Monica Levi

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RESUMO Objetivo: Analisar os clusters e seus determinantes sociais associados à vacinação contra o papilomavírus humano (HPV) no estado de Minas Gerais, Brasil. Métodos: Estudo ecológico, realizado nos 853 municípios de Minas Gerais, Brasil. O algoritmo K-means foi utilizado para a análise dos clustering. Considerou-se o cálculo da cobertura vacinal (CV) da vacina HPV, para o público masculino e feminino, faixa etária de nove a 14 anos, entre 2014 e 2022, e os indicadores socioeconômicos. Resultados: O sexo masculino apresentou a menor proporção de municípios de Minas Gerais com alcance de meta de CV. Dos cinco clusters gerados, o 1 (259 municípios) apresentou alta urbanização e CV alta, mas com desafios para a adesão masculina. O cluster 2 (178 municípios), identificou baixa CV e alta pobreza, com acesso limitado à saúde. O cluster 3 (166 municípios) apresentou alta CV e menor vulnerabilidade, sendo constituído por municípios com elevada adesão vacinal e condições socioeconômicas, indicando políticas de saúde efetivas. No cluster 4 (166 municípios), foram identificadas fragilidades em saúde pública e necessidade de intervenções direcionadas. O cluster 5 (84 municípios) apresentou alto urbanismo e desigualdade, mas com grande disparidade entre urbanização e adesão à vacinação. Conclusão: Assim, este estudo identificou que alta urbanização, menor vulnerabilidade e maior acesso aos serviços de saúde são fatores que podem impactar positivamente a adesão à vacina pelos adolescentes.

Objective: To analyze the clusters and their social determinants associated with vaccination against human papillomavirus (HPV) in the State of Minas Gerais, Brazil. Methods: Ecological study, carried out in 853 municipalities of Minas Gerais, Brazil. The K-means algorithm was used for clustering analysis. The calculation of vaccination coverage (VC) of the HPV vaccine, for males and females, age group 9 to 14 years, between 2014 and 2022, and socioeconomic indicators were considered. Results: Males had the lowest proportion of municipalities in Minas Gerais achieving the VC target. Of the 5 Clusters generated, Cluster 1 (259 municipalities) showed high urbanization and high VC, but with challenges for male adherence. Cluster 2 (178 municipalities) identified low VC and high poverty, with limited access to health. Cluster 3 (166 municipalities) presented high VC and lower vulnerability, consisting of municipalities with high vaccination uptake and socioeconomic conditions, indicating effective health policies. In Cluster 4 (166 municipalities), public health weaknesses and the need for targeted interventions were identified. Cluster 5 (84 municipalities) presented high urbanization and inequality, but with a large disparity between urbanization and vaccination adherence. Conclusion: Thus, this study identified that high urbanization, lower vulnerability and greater access to health services are factors that can positively impact vaccine adherence by adolescents.

Resumo Objetivo Analisar fatores individuais, socioeconômicos, demográficos e de cobertura dos atendimentos não presenciais avaliados pelo Centro de Referência para Imunobiológicos Especiais (CRIE) de Minas Gerais, Brasil. Métodos Estudo epidemiológico com delineamento misto, utilizando dados das solicitações de atendimentos não presenciais recebidas pelo CRIE de Minas Gerais entre 2022 e 2024. Variáveis categóricas foram descritas por frequências absoluta e relativa (%), enquanto as contínuas foram descritas por mediana e intervalo interquartílico. Modelos logísticos avaliaram as associações relacionadas ao atendimento, com cálculo de razão de chances (odds ratio, OR) e intervalos de confiança de 95% (IC95%). Como variáveis independentes, foram considerados dados sociodemográficos dos municípios. Resultados Foram analisadas 9.158 solicitações, sendo 51,8% do sexo feminino, com mediana de idade de 51 anos. Imunobiológicos foram prescritos para 89,6% dos indivíduos, sendo a vacina pneumocócica 23-valente a mais indicada (24,8%). A gerência regional de saúde de Coronel Fabriciano, Minas Gerais, apresentou a maior prevalência de encaminhamentos (n=1.232/13,4%), seguida da regional de Ponte Nova (n=1.174/12,8%). Municípios com maior número de famílias com renda de até meio salário mínimo apresentaram menor chance de prescrição (OR 0,99). Já a maior proporção de população pobre cadastrada no CadÚnico (OR 1,01) e a maior taxa de urbanização (OR 1,01) estiveram associadas a uma maior chance de prescrição. Conclusão Houve potencial de associação entre os determinantes sociais da saúde e os atendimentos não presenciais avaliados pelo CRIE, o que suscita a discussão acerca da necessidade de garantia da equidade no acesso à saúde.

Objective To analyze individual, socioeconomic, demographic, and coverage factors of non-face-to-face services evaluated by the Special Immunobiological Reference Centers (Centro de Referência para Imunobiológicos Especiais, CRIE) of Minas Gerais, Brazil. Methods Epidemiological study with a mixed design, using data from requests for non-face-to-face services received by the CRIE of Minas Gerais between 2022 and 2024. Categorical variables were described by absolute and relative frequencies (%), while continuous variables were described by median and interquartile range. Logistic models were used to assess the associations related to service provision, with the calculation of odds ratios (OR) and 95% confidence intervals (95%CI). Sociodemographic data of the municipalities were considered as independent variables. Results A total of 9,158 requests were analyzed, with 51.8% of the requests coming from female individuals, and a median age of 51 years. Immunobiological agents were prescribed to 89.6% of individuals, with the 23-valent pneumococcal vaccine being the most frequently indicated (24.8%). The Regional Health Management Department of Coronel Fabriciano, Minas Gerais, showed the highest prevalence of referrals (n=1,232/13.4%), followed by the Regional Health Management Department of Ponte Nova (n=1,174/12.8%). Municipalities with a higher number of families earning up to half the minimum wage showed a lower likelihood of prescription (OR 0.99). Conversely, a higher proportion of the poor population registered in the Single Registry for Social Programs (Cadastro Único, CadÚnico) (OR 1.01) and a higher urbanization rate (OR 1.01) were associated with a greater likelihood of receiving a prescription. Conclusion A potential association was found between social determinants of health and the non-face-to-face services evaluated by the CRIE, raising the discussion about the need to ensure equitable access to healthcare.

Key points •The negative impact of infectious diseases and their immunoprevention during the different stages of a woman’s life requires a broad approach including adolescence, adulthood, pregnancy and the postmenopausal phase. •Immunization of pregnant women should be a priority for the protection of the maternal-fetal dyad, especially in regions with high rates of infections preventable […] Key points •The negative impact of infectious diseases and their immunoprevention during the different stages of a woman’s life requires a broad approach including adolescence, adulthood, pregnancy and the postmenopausal phase. •Immunization of pregnant women should be a priority for the protection of the maternal-fetal dyad, especially in regions with high rates of infections preventable […]

Respiratory syncytial virus (RSV) is an important cause of respiratory illness. While most attention is paid to childhood infection, the RSV burden in adults ≥60 y should also be considered. In Brazil, this is generally underrecognized, where greater focus is toward other respiratory pathogens. This article presents insights from a multidisciplinary panel gathered to review epidemiologic data and current diagnostic approaches to RSV in Brazil (and their limitations) and develop communication strategies to improve knowledge and awareness. National surveillance data indicate a steady increase in cases of RSV-related severe acute respiratory illness (RSV-SARI) in those aged ≥60 y in recent years, with high fatality rates (>30%). Routine RSV testing in older individuals with respiratory symptoms is relatively low. Educational activities targeted toward health-care professionals and the general public are critical to raising awareness of the importance of RSV in older individuals, particularly as protective vaccines are now available.