Abstract The Chikungunya Virus (CHIKV) already has endemic circulation in about 100 countries and the number of infected patients increases every year, due to the effectiveness of the vector and human universal susceptibility to infection. The virus can also be transmitted from mother to child, more frequently intrapartum. About 50 % of neonates with CHIKV symptoms will have neurodevelopmental delay. It is therefore an infection of worldwide concern with a great impact on people's quality of life. The objective of this work is to describe two cases of confirmed vertical transmission by chikungunya virus, one of them with intrauterine infection and death of the neonate. Neonates with vertical chikungunya infection may present with clinical sepsis in the first few days of life, which is why this is a very important diagnosis, especially during outbreaks of the infection. (CHIKV 10 year child intrapartum 5 delay peoples people s life neonate diagnosis 1

ABSTRACT Objective: To analyze the factors associated with the individual use of insect repellent by women of childbearing age living in area endemic for arboviruses in Fortaleza, Brazil. Methods: This is a cohort study carried out between 2018 and 2019 with women aged between 15 and 39 years in Fortaleza, state of Ceará, Brazil. A total of 1,173 women users of one of the four selected primary health care units participated in the study. The outcome was divided into: continued use, discontinued use, and nonuse of insect repellent. Crude and adjusted multinominal logistic regression analysis was carried out guided by a hierarchical model, with presentation of the respective odds ratio (OR) and 95% confidence intervals (95%CI). The independent variables include: socioeconomic and demographic data, environmental and sanitary characteristics, knowledge of the insect repellent, and behavioral and pregnancy-related aspects. Results: Only 28% of the participants reported using insect repellent during the two waves of the cohort. Women with higher education (OR=2.55; 95%CI 1.44–4.51); who are employed (OR=1.51; 95%CI 1.12–2.03); who received guidance from healthcare professionals (OR=1.74; 95%CI 1.28–2.36) and the media (OR=1.43; 95%CI 1.01–2.02); who intensified precautions against mosquitoes during the epidemic (OR=3.64; 95%CI 2.29–5.78); and who were pregnant between 2016 and 2019 (OR=2.80; 95%CI 1.83–4.30) had increased odds for continued use of insect repellent. Conclusion: The use of insect repellent among women of childbearing age was associated with a higher level of education, employment, guidance on insect repellent provided by healthcare professionals and the media, behavioral changes to protect against mosquitoes during the Zika virus epidemic, and pregnancy when occurring as of the beginning of the epidemic period. Objective Fortaleza Brazil Methods 201 1 3 Ceará 1173 173 1,17 into model OR (OR 95 95%CI. 95CI CI . (95%CI) include data characteristics pregnancyrelated related aspects Results 28 OR=2.55 OR255 2 55 (OR=2.55 1.44–4.51 144451 44 4 51 1.44–4.51) OR=1.51 OR151 (OR=1.51 1.12–2.03 112203 12 03 1.12–2.03) OR=1.74 OR174 74 (OR=1.74 1.28–2.36 128236 36 OR=1.43 OR143 43 (OR=1.43 1.01–2.02 101202 01 02 1.01–2.02) OR=3.64 OR364 64 (OR=3.64 2.29–5.78 229578 29 5 78 2.29–5.78) OR=2.80 OR280 80 (OR=2.80 1.83–4.30 183430 83 30 Conclusion employment period 20 117 17 1,1 9 (95%CI OR=2.5 OR25 (OR=2.5 1.44–4.5 14445 OR=1.5 OR15 (OR=1.5 1.12–2.0 11220 0 OR=1.7 OR17 7 (OR=1.7 1.28–2.3 12823 OR=1.4 OR14 (OR=1.4 1.01–2.0 10120 OR=3.6 OR36 6 (OR=3.6 2.29–5.7 22957 OR=2.8 OR28 8 (OR=2.8 1.83–4.3 18343 11 1, OR=2. OR2 (OR=2. 1.44–4. 1444 OR=1. OR1 (OR=1. 1.12–2. 1122 1.28–2. 1282 1.01–2. 1012 OR=3. OR3 (OR=3. 2.29–5. 2295 1.83–4. 1834 OR=2 (OR=2 1.44–4 144 OR=1 (OR=1 1.12–2 112 1.28–2 128 1.01–2 101 OR=3 (OR=3 2.29–5 229 1.83–4 183 OR= (OR= 1.44– 14 1.12– 1.28– 1.01– 10 2.29– 22 1.83– 18 1.44 1.12 1.28 1.01 2.29 1.83 1.4 1.1 1.2 1.0 2.2 1.8 1. 2.

RESUMO Objetivo: Analisar os fatores associados ao uso de repelente individual por mulheres em idade fértil residentes em área endêmicas para arboviroses em Fortaleza, Brasil. Métodos: Coorte realizada entre 2018 e 2019, com mulheres entre 15 e 39 anos, moradoras em Fortaleza, Ceará, Brasil. Participaram 1.173 mulheres, usuárias de quatro unidades primárias de saúde do município. O desfecho foi categorizado em: uso continuado, uso descontinuado e não uso de repelente. Realizada análise de regressão logística multinominal norteada por modelo hierárquico, com apresentação dos respectivos odds ratio (OR) e intervalos de confiança de 95% (IC95%). As variáveis independentes incluem: dados socioeconômicos e demográficos, características ambientais e sanitárias, conhecimento sobre o repelente e aspectos comportamentais e relacionados à gravidez. Resultados: Somente 28% das participantes referiram o uso de repelente durante as duas ondas da coorte. Mulheres com escolaridade superior (OR=2,55; IC95% 1,44–4,51); com emprego (OR=1,51; IC95% 1,12–2,03); que receberam orientações por profissionais da saúde (OR=1,74; IC95% 1,28–2,36) e pela mídia (OR=1,43; IC95% 1,01–2,02); que intensificaram os cuidados contra o mosquito na epidemia (OR=3,64; IC95% 2,29–5,78); estavam grávidas entre 2016 e 2019 (OR=2,80; IC95% 1,83–4,30) tiveram as chances aumentadas para uso continuado de repelente. Conclusões: O uso de repelente entre mulheres em idade fértil mostrou-se associado a um maior nível de escolaridade, ao emprego, às orientações sobre repelente fornecidas por profissionais de saúde e pela mídia, às mudanças comportamentais de cuidado contra o mosquito durante a epidemia da Zika e à gravidez quando ocorrida a partir do início do período epidêmico. Objetivo Fortaleza Brasil Métodos 201 1 3 anos Ceará 1173 173 1.17 município hierárquico OR (OR 95 IC95%. IC95 IC . (IC95%) incluem demográficos sanitárias Resultados 28 coorte OR=2,55 OR255 2 55 (OR=2,55 1,44–4,51 144451 44 4 51 1,44–4,51) OR=1,51 OR151 (OR=1,51 1,12–2,03 112203 12 03 1,12–2,03) OR=1,74 OR174 74 (OR=1,74 1,28–2,36 128236 36 OR=1,43 OR143 43 (OR=1,43 1,01–2,02 101202 01 02 1,01–2,02) OR=3,64 OR364 64 (OR=3,64 2,29–5,78 229578 29 5 78 2,29–5,78) OR=2,80 OR280 80 (OR=2,80 1,83–4,30 183430 83 30 Conclusões mostrouse mostrou se epidêmico 20 117 17 1.1 9 IC9 (IC95% OR=2,5 OR25 (OR=2,5 1,44–4,5 14445 OR=1,5 OR15 (OR=1,5 1,12–2,0 11220 0 OR=1,7 OR17 7 (OR=1,7 1,28–2,3 12823 OR=1,4 OR14 (OR=1,4 1,01–2,0 10120 OR=3,6 OR36 6 (OR=3,6 2,29–5,7 22957 OR=2,8 OR28 8 (OR=2,8 1,83–4,3 18343 11 1. (IC95 OR=2, OR2 (OR=2, 1,44–4, 1444 OR=1, OR1 (OR=1, 1,12–2, 1122 1,28–2, 1282 1,01–2, 1012 OR=3, OR3 (OR=3, 2,29–5, 2295 1,83–4, 1834 (IC9 OR=2 (OR=2 1,44–4 144 OR=1 (OR=1 1,12–2 112 1,28–2 128 1,01–2 101 OR=3 (OR=3 2,29–5 229 1,83–4 183 (IC OR= (OR= 1,44– 14 1,12– 1,28– 1,01– 10 2,29– 22 1,83– 18 1,44 1,12 1,28 1,01 2,29 1,83 1,4 1,1 1,2 1,0 2,2 1,8 1, 2,

ABSTRACT Objective: To analyze the factors associated with the individual use of insect repellent by women of childbearing age living in area endemic for arboviruses in Fortaleza, Brazil. Methods: This is a cohort study carried out between 2018 and 2019 with women aged between 15 and 39 years in Fortaleza, state of Ceará, Brazil. A total of 1,173 women users of one of the four selected primary health care units participated in the study. The outcome was divided into: continued use, discontinued use, and nonuse of insect repellent. Crude and adjusted multinominal logistic regression analysis was carried out guided by a hierarchical model, with presentation of the respective odds ratio (OR) and 95% confidence intervals (95%CI). The independent variables include: socioeconomic and demographic data, environmental and sanitary characteristics, knowledge of the insect repellent, and behavioral and pregnancy-related aspects. Results: Only 28% of the participants reported using insect repellent during the two waves of the cohort. Women with higher education (OR=2.55; 95%CI 1.44–4.51); who are employed (OR=1.51; 95%CI 1.12–2.03); who received guidance from healthcare professionals (OR=1.74; 95%CI 1.28–2.36) and the media (OR=1.43; 95%CI 1.01–2.02); who intensified precautions against mosquitoes during the epidemic (OR=3.64; 95%CI 2.29–5.78); and who were pregnant between 2016 and 2019 (OR=2.80; 95%CI 1.83–4.30) had increased odds for continued use of insect repellent. Conclusion: The use of insect repellent among women of childbearing age was associated with a higher level of education, employment, guidance on insect repellent provided by healthcare professionals and the media, behavioral changes to protect against mosquitoes during the Zika virus epidemic, and pregnancy when occurring as of the beginning of the epidemic period.

RESUMO Objetivo: Analisar os fatores associados ao uso de repelente individual por mulheres em idade fértil residentes em área endêmicas para arboviroses em Fortaleza, Brasil. Métodos: Coorte realizada entre 2018 e 2019, com mulheres entre 15 e 39 anos, moradoras em Fortaleza, Ceará, Brasil. Participaram 1.173 mulheres, usuárias de quatro unidades primárias de saúde do município. O desfecho foi categorizado em: uso continuado, uso descontinuado e não uso de repelente. Realizada análise de regressão logística multinominal norteada por modelo hierárquico, com apresentação dos respectivos odds ratio (OR) e intervalos de confiança de 95% (IC95%). As variáveis independentes incluem: dados socioeconômicos e demográficos, características ambientais e sanitárias, conhecimento sobre o repelente e aspectos comportamentais e relacionados à gravidez. Resultados: Somente 28% das participantes referiram o uso de repelente durante as duas ondas da coorte. Mulheres com escolaridade superior (OR=2,55; IC95% 1,44–4,51); com emprego (OR=1,51; IC95% 1,12–2,03); que receberam orientações por profissionais da saúde (OR=1,74; IC95% 1,28–2,36) e pela mídia (OR=1,43; IC95% 1,01–2,02); que intensificaram os cuidados contra o mosquito na epidemia (OR=3,64; IC95% 2,29–5,78); estavam grávidas entre 2016 e 2019 (OR=2,80; IC95% 1,83–4,30) tiveram as chances aumentadas para uso continuado de repelente. Conclusões: O uso de repelente entre mulheres em idade fértil mostrou-se associado a um maior nível de escolaridade, ao emprego, às orientações sobre repelente fornecidas por profissionais de saúde e pela mídia, às mudanças comportamentais de cuidado contra o mosquito durante a epidemia da Zika e à gravidez quando ocorrida a partir do início do período epidêmico.

ABSTRACT Objective: To determine the prevalence and factors associated with the physical rehabilitation of critically ill children in Brazilian pediatric intensive care units. Methods: A 2-day, cross-sectional, multicenter point prevalence study comprising 27 pediatric intensive care units (out of 738) was conducted in Brazil in April and June 2019. This Brazilian study was part of a large multinational study called Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU). The primary outcome was the prevalence of mobility provided by physical therapy or occupational therapy. Clinical data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥ 72 hours. Results: Children under the age of 3 years comprised 68% of the patient population. The prevalence of therapist-provided mobility was 74%, or 277 out of the 375 patient-days. Out-of-bed mobility was most positively associated with family presence (adjusted odds ratios 3.31;95%CI 1.70 - 6.43) and most negatively associated with arterial lines (adjusted odds ratios 0.16; 95%CI 0.05 - 0.57). Barriers to mobilization were reported on 27% of patient-days, the most common being lack of physician order (n = 18). Potential safety events occurred in 3% of all mobilization events. Conclusion: Therapist-provided mobility in Brazilian pediatric intensive care units is frequent. Family presence was high and positively associated with out-of-bed mobility. The presence of physiotherapists 24 hours a day in Brazilian pediatric intensive care units may have a substantial impact on the mobilization of critically ill children. Objective Methods 2day, 2day 2 day, 2-day crosssectional, crosssectional cross sectional, sectional cross-sectional 738 2019 PARKPICU. PARKPICU PARK . (PARK-PICU) 7 Results 68 population therapistprovided therapist 74 74% 37 patientdays. patientdays days. days patient-days Outofbed Out bed adjusted 3.3195%CI 33195CI CI 3.31 31 95 170 1 70 1.7 6.43 643 6 43 0.16 016 0 16 95CI 005 05 0.0 0.57. 057 0.57 57 0.57) patientdays, days, n 18. 18 18) Conclusion Therapistprovided Therapist frequent outofbed 73 201 (PARK-PICU 3195 331 3.3 9 17 1. 6.4 64 4 0.1 01 00 0. 0.5 5 20 319 33 3. 6.

RESUMO Objetivo: Determinar a prevalência e os fatores associados à reabilitação física de crianças em estado grave em unidades de terapia intensiva pediátrica brasileiras. Métodos: Realizou-se um estudo de prevalência pontual multicêntrico, transversal, de 2 dias, abrangendo 27 unidades de terapia intensiva pediátrica (do total de 738) no Brasil em abril e junho de 2019. Este estudo brasileiro fez parte de um grande estudo multinacional chamado Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU). O desfecho primário foi a prevalência de mobilidade proporcionada pela fisioterapia ou pela terapia ocupacional. Foram coletados prospectivamente dados clínicos sobre a mobilidade do paciente, possíveis eventos de segurança de mobilidade e barreiras de mobilização em pacientes admitidos por ≥ 72 horas. Resultados: As crianças com idade inferior a 3 anos eram 68% da população de pacientes. A prevalência de mobilidade fornecida pelo terapeuta foi de 74%, ou 277 dos 375 pacientes-dia. A mobilidade para fora do leito foi mais positivamente associada à presença de familiares (razão de chance ajustada de 3,31; IC95% 1,70 - 6,43) e mais negativamente associada às linhas arteriais (razão de chance ajustada de 0,16; IC95% 0,05 - 0,57). Foram relatadas barreiras à mobilização em 27% dos pacientes-dia, sendo a mais comum a falta de prescrição médica (n = 18). Registaram-se eventuais eventos de segurança em 3% de todos os eventos de mobilização. Conclusão: A mobilidade proporcionada pelo terapeuta nas unidades de terapia intensiva pediátrica brasileiras é frequente. A presença de familiares foi alta e positivamente associada à mobilidade para fora do leito. A presença de fisioterapeutas 24 horas por dia nas unidades de terapia intensiva pediátrica brasileiras pode exercer papel importante na mobilização de crianças em estado grave. Objetivo Métodos Realizouse Realizou se multicêntrico transversal dias 738 2019 PARKPICU. PARKPICU PARK . (PARK-PICU) ocupacional paciente 7 Resultados 68 74 74% 37 pacientesdia. pacientesdia dia. pacientes-dia razão 3,31 331 31 IC95 IC 170 1 70 1,7 6,43 643 6 43 0,16 016 0 16 005 05 0,0 0,57. 057 0,57 57 0,57) pacientesdia, dia, n 18. 18 18) Registaramse Registaram Conclusão frequente 73 201 (PARK-PICU 3,3 33 IC9 17 1, 6,4 64 4 0,1 01 00 0, 0,5 5 20 3, 6,

Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS). VC, , (VC) poliomyelitis concern 1 201 2021 Brazil COVID19 COVID 19 COVID-1 STI (STI analysis NeweyWest Newey West Index index Covid19 Covid Covid-1 2019 SUS. SUS . (SUS) (VC 20 202 COVID1 COVID- Covid1 Covid- (SUS 2

Resumo A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde. (CV infância sanitária 1 201 2021 COVID19, COVID19 COVID 19, 19 COVID-19 Brasil STI (STI espacial Imunização NeweyWest, NeweyWest Newey West, West Newey-West Brasileiro local Saúde Observase Observa país social 20 202 COVID1 COVID-1 2 COVID-

Abstract The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted. reemergence re emergence vaccinepreventable preventable (VC countries 201 2021 COVID19 COVID 19 COVID-1 trend spacetime space distribution dose 1, 1 , 1) spatiotemporal spatio disposition 2015 2020 regions Northeast indicators inequality Strategy municipalities circulation however care hesitancy highlighted 20 202 COVID1 COVID- 2

Resumo A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal. (CV países 201 2021 COVID19, COVID19 COVID 19, 19 COVID-19 espaçotemporal espaço Tratase Trata se dose 1, 1 , 1) espaçotemporal, 2015 observase observa acentuandose acentuando 202 regiões Nordeste humano Família desiguais vírus básica vacina vacinal 20 COVID1 COVID-1 2 COVID-

Abstract Paper aims Analyzes the use of process management and safety culture practices in Radiotherapy Services and impacts on quality of patient care and safety. Originality Radiotherapy processes require controls and must be developed in an environment with safety. However, despite necessary practices, there are few studies that analyze their implementation and impacts. Research method Was conducted a survey and the data were analyzed using descriptive statistics and SEM-PLS. Main findings Process management practices and safety culture have been used in response to competitive environment and regulatory guidelines. The study confirmed the positive impact of using safety culture and process management practices. Implications for theory and practice Managerial support promoting management and improvement practices and safety culture, along use of process maps, feedback in response to incident reports, patient satisfaction surveys and teamwork contributes to the quality of care and safety. These practices can be prioritized to be deployed by managers and in theoretical models. However SEMPLS. SEMPLS SEM PLS. PLS SEM-PLS guidelines maps reports models

Resumo A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal.

Abstract The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.

Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

Resumo A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde.

Abstract: INTRODUCTION Arboviruses are associated with human disease, and non-human primates (NHPs) are important primary hosts. This study shows the detection of antibodies to Oropouche virus (OROV) in NHPs either living in urban parks or acclimatized at the Wild Animal Screening Center, Goiânia city. METHODS: Fifty blood samples were analyzed by hemagglutination-inhibition and neutralization assays. RESULTS: Two monkeys (Alouatta caraya) had antibodies to OROV by both techniques. CONCLUSIONS This is the first report demonstrating the detection of OROV antibodies in Goiás State and may represent the introduction/circulation of OROV in the region and a potential risk to the human population.