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The objective of this research was to analyze the relationship between socioeconomic statistics and homicide mortality rates in the city of Sao Paulo between 1988 and 1994. City districts were grouped into five geographic areas. A socioeconomic indicator (ISE) was constructed with census information combining average income of the family head, illiteracy rate for the population over 5 yr of age, average number of rooms and number of persons per household. The higher the score, the better the socioeconomic situation (possible values: 4 to 384). Deaths from homicide were grouped by residential areas, and the rates for these areas were calculated. The association between homicide rates and the socioeconomic situation was analyzed with Spearman correlation coefficients. Average ISE scores varied from 291 in the Central area (homicide rate = 27.96 deaths per 100000) to 119.9 in the East area (homicide rate = 40.38). The Spearman coefficient between ISEs and homicide rates was -0.98 (p < 0.05). Due to the heterogeneity inside the areas, the median ISE is a better indicator of the socioeconomic conditions yielding an rs = -1.0. Almost half the population resides in areas with the highest risk of homicide mortality (East and South). Taking the Central area as a reference, we found risks of 1.36 in the Western, 1.37 in the Northern, 1.44 in the Eastern and 2.67 in the Southern areas. [ABSTRACT FROM AUTHOR]

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.

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.

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.

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.

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.

Objective: To analyze vaccine hesitancy associated factors and repercussions on vaccination coverage., Methods: Cohort of children born in 2017-2018, living in Brazilian state capitals, Federal District (FD), and 12 inner region cities, stratified by socioeconomic level. National Vaccination Coverage Survey (2020) data on hesitancy, access and programmatic difficulties were obtained by interview and coverage was calculated from vaccination card dose and date records., Results: 37801 children were studied, 31001 in the capitals/FD, 6800 in the inner cities. Hesitation between 38.8(95%CI 33.6;44.4) and 57.9(95%CI 54.1;61.6) in high versus low stratum; 64.1(95%CI 58.9;68.9) to 41.7(95%CI 38.4;45.8) among mothers with <8 years of schooling versus 16 years or more; 42.1(95%CI 38.2;46.2) to 55.0(95%CI 52.0;54.7) among private service users versus public service only users. Coverage: full=7.2(95%CI 1.0;38.3); 25.3(95%CI 18.7;33.3) for hesitant people; and 44.7(95%CI 43.0;46.4) for the remainder., Conclusion: High vaccine hesitancy in several groups affecting vaccination coverage and hindering vaccination target achievement. Access problems and programmatic difficulties contribute to low coverage.

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.

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.

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.

Objective: To analyze factors associated with full vaccination coverage with valid doses, in children from four state capitals and three other cities in Southeast Brazil., Method: Analysis of a population survey conducted in 2020-2021, with a sample stratified according to socioeconomic levels of children born in 2017-2018, with data collected through photographic records of their vaccination cards. Odds ratios (OR) and 95% confidence intervals (95%CI) for full vaccination coverage were estimated based on the characteristics of the family, mother and child., Results: Among 8703 children, lowest coverage occurred in strata A and B (OR=0.39; 95%CI 0.23;0.67 and OR=0.38; 95%CI 0.25;0.58); in consumption level A/B (OR=0.38; 95CI% 0.28;0.52); among those with income >BRL8000/month (OR=0.23; 95%CI 0.12;0.42); in children of mothers with higher education (OR=0.47; 95%CI 0.32;0.71); in children not vaccinated exclusively in the public service (OR=0.37; 95%CI 0.26;0.51) and in children with a vaccination delay of up to 6 months (OR=0.28; 95%CI 0.22;0.37)., Conclusion: Coverage did not reach the targets for controlling vaccine-preventable diseases and was negatively associated with higher socioeconomic status., Main Results: Vaccination coverage for the full schedule with valid doses was very low, putting the control of vaccine-preventable diseases at risk in the four state capitals and three other cities in the interior region of Southeast Brazil., Implications for Services: Brazilian National Health System managers and workers need to know the factors associated with low vaccination coverage and increased risk of abandoning the schedule, access problems and National Immunization Program difficulties., Perspectives: Understanding determinants of low vaccination coverage provides support for the discussion and design of effective public policies to address barriers and qualify health services for vaccination.

Objective: To analyze measles, mumps, and rubella vaccination coverage among children up to 24 months old and factors associated with non-vaccination in a 2017-2018 live birth cohort, in state capitals and large interior region cities in Northeast Brazil., Methods: Population-based survey analyzing vaccination coverage and sociodemographic factors through logistic regression., Results: For 12,137 children, vaccination coverage was 79.3% (95%CI 76.5;81.8), and the dropout rate was 10.6%. Association with non-vaccination: socioeconomic stratum A (OR-a 1.29; 95%CI 1.10;1.50), living in the interior region (OR-a 1.22; 95%CI 1.07;1.39), no access to the Bolsa Família Program (OR-a 1.19, 95%CI 1.05;1.34), family income ≤BRL 1,000 (OR-a 1.17, 95%CI 1.03;1.31), mother not working (OR-a 1.28, 95%CI 1.15;1.42), >1 child per mother (OR-a 1.12, 95%CI 1.08;1.17), and no vaccination card (OR-a 10.69, 95%CI 6.27;18.20)., Conclusion: Low vaccination coverage and a high dropout rate in state capitals and municipalities in the interior region of Northeast Brazil., Main Results: 79.3% vaccination coverage with incomplete vaccination associated with living in higher socioeconomic strata and in interior region municipalities, and children without vaccination records. High dropout rates in the state capitals Natal and João Pessoa., Implications for Services: Recognition of low coverage and factors associated with non-vaccination provides health services with relevant information with a view to planning strategic actions to increase measles, mumps and rubella vaccination coverage., Perspectives: Low coverage and identification of non-vaccination indicate the importance of targeting actions in the Brazilian National Health System to achieve the targets recommended by the National Immunization Program, for populations in Northeast Brazil.

Objective: To analyze vaccination coverage up to 24 months of age according to race/ skin color in the 2017-2018 live birth cohort in Natal, Rio Grande do Norte, Brazil., Methods: Population-based survey conducted in 2020 and 2021. Vaccination coverage up to 24 months of age was estimated according to administered, valid and timely doses. Crude association of race/skin color was estimated by calculating the crude Prevalence Ratio and respective 95% Confidence Intervals, using Poisson regression., Results: Of the 688 children in the selected cohort, there was greater coverage among Black children for administered doses (White 30.5%; Black 47.8%; 95%CI) and valid doses (White 25.8%; Black 40.1%; 95%CI), although without statistical significance, and lower coverage for timely doses, in the full schedule excluding yellow fever (PR = 0.21; 95%CI 0.04;0.90)., Conclusion: There was lower timely coverage among Black children compared to White children., Main Results: It was found that racial inequalities and social disparities were reflected in vaccination coverage of Black children in the state of Rio Grande do Norte, showing lower prevalence of timely and full vaccination schedules among those children., Implications for Services: The results demonstrate the need to strengthen equitable public policies and the implementation of practices that seek to improve vaccination coverage, thus reducing racial inequalities in child immunization., Perspectives: Health service managers will be able to plan actions and strategies in childhood immunization services, in order to increase vaccination coverage and reduce vaccination hesitancy among Black people and people from lower socioeconomic strata.

Objective: To characterize the use of private services in infant vaccination and assess vaccination coverage according to the service used., Methods: : This was a national vaccination survey conducted in 2020 that estimated the use of private vaccination services and vaccination coverage among infants residing in state capitals and 12 inland municipalities., Results: : Of the 37,801 participants, 25.1% (95%CI 23.2;27.2) used private services at least once, with higher proportions in capitals, larger cities and in the South and Southeast regions. Socioeconomic and demographic differences were identified among families, based on the service used. The coverage for the set of vaccines administered up to 24 months was 60.3% (95%CI 58.6;62.0) in the public service and 59.5% (95%CI 55.9;63.0) in private services, and up-to-date vaccines, 10.3% (95%CI 9.1;11.6) and 9.4% (95%CI 7.4;11.8), respectively., Conclusion: The use of private services was frequent, with low coverage for the set of vaccines, regardless of the type of service used, especially for up-to-date vaccines.

Objective: To analyze full vaccination coverage in live births in 2017 and 2018 in the capitals of the Midwest region of Brazil, according to social strata., Methods: Population-based household survey with cluster sampling. Full coverage in children at 12 and 24 months of age and sociodemographic factors were analyzed., Results: 5,715 children were analyzed. Full coverage at 12 months of age was 67.9% (95%CI 65.4;70.4), while at 24 months it was 48.2% (95%CI 45.3;51.1). Pneumococcal vaccine had the highest vaccination coverage (91.3%), while the second dose of rotavirus vaccine had the lowest (74.2%). In Campo Grande, no vaccine reached coverage above 90%, with BCG (82.9%) and hepatitis B (82.1%) standing out. Campo Grande and Brasília had the worst vaccination coverage in the high social stratum (24 months of age)., Conclusion: Vaccination coverage in the Midwest was below 80%, falling short of the recommended target and associated with socioeconomic factors.

Objective: To estimate vaccination coverage, identify barriers and hesitancy to vaccinating children up to 24 months, born between 2017-2018, living in the urban area of Rio Branco, Acre, Brazil., Methods: Population survey carried out from 2020 to 2021, which assessed sociodemographic characteristics and vaccination status among children., Results: Among 451 included children, vaccination coverage was below 80%. Meningococcal C vaccine had the lowest coverage for administered doses (76.3%; 95%CI 70.5;81.3) and doses on time (27.4%; 95%CI 23.1;32.1). The statements "vaccines cause serious adverse reactions" (26.4%; 95%CI 18.1;36.8) and "you don't need vaccination for diseases that no longer exist" (22%; 95%CI 15.7;29.8) were the most frequent regarding vaccination hesitancy. Lack of vaccines was the main barrier to care (86.6%; 95%CI 71.8;94.3)., Conclusion: Vaccination coverage in children born in 2017-2018 was below the target recommended for the full schedule of administered doses, both valid and timely administered.

Objective: To estimate vaccination coverage in children born between 2017-2018, living in urban areas of state capitals, the Federal District and 12 inland municipalities in Brazil, and to identify associated factors., Methods: This was a household survey conducted between 2020-2022, among children up to 24 months old. Vaccination coverage was estimated according to family, maternal and child characteristics., Results: Among the 37,801 children in the sample, complete coverage (doses administered) was 60.1% (95%CI 58.6;61.6) and 6.1% (95%CI 5.4;7.0) had not received any vaccines. Coverage was lower among children of mothers with lower level of education (OR = 0.70; 95%CI 0.54;0.90) and in those who experienced delays in receiving any vaccine by 6 months old (OR = 0.28; 95%CI 0.24;0.32)., Conclusion: Vaccination coverage is below the expected levels. Effective communication strategies are needed to reinforce the importance of routine vaccination, prevent delays and abandonment of the vaccination schedule, in order to recover the high coverage levels achieved in past decades.

Objective: To estimate vaccination coverage and analyze sociodemographic factors associated with non-vaccination in children born in 2017 and 2018 in the state capitals of Northeast Brazil., Methods: A household survey using cluster sampling was conducted from 2020-2022 to estimate vaccination coverage and hesitancy. Factors associated with non-vaccination were analyzed using logistic regression to calculate Odds Ratios (OR) and their Confidence Intervals (95%CI)., Results: Natal was the capital with the lowest vaccination coverage, below 75.0% for most immunizers. Teresina had rates equal to or greater than 90.0% for all vaccines. Among those interviewed, 99.1% (95%CI 98.9;99.3) believe that vaccines are important for health; 95.4% (95%CI 95.0;95.8) trust immunobiologicals and 79.6% (95%CI% 78.8;80.3) are not afraid of reactions. Belonging to the highest socioeconomic stratum (adjusted OR: 1.34 - 95%CI 1.20;1.50) was as a factor associated with non-vaccination., Conclusion: Low coverage highlights the need for a better understanding of regional specificities and social inequalities.

Objective: To estimate hepatitis A vaccination coverage in 24-month-old children and identify factors associated with non-vaccination., Methods: This was a survey involving a sample stratified by socioeconomic strata in capital cities (2020-2022), with coverage estimates and 95% confidence intervals (95%CI), the factor analysis was performed using the prevalence ratio (PR) by means of Poisson regression., Results: Among 31,001 children, hepatitis A coverage was 88.1% (95%CI 86.8;89.2). Regarding socioeconomic strata (A/B), the variable immigrant parents/guardians was associated with non-vaccination (PR = 1.91; 95%CI 1.09;3.37); in strata C/D, children of Asian race/skin color (PR = 4.69; 95%CI 2.30;9.57), fourth-born child or later (PR = 1.68; 95%CI 1.06;2 .66), not attending daycare/nursery (PR = 1.67; 95%CI 1.24;2.24) and mother with paid work (PR = 1.42; 95%CI 1.16;1.74) were associated with non-vaccination., Conclusion: Hepatitis A coverage was below the target (95%), suggesting that specificities of social strata should be taken into consideration., Main Results: Hepatitis A vaccination coverage was 88%. Non-vaccination was greater in children with immigrant guardians (strata A/B); of Asian race/skin color, fourth-born child or later, those not attending daycare/nursery and mother with paid work (C/D strata)., Implications for Services: The results of this study contributed to the Ministry of Health and Health Departments in monitoring vaccination coverage and identifying factors that may negatively impact hepatitis A vaccination coverage., Perspectives: Further research is needed on the impact of migration on hepatitis A vaccination and vaccination in general. Health managers should be attentive to the different factors affecting vaccination among social strata.

Objective: To analyze vaccination coverage according to social strata in children up to 24 months old, living in the municipality of Londrina (PR), Brazil., Methods: This was a population-based survey conducted between 2021 and 2022, in which vaccination coverage and sociodemographic aspects of mothers and families were evaluated using Pearson's chi-square test., Results: In a sample of 456 children, complete vaccination coverage varied according to social strata, being 36.0% (95%CI 26.8;57.8); in stratum A; 59.5% (95%CI 26.1;86); in stratum B; 66.2% (95%CI 51.7;78.1); in stratum C; and 70.0% (95%CI 56.1;81.0) in stratum D., Conclusion: The analysis of vaccination coverage indicated that social stratum A is at highest risk for vaccine-preventable diseases., Main Results: The results of the study showed low full vaccination coverage in children up to 24 months of age in Londrina, being higher in the less financially advantaged social stratum, compared to the most advantaged., Implications for Services: The results found can support the qualification of the immunization program and enable, based on planning and ongoing health education, the definition of unique strategies to improve vaccination coverage., Perspectives: Future perspectives point to the importance of carrying out investigations into the challenges inherent to vaccination, as well as qualitative and quantitative research addressing health professionals to better understand the data.

Objective: To analyze the reliability of records held on the National Immunization Program Information System (SI-PNI) in a subsample of children included in the national vaccination coverage survey in Brazilian state capitals and Federal District in 2020., Methods: This was a study of agreement between data recorded on vaccination cards (doses and dates) and on the SI-PNI for 4050 children with full coverage at 24 months., Results: Data on 3587 children were held on the SI-PNI, with losses of 11% (95%CI: 10;12). Total agreement between doses and dates in the two sources was 86% (95%CI: 86;87), however taking each dose and vaccine individually, variation was greater, with 32% of data in only one source., Conclusion: Part of the information was not recorded, but the discrepancy can be considered small. Nonetheless, underrecording of doses and children can compromise vaccination coverage estimates, altering the numerator and denominator data., Main Results: Subsample of 4,050 children, among those completing the full schedule at 24 months studied in the national survey, 11% had not been recorded on the SI-PNI, 32% had unrecorded doses (doses or dates) and there was 8% disagreement between vaccination cards and SI-PNI records., Implications for Services: Recognizing the difficulties faced by the SI-PNI and the discrepancies between sources is essential for adopting initiatives to improve data quality, so as to avoid inaccurate estimates of childhood vaccination coverage., Perspectives: This study is expected to contribute to improving the quality of records and the usability of data for monitoring vaccination coverage of the immunization program from the local to the national level.

Objective: To evaluate vaccination coverage and delay in vaccine dose administration in infants in six municipalities in the Southern region of Brazil., Methodology: National Vaccination Coverage Survey 2020, with infants born alive in 2017 and 2018, carried out from September 2020 to March 2022. Coverage of doses administered, doses administered on time and delay in dose administration were evaluated., Results: For 4681 infants analyzed, coverage for vaccines recommended up to 24 months was 68.0% (95%CI 63.9;71.8%) for doses administered and 3.9% (95%CI 2.7%;5.7%) for doses administered on time. Delay time for the majority of late vaccinations was ≤ 3 months. For some boosters, 25% of vaccine administration was delayed by ≥ 6 months., Conclusion: In addition to tracking vaccine defaulters, strategies are needed to encourage compliance with the vaccination schedule at the recommended ages., Main Results: Vaccination coverage for the set of vaccines recommended up to 24 months was 68.0% and 3.9% for on-time doses. Delay time for some doses exceeded six months in up to 25% of infants with delayed vaccination., Implications for Services: Monitoring vaccine administration at the recommended ages is necessary, with the adoption of strategies that reinforce routine vaccination to prevent vaccination delays and abandonment., Perspectives: Primary care in surveillance and care for infants needs to reinforce actions to ensure timely vaccination. Studies to deepen knowledge of vaccination delay, determinants and strategies for their reduction are necessary.

Objective: To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color., Methods: Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression., Results: 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers., Conclusion: There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil., Main Results: Marked racial inequalities were found in the obstacles to vaccination of children under 24 months in Brazil and to timely vaccination at 5 months and in the first year of life., Implications for Services: Racial inequalities in the occurrence of vaccination shortcomings in health services, in the objective restrictions faced by families in taking their children to vaccination centers and in incomplete vaccination in a timely manner need to be addressed by the Brazilian National Health System., Perspectives: Equal public policies to address barriers to vaccination and qualification of health services need to be implemented. Studies need to deepen understanding of the structural determinants that lead to racial disparities.

Objective: To describe vaccination coverage and hesitation for the basic children's schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil., Methods: Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy., Results: Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy., Conclusion: Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities., Main Results: Vaccination coverage of children up to 4 years old was 50.2% in Belo Horizonte, and 64.9% in Sete Lagoas. Fear of severe reactions and believing that vaccination against eradicated diseases is unnecessary were the main reasons for vaccination hesitancy., Implications for Services: Recovery of high vaccination coverage among children, considering public health service access conditions and socioeconomic inequities. Acting on reasons for hesitancy that can assist in targeting actions., Perspectives: The multifactorial context of vaccination hesitancy demands the development of health education strategies to raise awareness about child immunization.

Soil conditioner is class of products used to enhance physics, physicochemical or soil biological activities, being able to recover disturbed or nutritional unbalanced soils. The formulation of a soil conditioner composed by bauxite residue (BR), and organic oil palm wastes, as raw materials, was recently proposed as an innovative strategy for the Brazilian acid soils amendment. Here we show the results of soil conditioner amended soil leaching tests and agronomical performance. The soil conditioners were formulated by BR mixed with decomposed POC (palm oil compost) and non-decomposed POMW (palm oil mill waste) oil palm wastes, in the proportion of 25% BR + 75% POC (T1) and 50% BR + 50% POMW (T2), in addition to the treatment with 100% POMW without BR (T3) and limestone at a dose calculated to raise soil pH to 6.0 (T4). Except for T4, all conditioners were applied to the soil at doses of 40, 80, and 120 t ha -1 for leaching tests. The experimental plots were composed of polyvinyl chloride columns, filled with 5 kg of soil, with bottles adapted with hoses at the bottom to facilitate drainage of the leachate. After leaching tests, the respective columns were used as pots for the cultivation of Brachiaria grass, stage with addition of a control composed by undisturbed soil (T5). The pH of the leachates had changes, but the use of BR associated with POMW was similar to the use of limestone. Of the 65 chemical elements evaluated, only nine were identified in the leachate, being most of them considered as plant nutrients. As for soil pH, limestone was slightly higher (6.6) than treatments that had BR (5.5). Brachiaria grass cultivated in the soil amended with conditioners showed similar results of limestone treated soil for the parameters of plant development and showed fertility improvement., 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 © 2023 Elsevier Inc. All rights reserved.)

Objective: The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016., Methods: A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy., Results: Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others., Conclusion: There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.

Bauxite residue (BR) is a by-product of Bayer process, which is applied for alumina production. Due to its inherent alkalinity and sodicity, the use of BR is globally limited to 23% of the 150 million tons (Mt) produced annually. Maximizing alternative and large-scale uses of BR is a game changer to promote the sustainability of the aluminum production chain. As a strategy for BR valorization, a soil conditioner composed of BR and palm oil residual biomass was proposed. Here we evaluate the BR (25%, 50% and 75%) batch composting with raw palm oil mill waste (POMW) and palm oil compost (POC). The pH, EC, total N and organic carbon, C:N ratio, water holding capacity (WHC), cation exchange capacity (CEC), granulometry and elemental composition were determined after 90 days of composting. Changes in temperature, pH and EC curves were observed during composting of soil conditioners for 90 days. Composting reduced the alkalinity and sodicity of BR, increasing CEC, moisture, organic carbon and total nitrogen. The formulation containing 25% of BR and 75% of POC showed WHC ≥ 60% and CEC ≥ 200 mmol c ·kg -1 , meeting the Brazilian legislation for production and commercialization of soil conditioners. This strategy could potentially consume 7.6% of all BR produced annually in the largest Brazilian alumina refinery. Concentrations of potentially toxic elements were far below the allowable levels in all formulations. Major and minor plant nutrients were present and the composting aggregated small particles in BR. Composting of BR is a new alternative for the valorization of mining tailings, allowing the development of an environmentally friendly and zero-waste product, which can be applied on a large scale in agriculture to improve soil fertility., 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 © 2022 Elsevier B.V. All rights reserved.)

Objective: The objective of this narrative review was to list some historical aspects of epidemiological surveillance, a technological intervention model initially designed to help control communicable diseases in the last century., Methods: This narrative was built based on texts selected to record the development of epidemiological surveillance in the United States and in the state of São Paulo, Brazil., Results: The origins of some of the actions that constitute epidemiological surveillance activities are presented, as well as a brief history of the establishment of the originally named Center for Disease Control, a United States agency that is held up as an example in relation to the way surveillance has been performed, practically all over the world. Likewise, we outline the paths that led to the establishment of the surveillance system in the state of São Paulo, drawing some parallels with the Brazilian system., Conclusion: The narrative concludes with a conceptual differentiation between epidemiological surveillance, monitoring and health surveillance.

This paper deals with the first ten epidemiology conferences held by ABRASCO between 1990 and 2017., Objective: To provide historical records of these events, highlighting the context in which they were conceived, the chosen themes and their role in the national and international epidemiological landscape, the venues, and the presidents of the different editions., Methods: Data were extracted from printed and electronic proceedings, with some data gaps that could not be filled., Results: The numbers and characteristics of different activities are also presented, with emphasis on conferences and roundtables, lectures, panels and debates, and the collaboration of the academic and professional community for coordinated communications and posters outlining a wide range of themes and approaches. This paper keeps record of most of the activities carried out., Conclusions: The authors are aware that the record presented is a pale picture of the real meaning of these meetings in which the development of epidemiology was being built, in an articulation between scholars and health services and as a cooperation between national researchers and our companions and friends who work in foreign institutions all around the world.

The authors report the case of an 86-year-old woman presenting with recurrent Klebsiella pneumoniae bacteraemia. She had severe aortic stenosis submitted to a recent transcatheter aortic valve implantation (TAVI). Initially, Klebsiella pneumoniae bacteraemia from a urinary source was diagnosed. Following another 4 episodes of bacteraemia with the same agent, the source was ultimately found to be a periprosthetic abscess. Considering the patient's unsuitability for surgery, a decision was made for life-long antimicrobial therapy. This approach has been successful in preventing recurrences or complications. Endocarditis is one of the most severe complications seen following TAVI, often carrying a poor prognosis. Even though Klebsiella spp. are common pathogens for healthcare-associated infections among the elderly, they are seldom the causative agent for endocarditis. Being the first reported case of TAVI-related Klebsiella endocarditis, it was successfully managed using a medical approach., Learning Points: Non-HACEK Gram-negative bacilli are organisms infrequently found to cause infective endocarditis (IE). This is the first reported case of transcatheter aortic valve implantation (TAVI)-related Klebsiella IE.Diagnosing an infectious complication associated with procedural or prosthetic material is not always straightforward; a high level of suspicion and a systematic approach are essential.Most cases of TAVI-related IE are ineligible for surgery due to a prohibitive procedural risk. Long-term antibiotic therapy may be a suitable alternative for patients with uncontrolled infection considered unfit for surgery., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interest, (© EFIM 2020.)

Vaccine hesitancy has been increasingly reported in Brazil. We describe secular trends and socioeconomic disparities from 1982 to 2015, using data from four population-based birth cohorts carried out in the city of Pelotas. Full immunization coverage (FIC) was defined as having received four basic vaccines (one dose of BCG and measles, and three doses of polio and DTP) scheduled for the first year of life. Information on income was collected through standardized questionnaires, and the slope index of inequality (SII) was calculated to express the difference in percent points between the rich and poor extremes of the income distribution. Full immunization coverage was 80.9% (95% CI 79.8%; 82.0%) in 1982, 97.2% (96.1%; 98.0%) in 1993, 87.8% (86.7%; 88.8%) in 2004 and 77.2% (75.8%; 78.4%) in 2015. In 1982 there was a strong social gradient with higher coverage among children from wealthy families (SII = 25.0, P < 0.001); by 2015, the pattern was inverted with higher coverage among poor children (SII = -6.0; P = 0.01). Vertical immunization programs in the 1980s and creation of the National Health Services in 1980 eliminated the social gradient that had been present up to the 1980s, to reach near universal coverage. The recent decline in coverage is likely associated with the growing complexity of the vaccination schedule and underfunding of the health sector. In addition, the faster decline observed among children from wealthy families is probably due to vaccine hesitancy., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The article aims to bring to the attention of readers and potential authors some aspects of the difficulties faced by scientific editors of Public Health journals. It discusses critical aspects, highlighting the expectations of authors, readers, editors and publishers; and presents results of empirical studies on publishing predictors, types and quality of peer review, formal characteristics of the publishing process, the working process of two Brazilian and one foreign Public Health journal, ethical issues involving authors and editors, specific editorial challenges faced by Brazilian Public Health journals, and the future of publications in the open access model scenario.

Objective: to describe yellow fever occurrence in the state of São Paulo, Brazil, in the period 2000-2010., Methods: this was a descriptive study using data regarding human cases, epizootics in non-human primates and virus vector isolation in São Paulo State, between 2000 and 2010., Results: three sylvatic yellow fever outbreaks were registered in the state with 32 human cases and 15 deaths; the cases occurred in unvaccinated individuals exposed to the sylvatic form of transmission; epizootics was confirmed before the virus began circulating in humans in the region of São José do Rio Preto and the virus was isolated twice in vectors., Conclusion: three sylvatic yellow fever outbreaks occurred in the state between 2000 and 2010, two of them in a transition area and the other in an area considered to be unaffected; vaccination and maintaining immunization coverage are necessary for preventing the disease.

We performed a retrospective analysis of clinical and laboratory data over 5 years in a tertiary centre to assess clinical and microbiological characteristics of patients with Raoultella spp. infection. Raoultella spp. were deemed responsible for clinical infections in 57 patients (R. planticola, n = 32 and R. ornithinolytica, n = 25). The most prevalent diagnoses for R. planticola were cystitis (50%; n = 16) followed by bacteraemia and pneumonia (9.4%; n = 3); for R. ornithinolytica, cystitis (36%; n = 9) followed by pneumonia (24%; n = 6). Immunodeficiency was present in 18 patients (56.3%) with R. planticola and in 16 patients (64%) with R. ornithinolytica infection. Of these, 55.6% and 37.5% had diabetes and 27.8% and 18.% were solid organ transplant recipients, respectively. All isolates were sensitive to third-generation cephalosporins, fluoroquinolones and aminoglycosides. Mortality of infections with R. planticola (n = 5; 15.6%) was higher than for R. ornithinolytica (n = 2; 8.0%), but the difference was not statistically significant.

The authors describe the case of a 48-year-old woman presenting with fever, joint pain and migratory skin lesions. She had no other symptoms or medical history. After an extensive and inconclusive work up, she was admitted to the hospital for further study. This patient was ultimately found to have Streptococcus gallolyticus subsp gallolyticus bacteraemia. This finding led to the diagnosis of mitral valve infective endocarditis related to an underlying rectum adenocarcinoma. This article points out diagnostic difficulties related to an unusual presentation of the underlying disease. Furthermore, the authors reinforce the need of keeping a high level of suspicion and a systematic approach in every case of fever of unknown origin. This case highlights the importance of performing a colonoscopy in the event of S. gallolyticus subsp gallolyticus bacteraemia, as it may provide an opportunity for detecting colonic lesions at an earlier stage., (2015 BMJ Publishing Group Ltd.)

This article describes the configuration of the scientific field in Brazil, characterizing the scientific communities in every major area of knowledge in terms of installed capacity, ability to train new researchers, and capacity for academic production. Empirical data from several sources of information are used to characterize the different communities. Articulating the theoretical contributions of Pierre Bourdieu, Ludwik Fleck, and Thomas Kuhn, the following types of capital are analyzed for each community: social capital (scientific prestige), symbolic capital (dominant paradigm), political capital (leadership in S & T policy), and economic capital (resources). Scientific prestige is analyzed by taking into account the volume of production, activity index, citations, and other indicators. To characterize symbolic capital, the dominant paradigms that distinguish the natural sciences, the humanities, applied sciences, and technology development are analyzed theoretically. Political capital is measured by presidency in one of the main agencies in the S & T national system, and research resources and fellowships define the economic capital. The article discusses the composition of these different types of capital and their correspondence to structural capacities in various communities with the aim of describing the configuration of the Brazilian scientific field.

This article discusses the use of the concept of class in health research, different sociological approaches to social stratification and class structure, and the explanatory potential of the class concept in studies on social determinants and health inequalities. It also elaborates on the operationalization models that have been developed for use in sociological, demographic, or health research, as well as the limitations and scope of these models. Four main operationalization models were highlighted: the model developed by Singer for studies on income distribution in Brazil and adapted by Barros for use in epidemiological research, the model of Bronfman and Tuirán to study the Mexican demographics census and adapted by Lombardi for epidemiological research, the model proposed by Goldthorpe for socioeconomic studies in the UK and adapted by the Spanish Society of Epidemiology, and the model proposed by Wright for research in sociology and political science, which has also been used in population surveys in health. In conclusion, each of the models presented is consistent with their underlying theoretical concept, precluding the selection of one model over the others.

Objective: To estimate the vaccination coverage in children born in the city of Salvador, analyzing these coverages by socioeconomic conditions., Method: A household survey on vaccination coverage was conducted with children born in 2005, in Salvador, Bahia, northeastern Brazil, who were aged between 18 to 36 months at the time of this study. Cluster sampling was performed in multiple stages. Census tracts were stratified using data from the national census conducted in 2000. Data was collected on socio-economic households. The sample size was defined by a specific methodology developed for immunization coverage surveys. The questionnaire was based upon the information contained in the vaccination cards. The estimated vaccination coverage in the various strata considered the sampling complex plan, weighting the observations according to the sampling fraction, the losses and the design effect., Results: There was inequality in the socioeconomic strata analyzed, where the coverage rate was directly proportional to socioeconomic status. Strata D and E showed statistically significant differences when compared to stratum A. Regarding to the complete scheme, children living in strata D and E have significantly less coverage than those residing in strata B. For vaccines not included in the basic scheme, the differences are very marked, showing less than 3% in stratum D and E., Conclusions: Vaccination coverage for the complete schedule at the end of 18 months of age with valid doses, was unsatisfactory and shows significant differences among the socio-economic strata with poor coverage in the poorest groups.

Objective: To analyze the use of the h-index as a measure of the bibliometric impact of Brazilian researchers' scientific publications., Methods: The scientific production of Brazilian CNPq 1-A researchers in the areas of public health, immunology and medicine were compared. The mean h-index of the groups of researchers in each area were estimated and nonparametric Kruskal Wallis test and multiple comparisons Behrens-Fisher test were used to compare the differences., Results: The h-index means were higher in the area of Immunology than in Public Health and Medicine when the Web of Science base was used. However, this difference disappears when the comparison is made using Scopus or Google Scholar., Conclusions: The emergence of Google Scholar brings a new level to discussions on the measure of the bibliometric impact of scientific publications. Areas with strong professional components, in which knowledge is produced and must also be published in the native language, vis-a-vis its dissemination to the international community, necessarily have a standard of scientific publications and citations different from areas exclusively or predominantly academic and they are best captured by Google Scholar.

The present essay deals with the relation between epidemiology and public policies, highlighting the epidemiology position in the public health field, analyzing the impact of public policies over epidemiological profile and contributions from epidemiology to the lay down, implementation and evaluation of public health policies. In the first title, the essay debates the links between the epidemiology and public health field, the social determinants and political action framework proposed by the WHO's Commission on Social Determinants of Health, and different approaches of health policies. In the second title the essay analyses the reduction of child stunting in Brazil as an example of public policies that impact epidemiological profile. The third title presents three strategic topics for the application of public health policies: reduction of social inequalities in health, health promotion and regulation of products and services that have impact over health. The fourth title discusses the possibilities and difficulties to combine the epidemiological knowledge in the lay down, implementation and evaluation of public policies and, finally, material examples of such relation between epidemiology and public policies are presented.

Background: Since 1988, Brazil's Unified Health System has sought to provide universal and equal access to immunisations. Inequalities in immunisation may be examined by contrasting vaccination coverage among children in the highest versus the lowest socioeconomic strata. The authors examined coverage with routine infant immunisations from a survey of Brazilian children according to socioeconomic stratum of residence census tract., Methods: The authors conducted a household cluster survey in census tracts systematically selected from five socioeconomic strata, according to average household income and head of household education, in 26 Brazilian capitals and the federal district. The authors calculated coverage with recommended vaccinations among children until 18 months of age, according to socioeconomic quintile of residence census tract, and examined factors associated with incomplete vaccination., Results: Among 17,295 children with immunisation cards, 14,538 (82.6%) had received all recommended vaccinations by 18 months of age. Among children residing in census tracts in the highest socioeconomic stratum, 77.2% were completely immunised by 18 months of age versus 81.2%-86.2% of children residing in the four census tract quintiles with lower socioeconomic indicators (p<0.01). Census tracts in the highest socioeconomic quintile had significantly lower coverage for bacille Calmette-Guérin, oral polio and hepatitis B vaccines than those with lower socioeconomic indicators. In multivariable analysis, higher birth order and residing in the highest socioeconomic quintile were associated with incomplete vaccination. After adjusting for interaction between socioeconomic strata of residence census tract and household wealth index, only birth order remained significant., Conclusions: Evidence from Brazilian capitals shows success in achieving high immunisation coverage among poorer children. Strategies are needed to reach children in wealthier areas.

We describe the case of a 55-year-old man with a biological prosthetic aortic valve who suffered from epigastrium and right hypochondrium pain associated with intermittent night sweats. Liver biopsy showed infectious hepatitis pattern without pathognomonic features. Coxiella burnetii serology was suggestive of chronic Q fever, and modified Duke's criteria for endocarditis were also fulfilled. The authors present a brief literature review concerning chronic Q fever, emphasizing absent previous reports of chronic Q fever with hepatitis and endocarditis and no increase in inflammatory markers.

We report the case of a 50-year-old HIV-positive woman with a congenital cyanotic heart disease who developed left axillary, subclavian, and brachiocephalic vein thrombosis and left lower aortopulmonary collateral arterial thrombosis, presenting as left hemibody swelling. We also briefly overview the literature regarding upper extremity deep vein thrombosis (UEDVT). Given the absence of other risk factors, it was our firm believe that our patient's UEDVT was due to a hypercoagulable state associated with congestive heart failure (CHF) and HIV infection.