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Resumen La vacuna oral contra el poliovirus (OPV) ha sido fundamental en controlar la epidemia de poliomielitis, y destaca por su seguridad, eficacia, facilidad de administración oral y bajo costo. Sin embargo, a pesar de estas ventajas, al tratarse de una vacuna con virus vivos atenuados, existe la posibilidad de mutaciones que confieran neurovirulencia. Por ende, es importante la vigilancia de parálisis flácida aguda (PFA), ya sea asociada a las vacunas atenuadas (VAPP) o a los virus derivados de vacunas (VDPV). En esta revisión presentamos datos importantes de Latinoamérica en los últimos años, donde se revisan los datos de VDPV de transmisión comunitaria, de origen ambiguo y asociadas con inmunodeficiencias. Debido a la presencia de VDPV, es importante fortalecer el sistema de vigilancia epidemiológica por PFA, con datos muy inferiores a los recomendados en estos últimos años en las Américas. Adicionalmente, es fundamental mejorar las coberturas vacunales para reducir la cantidad de lactantes en riesgo de adquirir poliomielitis. En consecuencia, presentamos las tasas de cobertura vacunal con la vacuna inactivada contra el poliovirus (IPV) en la región y analizamos los programas de vacunación contra la poliomielitis en concordancia con las recomendaciones de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE; mínimo 3 dosis de IPV) y del Grupo de Expertos en Asesoramiento Estratégico (SAGE) sobre Inmunización de la OMS (mínimo 2 dosis de IPV). El estudio concluye con recomendaciones de los autores para el cambio de OPV a uso exclusivo de IPV, para aumentar las coberturas vacunales y para reforzar la vigilancia por PFA en la región.

Objectives To investigate the pattern of multiple human papillomavirus (HPV) infections and associated factors in young women who access the Brazilian public health care system to better understand the characteristics of multiple HPV infections, a critical issue in this era of multivalent vaccines. Methods This was a cross-sectional, multicenter study with sexually active unvaccinated women (16–25 years old) from 119 primary Brazilian healthcare centers between September 2016 and November 2017. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. Results Of the 5268 women, 33.00% (95% CI 31.07–34.92) had multiple infections. At least one type of high-risk HPV was present in 85.50% of all multiple infections. All HPV types were detected more frequently in association with other types than alone. Young individuals who were single or in a casual relationship and those who had more than one sexual partner in the past year were more likely to have multiple infections. Conclusions In this work, a high rate of multiple HPV infections among unvaccinated young adults tended to increase due to certain risk factors. Such data can provide insight for decision makers in the development of public policies regarding HPV prevention., Plain Language Summary Understanding the characteristics of multiple infections is critical in the era of HPV multivalent vaccines for the prevention of cervical carcinomas. Therefore, in this cross-sectional study, we aimed to investigate the pattern of multiple HPV infections and associated factors in 5,268 sexually active unvaccinated women (16–25 years old) who access the Brazilian public health care system. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. A total of 33.00% (95% CI 31.07–34.92) had multiple infections (60.43% of the HPV-positive sample). The number of HPV types in a multiple infection ranged from 2 to 14 different types. The viral types more frequently identified were HPV 16 and 52. All HPV types were detected more frequently in association with other types than alone. The incidence of multiple infections was 1.29 times higher in single than in married or cohabitating participants. Women who had two or more partners in the last year also had higher rates of multiple infections than those who had fewer than two sexual partners. In conclusion, a high prevalence of multiple infections prior to the national HPV immunization program was observed, especially with the increase in less safe behavior factors.

Background In addition to screening by Pap smears, vaccination against human papillomavirus (HPV) can dramatically reduce cervical cancers caused by the virus. The acceptance of HPV vaccination is directly related to HPV knowledge. This research aimed to evaluate knowledge about HPV and vaccination among men and women aged 16–25 years who use the public health system in Brazil. Methods This was a cross-sectional, multicenter study of sexually active young adults recruited from 119 primary care units between 2016 and 2017. All participants answered a face-to-face standardized questionnaire. Results Of 8581 participants, the mean percentage of correct answers about HPV and vaccination was 51.79% (95% CI 50.90-52.67), but 75.91% (95% CI 74.13-77.69) had awareness of the HPV vaccination. Women answered a higher proportion of questions correctly than men did (p = 0.0003). Lower education level was the variable that most interfered with knowledge. The best information sources for knowledge were both health professionals and the media (1.33%, 95% CI 1.03-1.70). Conclusions The results emphasize the importance of educational programs about HPV and vaccination among young adults, especially in socially disadvantaged populations. These findings can help to increase the vaccination rate in the country and to stimulate public health policies., Highlights • This is the first nationwide study of young adults who use the public health system. • Lower education level was the variable that most interfered with knowledge. • The best information source was the combination of health professionals and the media. • These results can complement surveillance data on increasing the vaccination rate.

Resumo Objetivo Avaliar o Sistema de Vigilância em Imunizações considerando-se o módulo Registro do Vacinado, do Sistema de Informações do Programa Nacional de Imunizações, Brasil, 2017. Métodos Estudo descritivo, utilizando-se do Guidelines for Evaluating Public Health Surveillance Systems, publicado pelo Centers for Disease Control and Prevention (CDC/Atlanta/GA/United States), para avaliar os atributos de simplicidade, flexibilidade, qualidade dos dados, sensibilidade, oportunidade e utilidade do sistema para seis vacinas do calendário de vacinação da criança. Resultados O Sistema de Vigilância em Imunizações foi considerado complexo em sua descrição, flexível às mudanças no calendário vacinal, de baixa qualidade dos dados para as vacinas DTP e rotavírus, de aceitabilidade regular, com alta sensibilidade para a vacina BCG, inoportuno para a vacina contra hepatite B e útil às finalidades do Programa Nacional de Imunizações. Conclusão Qualidade dos dados, aceitabilidade e oportunidade não apresentaram resultados satisfatórios, sendo necessárias ações pelo aprimoramento do sistema de informações. Resumen Objetivo Comparar estructura y proceso de trabajo en atención primaria para implementar la teleconsulta médica en municipios de diferentes regiones y tamaños (mil habitantes: 100). Métodos Estudio transversal, con análisis descriptivo y bivariado, datos de 2017-2018 para evaluar la disponibilidad de computadora con internet, cámara, micrófono, altavoz y proceso de trabajo (uso de Telesalud, centro de regulación central y flujo de comunicación). Resultados Se analizaron 30.346 unidades y 38.865 grupos. La presencia de equipos de teleconsulta osciló entre 1,2% en los grandes municipios del Norte y 26,7% en pequeños municipios del Sur. El proceso de trabajo osciló entre 10,7% en pequeños municipios del Norte y 39,5% en grandes municipios del Sur. En comparación con el Sur, municipios medianos del Norte (OR=0,14 - IC95% 0,11;0,17) y Nordeste (OR=0,21 - IC95% 0,18;0,25) tenían menos probabilidades de contar con los equipos necesarios. Conclusión Existe la necesidad de inversiones en Salud Digital, con desigualdades regionales relevantes. Abstract Objetivo To evaluate the National Immunization Program Immunization Surveillance System, based on its Vaccination Record module, for Brazil in 2017. Methods This was a descriptive study using the Guidelines for Evaluating Public Health Surveillance Systems, published by the Centers for Disease Control and Prevention (CDC/Atlanta/GA/United States) to evaluate the attributes of simplicity, flexibility, data quality, sensitivity, timeliness and usefulness of the system for six vaccines on the child immunization schedule. Results The Immunization Surveillance System was considered complex in its description; flexible to changes in the immunization schedule; of poor data quality for the DTP and rotavirus vaccines; regular acceptability; high sensitivity for the BCG vaccine; untimely for the hepatitis B vaccine and useful for the purposes of the National Immunization Program. Conclusion The data quality, acceptability and timeliness results were not satisfactory, so that actions are needed to enhance the information system.

IntroductionHuman papillomavirus (HPV) infection is transmitted through skin-to-skin contact, and vaginal and anal sex are the most common transmission routes. Sex workers and men who have sex with men (MSM) are more exposed to the virus, and therefore, a higher frequency of this infection would be expected. The prevalence of HPV infection types and the forms and factors of transmission must be investigated to control infection-related outcomes. This protocol study will be the first nationwide study with a uniform methodology to evaluate HPV prevalence of and infection types among sex workers and MSM in Brazil.Methods and analysisThis multicentre cross-sectional study will be conducted with a respondent-driven sampling method to recruit 1174 sex workers and 1198 MSM from all regions of Brazil. The study will consist of preliminary interviews to verify the eligibility criteria and characterise the network size as well as a second questionnaire to obtain sociodemographic, behavioural and sexual information. Specimens from the oral cavity and anal and cervical or penile/scrotal sites will be collected. All HPV samples will be processed in a certified central laboratory. Other sexually transmitted infections will be evaluated by interview and by rapid testing for HIV and syphilis. Strict quality control will be conducted using different procedures, including the training and certification of the health professionals responsible for acquiring data and monitoring visits.Ethics and disseminationThe project was approved by the research ethics committee of the main institution and the corresponding ethics committees of the recruitment sites. Due to the literature gap on the sexual health of sex workers and MSM and the intense stigma surrounding these populations, a critical analysis of the study results will contribute to epidemiological knowledge and will be useful for the development of strategies against virus morbidities.

The present study aims to determine whether 17DD-YF-specific humoral and cellular immunological memory is maintained 8-years after primary vaccination with subdoses (10,447IU;3,013IU;587IU;158IU;31IU). For this purpose, this follow-up study was carried out in a subset of volunteers (n = 98) originally enrolled in the dose-response study in 2009 and 46 non-vaccinated controls. Our results demonstrated that vaccinees, who had seroconverted following primary vaccination and had not been revaccinated, present similar neutralizing antibodies levels and YF-specific cellular memory, particularly CMCD4 and EMCD8 as compared to the reference full dose (27,476IU). Although, PRNT seropositivity rates were similar across subgroups (94, 82, 83, 94, 80, and 91%, correspondingly), only doses above 587IU elicited similar iterative proportion of seropositivity rates, calculated as a progressive decrease on seropositivity rates along time (89, 80, 80, and 91%, respectively) as compared to 158IU and 31IU (68 and 46%, respectively). Noteworthy were the strong positive correlations ("EMCD4,EMCD8" and "TNFCD8,IFNCD8") observed in most subdoses, except for 31IU. Major similarities underscored the preserved antibody titers and the outstanding levels of EMCD8, relevant correlates of protection for YF-specific immunity. These findings provide evidences to support the regular use of dose sparing strategy for YF vaccine in adults.

Funda??o de Amparo ? Pesquisa do Estado de Minas Gerais, Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior, Bio-Manguinhos/FIOCRUZ, PROEP/ CPqRR/FIOCRUZ, Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico?CNPq (grant nos. 444417/2014-1 and 458134/2014-7), and Programa Nacional de Imuniza??es, Secretaria de Vigil?ncia em Sa?de?Minist?rio da Sa?de, Brazil (grant no. TC 277/2013). O.A.M.-F., A.T.-C., and L.R.A. received research fellowships from CNPq. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brazil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brazil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brazil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brazil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brazil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brazil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brazil. Secretaria Municipal de Sa?de. Belo Horizonte, MG, Brasil. Secretaria do Estado de Sa?de de Minas Gerais. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Escola Nacional de Sa?de P?blica. Rio de Janeiro, RJ, Brazil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Universidade Federal de Alfenas. Alfenas, MG, Brazil. Universidade de Bras?lia. Bras?lia, DF, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Bras?lia, DF, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Bras?lia, DF, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brazil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brazil. We evaluated the duration of neutralizing antibodies and the status of 17DD vaccine?specific T- and B-cell memory following primary and revaccination regimens for yellow fever (YF) in Brazil. We observed progressive decline of plaque-reduction neutralization test (PRNT) seropositivity and of the levels of effector memory CD4+ and CD8+ T cells, as well as interferon-?+CD8+ T cells, 10 years after primary vaccination. Revaccination restored PRNT seropositivity as well as the levels of effector memory CD4+, CD8+, and interferon-?+CD8+ T cells. Moreover, secondary or multiple vaccinations guarantee long-term persistence of PRNT positivity and cell-mediated memory 10 years after booster vaccination. These findings support the relevance of booster doses to heighten the 17DD-YF?specific immune response to guarantee the long-term persistence of memory components. Secondary or multiple vaccinations improved the correlates of protection triggered by 17DD-YF primary vaccination, indicating that booster regimens are needed to achieve efficient immunity in areas with high risk for virus transmission.

Funda??o de Amparo ? Pesquisa do Estado de Minas Gerais (FAPEMIG), BioManguinhos/FIOCRUZ, PROEP/IRR/FIOCRUZ, Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico-CNPq Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil. Universidade Federal de Minas Gerais. Departamento de Fisiologia e Biof?sica. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil Secretaria Municipal de Sa?de de Belo Horizonte. Belo Horizonte, MG, Brasil. Secretaria do Estado de Sa?de de Minas Gerais. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Escola Nacional de Sa?de P?blica Sergio Arouca. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiol?gicos. Rio de Janeiro, RJ, Brasil. Universidade de Bras?lia. Faculdade de Medicina. Bras?lia, DF, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Departamento de Imuniza??o e Doen?as Transmiss?veis. Bras?lia, DF, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Programa Nacional de Imuniza??es. Bras?lia, DF, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Instituto Ren? Rachou. Belo Horizonte, MG, Brasil. The Yellow Fever (YF) vaccination is recommended for people living in endemic areas and represents the most effective strategy to reduce the risk of infection. Previous studies have warned that booster regimens should be considered to guarantee the long-term persistence of 17DD-YF-specific memory components in adults living in areas with YF-virus circulation. Considering the lower seroconversion rates observed in children (9-12 months of age) as compared to adults, this study was designed in order to access the duration of immunity in single-dose vaccinated children in a 10-years cross-sectional time-span. The levels of neutralizing antibodies (PRNT) and the phenotypic/functional memory status of T and B-cells were measured at a baseline, 30-45 days, 1, 2, 4, 7, and 10 years following primary vaccination. The results revealed that a single dose induced 85% of seropositivity at 30-45 days and a progressive time-dependent decrease was observed as early as 2 years and declines toward critical values (below 60%) at time-spans of ?4-years. Moreover, short-lived YF-specific cellular immunity, mediated by memory T and B-cells was also observed after 4-years. Predicted probability and resultant memory analysis emphasize that correlates of protection (PRNT; effector memory CD8+ T-cells; non-classical memory B-cells) wane to critical values within ?4-years after primary vaccination. Together, these results clearly demonstrate the decline of 17DD-YF-specific memory response along time in children primarily vaccinated at 9-12 months of age and support the need of booster regimen to guarantee the long-term persistence of memory components for children living in areas with high risk of YF transmission.

Background The 17DD-yellow fever (YF) vaccine induces a long-lasting protective immunity, resulting from humoral and cellular immunological memory. The treatment of rheumatoid arthritis (RA) patients with disease-modifying anti-rheumatic drugs (DMARD) may affect pre-existing 17DD-vaccine protective immunity and increase the risk of acquiring YF infection. Our goal was to determine whether DMARD would affect the duration of YF-specific protective immunity in RA patients. Methods A total of 122 RA patients, previously immunized with the 17DD-YF vaccine (1–5, 5–9, and ≥ 10 years) and currently under DMARD therapy, were enrolled in the present investigation. Immunomodulatory therapy encompasses the use of conventional synthetic DMARD alone (csDMARD) or combines with biological DMARD (cs+bDMARD). A total of 226 healthy subjects were recruited as a control group (CONT). Neutralizing antibody responses were measured by a plaque-reduction neutralization test (PRNT), and cellular immunity was evaluated by an in vitro 17DD-YF-specific peripheral blood lymphoproliferative assay. Results The data demonstrated that csDMARD therapy did not affect the duration of protective immunity induced by the 17DD-YF vaccine compared to that of CONT, as both presented a significant time-dependent decline at 10 years after vaccination. Conversely, cs+bDMARD therapy induced a premature depletion in the main determinants of the vaccine protective response, with diminished PRNT seropositivity levels between 5 and 9 years and impaired effector memory in CD8+ T cells as early as 1–5 years after 17DD-YF vaccination. Conclusions These findings could support changing the vaccination schedule of this population, with the possibility of a planned booster dose upon the suspension of bDMARD in cases where this is allowed, even before 10 years following 17DD-YF vaccination. The benefit of a planned booster dose should be evaluated in further studies. Trial registration RBR-946bv5. Date of registration: March 05, 2018. Retrospectively registered

Objectives This study aimed to estimate the prevalence of genital, anal and oral HPV infection in Brazil through systematic review and meta-analysis. Methods We searched EMBASE, LILACS, MEDLINE, Web of Science and SciELO from inception to December 2018. Original research articles that assessed the prevalence of genital (i.e., cervical, penile), anal and oral HPV infection in Brazil were selected in pairs by independent authors. No sex, age, HPV vaccination, language or date restrictions were applied. HPV prevalence was estimated and stratified according to risk factors population and by geographic area throughout the country. The study prevalence was pooled using a random effects model. Analysis was performed using R (version 3.5.2), packages meta version 4.9-4 and metaphor 2.0-0. This review is registered on PROSPERO under protocol number CRD42016032751. Results We identified 3,351 references. After the screening process, 139 of them were eligible for this systematic review (57,513 total participants). Prevalence of cervical HPV was 25.41% (95% CI 22.71-28.32). Additionally, prevalence was 36.21% (95% CI 23.40, 51.33) in the penile region, 25.68% (95%CI 14.64, 41.04) in the anal region, and 11.89% (95%CI 6.26, 21.43) in the oral region. Subgroup analysis showed prevalence in each anatomic site was higher in high-risk populations. Conclusion The prevalence of HPV is high in the Brazilian population and varies by population risk and anatomic body site, with lower rates in the oral cavity compared to that in the cervical, penile and anal region. Studies on HPV have primarily been developed to evaluate infection and cancer in the cervical region. There is a profound lack of HPV data in many geographic regions of Brazil and for different anatomic sites.

The sexual behaviors of 15- to 24-year-olds increase the risk of this population to acquire sexually transmitted infections (STIs). The present study aimed to describe the sexual behavior in the transition to adulthood Brazilian population and its association with STI history. We analyzed cross-sectional data collected from 8562 sexually active women and men who participated in the National Survey of Human Papillomavirus Prevalence (POP-Brazil). This large-scale survey enrolled participants from 26 Brazilian capitals and the Federal District. Professionals from primary care facilities were trained to collect data utilizing a standardized questionnaire with questions on sociodemographic, sexual behavior, and drug use. We constructed a Poisson model with robust variance for both crude and adjusted analysis to investigate the associations between the variables. To adjust the distribution of the sample to the study population, we weighted the measures by the population size in each city and by gender. There were differences in several aspects from sexual behavior between genders. The majority of men reported an early sexual initiation, more sexual partners, and a different practice in sexual positions when compared with women. Women reported use of contraception more frequently than men (P

Resumo: Os objetivos consistiram em descrever os casos e verificar a frequência de anafilaxia relacionada à vacina sarampo, caxumba e rubéola (SCR) do produtor A, bem como avaliar os possíveis fatores de risco associados. Estudo de caso-controle (1:4), em Santa Catarina, Brasil, de 14 de julho de 2014 a 12 de janeiro de 2015, em crianças de um a menores de cinco anos, vacinadas com SCR e notificadas com anafilaxia, sendo os controles sem anafilaxia. Utilizou-se, como medida de associação, odds ratio (OR) com intervalo de 95% de confiança (IC95%) e os testes qui-quadrado e exato de Fisher. Calcularam-se taxas de anafilaxia por doses distribuídas/aplicadas. Entrevistaram-se 15 casos e 60 controles, em 12 municípios. As taxas de anafilaxia foram 2,46 e 5,05 por doses distribuídas e aplicadas, respectivamente. Dentre os casos de anafilaxia, oito (53,4%) eram do sexo masculino, e dentre os controles, 36 (60%), com p = 0,64. Na análise bivariada referente à anafilaxia e alergia à proteína do leite de vaca (APLV), verificou-se OR = 51,62, com p = 0,00002 e IC95%: 5,59-476,11. As variáveis alergia alimentar familiar, aleitamento materno, evento adverso pós-vacinação (EAPV) anterior e vacinação simultânea não foram estatisticamente significativas (p = 0,48; p = 1,00; p = 0,49; p = 0,61). Taxas de anafilaxia por doses distribuídas/aplicadas ficaram acima de 1/100 mil doses aplicadas (taxa esperada). Anafilaxia e APLV apresentaram associação estatisticamente significativa. Não foram encontradas associações estatísticas referentes à vacinação simultânea, aleitamento materno, alergia alimentar familiar e EAPV anterior. Recomendou-se ao produtor informar na bula todos os componentes do produto e que crianças com história pregressa de APLV não sejam vacinadas com essa vacina.

Streszczenie Wprowadzenie W marcu 2010 r. wprowadzono do stosowania w Brazylii 10-walentną skoniugowaną szczepionke przeciwko pneumokokom ( pneumococcal conjugate vaccine ; PCV10). Podstawą dopuszczenia jej do obrotu bylo wykazanie, ze w zakresie wskaźnikow immunologicznych dotyczących skuteczności w zapobieganiu zakazeniom pneumokokowym nie byla ona gorsza od szczepionki 7-walentnej. Schemat dawkowania PCV10 obejmuje podanie trzech podstawowych dawek w wieku 2, 4 i 6 miesiecy oraz dawki przypominającej w wieku 12 miesiecy. W czasie wprowadzania szczepionki na rynek zaproponowano szczepienie pojedynczą dawką wszystkich dzieci w wieku 12–23 miesiecy, nieobjetych podstawowym cyklem szczepien. Analizowano skutecznośc szczepionki PCV10 w profilaktyce inwazyjnych chorob pneumokokowych u dzieci w Brazylii. Metody Od 1 marca 2010 r. do 31 grudnia 2012 r. w 10 stanach w Brazylii u dzieci w wieku kwalifikującym do podania co najmniej jednej dawki PCV10 prowadzono badania przesiewowe w kierunku inwazyjnych chorob pneumokokowych, określanych jako wyhodowanie Streptococcus pneumoniae z krwi, plynu mozgowo-rdzeniowego lub innego miejsca, ktore w warunkach fizjologicznych nie jest skolonizowane przez bakterie. U dzieci wykonywano badania laboratoryjne oraz prowadzono obserwacje szpitalną. Jednym z celow badania bylo utworzenie w kazdym przypadku odpowiedniej grupy kontrolnej, obejmującej 4 dzieci odpowiadających pod wzgledem wieku i miejsca zamieszkania. Do analizy wykorzystano warunkową regresje logistyczną, a skutecznośc PCV10 obliczono jako (1 – skorygowany sparowany iloraz szans) × 100% zarowno do typu szczepionki, jak i odpowiednich serotypow bakterii zawartych w szczepionce (to znaczy w tej samej grupie serologicznej co serotyp szczepionki). Wyniki W 316 przypadkach chorob inwazyjnych (mediana wieku 13,2 miesiąca, zakres 2,6–53,1) i u 1219 dzieci w grupie kontrolnej (13,3 miesiąca, 2,6–53,1) skorygowana skutecznośc dostosowanego do wieku schematu szczepienia PCV10 wyniosla 83,8% (95% CI: 65,9–92,3) przeciwko serotypom zawartym w szczepionce i 77,9% (41,0–91,7) przeciwko serotypom związanym ze szczepionką. Skutecznośc przeciwko określonym serotypom wykazano wobec dwoch najczestszych serotypow zawartych w szczepionce – 14 (87,7%, 60,8–96,1) i 6B (82,8%, 23,8–96,1) oraz serotypowi 19A (82,2%, 10,7–96,4), związanemu z serotypem szczepionki 19F. Pojedyncza dawka szczepienia u dzieci w wieku 12–23 miesiecy, nieobjetych podstawowym cyklem szczepien, skutecznie zapobiegala chorobom wywolanym przez rodzaje bakterii zawarte w szczepionce (68,0%, 17,6–87,6). Nie wykazano skuteczności przeciwko serotypom pneumokokow niezawartych w szczepionce, zarowno po odpowiednim do wieku podstawowym cyklu szczepien, jak i po pojedynczym szczepieniu. Interpretacja Szczepionka PCV10 podawana w Brazylii w ramach rutynowego programu szczepien ochronnych zapobiega chorobom inwazyjnym wywolywanym przez serotypy pneumokokow zawarte w szczepionce. Podanie PCV10 moze wywolac tez ochrone krzyzową przeciwko niektorym serotypom związanym ze szczepionką.

Introduction Human papillomavirus (HPV) is associated with the development of genital warts and different types of cancer, including virtually all cervical cancers and a considerable number of penile, anal and oropharyngeal cancers. Data regarding the prevalence of HPV infection in Brazil are limited and fragmented. We aim to determine HPV prevalence in sexually active women and men aged 16–25 years and to investigate regional differences in virus prevalence and types. Methods and analysis This is a nationwide, multicentric, cross-sectional, prospective study that will include participants aged 16–25 years from all Brazilian capital cities. Recruitment will occur in primary health units by trained health professionals who will be responsible for collecting biological samples and interviewing the volunteers. After signing informed consent, all participants will answer a questionnaire that will collect sociodemographic and behavioural data. All samples will be processed in a certified central laboratory, and strict quality control will be performed by many different procedures, including double data entry, training and certification of primary care health professionals responsible for data collection, simulation of interviews, and auditing and monitoring of visits. The sample size will be standardised based on the population distribution of each capital using SAS and R statistical software. Ethics and dissemination The project was approved by the research ethics committee of the main institution and the corresponding ethics committees of the recruitment sites. This will be the first Brazilian nationwide study to determine overall HPV prevalence and to examine regional differences and social, demographic and behavioural factors related to HPV infection. Critical analysis of the study results will contribute to epidemiological knowledge and will set a baseline for future evaluation of the impact of the National HPV Vaccination Program.

In August 2012, the Brazilian Ministry of Health introduced inactivated polio vaccine (IPV) as part of sequential polio vaccination schedule for all infants beginning their primary vaccination series. The revised childhood immunization schedule included 2 doses of IPV at 2 and 4 months of age followed by 2 doses of oral polio vaccine (OPV) at 6 and 15 months of age. One annual national polio immunization day was maintained to provide OPV to all children aged 6 to 59 months. The decision to introduce IPV was based on preventing rare cases of vaccine-associated paralytic polio, financially sustaining IPV introduction, ensuring equitable access to IPV, and preparing for future OPV cessation following global eradication. Introducing IPV during a national multivaccination campaign led to rapid uptake, despite challenges with local vaccine supply due to high wastage rates. Continuous monitoring is required to achieve high coverage with the sequential polio vaccine schedule.

Objective: describe rapid monitoring of vaccination coverage (RMC) following Measles Mumps Rubella (MMR) (2008-2011) and Multivaccination (2012) vaccination campaigns. Methods: descriptive study using National Immunization Program administrative data on vaccine coverage as well as RMC data, in addition to data on the grounds for non-vaccination (2011-2012). Result: MMR vaccine coverage exceeded 95% in the campaigns. RMC data on a single dose of MMR found 92% post-campaign coverage in 2008 and 96% in 2011. In 2011, 41,700 MMR doses were administered post-campaign, raising vaccination coverage to 99.5% in that year. In 2012 post-campaign coverage ranged between 97% (polio and hepatitis B) and 82% (second diphtheria-tetanus-pertussis booster). "Lack of time" was the main motive for non-vaccination (43.6% in 2011 and 32.7% in 2012). Conclusion: RMC is a useful tool for evaluating vaccination coverage and reaching those not vaccinated, in addition to informing interventions.

Proponer y poner a prueba un modelo para analizar el nivel de riesgo de reintroducción y transmisión del virus del sarampión que existe en los municipios durante el período posterior a la eliminación en la Región de las Américas.Se realizó un estudio ecológico y analítico empleando datos sobre la epidemia de sarampión que afectó al noreste del Brasil del 2013 al 2015. Las variables para el análisis se seleccionaron después de efectuar un amplio examen de las publicaciones científicas sobre el riesgo de importación de casos de sarampión. Se llevó a cabo un análisis con una sola variable considerando la presencia o ausencia de los casos de sarampión confirmados en 184 municipios del estado de Ceará (Brasil) para evaluar la asociación entre la variable dependiente y 23 variables independientes, que se agruparon en cuatro categorías: 1) características de los municipios; 2) indicadores de calidad de los programas de vacunación y la vigilancia epidemiológica; 3) estructura de organización de la respuesta de salud pública, y 4) indicadores del impacto seleccionados. Se consideró significativo un valor deEl modelo tenía una sensibilidad de 95% en el caso de la concordancia entre los municipios clasificados dentro de las categorías de “riesgo alto” y “riesgo muy alto” y los que tuvieron una epidemia entre el 2013 y el 2015 en Ceará. De los 38 municipios que tuvieron una epidemia, 76% (29/38) se clasificaron dentro de las categorías de “riesgo alto” y “riesgo muy alto”; 146 municipios no notificaron casos (Dado el riesgo inminente de reintroducción de la circulación del sarampión durante el período posterior a la eliminación en la Región de las Américas, este modelo puede ser útil para reconocer las zonas en las que existe un mayor riesgo de reintroducción y transmisión continua del sarampión. El conocimiento de las zonas vulnerables podría desembocar en actividades de vigilancia y seguimiento apropiadas para evitar la transmisión sostenida.Elaborar e testar um modelo para analisar o risco de reintrodução e transmissão do vírus do sarampo ao nível municipal no período pós-eliminação nas Américas.Um estudo analítico-ecológico foi realizado com base nos dados da epidemia de sarampo ocorrida em 2013–2015 no nordeste do Brasil. As variáveis para análise foram selecionadas após extensa revisão da literatura científica sobre o risco de importação de casos de sarampo. Uma análise univariada considerando a presença ou a ausência de casos confirmados de sarampo em 184 municípios no Estado do Ceará foi conduzida para avaliar a associação entre a variável dependente e 23 variáveis independentes divididas em quatro grupos: 1) características dos municípios, 2) indicadores de qualidade dos programas de vacinação e da vigilância epidemiológica, 3) estrutura organizacional para resposta em saúde pública e 4) indicadores de impacto selecionados. Um nível de significância de 5% foi definido. Todas as variáveis comA sensibilidade do modelo foi de 95% para concordância entre os municípios categorizados como “risco alto” e “risco muito alto” e os que registraram a ocorrência de epidemia entre 2013 e 2015 no Ceará. Dos 38 municípios onde ocorreu uma epidemia, 76% (29/38) apresentaram “risco alto” e “risco muito alto” de reintrodução e transmissão do vírus do sarampo e 146 municípios não notificaram casos (Diante do risco iminente de reintrodução da circulação do vírus do sarampo no período pós-eliminação nas Américas, este modelo pode servir para identificar as áreas de maior risco de reintrodução e transmissão contínua do vírus do sarampo. Conhecer as áreas vulneráveis incentiva a adoção de procedimentos adequados de vigilância e monitoramento a fim de prevenir a transmissão sustentada.

In Brazil, more than two centuries have passed since the first time (1804) the vaccine was administered as a control measure to prevent smallpox. Exactly a century later (1904), an epidemic of this disease led the President of the Republic Rodrigues Alves, to establish the obligation of the vaccination. In the same year, the hygienist Osvaldo Cruz coordinated the mass vaccination of the Rio de Janeiro`s population in order to control the epidemic. This movement generated a historical episode known as “The Vaccine Revolt” characterized by population rebellion and rejection to the measure adopted, culminating in the suspension of mandatory vaccination.

Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiologicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiologicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Governo do Estado de Minas Gerais. Secretaria de Estado de Sa?de. Belo Horizonte, MG, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiologicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiologicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiologicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Universidade Federal de Alfenas. Alfenas, MG, Brasil. Instituto de Biologia do Exercito. Rio de Janeiro, RJ, Brasil. Instituto de Biologia do Exercito. Rio de Janeiro, RJ, Brasil. Instituto de Biologia do Exercito. Rio de Janeiro, RJ, Brasil. Instituto de Biologia do Exercito. Rio de Janeiro, RJ, Brasil. Instituto de Biologia do Exercito. Rio de Janeiro, RJ, Brasil. Instituto de Biologia do Exercito. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Assessoria Cl?nica de Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiologicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Instituto de Tecnologia em Imunobiologicos Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Funda??o Oswaldo Cruz. Assessoria Cl?nica de Bio-Manguinhos. Rio de Janeiro, RJ, Brasil. Ministerio da Saude. Secretaria de Vigilancia em Saude. Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Brasil. Universidade de Bras?lia. Brasilia, DF, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. US Food and Drug Administration. Center for Biologics Evaluation and Research. Silver Spring, MD USA Funda??o Oswaldo Cruz. Diretoria Regional de Bras?lia. Bras?lia, DF, Brasil. Funda??o Oswaldo Cruz. Escola Nacional de Sa?de Publica. Rio de Janeiro, DF, Brasil. Funda??o Oswaldo Cruz. Centro de Pesquisas Ren? Rachou. Belo Horizonte, MG, Brasil. A single vaccination of Yellow Fever vaccines is believed to confer life-long protection. In this study, results of vaccinees who received a single dose of 17DD-YF immunization followed over 10 y challenge this premise. YF-neutralizing antibodies, subsets of memory T and B cells as well as cytokine-producing lymphocytes were evaluated in groups of adults before (NVday0) and after (PVday30-45, PVyear1-4, PVyear5-9, PVyear10-11, PVyear12-13) 17DD-YF primary vaccination. YF-neutralizing antibodies decrease significantly from PVyear1-4 to PVyear12-13 as compared to PVday30-45, and the seropositivity rates (PRNT?2.9Log10mIU/mL) become critical (lower than 90%) beyond PVyear5-9. YF-specific memory phenotypes (effector T-cells and classical B-cells) significantly increase at PVday30-45 as compared to na've baseline. Moreover, these phenotypes tend to decrease at PVyear10-11 as compared to PVday30-45. Decreasing levels of TNF-?(+) and IFN-?(+) produced by CD4(+) and CD8(+) T-cells along with increasing levels of IL-10(+)CD4(+)T-cells were characteristic of anti-YF response over time. Systems biology profiling represented by hierarchic networks revealed that while the na've baseline is characterized by independent micro-nets, primary vaccinees displayed an imbricate network with essential role of central and effector CD8(+) memory T-cell responses. Any putative limitations of this cross-sectional study will certainly be answered by the ongoing longitudinal population-based investigation. Overall, our data support the current Brazilian national immunization policy guidelines that recommend one booster dose 10 y after primary 17DD-YF vaccination.

Introduction Human papillomavirus (HPV) infection is a cause of premalignant and malignant cancer in the lower genital and digestive tracts. In Brazil, there have been no prevalence studies that included a nationwide sample, and the prevalence of HPV has not been determined in many regions. Methods We will search the EMBASE, LILACS, MEDLINE, Web of Science and SciELO databases and previously published review articles to identify original research articles assessing HPV prevalence of the perineal (cervical, penile and anal) and oral areas. No exclusion criteria related to language or publication date will apply. 2 reviewers will independently screen for eligibility and perform data extraction. Discrepancies will be resolved through consensus; the opinion of a third reviewer will be sought as necessary. Relevant measures and data about study and population characteristics will be extracted from the included studies. Where possible, study prevalence will be pooled using a random-effects meta-analysis. The methodological quality of the studies will be assessed using an adapted version of the NIH ‘Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies’. The overall quality of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Ethics and dissemination We expect to estimate the prevalence of perineal and oral HPV infection in the general population as well as the prevalence of HPV infection in individuals with premalignant and malignant lesions in Brazil and its 5 geographic regions. This systematic review does not require ethical approval. Trial registration number CRD42016032751.