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1.
[SciELO Preprints] - Maternity in adolescence in Brazil: high fertility rates and stark inequalities across municipalities and regions
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J D Barros, Aluisio
Blumenberg, Cauane
Calu Costa, Janaína
Vidaletti Ruas , Luis Paulo
Peixoto Lima, Natália
C Wehrmeister , Fernando
dos Santos Costa , Francine
Eunice Sá da Silva , Luiza
G Victora , Cesar
A gravidez na adolescência é um desafio de saúde pública no Brasil, com uma taxa de fecundidade de 43,6 nascimentos por mil meninas de 15 a 19 anos em 2022. Este estudo investigou as desigualdades nas taxas de fecundidade adolescente (TFA) nos municípios brasileiros, utilizando dados do Sistema de Informações sobre Nascidos Vivos (SINASC) e do Censo Demográfico de 2022. A análise considerou nascimentos entre 2020 e 2022, excluindo municípios com menos de 50 nascimentos nos três anos. As TFAs municipais foram comparadas com a taxa média de países classificados por nível de renda (alta, média-alta, média-baixa e baixa renda) e descritas conforme o Índice Brasileiro de Privação e o tamanho populacional. As desigualdades dentro de cada região geográfica foram avaliadas usando a diferença absoluta média em relação à média regional e a amplitude. Foram observadas grandes disparidades nas TFAs entre as regiões, com o Norte e Nordeste apresentando as maiores taxas, e o Sul e Sudeste, as menores. O Centro-Oeste teve valores intermediários. As desigualdades entre os municípios foram evidenciadas por gráficos e índices, com uma pequena parcela de municípios da região Norte mostrando TFA excepcionalmente alta. Foi identificada uma forte associação entre vulnerabilidade social e gravidez precoce, com municípios em situações de maior privação apresentando taxas de fecundidade marcadamente mais altas. Os resultados destacam a necessidade de políticas públicas que abordem os determinantes contextuais subjacentes para reduzir as taxas de fecundidade entre adolescentes no Brasil.
Versão em Português: https://doi.org/10.1590/SciELOPreprints.11537
Adolescent childbearing is a major public health challenge in Brazil, with a fertility rate of 43.6 births per thousand girls aged 15-19 years in 2022. This study investigated inequalities in adolescent fertility rates (AFR) across Brazilian municipalities, utilizing data from the National Live Births Information System (SINASC) and the 2022 Demographic Census. Analyses included births between 2020 and 2022, excluding municipalities with fewer than 50 births in the 3 years. Municipal AFRs were compared with the average rate in countries classified by income level (high, upper-middle, lower-middle, and low income) and described according to the Brazilian Deprivation Index and population size. Inequalities within each geographic region were assessed using the mean absolute difference to the regional mean and range. Substantial disparities in AFR across regions were found, with the North and Northeast exhibiting the highest estimates, while the South and Southeast showed comparatively lower rates. The Midwest presented intermediate values. We found vast inequalities between municipalities, revealed by graphs and summary measures. A small proportion of municipalities, concentrated in the North region, experience exceptionally high AFR. A strong association between social vulnerability and early childbearing was also identified. Municipalities with higher levels of deprivation had markedly higher AFR, underscoring the influence of broader socio-economic factors on adolescent fertility. The results emphasize the need for targeted interventions and policies that address these underlying contextual determinants to reduce fertility rates among girls in Brazil effectively.
Versão em Português: https://doi.org/10.1590/SciELOPreprints.11537
2.
[SciELO Preprints] - Maternity in adolescence in Brazil: high fertility rates and stark inequalities across municipalities and regions
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J D Barros , Aluisio
Blumenberg , Cauane
Calu Costa , Janaína
Vidaletti Ruas , Luis Paulo
Peixoto Lima, Natália
C Wehrmeister , Fernando
dos Santos Costa , Francine
Sá da Silva , Luiza Eunice
G Victora , Cesar
Adolescent childbearing is a major public health challenge in Brazil, with a fertility rate of 43.6 births per thousand girls aged 15-19 years in 2022. This study investigated inequalities in adolescent fertility rates (AFR) across Brazilian municipalities, utilizing data from the National Live Births Information System (SINASC) and the 2022 Demographic Census. Analyses included births between 2020 and 2022, excluding municipalities with fewer than 50 births in the 3 years. Municipal AFRs were compared with the average rate in countries classified by income level (high, upper-middle, lower-middle, and low income) and described according to the Brazilian Deprivation Index and population size. Inequalities within each geographic region were assessed using the mean absolute difference to the regional mean and range. Substantial disparities in AFR across regions were found, with the North and Northeast exhibiting the highest estimates, while the South and Southeast showed comparatively lower rates. The Midwest presented intermediate values. We found vast inequalities between municipalities, revealed by graphs and summary measures. A small proportion of municipalities, concentrated in the North region, experience exceptionally high AFR. A strong association between social vulnerability and early childbearing was also identified. Municipalities with higher levels of deprivation had markedly higher AFR, underscoring the influence of broader socio-economic factors on adolescent fertility. The results emphasize the need for targeted interventions and policies that address these underlying contextual determinants to reduce fertility rates among girls in Brazil effectively.
English version: https://doi.org/10.1590/SciELOPreprints.11534
A gravidez na adolescência é um desafio de saúde pública no Brasil, com uma taxa de fecundidade de 43,6 nascimentos por mil meninas de 15 a 19 anos em 2022. Este estudo investigou as desigualdades nas taxas de fecundidade adolescente (TFA) nos municípios brasileiros, utilizando dados do Sistema de Informações sobre Nascidos Vivos (SINASC) e do Censo Demográfico de 2022. A análise considerou nascimentos entre 2020 e 2022, excluindo municípios com menos de 50 nascimentos nos três anos. As TFAs municipais foram comparadas com a taxa média de países classificados por nível de renda (alta, média-alta, média-baixa e baixa renda) e descritas conforme o Índice Brasileiro de Privação e o tamanho populacional. As desigualdades dentro de cada região geográfica foram avaliadas usando a diferença absoluta média em relação à média regional e a amplitude. Foram observadas grandes disparidades nas TFAs entre as regiões, com o Norte e Nordeste apresentando as maiores taxas, e o Sul e Sudeste, as menores. O Centro-Oeste teve valores intermediários. As desigualdades entre os municípios foram evidenciadas por gráficos e índices, com uma pequena parcela de municípios da região Norte mostrando TFA excepcionalmente alta. Foi identificada uma forte associação entre vulnerabilidade social e gravidez precoce, com municípios em situações de maior privação apresentando taxas de fecundidade marcadamente mais altas. Os resultados destacam a necessidade de políticas públicas que abordem os determinantes contextuais subjacentes para reduzir as taxas de fecundidade entre adolescentes no Brasil.
English version: https://doi.org/10.1590/SciELOPreprints.11534
3.
Use of ascorbic acid (vitamin C) and alpha tocopherol (vitamin E) as adjuvants in the treatment of neuropathic pain
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Azevedo Filho, Fernando Antonio Silva de
; Castro, Yasmim Machado Chaves de
; Cerqueira, Marcos Pinho
; Rodrigues, Thiago Arruda
; Ali-Abdouni, Yussef
; Fucs, Patrícia Maria de Moraes Barros
.






RESUMO JUSTIFICATIVA E OBJETIVOS: Altas concentrações de radicais livres podem danificar ácidos nucleicos, proteínas e lipídios e o seu acúmulo pode estar envolvido na hipersensibilidade à dor. O objetivo deste estudo foi avaliar o efeito das vitaminas C e E como adjuvantes no tratamento da dor neuropática. MÉTODOS: Foram incluídos 98 pacientes com dor neuropática, classificados pelo Douleur Neuropathique 4 Questions (DN4), randomizados em dois grupos, controle e intervenção. O grupo controle recebeu 150 mg de pregabalina e o grupo intervenção150 mg de pregabalina associada a 500mg de vitamina C e 400mg de vitamina E. O tratamento e acompanhamento dos participantes foi de 12 semanas. Na avaliação inicial, os pacientes responderam ao Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) para avaliar a funcionalidade dos membros superiores; a qualidade de vida foi descrita utilizado o World Health Organization Quality of Life-Bref (WHOQOL-bref) e a avaliação da dor foi mensurada através da escala analógica visual (EAV). Após 12 semanas de tratamento, os pacientes responderam aos mesmos instrumentos. RESULTADOS: Oitenta e seis pacientes concluíram o tratamento. As perdas de participação na amostra foram por abandono do tratamento (n=7) ou por efeito adverso à pregabalina (n=5). O grupo intervenção apresentou resultados superiores em comparação com o grupo de controle. As comparações múltiplas entre grupos e momentos para os escores avaliados demonstraram uma diferença média do pré-tratamento para o pós-tratamento somente no grupo de intervenção (p < 0,05), com redução média no Quick-DASH e no EAV e um aumento médio no WHOQOL. CONCLUSÃO: Foi observado que o uso da vitamina C e E, em associação com a pregabalina, apresentou um efeito analgésico maior quando comparado ao uso isolado da pregabalina.
ABSTRACT BACKGROUND AND OBJECTIVES: High concentrations of free radicals can damage nucleic acids, proteins and lipids and their accumulation may be involved in hypersensitivity to pain. The objective of this study was to evaluate the effect of vitamins C and E as adjuvants in the treatment of neuropathic pain. METHODS: This study included 98 patients with neuropathic pain, classified by the Douleur Neuropathique 4 Questions (DN4), randomized into two groups: control and intervention. The control group received 150 mg of pregabalin and the intervention group 150 mg of pregabalin combined with 500 mg of vitamin C and 400 mg of vitamin E. Treatment and follow-up of the participants lasted 12 weeks. At the initial assessment, the patients answered the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) to assess upper limb functionality; quality of life was described using the World Health Organization Quality of Life-Bref (WHOQOL-bref) and pain assessment was measured using the visual analogue scale (VAS). After 12 weeks of treatment, the patients responded to the same instruments. RESULTS: 86 patients completed treatment. Losses of participation in the sample were due to abandonment of treatment (n=7) or adverse effects to pregabalin (n=5). The intervention group presented superior results compared to the control group. Multiple comparisons between groups and moments for the evaluated scores demonstrated a mean difference from pre-treatment to post-treatment only in the intervention group (p < 0.05), with a mean reduction in Quick-DASH and VAS and a mean increase from WHOQOL. CONCLUSION: It was observed that the use of vitamin C and E in combination with pregabalin had a greater analgesic effect than the use of pregabalin alone.
4.
New spirometry recommendations from the Brazilian Thoracic Association - 2024 update
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Albuquerque, André Luís Pereira de
; Berton, Danilo C
; Campos, Eloara Vieira Machado Ferreira Álvares S
; Queiroga-Júnior, Fernando José Pinho
; Santana, Alfredo Nicodemos Cruz
; Wong, Bruno de Moraes Santos
; Batista, Diane Rezende
; Melo, Felipe Xavier de
; Didier-Neto, Fernando Moacyr Fragoso
; Barros, João Adriano de
; Salge, João Marcos
; Neder, José Alberto
; Serra, Juliane Penalva Costa
; Voss, Larissa Rego
; Fuccio, Marcelo Bicalho de
; Soares, Maria Raquel
; Lima, Mariana Lafeta
; Mendes, Paulo Roberto Araújo
; Rodrigues-Junior, Roberto
; Melo, Saulo Maia D’Avila
; Rodrigues, Sílvia Carla Sousa
; Lessa, Thamine
; Pereira, Carlos Alberto de Castro
; Coutinho, Helen Moreira























RESUMO A última diretriz de função pulmonar da Sociedade Brasileira de Pneumologia e Tisiologia foi publicada em 2002, sendo que nesse intervalo houve atualizações de diretrizes internacionais (principalmente da European Respiratory Society e American Thoracic Society), além de novas publicações internacionais e nacionais sobre diversos aspectos da realização, interpretação e implicações clínicas da espirometria. Apesar dessas atualizações internacionais, é fundamental uma análise criteriosa do que se aplica a nossa realidade, uma vez que há trabalhos que avaliaram justamente indivíduos representativos da nossa população e que podem ter respostas diferentes das amostras internacionais. O presente documento foi resultado do trabalho de um grupo de especialistas em função pulmonar que avaliou as publicações científicas relacionadas e sua aplicabilidade para a população brasileira. Após as discussões, foram elaboradas as novas recomendações de espirometria, abrangendo diversos aspectos como sua orientação e realização técnica, indicações e contraindicações, interpretação, conceitos de normalidade e sua variabilidade relacionada, valores de referência, classificação de gravidade funcional e, finalmente, resposta ao broncodilatador inalatório. Por fim, foi destacada a associação dos resultados com o contexto clínico do paciente e sua probabilidade pré-teste.
ABSTRACT The latest pulmonary function guideline from the Brazilian Thoracic Association was published in 2002, since which there have been updates to international guidelines (mainly those from the European Respiratory Society and the American Thoracic Society), as well as new national and international publications on various aspects of the performance, interpretation, and clinical implications of spirometry. Despite those updates, a careful analysis of what applies to the reality in Brazil is essential, because there have been studies that evaluated individuals who are representative of our population and who could show responses different from those of individuals in other regions of the world. This document is the result of the work of a group of specialists in pulmonary function who evaluated relevant scientific articles that could be applicable to the population of Brazil. After the discussions, new spirometry guidelines were drawn up, covering various aspects such as its technical parameters and performance; its indications and contraindications; its interpretation; concepts of normality and their related variability; reference values; classification of functional severity; and response to an inhaled bronchodilator. Finally, the guidelines emphasize the need to always interpret spirometry results in the context of the clinical condition of the patient and of the pretest probability.
5.
Improvement of motor function in mice after implantation of mononuclear stem cells from human umbilical cord and placenta blood after 3 and 6 weeks of experimental spinal cord injury
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Araujo, Thiego Pedro Freitas
; Cristante, Alexandre Fogaça
; Marcon, Raphael Martus
; Santos, Gustavo Bispo dos
; Nicola, Maria Helena Alves
; Araujo, Alex Oliveira de
; Sanchez, Fernando Barbosa
; Barros Filho, Tarcísio Eloy Pessoa de
.








Abstract Study design Experimental study utilizing with a standardized model (MASCIS Impactor) of Spinal Cord Injury (SCI) in Balb C mouse model with implantation of mononuclear stem cells derived from the human umbilical cord and placenta blood in the early chronic phase of SCI. Objectives The aim of this study was to evaluate the nerve regeneration and motor functional recovery in Balb C mice with surgically induced paraplegia in response to the use of mononuclear stem cells, in early chronic phase (> 2 weeks and < 6 months), because there is yet potential of neuronal and functional recovery as the neuronal scar is not still completely established. Methods Forty-eight mice were randomly assigned to 6 groups of 8 animals. Group 1 received the stem cells 3 weeks after the trauma, and Group 2 received them six weeks later. In Group 3, saline solution was injected at the site of the lesion 3 weeks after the trauma, and in Group 4, 6 weeks later. Group 5 underwent only spinal cord injury and Group 6 underwent laminectomy only. The scales used for motor assessment were BMS and MFS for 12 weeks. Results The intervention groups showed statistically significant motor improvement. In the histopathological analysis, the intervention groups had a lower degree of injury (p < 0.05). Regarding axonal budding, the intervention groups showed increasing in axonal budding in the caudal portion (p < 0.05). Conclusions The use of stem cells in mice in the chronic phase after 3 and 6 weeks of SCI brings functional and histopathological benefits to them.
6.
Antivirais para pacientes adultos hospitalizados com infecção por SARS-CoV-2: Um estudo de Fase II/III, randomizado, multicêntrico, controlado por placebo, adaptativo, com múltiplos braços e estágios. COALITION COVID-19 BRAZIL IX - REVOLUTIOn: protocolo e plano de análise estatística
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Maia, Israel Silva
; Marcadenti, Aline
; Zampieri, Fernando Godinho
; Damiani, Lucas Petri
; Santos, Renato Hideo Nakagawa
; Negrelli, Karina Leal
; Gomes, Samara Pinheiro do Carmo
; Gomes, Jaqueline Oliveira
; Carollo, Mariana Barbosa dos Santos
; Miranda, Tamiris Abait
; Santucci, Eliana
; Valeis, Nanci
; Laranjeira, Ligia Nasi
; Westphal, Glauco Adrieno
; Horta, Jacques Gabriel Alvares
; Flato, Uri Adrian Prync
; Fernandes, Camilo
; Barros, Waldemar Carlos
; Bolan, Renata S
; Gebara, Otávio Celso Eluf
; Alencar Filho, Meton Soares de
; Hamamoto, Victor Augusto
; Hernandes, Mauro Esteves
; Golin, Nicole Alberti
; Olinda, Ronald Torres de
; Machado, Flávia Ribeiro
; Rosa, Régis Goulart
; Veiga, Viviane Cordeiro
; Azevedo, Luciano César Pontes de
; Avezum, Alvaro
; Lopes, Renato Delascio
; Souza, Tiago Moreno L
; Berwanger, Otávio
; Cavalcanti, Alexandre Biasi
.


































RESUMO Os medicamentos reaproveitados são importantes em contextos de recursos limitados porque as intervenções estão mais rapidamente disponíveis, já foram testadas com segurança em outras populações e são, em geral, mais baratas. Os medicamentos reaproveitados são uma solução eficaz, especialmente para doenças emergentes, como a COVID-19. O estudo REVOLUTIOn visa avaliar três medicamentos antivirais reaproveitados: atazanavir, daclatasvir e sofosbuvir, já utilizados em pacientes infectados pelo HIV ou pelo vírus da hepatite C, em um estudo randomizado, controlado por placebo, adaptativo, multibraço e em múltiplos estágios. Os medicamentos serão testados simultaneamente em um ensaio de Fase II para primeiro identificar se algum deles, isoladamente ou em combinação, reduz a carga viral. Se reduzirem, será iniciado um estudo de Fase III para investigar se tais medicamentos são capazes de aumentar o número de dias sem suporte respiratório. Os participantes devem ser adultos hospitalizados com idade ≥ 18 anos com início dos sintomas ≤ 9 dias e saturação de oxigênio ≤ 94% em ar ambiente ou necessidade de oxigênio suplementar para manter saturação de oxigênio > 94%. O tamanho total esperado da amostra varia entre 252 e 1.005 participantes, dependendo do número de estágios que serão concluídos no estudo. Assim, o protocolo é aqui descrito em detalhes, juntamente do plano de análise estatística. Em conclusão, o estudo REVOLUTIOn foi concebido para fornecer evidências se o atazanavir, o daclatasvir ou o sofosbuvir reduzem a carga viral de SARS-CoV-2 em pacientes com COVID-19 e aumentam o número de dias em que os pacientes ficam sem suporte respiratório. Neste artigo de protocolo, descrevem-se a fundamentação, o desenho e a situação do ensaio. Identificador do ClinicalTrials.gov:NCT04468087
ABSTRACT Repurposed drugs are important in resource-limited settings because the interventions are more rapidly available, have already been tested safely in other populations and are inexpensive. Repurposed drugs are an effective solution, especially for emerging diseases such as COVID-19. The REVOLUTIOn trial has the objective of evaluating three repurposed antiviral drugs, atazanavir, daclatasvir and sofosbuvir, already used for HIV- and hepatitis C virus-infected patients in a randomized, placebo-controlled, adaptive, multiarm, multistage study. The drugs will be tested simultaneously in a Phase II trial to first identify whether any of these drugs alone or in combination reduce the viral load. If they do, a Phase III trial will be initiated to investigate if these medications are capable of increasing the number of days free respiratory support. Participants must be hospitalized adults aged ≥ 18 years with initiation of symptoms ≤ 9 days and SpO2 ≤ 94% in room air or a need for supplemental oxygen to maintain an SpO2 > 94%. The expected total sample size ranges from 252 to 1,005 participants, depending on the number of stages that will be completed in the study. Hence, the protocol is described here in detail together with the statistical analysis plan. In conclusion, the REVOLUTIOn trial is designed to provide evidence on whether atazanavir, daclatasvir or sofosbuvir decrease the SARS-CoV-2 load in patients with COVID-19 and increase the number of days patients are free of respiratory support. In this protocol paper, we describe the rationale, design, and status of the trial. ClinicalTrials.gov identifier:NCT04468087
7.
Vacinação para influenza em idosos na pandemia COVID-19: estudo de base populacional em 133 cidades brasileiras
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Menezes, Ana Maria Baptista
; Hallal, Pedro Curi
; Silveira, Mariângela Freitas
; Wehrmeister, Fernando César
; Horta, Bernardo Lessa
; Barros, Aluísio Jardim Dornellas de
; Hartwig, Fernando Pires
; Oliveira, Paula Duarte
; Vidaletti, Luís Paulo
; Mesenburg, Marilia Arndt
; Jacques, Nadege
; Barros, Fernando C
; Victora, Cesar Gomes
.













Resumo Imunizações de rotina durante pandemias podem ser prejudicadas. Este estudo estimou a cobertura vacinal para influenza em idosos durante a COVID-19 através do EPICOVID-19, inquérito populacional realizado em 133 cidades sentinelas dos 26 estados brasileiros e Distrito Federal. Selecionou-se 25 setores censitários por cidade, amostragem proporcional ao tamanho, dez domicílios por setor e uma pessoa por domicílio, aleatoriamente. O quantitativo de 8.265 idosos (≥ 60 anos) foram entrevistados e responderam se haviam sido vacinados contra gripe em 2020. A cobertura foi 82,3% (IC95% 80,1; 84,2), sem diferenças por sexo, idade ou região. Maiores coberturas ocorreram nos mais ricos (84,7% versus 80,1% nos mais pobres) e nos mais escolarizados (87,3% versus 83,2% nos menos escolarizados). Menor cobertura nos indígenas (56,9% versus coberturas superiores a 80% nos demais grupos étnicos). Houve associação positiva com número de comorbidades entre homens, mas não entre mulheres. A maioria vacinou-se na rede pública (97,5%), sendo a rede privada mais utilizada na região Sul, pelos mais escolarizados e mais ricos. Conclui-se que a cobertura vacinal ficou sete pontos percentuais abaixo da meta governamental (90%), e que desigualdades devem ser revertidas em futuras campanhas.
Abstract Routine immunization during pandemics can be harmed. This study estimated the influenza vaccination coverage in older adults during the COVID-19 through the EPICOVID-19, a population-based study conducted in 133 cities from the 26 Brazilian states and Federal District. We selected 25 census tracts per city, with probability proportional to the tract’s size, ten households by census tract, and one random individual interviewed. A total of 8,265 older adults (≥60 years old) were interviewed and asked whether they had been vaccinated against flu in 2020. Vaccination coverage was 82.3% (95% CI: 80.1-84.2) with no difference by gender, age, and region; higher vaccination coverage was observed among the wealthiest (84.7% versus 80.1% in the poorest) and among the more educated (87.3% versus 83.2% less educated); lower coverage among indigenous (56.9% versus > 80% among other ethnic groups). A positive association was identified with the number of comorbidities among men but not among women. Most of the population was vaccinated (97.5%) in the public health system. The private network was chosen mainly in the South by the wealthiest and more educated. Vaccination coverage was seven percentage points lower than the government target (90%), and inequalities should be reversed in future campaigns.
8.
Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de
; Hammond, Naomi
; Li, Yang
; Azevedo, Luciano Cesar Pontes de
; Cavalcanti, Alexandre Biasi
; Taniguchi, Leandro
; Gobatto, André
; Japiassú, André Miguel
; Bafi, Antonio Tonete
; Mazza, Bruno Franco
; Noritomi, Danilo Teixeira
Dal-Pizzol, Felipe
Bozza, Fernando
Salluh, Jorge Ibrahin Figueira
Westphal, Glauco Adrieno
Soares, Márcio
Assunção, Murillo Santucci César de
Lisboa, Thiago
Lobo, Suzana Margarete Ajeje
Barbosa, Achilles Rohlfs
Ventura, Adriana Fonseca
Souza, Ailson Faria de
Silva, Alexandre Francisco
Toledo, Alexandre
Reis, Aline
Cembranel, Allan
Rea Neto, Alvaro
Gut, Ana Lúcia
Justo, Ana Patricia Pierre
Santos, Ana Paula
Albuquerque, André Campos D. de
Scazufka, André
Rodrigues, Antonio Babo
Fernandino, Bruno Bonaccorsi
Silva, Bruno Goncalves
Vidal, Bruno Sarno
Pinheiro, Bruno Valle
Pinto, Bruno Vilela Costa
Feijo, Carlos Augusto Ramos
Abreu Filho, Carlos de
Bosso, Carlos Eduardo da Costa Nunes
Moreira, Carlos Eduardo Nassif
Ramos, Carlos Henrique Ferreira
Tavares, Carmen
Arantes, Cidamaiá
Grion, Cintia
Mendes, Ciro Leite
Kmohan, Claudio
Piras, Claudio
Castro, Cristine Pilati Pileggi
Lins, Cyntia
Beraldo, Daniel
Fontes, Daniel
Boni, Daniela
Castiglioni, Débora
Paisani, Denise de Moraes
Pedroso, Durval Ferreira Fonseca
Mattos, Ederson Roberto
Brito Sobrinho, Edgar de
Troncoso, Edgar M. V.
Rodrigues Filho, Edison Moraes
Nogueira, Eduardo Enrico Ferrari
Ferreira, Eduardo Leme
Pacheco, Eduardo Souza
Jodar, Euzebio
Ferreira, Evandro L. A.
Araujo, Fabiana Fernandes de
Trevisol, Fabiana Schuelter
Amorim, Fábio Ferreira
Giannini, Fabio Poianas
Santos, Fabrício Primitivo Matos
Buarque, Fátima
Lima, Felipe Gallego
Costa, Fernando Antonio Alvares da
Sad, Fernando Cesar dos Anjos
Aranha, Fernando G.
Ganem, Fernando
Callil, Flavio
Costa Filho, Francisco Flávio
Dall´Arto, Frederico Toledo Campo
Moreno, Geovani
Friedman, Gilberto
Moralez, Giulliana Martines
Silva, Guilherme Abdalla da
Costa, Guilherme
Cavalcanti, Guilherme Silva
Cavalcanti, Guilherme Silva
Betônico, Gustavo Navarro
Betônico, Gustavo Navarro
Reis, Hélder
Araujo, Helia Beatriz N.
Hortiz Júnior, Helio Anjos
Guimaraes, Helio Penna
Urbano, Hugo
Maia, Israel
Santiago Filho, Ivan Lopes
Farhat Júnior, Jamil
Alvarez, Janu Rangel
Passos, Joel Tavares
Paranhos, Jorge Eduardo da Rocha
Marques, José Aurelio
Moreira Filho, José Gonçalves
Andrade, Jose Neto
Sobrinho, José Onofre de C
Bezerra, Jose Terceiro de Paiva
Alves, Juliana Apolônio
Ferreira, Juliana
Gomes, Jussara
Sato, Karina Midori
Gerent, Karine
Teixeira, Kathia Margarida Costa
Conde, Katia Aparecida Pessoa
Martins, Laércia Ferreira
Figueirêdo, Lanese
Rezegue, Leila
Tcherniacovsk, Leonardo
Ferraz, Leone Oliveira
Cavalcante, Liane
Rabelo, Ligia
Miilher, Lilian
Garcia, Lisiane
Tannous, Luana
Hajjar, Ludhmila Abrahão
Paciência, Luís Eduardo Miranda
Cruz Neto, Luiz Monteiro da
Bley, Macia Valeria
Sousa, Marcelo Ferreira
Puga, Marcelo Lourencini
Romano, Marcelo Luz Pereira
Nobrega, Marciano
Arbex, Marcio
Rodrigues, Márcio Leite
Guerreiro, Márcio Osório
Rocha, Marcone
Alves, Maria Angela Pangoni
Alves, Maria Angela Pangoni
Rosa, Maria Doroti
Dias, Mariza D’Agostino
Martins, Miquéias
Oliveira, Mirella de
Moretti, Miriane Melo Silveira
Matsui, Mirna
Messender, Octavio
Santarém, Orlando Luís de Andrade
Silveira, Patricio Júnior Henrique da
Vassallo, Paula Frizera
Antoniazzi, Paulo
Gottardo, Paulo César
Correia, Paulo
Ferreira, Paulo
Torres, Paulo
Silva, Pedro Gabrile M. de Barros e
Foernges, Rafael
Gomes, Rafael
Moraes, Rafael
Nonato filho, Raimundo
Borba, Renato Luis
Gomes, Renato V
Cordioli, Ricardo
Lima, Ricardo
López, Ricardo Pérez
Gargioni, Ricardo Rath de Oliveira
Rosenblat, Richard
Souza, Roberta Machado de
Almeida, Roberto
Narciso, Roberto Camargo
Marco, Roberto
waltrick, Roberto
Biondi, Rodrigo
Figueiredo, Rodrigo
Dutra, Rodrigo Santana
Batista, Roseane
Felipe, Rouge
Franco, Rubens Sergio da Silva
Houly, Sandra
Faria, Sara Socorro
Pinto, Sergio Felix
Luzzi, Sergio
Sant’ana, Sergio
Fernandes, Sergio Sonego
Yamada, Sérgio
Zajac, Sérgio
Vaz, Sidiner Mesquita
Bezerra, Silvia Aparecida Bezerra
Farhat, Tatiana Bueno Tardivo
Santos, Thiago Martins
Smith, Tiago
Silva, Ulysses V. A.
Damasceno, Valnei Bento
Nobre, Vandack
Dantas, Vicente Cés de Souza
Irineu, Vivian Menezes
Bogado, Viviane
Nedel, Wagner
Campos Filho, Walther
Dantas, Weidson
Viana, William
Oliveira Filho, Wilson de
Delgadinho, Wilson Martins
Finfer, Simon
Machado, Flavia Ribeiro










RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.
Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
https://doi.org/10.5935/0103-507x.20210028
273 downloads
9.
[SciELO Preprints] - Influenza vaccination in the elderly during the COVID-19 pandemic: A population-based study in 133 Brazilian cities
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Menezes, Ana Maria B
Curi Hallal, Pedro
Freitas Silveira, Mariângela
C Wehrmeister, Fernando
Lessa Horta, Bernardo
Jardim Dornellas de Barros, Aluísio
Pires Hartwig, Fernando
Oliveira, Paula
Vidaletti, Luís Paulo
A Mesenburg, Marilia
Jacques, Nadege
C Barros, Fernando
Gomes Victora, Cesar
Influenza vaccination coverage in the elderly was analysed during the COVID-19 pandemic through the EPICOVID-19, a population-based study conducted in 133 cities from the 26 Brazilian states and Federal District. Twenty five census tracts were sampled with probability proportional to the size of the tract, 10 households by census tracts and one random person interviewed. A total of 33,250 people were interviewed being 8,262 ≥60 years old. The elderly were asked whether they had had a flu vaccine in 2020. Vaccination coverage was 82.3% (CI95%=8 0.1-84.2) with no difference by sex, age, and region. Higher vaccination coverage was observed in the richest compared to the poorest (84.7% and 80.1%; p=<0.001), and among those with higher schooling (87.3% and 83.2; p=0.007). The indigenous presented lower coverage (56.9%) than other ethnic groups (>80%) (p=0.056). A positive association existed between vaccination coverage and number of comorbidities for men, but not for women. Most of those who were vaccinated (97.5%) received the vaccine in the public health system. The private was chosen mostly in the south, by the rich and by those with more schooling. Vaccination coverage was seven percentage points lower than the government target, and inequalities should be reverted in future campaigns.
Avaliou-se a cobertura vacinal para influenza em idosos na pandemia COVID-19 através do EPICOVID-19, inquérito de base populacional realizado em 133 cidades sentinela dos 26 estados brasileiros e Distrito Federal. Selecionou-se 25 setores censitários por cidade com amostragem proporcional ao tamanho, 10 domicílios por setor e uma pessoa por domicílio, aleatoriamente. Foram entrevistadas 33.250 pessoas, sendo 8.265 idosos. Perguntou-se aos idosos se haviam sido vacinados contra gripe em 2020. A cobertura foi de 82,3% (IC 95% 80,1–84,2), sem diferenças por sexo, idade ou região. Foram observadas maiores coberturas no quintil mais rico (84,7% contra 80,1% no mais pobre; p<0.001) e naqueles com graduação completa (87,3% contra 83,2% com fundamental incompleto; p=0.007), e menor cobertura nos indígenas (56,9% comparado a coberturas superiores a 80% nos demais grupos étnicos) (p=0,056). Houve associação positiva da cobertura com número de comorbidades entre homens, mas não entre mulheres. A maioria vacinou-se na rede pública (97,5%), sendo a rede privada mais utilizada na região sul, pelos mais escolarizados e mais ricos. Conclui-se que a cobertura vacinal ficou sete pontos percentuais abaixo da meta governamental, e que desigualdades devem ser revertidas em futuras campanhas.
10.
COVID-19 and social distancing among children and adolescents in Brazil
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Barros, Fernando C
; Hartwig, Fernando P
; Barros, Aluísio J D
; Menezes, Ana M B
; Horta, Bernardo L
; Struchiner, Cláudio J
; Vidaletti, Luis Paulo
; Silveira, Mariangela F
; Mesenburg, Marilia A
; Delagostin, Odir A
; Hallal, Pedro C
; Victora, Cesar G
.












ABSTRACT OBJECTIVE To estimate the prevalence of SARS-CoV-2 antibodies and the adherence to measures of social distancing in children and adolescents studied in three national surveys conducted in Brazil between May–June 2020. METHODS Three national serological surveys were conducted in 133 sentinel cities located in all 27 Federative Units. Multistage probability sampling was used to select 250 individuals per city. The total sample size in age ranges 0–9 and 10–19 years old are of 4,263 and 8,024 individuals, respectively. Information on children or adolescents was gathered with a data collection app, and a rapid point-of-case test for SARS-CoV-2 was conducted on a finger prick blood sample. RESULTS The adjusted prevalence of antibodies was 2.9% (2.2–3.6) among children 0–9 years, 2.2% (1.8–2.6) among adolescents 10-19 years, and 3.0% (2.7–3.3) among adults 20+years. Prevalence of antibodies was higher among poor children and adolescents compared to those of rich families. Adherence to social distancing measures was seen in 72.4% (71.9–73.8) of families with children, 60.8% (59.6–61.9) for adolescents, and 57.4% (56.9–57.8) for adults. For not leaving the house except for essential matters the proportions were 81.7% (80.5–82.9), 70.6% (69.6–61.9), and 65.1% (64.7–65.5), respectively. Among children and adolescents, social distancing was strongly associated with socioeconomic status, being much higher in the better-off families. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 showed comparable levels among children, adolescents, and adults. Adherence to social distancing measures was more prevalent in children, followed by adolescents. There were important socioeconomic differences in the adherence to social distancing among children and adolescents.
https://doi.org/10.11606/s1518-8787.2021055003832
132 downloads
11.
Time-dependent decay of detectable antibodies against SARS-CoV-2: A comparison of ELISA with two batches of a lateral-flow test
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Silveira, Mariangela F
; Mesenburg, Marilia A
; Dellagostin, Odir A
; Oliveira, Natasha R de
; Maia, Mara AC
; Santos, Francisco D
; Vale, André
; Menezes, Ana M B
; Victora, Gabriel D
; Victora, Cesar G
Barros, Aluisio JD
Vidaletti, Luis Paulo
Hartwig, Fernando P
Barros, Fernando C
Hallal, Pedro C
Horta, Bernardo L









ABSTRACT Background: Large-scale epidemiological studies of seroprevalence of antibodies against SARS-CoV-2 often rely on point-of-care tests that provide immediate results to participants. Yet, little is known on how long rapid tests remain positive after the COVID-19 episode, or how much variability exists across different brands and even among batches of the same test. Methods: In November 2020, we assessed the sensitivity of three tests applied to 133 individuals with a previous positive PCR result between April and October. All subjects provided finger prick blood samples for two batches (A and B) of the Wondfo lateral-flow IgG/IgM test, and dried blood spot samples for the S-UFRJ ELISA test. Results: Overall sensitivity levels were 92.5% (95% CI 86.6-96.3), 63.2% (95% CI 54.4-71.4) and 33.8% (95% CI 25.9-42.5) for the S-UFRJ test, Wondfo A and Wondfo B tests, respectively. There was no evidence of a decline in the positivity of S-UFRJ with time since the diagnosis, but the two Wondfo batches showed sharp reductions to as low as 41.9% and 19.4%, respectively, for subjects with a positive PCR in June or earlier. Positive results for batch B of the rapid test were 35% to 54% lower than for batch A at any given month of diagnosis. Interpretation: Whereas the ELISA test showed high sensitivity and stability of results over the five months of the study, both batches of the rapid test showed substantial declines, with one of the batches consistently showing lower sensitivity levels than the other. ELISA tests based on dried-blood spots are an inexpensive alternative to rapid lateral-flow tests in large-scale epidemiological studies.
https://doi.org/10.1016/j.bjid.2021.101601
40 downloads
12.
Population-level seropositivity trend for SARS-Cov-2 in Rio Grande do Sul, Brazil
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Barros, Aluísio J D
; Victora, Cesar G
; Menezes, Ana M B
; Horta, Bernardo L
; Barros, Fernando C
; Hartwig, Fernando P
; Victora, Gabriel D
; Vidaletti, Luis Paulo
; Silveira, Mariângela F
; Mesenburg, Marilia A
; Jacques, Nadège
; Struchiner, Cláudio J
; Brust, Flávia Roberta
; Dall’Agnol, Marinel M
; Delamare, Ana Paula Longaray
; François, Carlos Henrique R
; Ikeda, Maria Letícia R
; Pellegrini, Débora C P
; Reuter, Cézane Priscila
; Silva, Shana G da
; Dellagostin, Odir A
; Hallal, Pedro C
.






















ABSTRACT OBJECTIVE To describe the evolution of seropositivity in the State of Rio Grande do Sul, Brazil, through 10 consecutive surveys conducted between April 2020 and April 2021. METHODS Nine cities covering all regions of the State were studied, 500 households in each city. One resident in each household was randomly selected for testing. In survey rounds 1–8 we used the rapid WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech Co., Guangzhou, China). In rounds 9–10, we used a direct ELISA test that identifies IgG to the viral S protein (S-UFRJ). In terms of social distancing, individuals were asked three questions, from which we generated an exposure score using principal components analysis. RESULTS Antibody prevalence in early April 2020 was 0.07%, increasing to 10.0% in February 2021, and to 18.2% in April 2021. In round 10, self-reported whites showed the lowest seroprevalence (17.3%), while indigenous individuals presented the highest (44.4%). Seropositivity increased by 40% when comparing the most with the least exposed. CONCLUSIONS The proportion of the population already infected by SARS-Cov-2 in the state is still far from any perspective of herd immunity and the infection affects population groups in very different levels.
13.
Population-level seropositivity trend for SARS-Cov-2 in Rio Grande do Sul, Brazil
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Barros, Aluísio J D
; Victora, Cesar G
; Menezes, Ana M B
; Horta, Bernardo L
; Barros, Fernando C
; Hartwig, Fernando P
; Victora, Gabriel D
; Vidaletti, Luis Paulo
; Silveira, Mariângela F
; Mesenburg, Marilia A
; Jacques, Nadège
; Struchiner, Cláudio J
; Brust, Flávia Roberta
; Dall’Agnol, Marinel M
; Delamare, Ana Paula Longaray
; François, Carlos Henrique R
; Ikeda, Maria Letícia R
; Pellegrini, Débora C P
; Reuter, Cézane Priscila
; Silva, Shana G da
; Dellagostin, Odir A
; Hallal, Pedro C
.






















ABSTRACT OBJECTIVE To describe the evolution of seropositivity in the State of Rio Grande do Sul, Brazil, through 10 consecutive surveys conducted between April 2020 and April 2021. METHODS Nine cities covering all regions of the State were studied, 500 households in each city. One resident in each household was randomly selected for testing. In survey rounds 1–8 we used the rapid WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech Co., Guangzhou, China). In rounds 9–10, we used a direct ELISA test that identifies IgG to the viral S protein (S-UFRJ). In terms of social distancing, individuals were asked three questions, from which we generated an exposure score using principal components analysis. RESULTS Antibody prevalence in early April 2020 was 0.07%, increasing to 10.0% in February 2021, and to 18.2% in April 2021. In round 10, self-reported whites showed the lowest seroprevalence (17.3%), while indigenous individuals presented the highest (44.4%). Seropositivity increased by 40% when comparing the most with the least exposed. CONCLUSIONS The proportion of the population already infected by SARS-Cov-2 in the state is still far from any perspective of herd immunity and the infection affects population groups in very different levels.
14.
COVID-19 and social distancing among children and adolescents in Brazil
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Barros, Fernando C
; Hartwig, Fernando P
; Barros, Aluísio J D
; Menezes, Ana M B
; Horta, Bernardo L
; Struchiner, Cláudio J
; Vidaletti, Luis Paulo
; Silveira, Mariangela F
; Mesenburg, Marilia A
; Delagostin, Odir A
; Hallal, Pedro C
; Victora, Cesar G
.












ABSTRACT OBJECTIVE To estimate the prevalence of SARS-CoV-2 antibodies and the adherence to measures of social distancing in children and adolescents studied in three national surveys conducted in Brazil between May–June 2020. METHODS Three national serological surveys were conducted in 133 sentinel cities located in all 27 Federative Units. Multistage probability sampling was used to select 250 individuals per city. The total sample size in age ranges 0–9 and 10–19 years old are of 4,263 and 8,024 individuals, respectively. Information on children or adolescents was gathered with a data collection app, and a rapid point-of-case test for SARS-CoV-2 was conducted on a finger prick blood sample. RESULTS The adjusted prevalence of antibodies was 2.9% (2.2–3.6) among children 0–9 years, 2.2% (1.8–2.6) among adolescents 10-19 years, and 3.0% (2.7–3.3) among adults 20+years. Prevalence of antibodies was higher among poor children and adolescents compared to those of rich families. Adherence to social distancing measures was seen in 72.4% (71.9–73.8) of families with children, 60.8% (59.6–61.9) for adolescents, and 57.4% (56.9–57.8) for adults. For not leaving the house except for essential matters the proportions were 81.7% (80.5–82.9), 70.6% (69.6–61.9), and 65.1% (64.7–65.5), respectively. Among children and adolescents, social distancing was strongly associated with socioeconomic status, being much higher in the better-off families. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 showed comparable levels among children, adolescents, and adults. Adherence to social distancing measures was more prevalent in children, followed by adolescents. There were important socioeconomic differences in the adherence to social distancing among children and adolescents.
15.
Vacinação para influenza em idosos na pandemia COVID-19: estudo de base populacional em 133 cidades brasileiras
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Menezes, Ana Maria Baptista
; Hallal, Pedro Curi
; Silveira, Mariângela Freitas
; Wehrmeister, Fernando César
; Horta, Bernardo Lessa
; Barros, Aluísio Jardim Dornellas de
; Hartwig, Fernando Pires
; Oliveira, Paula Duarte
; Vidaletti, Luís Paulo
; Mesenburg, Marilia Arndt
; Jacques, Nadege
; Barros, Fernando C
; Victora, Cesar Gomes
.













Resumo Imunizações de rotina durante pandemias podem ser prejudicadas. Este estudo estimou a cobertura vacinal para influenza em idosos durante a COVID-19 através do EPICOVID-19, inquérito populacional realizado em 133 cidades sentinelas dos 26 estados brasileiros e Distrito Federal. Selecionou-se 25 setores censitários por cidade, amostragem proporcional ao tamanho, dez domicílios por setor e uma pessoa por domicílio, aleatoriamente. O quantitativo de 8.265 idosos (≥ 60 anos) foram entrevistados e responderam se haviam sido vacinados contra gripe em 2020. A cobertura foi 82,3% (IC95% 80,1; 84,2), sem diferenças por sexo, idade ou região. Maiores coberturas ocorreram nos mais ricos (84,7% versus 80,1% nos mais pobres) e nos mais escolarizados (87,3% versus 83,2% nos menos escolarizados). Menor cobertura nos indígenas (56,9% versus coberturas superiores a 80% nos demais grupos étnicos). Houve associação positiva com número de comorbidades entre homens, mas não entre mulheres. A maioria vacinou-se na rede pública (97,5%), sendo a rede privada mais utilizada na região Sul, pelos mais escolarizados e mais ricos. Conclui-se que a cobertura vacinal ficou sete pontos percentuais abaixo da meta governamental (90%), e que desigualdades devem ser revertidas em futuras campanhas.
Abstract Routine immunization during pandemics can be harmed. This study estimated the influenza vaccination coverage in older adults during the COVID-19 through the EPICOVID-19, a population-based study conducted in 133 cities from the 26 Brazilian states and Federal District. We selected 25 census tracts per city, with probability proportional to the tract’s size, ten households by census tract, and one random individual interviewed. A total of 8,265 older adults (≥60 years old) were interviewed and asked whether they had been vaccinated against flu in 2020. Vaccination coverage was 82.3% (95% CI: 80.1-84.2) with no difference by gender, age, and region; higher vaccination coverage was observed among the wealthiest (84.7% versus 80.1% in the poorest) and among the more educated (87.3% versus 83.2% less educated); lower coverage among indigenous (56.9% versus > 80% among other ethnic groups). A positive association was identified with the number of comorbidities among men but not among women. Most of the population was vaccinated (97.5%) in the public health system. The private network was chosen mainly in the South by the wealthiest and more educated. Vaccination coverage was seven percentage points lower than the government target (90%), and inequalities should be reversed in future campaigns.
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