ABSTRACT Objective To describe vaccination coverage and hesitation for the basic children’s schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. Methods Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. Results Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. Conclusion Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities. childrens children s state Brazil Populationbased Population based 202 2022 doses, , doses) strata were respectively 502 50 2 50.2 95%CI 95CI CI 95 44.156.2 441562 44.1 56.2 44 1 56 44.1;56.2 16 6 1.6 0.92.7, 0927 0.9 2.7 0 9 7 0.9;2.7) n 1,866, 1866 1,866 866 1,866) 649 64 64.9 56.972.1 569721 56.9 72.1 72 56.9;72.1 10 1.0 0.32.8, 0328 0.3 2.8 3 8 0.3;2.8) 451, 451 451) vaccines coverages disparities 20 5 50. 156 44.156. 44156 441 44. 562 56. 4 44.1;56. 1. 92 0.92.7 092 09 0. 27 2. 0.9;2.7 186 1,86 86 64. 972 56.972. 56972 569 721 72. 56.9;72. 32 0.32.8 032 03 28 0.3;2.8 45 15 44.156 4415 44.1;56 0.92. 0.9;2. 18 1,8 97 56.972 5697 56.9;72 0.32. 0.3;2. 44.15 44.1;5 0.92 0.9;2 1, 56.97 56.9;7 0.32 0.3;2 44.1; 0.9; 56.9; 0.3;

resumen está disponible en el texto completo

RESUMO Objetivo Descrever as coberturas e hesitação das vacinas do calendário básico infantil em Belo Horizonte e Sete Lagoas, Minas Gerais. Métodos Inquéritos epidemiológicos de base populacional realizados de 2020 a 2022, para estimar coberturas vacinais por tipo de imunobiológico e esquema completo (doses válidas e aplicadas) segundo estratos socioeconômicos, e os motivos de hesitação vacinal. Resultados A cobertura global com doses válidas e a hesitação vacinal de pelo menos uma vacina foram, respectivamente, de 50,2% (IC95% 44,1;56,2) e 1,6% (IC95% 0,9;2,7), em Belo Horizonte (n = 1.866), e de 64,9% (IC95% 56,9;72,1) e 1,0% (IC95% 0,3;2,8), em Sete Lagoas (n = 451), com diferenças entre os estratos. O receio de reações graves foi o principal motivo de hesitação vacinal. Conclusão Identificou-se coberturas abaixo do preconizado para a maioria das vacinas. A desinformação deve ser combatida, evitando-se a hesitação vacinal. Há necessidade premente de recuperar as coberturas, considerando acesso ao SUS e disparidades socioeconômicas. Gerais 202 2022 aplicadas socioeconômicos foram respectivamente 502 50 2 50,2 IC95% IC95 IC (IC95 44,156,2 441562 44,1 56,2 44 1 56 44,1;56,2 16 6 1,6 0,92,7, 0927 0,9 2,7 , 0 9 7 0,9;2,7) n 1.866, 1866 1.866 866 1.866) 649 64 64,9 56,972,1 569721 56,9 72,1 72 56,9;72,1 10 1,0 0,32,8, 0328 0,3 2,8 3 8 0,3;2,8) 451, 451 451) Identificouse Identificou se combatida evitandose evitando socioeconômicas 20 5 50, IC9 (IC9 156 44,156, 44156 441 44, 562 56, 4 44,1;56, 1, 92 0,92,7 092 09 0, 27 2, 0,9;2,7 186 1.86 86 64, 972 56,972, 56972 569 721 72, 56,9;72, 32 0,32,8 032 03 28 0,3;2,8 45 (IC 15 44,156 4415 44,1;56 0,92, 0,9;2, 18 1.8 97 56,972 5697 56,9;72 0,32, 0,3;2, 44,15 44,1;5 0,92 0,9;2 1. 56,97 56,9;7 0,32 0,3;2 44,1; 0,9; 56,9; 0,3;

ABSTRACT Objective To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Methods Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. Results 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. Conclusion There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil. 2 Brazil raceskin skin color 37801 37 801 37,80 201 Survey 95 1 regression 72 7 7.2 95%CI 95CI CI 6.38.2 6382 6.3 8.2 6 3 8 6.3;8.2 234 23 4 23.4 21.725.1 217251 21.7 25.1 21 25 21.7;25.1 taken 75 1.252.45 125245 1.25 2.45 45 1.25;2.45 97 1.572.48 157248 1.57 2.48 57 48 1.57;2.48 respectively 499 49 9 49.9 47.851.9 478519 47.8 51.9 47 51 47.8;51.9 611 61 61.1 59.263.0 592630 59.2 63.0 59 63 0 59.2;63.0 Blackmixed mixed 3780 80 37,8 20 7. 38 6.38. 638 6. 82 8. 6.3;8. 23. 725 21.725. 21725 217 21. 251 25. 21.7;25. 252 1.252.4 12524 125 1.2 245 2.4 1.25;2.4 572 1.572.4 15724 157 1.5 248 1.57;2.4 49. 851 47.851. 47851 478 47. 519 51. 47.8;51. 61. 263 59.263. 59263 592 59. 630 63. 59.2;63. 378 37, 6.38 6.3;8 21.725 2172 21.7;25 1.252. 1252 1. 2. 1.25;2. 1.572. 1572 15 1.57;2. 85 47.851 4785 47.8;51 26 59.263 5926 59.2;63 6.3; 21.72 21.7;2 1.252 1.25;2 1.572 1.57;2 47.85 47.8;5 59.26 59.2;6 21.7; 1.25; 1.57; 47.8; 59.2;

resumen está disponible en el texto completo

RESUMO Objetivo Descrever a completude vacinal em tempo oportuno nos primeiros 24 meses de vida no Brasil e os obstáculos para vacinação, testando-se associações com raça/cor da pele materna. Métodos Fez-se coleta de informações sobre os nascidos em 2017 e 2018, constantes no Inquérito Nacional de Cobertura Vacinal. Foram calculados prevalência e intervalos de confiança de 95% de obstáculos à vacinação e completude vacinal em tempo oportuno aos 5 meses, primeiro e segundo ano, segundo raça/cor da pele materna. Empregou-se regressão logística para análise de associações. Resultados Analisaram-se dados de 37.801 crianças. Do total, 7,2% (IC95% 6,3;8,2) dos responsáveis enfrentaram dificuldades para levar seus filhos para vacinação e 23,4% (IC95% 21,7;25,1) das crianças não foram vacinadas, mesmo sendo levadas. Essas proporções foram 75% (IC95% 1,25;2,45) e 97% (IC95% 1,57;2,48) mais elevadas, respectivamente, entre pretas; e 49,9% (IC95% 47,8;51,9) e 61,1% (IC95% 59,2;63,0) das crianças tiveram atraso em alguma vacina até os 5 meses e o primeiro ano, respectivamente. Tais valores foram maiores entre pardas/pretas. Conclusão Há desigualdades raciais nos obstáculos enfrentados e na vacinação no Brasil. 2 testandose testando se raçacor raça cor materna Fezse Fez 201 2018 Vacinal 95 ano Empregouse Empregou Analisaramse Analisaram 37801 37 801 37.80 total 72 7 7,2 IC95% IC95 IC (IC95 6,38,2 6382 6,3 8,2 6 3 8 6,3;8,2 234 23 4 23,4 21,725,1 217251 21,7 25,1 21 25 1 21,7;25,1 vacinadas levadas 75 1,252,45 125245 1,25 2,45 45 1,25;2,45 97 1,572,48 157248 1,57 2,48 57 48 1,57;2,48 elevadas respectivamente pretas 499 49 9 49,9 47,851,9 478519 47,8 51,9 47 51 47,8;51,9 611 61 61,1 59,263,0 592630 59,2 63,0 59 63 0 59,2;63,0 pardaspretas pardas pardas/pretas 20 3780 80 37.8 7, IC9 (IC9 38 6,38, 638 6, 82 8, 6,3;8, 23, 725 21,725, 21725 217 21, 251 25, 21,7;25, 252 1,252,4 12524 125 1,2 245 2,4 1,25;2,4 572 1,572,4 15724 157 1,5 248 1,57;2,4 49, 851 47,851, 47851 478 47, 519 51, 47,8;51, 61, 263 59,263, 59263 592 59, 630 63, 59,2;63, 378 37. (IC 6,38 6,3;8 21,725 2172 21,7;25 1,252, 1252 12 1, 2, 1,25;2, 1,572, 1572 15 1,57;2, 85 47,851 4785 47,8;51 26 59,263 5926 59,2;63 6,3; 21,72 21,7;2 1,252 1,25;2 1,572 1,57;2 47,85 47,8;5 59,26 59,2;6 21,7; 1,25; 1,57; 47,8; 59,2;

ABSTRACT Background: Trachoma is the leading infectious cause of blindness worldwide. It is a neglected tropical disease caused by Chlamydia trachomatis. The objective of this study was to analyze the trachoma-associated morbidity and mortality in Brazil from 2000 to 2022. This ecological time-series study was based on secondary data on trachoma obtained from hospital admissions (trachoma as the primary or secondary cause) and death certificates (trachoma as the underlying or associated cause). Methods: We calculated the sex- and age-standardized rates of hospital admissions and trachoma-specific mortality according to sociodemographic variables and analyzed the spatial distribution. Results: We identified 141/263,292,807 hospital admissions (primary cause: 83.0%) and 126/27,596,830 death certificates (associated cause: 91.3%) related to trachoma. Trachoma-related sequelae were reported in 8.5% of hospital admissions and 6.3% of death certificates. Trachoma was more common in males (hospital admissions and death certificates), people aged ≥70 years (hospital admissions and death certificates), those with brown skin (hospital admissions and death certificates), and those living in the North (hospital admissions) and Northeast (death certificates) regions of Brazil. Conclusions: Despite the relatively low rates of trachoma morbidity in Brazil, the associated mortality rates are of concern. The heterogeneous patterns of occurrence in the country in terms of population and territory reinforce the need to evaluate and monitor the available data, despite the low prevalence, in order to achieve and maintain the elimination targets in Brazil in the future. Background worldwide trachomatis trachomaassociated 200 2022 timeseries time series cause. . Methods sex agestandardized age standardized trachomaspecific specific distribution Results 141263292807 141 263 292 807 141/263,292,80 83.0% 830 83 0 12627596830 126 27 596 126/27,596,83 91.3% 913 91 3 Trachomarelated 85 8 5 8.5 63 6 6.3 certificates, , 70 ≥7 Conclusions concern prevalence future 20 202 14126329280 14 26 29 80 141/263,292,8 83.0 1262759683 12 2 59 126/27,596,8 91.3 9 8. 6. 7 ≥ 1412632928 1 141/263,292, 83. 126275968 126/27,596, 91. 141263292 141/263,292 12627596 126/27,596 14126329 141/263,29 1262759 126/27,59 1412632 141/263,2 126275 126/27,5 141263 141/263, 12627 126/27, 14126 141/263 1262 126/27 1412 141/26 126/2 141/2 126/ 141/

resumen está disponible en el texto completo

RESUMO Objetivo Descrever a completude vacinal em tempo oportuno nos primeiros 24 meses de vida no Brasil e os obstáculos para vacinação, testando-se associações com raça/cor da pele materna. Métodos Fez-se coleta de informações sobre os nascidos em 2017 e 2018, constantes no Inquérito Nacional de Cobertura Vacinal. Foram calculados prevalência e intervalos de confiança de 95% de obstáculos à vacinação e completude vacinal em tempo oportuno aos 5 meses, primeiro e segundo ano, segundo raça/cor da pele materna. Empregou-se regressão logística para análise de associações. Resultados Analisaram-se dados de 37.801 crianças. Do total, 7,2% (IC95% 6,3;8,2) dos responsáveis enfrentaram dificuldades para levar seus filhos para vacinação e 23,4% (IC95% 21,7;25,1) das crianças não foram vacinadas, mesmo sendo levadas. Essas proporções foram 75% (IC95% 1,25;2,45) e 97% (IC95% 1,57;2,48) mais elevadas, respectivamente, entre pretas; e 49,9% (IC95% 47,8;51,9) e 61,1% (IC95% 59,2;63,0) das crianças tiveram atraso em alguma vacina até os 5 meses e o primeiro ano, respectivamente. Tais valores foram maiores entre pardas/pretas. Conclusão Há desigualdades raciais nos obstáculos enfrentados e na vacinação no Brasil.

ABSTRACT Objective To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Methods Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. Results 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. Conclusion There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil.

resumen está disponible en el texto completo

RESUMO Objetivo Descrever as coberturas e hesitação das vacinas do calendário básico infantil em Belo Horizonte e Sete Lagoas, Minas Gerais. Métodos Inquéritos epidemiológicos de base populacional realizados de 2020 a 2022, para estimar coberturas vacinais por tipo de imunobiológico e esquema completo (doses válidas e aplicadas) segundo estratos socioeconômicos, e os motivos de hesitação vacinal. Resultados A cobertura global com doses válidas e a hesitação vacinal de pelo menos uma vacina foram, respectivamente, de 50,2% (IC95% 44,1;56,2) e 1,6% (IC95% 0,9;2,7), em Belo Horizonte (n = 1.866), e de 64,9% (IC95% 56,9;72,1) e 1,0% (IC95% 0,3;2,8), em Sete Lagoas (n = 451), com diferenças entre os estratos. O receio de reações graves foi o principal motivo de hesitação vacinal. Conclusão Identificou-se coberturas abaixo do preconizado para a maioria das vacinas. A desinformação deve ser combatida, evitando-se a hesitação vacinal. Há necessidade premente de recuperar as coberturas, considerando acesso ao SUS e disparidades socioeconômicas.

ABSTRACT Objective To describe vaccination coverage and hesitation for the basic children’s schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. Methods Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. Results Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. Conclusion Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities.

Resumo O objetivo deste artigo é analisar a magnitude e o perfil das demandas judiciais por bens e serviços de saúde pública, verificando também a presença de demandas judiciais para doenças tropicais negligenciadas (DTNs) no Estado do Piauí entre 2000-2020. Estudo transversal descritivo a partir de bases de dados do Tribunal de Justiça do Piauí acerca de processos judiciais demandando bens e serviços de saúde à administração pública direta. Foram identificados inicialmente um total de 6.658 processos judiciais. Após análise de elegibilidade, 1.384 processos (20,8%) foram analisados, verificando-se aumento da demanda a partir de 2017. Ressalta-se as características: origem na capital Teresina (614; 44,4%), 40 a 59 anos de idade (372; 26,9%), sexo feminino (761; 55,0%), agricultores (123; 8,9%), assistência jurídica pública (1.063; 76,8%), julgados procedentes (594; 42,9%). Cinco (5; 0,4%) demandas judiciais para DTNs, uma leishmaniose visceral solicitando transporte, procedente; quatro para hanseníase (dois medicamentos, um concedido, outro extinto sem resolução do mérito, uma consulta e um exame, ambos concedidos). A judicialização do direito à saúde é expressiva e crescente no estado do Piauí. A baixa demanda relacionada a DTNs pode traduzir limitação de acesso não apenas à saúde, mas ao Poder Judiciário.

Abstract This article aims to analyse the magnitude and profile of legal demands for public health goods and services, also verifying the presence of legal demands for neglected tropical diseases (NTDs) in the State of Piauí between 2000-2020. Cross-sectional descriptive study based on the databases of the Court of Justice of Piauí on lawsuits demanding from the Direct Public Administration, goods and health services. A total of 6,658 lawsuits were initially identified. After eligibility analysis, 1,384 cases (20.8%) were analysed, with an increase in demand from 2017. We highlight the characteristics: origin in the capital Teresina (614; 44.4%), 40 to 59 years of age (372; 26.9%), female (761; 55.0%), farmers (123; 8.9%), public legal assistance (1,063; 76.8%), upheld (594; 42.9%). Five (5; 0.4%) lawsuits for NTDs, one visceral leishmaniasis requesting transportation, with granting, four for leprosy (two medicines, one granted, other extinguished without resolution of the merit, one consultation and one exam granted). The judicialization of the right to health is expressive and growing in the State of Piauí. The low demand related to NTDs may translate into limited access not only to health care, but also to the judiciary.

Resumo O objetivo deste artigo é analisar a magnitude e o perfil das demandas judiciais por bens e serviços de saúde pública, verificando também a presença de demandas judiciais para doenças tropicais negligenciadas (DTNs) no Estado do Piauí entre 2000-2020. Estudo transversal descritivo a partir de bases de dados do Tribunal de Justiça do Piauí acerca de processos judiciais demandando bens e serviços de saúde à administração pública direta. Foram identificados inicialmente um total de 6.658 processos judiciais. Após análise de elegibilidade, 1.384 processos (20,8%) foram analisados, verificando-se aumento da demanda a partir de 2017. Ressalta-se as características: origem na capital Teresina (614; 44,4%), 40 a 59 anos de idade (372; 26,9%), sexo feminino (761; 55,0%), agricultores (123; 8,9%), assistência jurídica pública (1.063; 76,8%), julgados procedentes (594; 42,9%). Cinco (5; 0,4%) demandas judiciais para DTNs, uma leishmaniose visceral solicitando transporte, procedente; quatro para hanseníase (dois medicamentos, um concedido, outro extinto sem resolução do mérito, uma consulta e um exame, ambos concedidos). A judicialização do direito à saúde é expressiva e crescente no estado do Piauí. A baixa demanda relacionada a DTNs pode traduzir limitação de acesso não apenas à saúde, mas ao Poder Judiciário.

Abstract This article aims to analyse the magnitude and profile of legal demands for public health goods and services, also verifying the presence of legal demands for neglected tropical diseases (NTDs) in the State of Piauí between 2000-2020. Cross-sectional descriptive study based on the databases of the Court of Justice of Piauí on lawsuits demanding from the Direct Public Administration, goods and health services. A total of 6,658 lawsuits were initially identified. After eligibility analysis, 1,384 cases (20.8%) were analysed, with an increase in demand from 2017. We highlight the characteristics: origin in the capital Teresina (614; 44.4%), 40 to 59 years of age (372; 26.9%), female (761; 55.0%), farmers (123; 8.9%), public legal assistance (1,063; 76.8%), upheld (594; 42.9%). Five (5; 0.4%) lawsuits for NTDs, one visceral leishmaniasis requesting transportation, with granting, four for leprosy (two medicines, one granted, other extinguished without resolution of the merit, one consultation and one exam granted). The judicialization of the right to health is expressive and growing in the State of Piauí. The low demand related to NTDs may translate into limited access not only to health care, but also to the judiciary.

ABSTRACT Background: To analyze the temporal evolution of research on Neglected Tropical Diseases (NTDs) published by the Journal of the Brazilian Society of Tropical Medicine (JBSTM). Methods: We performed an analysis of the scientific production in JBSTM on NTDs using an advanced search, which included authors’ descriptors, title, and abstract, and by combining specific terms for each NTDs from 1991 to 2021. Data related to authors, countries of origin, institutions, and descriptors, were evaluated and analyzed over time. Bibliographic networks were constructed using VOSviewer 1.6.16. Results: The JBSTM published 4,268 scientific papers during this period. Of these 1,849 (43.3%) were related to NTDs. The number of publications on NTDs increased by approximately 2.4-fold, from 352 (total 724) during 1991-2000 to 841 (total 2,128) during 2011-2021, despite the proportional reduction (48.6% versus 39.5%). The most common singular NTDs subject of publications included Chagas disease (31.4%; 581/1,849), leishmaniasis (25.5%, 411/1,849), dengue (9.4%, 174/1,849), schistosomiasis (9.0%; 166/1,849), and leprosy (6.5%, 120/1,849), with authorship mostly from Brazil’s South and Southeast regions. Conclusions: Despite the proportional reduction in publications, JBSTM remains an important vehicle for disseminating research on NTDs during this period. There is a need to strengthen the research and subsequent publications on specific NTDs. Institutions working and publishing on NTDs in the country were concentrated in the South and Southeast regions, requiring additional investments in institutions in other regions of the country. Background (NTDs JBSTM. . (JBSTM) Methods search authors descriptors title abstract 199 2021 origin time 1616 1 6 16 1.6.16 Results 4268 4 268 4,26 period 1849 849 1,84 43.3% 433 43 3 (43.3% 2.4fold, 24fold fold 2.4 fold, 2 2.4-fold 35 total 724 19912000 2000 1991-200 84 2,128 2128 128 20112021, 20112021 2011 2021, 2011-2021 48.6% 486 48 (48.6 39.5%. 395 39.5% 39 5 39.5%) 31.4% 314 31 (31.4% 581/1,849, 5811849 581/1,849 , 581 581/1,849) 25.5%, 255 25 (25.5% 411/1,849, 4111849 411/1,849 411 411/1,849) 9.4%, 94 9 (9.4% 174/1,849, 1741849 174/1,849 174 174/1,849) 9.0% 90 0 (9.0% 166/1,849, 1661849 166/1,849 166 166/1,849) 6.5%, 65 (6.5% 120/1,849, 1201849 120/1,849 120 120/1,849) Brazils Brazil s Conclusions (JBSTM 19 202 161 1.6.1 426 26 4,2 184 1,8 43.3 (43.3 4fold 2.4fold 24 2. 72 1991200 200 1991-20 8 2,12 212 12 2011202 201 2011-202 48.6 (48. 39.5 31.4 (31.4 581184 581/1,84 58 25.5% (25.5 411184 411/1,84 41 9.4% (9.4 174184 174/1,84 17 9.0 (9.0 166184 166/1,84 6.5% (6.5 120184 120/1,84 20 1.6. 42 4, 18 1, 43. (43. 7 199120 1991-2 2,1 21 201120 2011-20 48. (48 39. 31. (31. 58118 581/1,8 25.5 (25. 41118 411/1,8 9.4 (9. 17418 174/1,8 9. 16618 166/1,8 6.5 (6. 12018 120/1,8 1.6 (43 19912 1991- 2, 20112 2011-2 (4 (31 5811 581/1, 25. (25 4111 411/1, (9 1741 174/1, 1661 166/1, 6. (6 1201 120/1, 1. 2011- ( (3 581/1 (2 411/1 174/1 166/1 120/1 581/ 411/ 174/ 166/ 120/

ABSTRACT Background: To analyze the epidemiology, surveillance, and control strategies for trachoma in the state of Ceará, northeast Brazil, from 2007 to 2021. Methods: This ecological study was based on secondary data from the Information System on Notifiable Diseases of the Secretary of Health of the state of Ceará. Data from school and home surveys for trachoma detection obtained during the study period were analyzed, the percentage of positivity was estimated, and sociodemographic and clinico-epidemiological factors were investigated. Results: The coverage of trachoma surveillance and control actions in Ceará municipalities increased from 12.5% in 2007 to 55.9% in 2019, but with an average restriction of 8.0% during the COVID-19 pandemic. The estimated trachoma positivity (mean overall positivity) was less than 5.0% (2.76%, 95% CI 1.2-5.2), with a higher proportion of cases in the 5-9-year age group (45.0%, 95% CI 44.6-45.4), in females (53.2%, 95% CI 52.8-53.6), and rural areas (52.6%, 95% CI 52.2-53.0). Positivity above 10.0% was observed in the Litoral Leste/Jaguaribe and Sertão Central regions, with a higher occurrence of the follicular inflammatory clinical form (98.1%, 95% CI 98.0-98.2). Conclusions: Trachoma remains in the state of Ceará and is likely underreported. Despite recent advances, the fragility of health surveillance activities compromises the recognition of the actual magnitude and distribution of trachoma in the state. Accurate information is fundamental for planning, monitoring, and evaluating surveillance and disease control. Background epidemiology Brazil 200 2021 Methods analyzed clinicoepidemiological clinico epidemiological investigated Results 125 12 5 12.5 559 55 9 55.9 2019 80 8 0 8.0 COVID19 COVID 19 COVID-1 pandemic mean 50 5.0 2.76%, 276 2 76 (2.76% 95 1.25.2, 1252 1.2 5.2 , 1 1.2-5.2) 59year year 45.0%, 450 45 (45.0% 44.645.4, 446454 44.6 45.4 44 6 4 44.6-45.4) 53.2%, 532 53 (53.2% 52.853.6, 528536 52.8 53.6 52 52.8-53.6) 52.6%, 526 (52.6% 52.253.0. 522530 52.2 53.0 . 52.2-53.0) 100 10 10.0 LesteJaguaribe Leste Jaguaribe regions 98.1%, 981 98 (98.1% 98.098.2. 980982 98.0 98.2 98.0-98.2) Conclusions underreported advances planning monitoring 20 202 12. 55. 201 8. COVID1 COVID- 5. 2.76% 27 7 (2.76 25 1.25.2 1. 1.2-5.2 45.0% (45.0 645 44.645.4 44645 446 44. 454 45. 44.6-45.4 53.2% (53.2 853 52.853.6 52853 528 52. 536 53. 52.8-53.6 52.6% (52.6 253 52.253.0 52253 522 530 52.2-53.0 10. 98.1% (98.1 098 98.098.2 98098 980 98. 982 98.0-98.2 2.76 (2.7 1.25. 1.2-5. 45.0 (45. 64 44.645. 4464 44.6-45. 53.2 (53. 85 52.853. 5285 52.8-53. 52.6 (52. 52.253. 5225 52.2-53. 98.1 (98. 09 98.098. 9809 98.0-98. 2.7 (2. 1.25 1.2-5 (45 44.645 44.6-45 (53 52.853 52.8-53 (52 52.253 52.2-53 (98 98.098 98.0-98 2. (2 1.2- (4 44.64 44.6-4 (5 52.85 52.8-5 52.25 52.2-5 (9 98.09 98.0-9 ( 44.6- 52.8- 52.2- 98.0-

ABSTRACT Objective: The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016. Methods: A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy. Results: Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others. Conclusion: There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage. Objective 1 2 2016 Methods 37836 37 836 37,83 201 10 cards stratum administered timely calculated Family surveyed contraindications difficulties program hesitancy Results vaccinated 75 strata others Conclusion 2019 COVID19 COVID 19 COVID-1 pandemic 3783 3 83 37,8 20 7 COVID1 COVID- 378 8 37,

RESUMO Objetivo: Inquérito nacional de cobertura vacinal aos 12 e 24 meses de idade foi realizado para investigar as quedas nas coberturas a partir de 2016. Métodos: Amostra de 37.836 nascidos vivos das coortes de 2017 e 2018 residentes nas capitais, Distrito Federal (DF) e 12 cidades com mais de 100 mil habitantes, acompanhados nos primeiros 24 meses por registros nas cadernetas de vacinação. Setores censitários foram estratificados segundo condições socioeconômicas, e o mesmo número de crianças foi incluído para cada estrato. Calcularem-se coberturas vacinais de cada vacina e coberturas completas aos 12 e 24 meses, doses aplicadas, válidas e oportunas. Fatores familiares, maternos e da criança associados à cobertura foram pesquisados. Os motivos para não vacinar analisados foram: contraindicações médicas, dificuldades de acesso, problemas no funcionamento do programa e hesitação vacinal. Resultados: Os resultados preliminares mostram que menos de 1% das crianças não foram vacinadas, as coberturas pelo esquema completo são menores que 75% em todas as capitais e no DF, as vacinas com mais de uma dose perdem cobertura progressivamente, há diferenças entre os estratos socioeconômicos, favoráveis aos estratos mais altos em algumas cidades e aos estratos mais baixos em outras. Conclusão: Houve realmente redução da cobertura vacinal em todas as capitais e no DF para as crianças nascidas em 2017 e 2018, denotando piora na execução do Programa Nacional de Imunizações durante os anos de 2017 a 2019. O inquérito realizado não mensurou os impactos da pandemia de COVID-19 que podem ter reduzido ainda mais as coberturas vacinais. Objetivo 1 2 2016 Métodos 37836 37 836 37.83 201 (DF 10 habitantes vacinação socioeconômicas estrato Calcularemse Calcularem se aplicadas oportunas familiares pesquisados médicas acesso Resultados vacinadas 75 progressivamente socioeconômicos outras Conclusão 2019 COVID19 COVID 19 COVID-1 3783 3 83 37.8 20 7 COVID1 COVID- 378 8 37.

RESUMO Objetivo: Inquérito nacional de cobertura vacinal aos 12 e 24 meses de idade foi realizado para investigar as quedas nas coberturas a partir de 2016. Métodos: Amostra de 37.836 nascidos vivos das coortes de 2017 e 2018 residentes nas capitais, Distrito Federal (DF) e 12 cidades com mais de 100 mil habitantes, acompanhados nos primeiros 24 meses por registros nas cadernetas de vacinação. Setores censitários foram estratificados segundo condições socioeconômicas, e o mesmo número de crianças foi incluído para cada estrato. Calcularem-se coberturas vacinais de cada vacina e coberturas completas aos 12 e 24 meses, doses aplicadas, válidas e oportunas. Fatores familiares, maternos e da criança associados à cobertura foram pesquisados. Os motivos para não vacinar analisados foram: contraindicações médicas, dificuldades de acesso, problemas no funcionamento do programa e hesitação vacinal. Resultados: Os resultados preliminares mostram que menos de 1% das crianças não foram vacinadas, as coberturas pelo esquema completo são menores que 75% em todas as capitais e no DF, as vacinas com mais de uma dose perdem cobertura progressivamente, há diferenças entre os estratos socioeconômicos, favoráveis aos estratos mais altos em algumas cidades e aos estratos mais baixos em outras. Conclusão: Houve realmente redução da cobertura vacinal em todas as capitais e no DF para as crianças nascidas em 2017 e 2018, denotando piora na execução do Programa Nacional de Imunizações durante os anos de 2017 a 2019. O inquérito realizado não mensurou os impactos da pandemia de COVID-19 que podem ter reduzido ainda mais as coberturas vacinais.

ABSTRACT Objective: The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016. Methods: A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy. Results: Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others. Conclusion: There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.

Objective: To analyze temporal trends and spatial patterns of mortality from neglected tropical diseases (NTD) in Piauí, 2001-2018. Methods: Mixed ecological study, with hazard ratio (RR) calculation,spatio- temporal trend analysis, Poisson regression with inflection points, using data from the Mortality Information System. Results: There were 2,609 deaths due to NTD in the period (4.60/100,000 inhabitants), 55.2% due to Chagas disease. There was a higher risk of death in men (RR=1.76 – 95%CI 1.25;2.46), aged ≥60 years (RR=40.71 – 95%CI 10.01;165.53), municipalities with vulnerability average social (RR=1.76 – 95%CI 1.09;2.84), smaller population size (RR=1.99 – 95%CI 1.28;3.10) and Cerrados macro-region (RR=4.51-95%CI 2.51;8.11). There was an upward trend in mortality rates from 2001-2008 and a reduction from 2009- 2018. Conclusion: Mortality due to NTD in Piauí remains high, particularly due to Chagas disease, among groups with greater vulnerability, with concentration of higher rates in the southwest of the semi-arid macro-region, northeast and south of the Cerrados.

Objetivo: Analizar las tendencias temporales y patrones espaciales de mortalidad por enfermedades tropicales desatendidas (ETD) en Piauí, 2001-2018. Métodos: Estudio ecológico mixto, con cálculo de hazard ratio (RR), análisis de tendencias espacio-temporales, regresión de Poisson con puntos de inflexión, utilizando datos del Sistema de Información de Mortalidad. Resultados: Hubo 2.609 defunciones por ETD en el período (4,60/100.000 habitantes), 55,2% por enfermedad de Chagas. Hubo un mayor riesgo de muerte en hombres (RR=1,76 – IC95% 1,25;2,46), edad ≥60 años (RR=40,71 – IC95% 10,01;165,53), municipios con vulnerabilidad social media (RR=1,76 – IC95% 1,09;2,84), tamaño de población más pequeño (RR=1,99 – IC95% 1,28;3,10) y macrorregión de Cerrados (RR=4,51 – IC95% 2,51;8,11). Hubo tendencia al alza en las tasas de mortalidad de 2001-2008 y  reducción de 2009-2018. Conclusión: La mortalidad por ETD en Piauí sigue siendo alta, particularmente por la enfermedad de Chagas, entre los grupos con mayor vulnerabilidad, con concentración de tasas más altas en el suroeste de la macrorregión semiárida, noreste y sur de los Cerrados.

Objetivo: Analisar tendência temporal e padrões espaciais da mortalidade por doenças tropicais negligenciadas (DTNs) no Piauí, Brasil, 2001-2018. Métodos: Estudo ecológico misto, com cálculo de razão de risco (RR), análise de tendência  espaço-temporal e regressão de Poisson com pontos de inflexão, utilizando-se dados do Sistema de Informações sobre Mortalidade. Resultados: Verificou-se 2.609 óbitos por DTNs no período (4,60/100 mil habitantes), 55,2% por doença de Chagas. Houve maior risco de morte em homens (RR=1,76 –IC95% 1,25;2,46), idade ≥60 anos (RR=40,71 –IC95% 10,01;165,53), municípios com vulnerabilidade social média (RR=1,76 – IC95% 31,09;2,84), menor porte populacional (RR=1,99 – IC95% 1,28;3,10) e macrorregião dos Cerrados (RR=4,51 – IC95% 2,51;8,11). Verificou-se tendência de aumento nas taxas de mortalidade em 2001-2008 e redução em 2009-2018. Conclusão: A mortalidade por DTNs no Piauí persiste elevada, particularmente por doença de Chagas, entre grupos de maior vulnerabilidade, concentrando-se as maiores taxas no sudoeste da macrorregião do Semiárido, nordeste e sul dos Cerrados.

Resumo Objetivo Analisar tendência temporal e padrões espaciais da mortalidade por doenças tropicais negligenciadas (DTNs) no Piauí, Brasil, 2001-2018. Métodos Estudo ecológico misto, com cálculo de razão de risco (RR), análise de tendência espaço-temporal, regressão de Poisson com pontos de inflexão, utilizando-se dados do Sistema de Informações sobre Mortalidade. Resultados Verificaram-se 2.609 óbitos por DTNs no período (4,60/100 mil habitantes), 55,2% por doença de Chagas. Houve maior risco de morte no sexo masculino (RR=1,76; IC95% 1,25;2,46), idade ≥60 anos (RR=40,71; IC95% 10,01;165,53), municípios com vulnerabilidade social média (RR=1,76; IC95% 1,09;2,84), menor porte populacional (RR=1,99; IC95% 1,28;3,10) e macrorregião dos Cerrados (RR=4,51; IC95% 2,51;8,11). Verificou-se tendência de aumento nas taxas de mortalidade em 2001-2008 e redução em 2009-2018. Conclusão A mortalidade por DTNs no Piauí persiste elevada, particularmente por doença de Chagas, entre grupos de maior vulnerabilidade, concentrando-se as maiores taxas no sudoeste da macrorregião do Semiárido, nordeste e sul dos Cerrados.

Abstract Objetive To analyze temporal trends and spatial patterns of mortality due to neglected tropical diseases (NTDs) in Piauí, Brazil, 2001-2018. Methods This was a mixed ecological study, with risk ratio (RR) calculation, spatiotemporal trend analysis, Poisson joinpoint regression, using data from the Mortality Information System. Results There were 2,609 deaths due to NTDs in the period (4.60/100,000 inhabitants), 55.2% were due to Chagas’ disease. There was a higher risk of death in male (RR=1.76; 95%CI 1.25;2.46), being aged ≥60 years (RR=40.71; 95%CI 10.01;165.53), municipalities with medium vulnerability social (RR=1.76; 95%CI 1.09;2.84), smaller population size (RR=1.99; 95%CI 1.28;3.10) and the Cerrados macro-region (RR=4.51; 95%CI 2.51;8.11). There was an upward trend in mortality rates from 2001-2008 and a falling trend from 2009-2018. Conclusion Mortality due to NTDs in Piauí remains high, particularly due to Chagas’ disease, among groups with greater vulnerability, with concentration of higher rates in the southwest of the Semiarid macro-region and the northeast and south of the Cerrados macro-region.

Resumen Objetivo Analizar las tendencias temporales y patrones espaciales de mortalidad por enfermedades tropicales desatendidas (ETD) en Piauí, 2001-2018. Métodos Estudio ecológico mixto, con cálculo de razón de riesgo (RR), análisis de tendencias espacio-temporales, regresión de Poisson con puntos de inflexión, utilizando datos del Sistema de Información de Mortalidad. Resultados Hubo 2.609 defunciones por ETD en el período (4,60/100.000 habitantes), 55,2% por enfermedad de Chagas. Hubo un mayor riesgo de muerte el sexo masculino (RR=1,76; IC95% 1,25;2,46), edad ≥60 años (RR=40,71; IC95% 10,01;165,53), municipios con vulnerabilidad social mediana (RR=1,76; IC95% 1,09;2,84), con menor población (RR=1,99; IC95% 1,28;3,10) y la macrorregión de los Cerrados (RR=4,51; IC95% 2,51;8,11). Hubo tendencia al alta en las tasas de mortalidad de 2001-2008 y reducción de 2009-2018. Conclusión La mortalidad por ETD en Piauí sigue siendo alta, particularmente por la enfermedad de Chagas, entre los grupos con mayor vulnerabilidad, con concentración de tasas más altas en el Suroeste de la macrorregión del Semiárido, noreste y sur de los Cerrados.