Co., Inc.: Employee of MSD Brazil, a subsidiary of Merck &amp; Co., Inc.,.

Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil

BackgroundThere is limited information on the inequity of access to vaccination in low-and-middle-income countries during the COVID-19 pandemic. Here, we described the progression of the Brazilian immunisation program for COVID-19, and the association of socioeconomic development with vaccination rates, considering the potential protective effect of primary health care coverage.MethodsWe performed an ecological analysis of COVID-19 immunisation data from the Brazilian National Immunization Program from January 17 to August 31, 2021. We analysed the dynamics of vaccine coverage in the adult population of 5,570 Brazilian municipalities. We estimated the association of human development index (HDI) levels (low, medium, and high) with age-sex standardised first dose coverage using a multivariable negative binomial regression model. We evaluated the interaction between the HDI and primary health care coverage. Finally, we compared the adjusted monthly progression of vaccination rates, hospital admission and in-hospital death rates among HDI levels.FindingsFrom January 17 to August 31, 2021, 202,427,355 COVID-19 vaccine doses were administered in Brazil. By the end of the period, 64·2% of adults had first and 31·4% second doses, with more than 90% of those aged ≥60 years with primary scheme completed. Four distinct vaccine platforms were used in the country, ChAdOx1-S/nCoV-19, Sinovac-CoronaVac, BNT162b2, Ad26.COV2.S, composing 44·8%, 33·2%, 19·6%, and 2·4% of total doses, respectively. First dose coverage differed between municipalities with high, medium, and low HDI (Median [interquartile range] 72 [66, 79], 68 [61, 75] and 63 [55, 70] doses per 100 people, respectively). Municipalities with low (Rate Ratio [RR, 95% confidence interval]: 0·87 [0·85-0·88]) and medium (RR [95% CI]: 0·94 [0·93-0·95]) development were independently associated with lower vaccination rates compared to those with high HDI. Primary health care coverage modified the association of HDI and vaccination rate, improving vaccination rates in those municipalities of low HDI and high primary health care coverage. Low HDI municipalities presented a delayed decrease in adjusted in-hospital death rates by first dose coverage compared to high HDI locations.InterpretationIn Brazil, socioeconomic disparities negatively impacted the first dose vaccination rate. However, the primary health care mitigated these disparities, suggesting that the primary health care coverage guarantees more equitable access to vaccines in vulnerable locations.FundingThis work is part of the Grand Challenges ICODA pilot initiative, delivered by Health Data Research UK and funded by the Bill & Melinda Gates Foundation and the Minderoo Foundation. This study was supported by the National Council for Scientific and Technological Development (CNPq), the Coordination for the Improvement of Higher Education Personnel (CAPES) - Finance Code 001, Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ) and the Pontifical Catholic University of Rio de Janeiro.

Vaccine Mismatches, Viral Circulation, and Clinical Severity Patterns of Influenza B Victoria and Yamagata Infections in Brazil over the Decade 2010-2020: A Statistical and Phylogeny-Trait Analyses.

Worldwide, infections by influenza viruses are considered a major public health challenge. In this study, influenza B vaccine mismatches and clinical aspects of Victoria and Yamagata infections in Brazil were assessed. Clinical samples were collected from patients suspected of influenza infection. In addition, sociodemographic, clinical, and epidemiological information were collected by the epidemiological surveillance teams. Influenza B lineages were determined by real-time RT-PCR and/or Sanger sequencing. In addition, putative phylogeny–trait associations were assessed by using the BaTS program after phylogenetic reconstruction by a Bayesian Markov Chain Monte Carlo method (BEAST software package). Over 2010–2020, B/Victoria and B/Yamagata-like lineages co-circulated in almost all seasonal epidemics, with B/Victoria predominance in most years. Vaccine mismatches between circulating viruses and the trivalent vaccine strains occurred in five of the eleven seasons (45.5%). No significant differences were identified in clinical presentation or disease severity caused by both strains, but subjects infected by B/Victoria-like viruses were significantly younger than their B/Yamagata-like counterparts (16.7 vs. 31.4 years, p < 0.001). This study contributes to a better understanding of the circulation patterns and clinical outcomes of B/Victoria- and B/Yamagata-like lineages in Brazil and advocate for the inclusion of a quadrivalent vaccine in the scope of the Brazilian National Immunization Program.

EE320 Budget Impact Analysis of Implementing a 23-Valent Pneumococcal Polysaccharide Vaccine in the Brazilian National Immunization Program for Adults 60 Years Old

Brazil does not have pneumococcal vaccine as part of the older adults’ immunization schedule in National Immunization Program (NIP). This study aims to estimate the budget impact of implementing a single dose of 23-valent polysaccharide vaccine (PPSV23) into NIP for adults aged 60 years from the Brazilian public payer perspective.

Spatial analysis of vaccine coverage on the first year of life in the northeast of Brazil

BackgroundOver time, vaccination has been consolidated as one of the most cost effective and successful public health interventions and a right of every human being. This study aimed to assess the spatial dynamics of the vaccine coverage (VC) rate of children aged < 1 year per municipality in the Brazilian Northeast at 2016 and 2017.MethodsThis is a mixed-type ecological study that use a Public domain data Health Information. Vaccine doses were obtained from the Information System of the Brazilian National Immunization Program, and live births from the Brazilian Information System of Live Births of the Brazilian Unified Health System. Descriptive analysis of the coverage of all the vaccines for each year of the study was conducted, and Mann–Whitney U test was used to compare VC between the study years. Chi-squared test was used to evaluate the association between the years and VC, which was stratified into four ranges, very low, low, adequate, and high. Spatial distribution was analyzed according to both each study year and vaccine and presented as thematic maps. Spatial autocorrelation was analyzed using Moran’s Global and Local statistics.ResultsCompared with 2017, 2016 showed better VC (p < 0.05), except for Bacillus Calmette–Guérin. In the spatial analysis of the studied vaccines, the Global Moran’s Index did not show any spatial autocorrelation (p > 0.05), but the Local Moran’s Index showed some municipalities, particularly the Sertão Paraibano region, with high VC, high similarity, and a positive influence on neighboring municipalities (p < 0.05). In contrast, most municipalities with low VC were concentrated in the Mata Paraibano region, negatively influencing their neighbors (p < 0.05).ConclusionUneven geographic regions and clusters of low VC for children aged < 1 year in the State of Paraíba were spatially visualized. Health policy makers and planners need to urgently devise and coordinate an action plan directed at each state’s regions to fulfill the vaccination calendar, thereby reversing the vulnerability of this age group, which is at a higher risk of diseases preventable by vaccination.

Impact of the COVID-19 Pandemic on Human Papillomavirus Vaccination in Brazil.

Objective: To analyze the number of applied HPV vaccine doses before (from April 2019 to March 2020) and after (from April 2020 to September 2020) social distancing measures in response to the COVID-19 pandemic in states and regions of Brazil. Methods: Ecological time-series study, using data from the Brazilian National Immunization Program (PNI). Using the Mann-Whitney test, we evaluated the difference between the median number of applied doses during the periods April 2019 to March 2020 and from April 2020 to September 2020. Spatial analysis identified clusters with a high or low percentage reduction in the median applied doses. Prais-Winsten regression models identified temporal trends in the applieddoses from both periods. Results: There was a significant reduction in the median HPV vaccine doses applied, formation of spatial clusters and, after a sharp drop in the number of applieddoses during the months following social distancing. There was a tendency to increase the applied vaccines doses. Conclusion: The COVID-19 pandemic resulted in reduction of the number of HPV vaccine doses applied as a possible effect of restrictive measures caused by the pandemic.

The Impact of an Inactivated Hepatitis A Vaccine with One Dose in Brazil: A Retrospective Time-Series.

Background: In 2014, a recommended one-dose of inactivated hepatitis A vaccine was included in the Brazilian National Immunization Program targeting children 12–24 months. This decision addressed the low to intermediate endemicity status of hepatitis A across Brazil and the high rate of infection in children and adolescents between 5 and 19 years old. The aim of the study was to conduct a time-series analysis on hepatitis A incidence across age groups and to assess the hepatitis A distribution throughout Brazilian geographic regions. Methods: An interrupted time-series analysis was performed to assess hepatitis A incidence rates before (2010–2013) and after (2015–2018) hepatitis A vaccine program implementation. The time-series analysis was stratified by age groups while a secondary analysis examined geographic distribution of hepatitis A cases. Results: Overall incidence of hepatitis A decreased from 3.19/100.000 in the pre-vaccine period to 0.87/100.000 (p = 0.022) post-vaccine introduction. Incidence rate reduction was higher among children aged 1-4 years old, with an annual reduction of 67.6% in the post-vaccination period against a 7.7% annual reduction in the pre-vaccination period (p < 0.001). Between 2015 and 2018, the vaccination program prevented 14,468 hepatitis A cases. Conclusion: Our study highlighted the positive impact of a recommended one-dose inactivated hepatitis A vaccine for 1–4-years-old in controlling hepatitis A at national level.

Invasive pneumococcal disease in children with cancer: Incidence density, risk factors and isolated serotypes

BackgroundPediatric oncology patients (POP) have a high risk of infections due to impaired immunity. Invasive pneumococcal disease (IPD) is an important cause of severe infection in these patients and it is associated with high mortality. This study aimed to evaluate the incidence and risk factors associated with IPD at a Pediatric Oncology Center in Brazil. MethodsThis was a retrospective case-control study. All IPD cases in children with cancer from 2005 through 2016 were reviewed. Each case of IPD was matched with two controls from a cohort of patients matched for year of IPD, age and disease in order to assess risk factors. The incidence density was calculated as the number of IPD per 100,000 patients-year. ResultsA total of 51 episodes of IPD in 49 patients was identified. All pneumococci were isolated from blood cultures. The median age was five years and 67% were male; mortality rate was 7.8%. The IPD incidence density rate in POP was 311.21 per 100,000 patients-year, significantly higher than the rate in the general pediatric population. Severe neutropenia was the only risk factor associated with IPD, after multivariate conditional logistic regression analysis. ConclusionAlthough pneumococcal disease decreased after the introduction of 10-valent pneumococcal vaccine in the Brazilian national immunization schedule in 2010, there was no decrease in the IPD incidence rate in our cohort. A higher coverage rate of pneumococcal vaccination in children in the general population might be necessary to reduce the incidence rate in this high-risk population.