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Background: The length of hospital stays for severe COVID-19 cases significantly impacts the overall burden on the health system. Current COVID-19 vaccines have proven effective at reducing severe cases. However, the influence of vaccination status on the progression of COVID-19 after hospitalization is not well understood. Here, we estimated the impact of vaccination on the length of stay of hospitalized COVID-19 cases in Brazil., Methods: We utilized nationwide data from hospital stays due to COVID-19 and the vaccination status of over 1.6 million individuals who tested positive for COVID-19 between January 17, 2021, and January 31, 2022. A competing-risk survival analysis was conducted to assess the COVID-19 in-hospital progression. We considered the hospital pathway according to four states: ward, ICU, discharge and death and measuring the length of stay accordingly., Findings: Over half of hospital patients were unvaccinated. For patients aged 50-69-year-olds, the average length of stay for those discharged directly from the hospital ward (ward-to-discharge) ranged from 12.51 days (95 % CI, 12.39-12.63) in the unvaccinated to 11.02 days (95 % CI, 10.98-11.07) in booster recipients. Similar results were observed in the 20-49 and 70 or + age groups. For all age groups, the average time between hospital admission and ICU entrance was shorter in the unvaccinated. In the 50-69 age group, the average interval between ICU and discharge was 19.29 days (95 % CI, 18.95-19.64) in the unvaccinated and 16.92 days (95 % CI, 16.78-17.07) in the booster recipients, with a similar trend in other age groups. A higher discharge probability was observed among vaccinated individuals including hospital-to-discharge and ICU-to-discharge pathways., Interpretation: Vaccination reduced hospital admissions and length-of-stay across the hospital-to-discharge and ICU-to-discharge pathways, contributing to a reduced health system burden. Our results demonstrate that even when vaccines do not prevent severe cases leading to hospitalizations, they significantly shorten the duration of hospital stays., Funding: Fundação Oswaldo Cruz (FIOCRUZ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ), Pan American Health Organization (PAHO), Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde do Ministério da Saúde do Brasil (DECIT/SCTIE/MS)., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Cleber Vinicius Brito dos Santos reports financial support was provided by National Council for Scientific and Technological Development. Cleber Vinicius Brito dos Santos reports financial support was provided by Carlos Chagas Filho Foundation for Research Support of Rio de Janeiro State. Claudio Jose Struchiner reports financial support was provided by Carlos Chagas Filho Foundation for Research Support of Rio de Janeiro State. Claudio Jose Struchiner reports financial support was provided by National Council for Scientific and Technological Development. Daniel Antunes Maciel Villela reports was provided by National Council for Scientific and Technological Development. Guilherme Loureiro Werneck reports a relationship with Carlos Chagas Filho Foundation for Research Support of Rio de Janeiro State that includes: funding grants. Guilherme Loureiro Werneck reports a relationship with National Council for Scientific and Technological Development that includes: funding grants. Paula Mendes Luz reports a relationship with National Council for Scientific and Technological Development that includes: funding grants. Paula Mendes Luz reports a relationship with Carlos Chagas Filho Foundation for Research Support of Rio de Janeiro State that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

The aim was to describe cases of anaphylaxis following the Attenuated Dengue Vaccine (TAK-003) in Brazil, from March 1, 2023, to March 11, 2024. A descriptive study of anaphylaxis cases following TAK-003 was conducted, as reported in the National System of Surveillance of Adverse Events Following Immunization (AEFI). Percentages and notification rates of AEFI per million doses administered (DA) were calculated. In total, 380,358 doses of TAK-003 were administered, and 626 AEFI were reported. Of these, 85 were cases of immediate hypersensitivity, with 24 (63.1 cases per million) being anaphylaxis, including three anaphylactic shock. For 10 (41.7 %) cases, reactions began within 15 min after vaccination. No deaths related to anaphylaxis were reported. In light of the safety signal identification (increased frequency of anaphylaxis post-dengue vaccination), the Ministry of Health of Brazil published recommendations for intensifying actions for safe vaccination, including healthcare professional training and post-vaccination observation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: COVID-19 vaccines have proven highly effective among individuals without a previous SARS-CoV-2 infection, but their effectiveness in preventing symptomatic infection and severe outcomes among individuals with previous infection is less clear. We aimed to estimate the effectiveness of four COVID-19 vaccines against symptomatic infection, hospitalisation, and death for individuals with laboratory-confirmed previous SARS-CoV-2 infection., Methods: Using national COVID-19 notification, hospitalisation, and vaccination datasets from Brazil, we did a test-negative, case-control study to assess the effectiveness of four vaccines (CoronaVac [Sinovac], ChAdOx1 nCoV-19 [AstraZeneca], Ad26.COV2.S [Janssen], and BNT162b2 [Pfizer-BioNtech]) for individuals with laboratory-confirmed previous SARS-CoV-2 infection. We matched cases with RT-PCR positive, symptomatic COVID-19 with up to ten controls with negative RT-PCR tests who presented with symptomatic illnesses, restricting both groups to tests done at least 90 days after an initial infection. We used multivariable conditional logistic regression to compare the odds of test positivity and the odds of hospitalisation or death due to COVID-19, according to vaccination status and time since first or second dose of vaccines., Findings: Between Feb 24, 2020, and Nov 11, 2021, we identified 213 457 individuals who had a subsequent, symptomatic illness with RT-PCR testing done at least 90 days after their initial SARS-CoV-2 infection and after the vaccination programme started. Among these, 30 910 (14·5%) had a positive RT-PCR test consistent with reinfection, and we matched 22 566 of these cases with 145 055 negative RT-PCR tests from 68 426 individuals as controls. Among individuals with previous SARS-CoV-2 infection, vaccine effectiveness against symptomatic infection 14 or more days from vaccine series completion was 39·4% (95% CI 36·1-42·6) for CoronaVac, 56·0% (51·4-60·2) for ChAdOx1 nCoV-19, 44·0% (31·5-54·2) for Ad26.COV2.S, and 64·8% (54·9-72·4) for BNT162b2. For the two-dose vaccine series (CoronaVac, ChAdOx1 nCoV-19, and BNT162b2), effectiveness against symptomatic infection was significantly greater after the second dose than after the first dose. Effectiveness against hospitalisation or death 14 or more days from vaccine series completion was 81·3% (75·3-85·8) for CoronaVac, 89·9% (83·5-93·8) for ChAdOx1 nCoV-19, 57·7% (-2·6 to 82·5) for Ad26.COV2.S, and 89·7% (54·3-97·7) for BNT162b2., Interpretation: All four vaccines conferred additional protection against symptomatic infections and severe outcomes among individuals with previous SARS-CoV-2 infection. The provision of a full vaccine series to individuals after recovery from COVID-19 might reduce morbidity and mortality., Funding: Brazilian National Research Council, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Oswaldo Cruz Foundation, JBS, Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Generalitat de Catalunya., Competing Interests: Declaration of interests MB-N reports grants from the Fazer o Bem Faz Bem programme from JBS. AIK reports grants from Bristol Myers Squibb, Regeneron, and Serimmune; and grants and personal fees from Tata Medical Devices, outside the submitted work. VdAO, VSB, MLB, JC, and MB-N are employees of Fiocruz, a federal public institution, which manufactures Vaxzevria (ChAdOx1 nCoV-19 vaccine) in Brazil through a full technology transfer agreement with AstraZeneca. Fiocruz allocates all its manufactured products to the Ministry of Health for public health use. All other authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Chagas disease continues to be an important cause of morbidity, mortality and disability in several Latin American countries, including Brazil. Using findings from the Global Burden of Disease Study 2016 (GBD, 2016), we present years of life lost, years lived with disability, and disability-adjusted life years due to Chagas disease in Brazil, by sex, age group, and Brazilian states, from 1990 to 2016. Results are reported in absolute numbers and age-standardized rates (per 100,000 population) with 95% uncertainty intervals. In 2016, 141,640 disability-adjusted life years (95% uncertainty intervals: 129,065-155,941) due to Chagas disease were estimated in Brazil, with a relative reduction of 36.7% compared with 1990 (223,879 disability-adjusted life years (95% uncertainty intervals: 209,372-238,591)). Age-standardized disability-adjusted life year rates declined at the national level (-69.7%) and in all Brazilian states between 1990 and 2016, but with different regional patterns. The decrease in the disability-adjusted life year rates was driven primarily by a consistent reduction in the years of life lost rates, the main component of total disability-adjusted life years for Chagas disease. The highest fatal and non-fatal burden due to Chagas disease was observed among males, the elderly, and in those Brazilian states encompassing important endemic areas for vector transmission in the past. Despite the consistent reduction in its burden during the period, Chagas disease is still an important and neglected cause of health lost due to premature mortality and disability in Brazil. Efforts should be made to maintain the political interest and sustainability of surveillance and control actions for Chagas disease, prevent the risk of re-emergence of vector transmission in endemic areas, and provide health care to chronically infected individuals, including early diagnosis and treatment interventions., (Copyright © 2019 Australian Society for Parasitology. Published by Elsevier Ltd. All rights reserved.)