Tag: pubmed

Cad Saude Publica. 2025 Jan 13;40(11):e00217323. doi: 10.1590/0102-311XPT217323. eCollection 2025.

ABSTRACT

This study aimed to evaluate the overall excess mortality and COVID-19 mortality in the regions of Brazil, in 2020, by sex and age group. An ecological study was carried out to calculate the overall excess mortality, by sex and age group, using the expected number of deaths in a non-pandemic context and the deaths observed in 2020. Data on deaths were extracted from the Brazilian Mortality Information System, in addition to population data from the Brazilian Institute of Geography and Statistics. Excess mortality was calculated considering: the difference between the mortality rates observed in 2020 and the average of the rates from 2015 to 2019, standardized by age; and the difference between observed deaths obtained via a quasi-Poisson model and the deaths expected for 2020. In Brazil, the standardized overall mortality rate in 2020 was 590 deaths per 100,000 inhabitants, with excess mortality of 44 deaths per 100,000 inhabitants, while the mortality rate from COVID-19 was 79 deaths per 100,000 inhabitants. The highest overall mortality rates were observed in the North and Northeast regions. The excess deaths estimated by the ratio between observed and expected deaths nationwide in 2020 was 16%; of which 17% were males, 16% were females, 7% were individuals from 0 to 59 years old, and 20% were individuals aged 60 years or older. These outcomes enabled a better understanding on the impact of the COVID-19 pandemic on the mortality in Brazil in 2020, indicating a more pronounced excess mortality in the North, Northeast and Central-West regions and among men older than 60 years.

PMID:39813565 | DOI:10.1590/0102-311XPT217323

Cad Saude Publica. 2025 Jan 13;40(11):e00052624. doi: 10.1590/0102-311XPT052624. eCollection 2025.

ABSTRACT

This study aimed to identify the existence of therapeutic itineraries shared by users of specialized mental health services in a medium-sized municipality. This is a cross-sectional study, carried out from August to November 2019 including 341 users of specialized mental health services in the municipality of Itatiba, São Paulo State, Brazil. To identify the itineraries, based on a set of variables, the users were grouped with clustering. The best measure of silhouette of cohesion and separation (> 0.3) for the clusters was achieved based on four variables: situation in which the mental health problem was identified, place of first care, origin of referral to the current service, and bond maintenance with primary health care (PHC). The clusters identified in the study demonstrated: (1) low participation of PHC in welcoming new cases, with most of the care taking place in specialized services; (2) high proportion of cases identified in crisis situations; (3) low participation of PHC in the referral of cases, with high access to specialized services by spontaneous demand; (4) lack of continuity in PHC services after entering the specialized service. The study highlighted significant weaknesses in the studied healthcare network, evincing the need to develop strategies that foster the services integration, especially regarding PHC, both to favor access to specialized care in a timely manner and to enable the continuity of care between different healthcare facilities.

PMID:39813561 | DOI:10.1590/0102-311XPT052624

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e2024432. doi: 10.1590/S2237-96222024v33e2024432.especial2.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To evaluate opportunity for vaccination in children born alive in Londrina, up to 6 months old and the relationship between socioeconomic stratum and vaccination regularity.

METHOD: Population survey study based on a retrospective cohort of children born in 2017 and 2018 that identified vaccines not administered in a given session. Vaccination regularity was compared between socioeconomic strata using Pearson’s chi-square test.

RESULTS: Out of 456 vaccination cards, the proportion of vaccination opportunities not recovered for doses to be administered at birth and at two, four and six months was 5.0% (95%CI 3.1;7.5), 4. 5% (95%CI 2.8;6.9), 7.2% (95%CI 5.0;10.2) and 2.1% (95%CI 1.0;4.0), respectively. There was no statistical difference in vaccination regularity between the strata.

CONCLUSION: Missed opportunities for vaccination were found at all ages. Socioeconomic stratum did not influence vaccination regularity.

PMID:39813547 | DOI:10.1590/S2237-96222024v33e2024432.especial2.en

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e2023539. doi: 10.1590/S2237-96222024v33e2023539.especial2.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To estimate and compare vaccination coverage among children born in 2017-2018 in São Paulo and Campinas, according to the Vaccination Coverage Survey (ICV 2020) and the National Immunization Program Information System (SI-PNI).

METHODS: ICV 2020 analyzed vaccination card records. Coverage was calculated and compared to doses recorded on the SI-PNI, divided by the target population.

RESULTS: In São Paulo, according to ICV, in 2017 only BCG (91.7%; 95%CI 87.0;94.7) and rotavirus first dose (90.6%; 95%CI 86.5;93.5) achieved the goals; in 2018, BCG (93.4%; 95%CI 89.5;95.8), rotavirus first dose (90.5%; 95%CI 85.3;94.0), pneumococcal first dose (95.3%; 95%CI 91.7;97.4), meningococcal C first dose (95.1%; 95%CI 91.5;97.2) and pneumococcal second dose (95.0%; 95%CI 91.4;95.0). In Campinas, only BCG achieved the target in 2017 (93.0%; 95%CI 88.8;95.7) and none in 2018. According to the SI-PNI, no vaccine achieved the target in either city.

CONCLUSION: Vaccination coverage was lower than expected and more precise estimates are necessary for adequate monitoring of childhood vaccination status.

PMID:39813546 | DOI:10.1590/S2237-96222024v33e2023539.especial2.en

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e20231307. doi: 10.1590/S2237-96222024v33e20231307.especial2.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To estimate vaccination coverage and analyze factors associated with full vaccination among children up to 15 months old in the city of Natal-RN, Brazil.

METHODS: Population-based survey with data recorded on children’s vaccination cards and interviews conducted in 2020 and 2021. Analysis of factors associated with complete vaccination was performed by calculating prevalence ratios (PR) and 95% confidence intervals (95%CI) using Poisson regression.

RESULTS: Among 688 children studied, vaccination coverage was 45.4% (95%CI 37.2;53.9) and 15.5% (95%CI 10.6;22.2) for valid and on-time doses, respectively. Higher vaccination coverage was associated with females (PR=1.08; 95%CI 0.78;1.48) and socioeconomic strata C and D (PR=1.44; 95%CI 1.03;2.02).

CONCLUSIONS: The results demonstrate that the city of Natal has low vaccination coverage for all immunobiologicals.

PMID:39813545 | DOI:10.1590/S2237-96222024v33e20231307.especial2.en

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e20231303. doi: 10.1590/S2237-96222024v33e20231303.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To describe the polio vaccination status in 26 state capitals, the Federal District, and 12 municipalities in Brazil, among children born between 2017 and 2018.

METHODS: This was a population-based household survey conducted from 2020 to 2022, which assessed polio vaccination coverage in children, considering valid, administered, and timely doses by municipality.

RESULTS: Data were collected from 37,801 children. Vaccination coverage for the complete valid dose schedule was 87.5% (95%CI 86.2;88.7), dropping to 79.6% (95%CI 78.1;81.0), when the booster dose was considered. The dropout rate was 4.5% for the complete schedule, and 11.7% for the first booster. There was no correlation between campaign implementation and high coverage.

CONCLUSION: Vaccination coverage for the complete valid dose schedule and the first booster did not meet the 95.0% target. Regional disparities and the association between vaccination coverage and social indicators should be taken into consideration in strategies to increase coverage.

PMID:39813544 | DOI:10.1590/S2237-96222024v33e20231303.en

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e20231224. doi: 10.1590/S2237-96222024v33e20231224.especial2.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To analyze vaccination coverage and factors associated with incomplete vaccination in inland municipalities of Northeastern Brazil.

METHODS: This was a household survey using cluster sampling conducted in Vitória da Conquista, Bahia state, Caruaru, Pernambuco state, Sobral, Ceará state and Imperatriz, Maranhão state between 2020 and 2022. Vaccination coverage by valid doses and vaccine hesitancy were analyzed, with the odds ratio (OR) estimated and adjusted using logistic regression.

RESULTS: Among 1,847 children, complete vaccination coverage was 49.2% (95%CI 43.9;54.5). Factors associated with incomplete vaccination included: higher income (OR 1.53; 95%CI 1.02;2.31), residence in Sobral (OR 4.35; 95%CI 3.04; 6.21) and >1 child (OR 1.20; 95%CI 1.11;1.32). Parental decision not to vaccinate and difficulties in traveling to vaccination centers contributed to vaccine hesitancy.

CONCLUSION: Low vaccination coverage and incomplete vaccination were associated with social issues in the socioeconomic strata analyzed.

PMID:39813543 | DOI:10.1590/S2237-96222024v33e20231224.especial2.en

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e20231219. doi: 10.1590/S2237-96222024v33e20231219.especial2.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To analyse vaccination coverage and factors associated with incomplete polio vaccination in a cohort of children born in 2017-2018, in state capitals and interior region municipalities of Northeast Brazil.

METHODS: Household survey of children aged ≤24 months conducted between 2020 and 2022. Vaccination coverage and dropout rates were estimated, as well as factors associated with incomplete vaccination, analyzed by calculating odds ratios (OR) and 95% confidence intervals (95%CI).

RESULTS: : Among 12,137 children, vaccination coverage (4 doses) was 80.9% (95%CI 78.4;83.1); 8.4% were not vaccinated. Not having a vaccination card (OR=18.06; 95%CI 10.01;32.61) and use of private services (OR=1.46; 95%CI 1.23;1.74) were associated with incomplete vaccination. Higher dropout rates were found for the booster dose, especially in the highest stratum.

CONCLUSION: Low vaccination coverage, poor dose follow-up and high dropout rates were found for polio vaccines in the areas studied.

PMID:39813542 | DOI:10.1590/S2237-96222024v33e20231219.especial2.en

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e20231218. doi: 10.1590/S2237-96222024v33e20231218.especial2.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To estimate measles-mumps-rubella vaccination coverage, delay and loss to follow-up in children up to 24 months old living in Brazilian cities.

METHODS: Surveys and questionnaires with a retrospective cohort of live births in 2017-2018, analyzing vaccination coverage and sociodemographic data of children and families, based on vaccination card records and interviews.

RESULTS: Valid coverage of first dose was 90.0% (95%CI 88.9;91.0) and 81.1% for the second dose (95%CI 79.8;82.4). Delay for both doses was 23.2% (95%CI 21.9;24.5) and loss to follow-up was 10.8% (95%CI 9.9;11.8). Socioeconomic stratum A had the lowest vaccination coverage and the higher the child’s birth order, the lower the vaccination coverage for the second dose. Children whose mothers had 13 to 15 years of education had higher vaccination coverage.

CONCLUSION: Coverage did not meet the recommended target. Differentiated strategies to resolve difficulties in access, misinformation, and vaccination hesitancy will help improve vaccination coverage.

PMID:39813541 | DOI:10.1590/S2237-96222024v33e20231218.especial2.en

Epidemiol Serv Saude. 2025 Jan 10;33(spe2):e20231195. doi: 10.1590/S2237-96222024v33e20231195.especial2.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To estimate prevalence of the full vaccination schedule for children 12 to 24 months old and to analyze associated factors.

METHODS: Survey with cluster sampling carried out in Vitória, Espírito Santo, Brazil, between December 16, 2020, and January 4, 2021. Children born in Vitória in 2017 and 2018 were included. We estimated the prevalence of vaccination schedules. Poisson regression was used to verify association with full vaccination coverage.

RESULTS: We included 788 children. Full vaccination coverage was found to be 57% taking a 95% confidence interval (95%CI 50.98;62.98). Prevalence of full vaccination coverage was lowest when private services were used for immunization (prevalence ratio [PR] 0.67; 95%CI 0.51;0.86) and when mothers had ≥ 4 children (PR 0.55; 95%CI 0.32;0.94).

CONCLUSION: We found low vaccination coverage and a drop in booster doses. Use of private services for immunization and number of children were associated with incomplete vaccination coverage.

PMID:39813540 | DOI:10.1590/S2237-96222024v33e20231195.especial2.en