Vinícius Santiago dos Santos

Indigenous populations in Brazil were prioritized for coronavirus disease 2019 (COVID‐19) vaccination due to their increased vulnerability. The aim of the study was to describe COVID‐19 vaccination coverage among Indigenous population across Brazilian regions and Special Indigenous Health Districts (DSEIs; acronym for Distritos Sanitários Especiais Indígenas ). A retrospective study was conducted using data from January 17, 2021, to June 27, 2024, obtained from the open‐access COVID‐19 vaccination database made available by the Brazilian Ministry of Health, covering the 4‐year period of the pandemic. The dataset included information on the Indigenous population (number of inhabitants), as well as the number and type of vaccine doses administered (first dose, second dose, single dose, and booster dose). Second dose refers to vaccines requiring a two‐dose primary schedule, whereas single‐dose refers to vaccines administered as a single primary dose; booster dose refers to any additional dose given after completion of the primary vaccination schedule and, according to the database, was restricted to individuals aged ≥ 18 years. Vaccination coverage was calculated by dividing the number of doses administered by the total Indigenous population, based on estimated from the 2022 Brazilian Institute of Geography and Statistics (IBGE; acronym for Instituto Brasileiro de Geografia e Estatística ) Census, and multiplying by 100. The data was analyzed and presented according to Brazil's federative units (states and the Federal District) and DSEIs. A total of 1 490 036 COVID‐19 vaccine doses were administered to the Indigenous population. Of these, 631 990 (42%) corresponded to first doses, 551 602 (27%) to second or single doses, and 306 444 (21%) to booster doses. These doses corresponded to vaccination coverage of 89%, 78%, and 43% of the Indigenous population ( N = 707 739), respectively. Across the 27 federative units, the lowest coverage for the first dose was observed in Tocantins (83%), Roraima (74%), and Pará (73%), while for second or single doses the lowest rates were found in Amapá (63%), Roraima (60%), and Pará (58%). Among the 34 DSEIs, 13 (38.2%) did not reach 90% coverage for the first dose, and 21 (61.8%) did not reach this threshold for the second or single doses. The lowest coverage levels were identified in Araguaia (65% and 44%), Rio Tapajós (59% and 40%), and Kaiapó do Pará (56% and 34%) for first and second or single doses, respectively. Vaccination coverage against COVID‐19 among Brazil's Indigenous population has not fully reached the 90% target recommended by the Brazilian government in alignment with the World Health Organization after 4 years of the pandemic. This gap may be explained by multiple factors, including cultural barriers, remote geographic conditions, and logistical challenges related to vaccine distribution.

Cystic fibrosis (CF) is a rare genetic disease caused by pathogenic variants in the CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) gene, with wide clinical variability influence not only by the CFTR genotype but also by environmental and modifier genes such as ADAM33 (A Disintegrin and Metalloproteinase Domain 33). The rs2280091 variant in ADAM33 may affect lung function and contribute to differences in disease severity. This study investigated the association between this genetic variant and lung function in CF patients. This cross-sectional study included 55 CF patients from a Brazilian center, with diagnosis confirmed by sweat testing and CFTR genotyping. Pulmonary function was evaluated by spirometry before and after bronchodilator (BD) administration according to the American Thoracic Society/European Respiratory Society guidelines, analyzing Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), FEV1/FVC ratio, Forced Expiratory Flow at 25%, 50%, and 75% of FVC (FEF25%, FEF50%, and FEF75%), mean Forced Expiratory Flow between 25% and 75% of FVC (FEF25–75%), and Maximal Expiratory Forced Flow (MEF). The ADAM33 rs2280091 variant was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and statistical analyses included Kruskal–Wallis and Mann–Whitney tests, chi-square (χ²) tests, and calculation of odds ratios (ORs) with 95% confidence intervals (95% CI). The study included 55 CF patients, predominantly female (96.4%) and Caucasian (52.7%), with a median age of 17 years. CFTR genotyping revealed F508del/F508del as the most common genotype (52.7%). Analysis of the ADAM33 rs2280091 variant demonstrated that the AA genotype was most frequent in both CF patients (69.1%) and healthy controls (78.6%). Notably, the GG genotype was significantly enriched in CF patients (18.2%) compared with the controls (0.02%), yielding an odds ratio of 12.06 (95% CI: 4.86–29.91), while the G allele was also associated with increased disease risk (24.5% vs. 11.6%). Pulmonary function assessment indicated that carriers of the GG genotype or G allele had higher Forced Expiratory Flow parameters (FEF25%, FEF50%, FEF25–75%, and MEF) and improved BD responsiveness, suggesting a potential modulatory role of ADAM33 in peripheral airway function in CF. The G allele of the ADAM33 rs2280091 variant was more frequent among recruited CF patients and associated with improved peripheral airway function and BD response. These findings may reflect a survivor effect, in which carriers of this allele are more likely to reach clinical follow-up and recruitment rather than indicating a direct association with increased disease risk.

Since the slavery period in Brazil, the Quilombola population has faced problems related to social vulnerability and poor health. The coronavirus disease (COVID)‐19 pandemic has made this social inequality more evident, and the postpandemic scenario has proved even more challenging with the difficult access to basic living conditions, including low vaccination coverage. In view of this, this study aims to present the epidemiological profile of vaccination against COVID‐19 in the population living in quilombos in Brazil. An observational study was carried out using information from the National Health Data Network provided by the Brazilian Ministry of Health. Vaccination coverage was correlated with the human development index (HDI) and health quality indicators. In the Quilombola population, a total of 1 848 494 doses of vaccines were administered, mostly related to the first dose (45.43%) and the second or single‐dose vaccine vials (42.17%), representing a vaccination coverage of 48.43% and 49.41%, respectively; in addition, a total of 159.26 doses were administered per 100 inhabitants. There was an imbalance in the vaccination coverage rate and the number of doses administered in relation to the macroregions of Brazil and the Federative Units. In terms of doses administered by age group, the highest concentration was observed among individuals aged 20–59, with over 100 000 doses administered within each group. In the Spearman correlation, the following coefficients were significant: (a) first dose with municipal health spending [CC = −0.57]; (b) second dose or single‐dose vaccine vial with HDI [CC = 0.58], HDI–income [CC = 0.58], HDI–education [CC = 0.65], and municipal health spending [CC = −0.61]; and (c) the total number of doses with HDI [CC = 0.58], HDI–income [CC = 0.56], HDI–education [CC = 0.67], and municipal health spending [CC = −0.55]. The epidemiological profile of vaccination against COVID‐19 in the Quilombola population in Brazil was associated with a wide variability in relation to macroregions and Federative Units, with few Federative Units vaccinating more than 50% of Quilombola individuals. Among the markers evaluated, the best HDI and the best quality of health services were associated with better vaccination coverage for the first dose, second dose, single‐dose vaccine vial, and total number of doses administered in the Quilombola population, demonstrating that there is a relation between social and economic characteristics and the management of vaccines with a potential influence on the outcomes associated with the COVID‐19 pandemic.