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Background Brazil faced a yellow fever(YF) outbreak in 2016–2018 and vaccination was considered for autoimmune rheumatic disease patients(ARD) with low immunosuppression due to YF high mortality. Objective This study aimed to evaluate, prospectively for the first time, the short-term immunogenicity of the fractional YF vaccine(YFV) immunization in ARD patients with low immunossupression. Methods and Results A total of 318 participants(159 ARD and 159 age- and sex-matched healthy controls) were vaccinated with the fractional-dose(one fifth) of 17DD-YFV. All subjects were evaluated at entry(D0), D5, D10, and D30 post-vaccination for clinical/laboratory and disease activity parameters for ARD patients. Post-vaccination seroconversion rate(83.7%vs.96.6%, p = 0.0006) and geometric mean titers(GMT) of neutralizing antibodies[1143.7 (95%CI 1012.3–1292.2) vs.731 (95%CI 593.6–900.2), p0.05). Conclusion Fractional-dose 17DD-YF vaccine in ARD patients resulted in a high rate of seroconversion rate(>80%) but lower than controls, with a longer but less intense viremia. This vaccine was immunogenic, safe and did not induce flares in ARD under low immunosuppression and may be indicated in YF outbreak situations and for patients who live or travel to endemic areas. Trial registration This clinical trial was registered with Clinicaltrials.gov (#NCT03430388)., Author summary Yellow fever is a viral hemorragic fever with high mortality rate and the vaccine is a remarkably successful way of preventing it. As a live attenuated virus vaccine, it is not recommended for rheumatic and other immunossupressed patients in general. However, in an outbreak scenario, the risk of dying of the disease can be higher than the risk of a vaccine serious adverse event. In 2018, the fractional-dose yellow fever vaccine was offered to the hospital employees and to the rheumatic patients without or with low immunossupression therapy in Hospital das Clinicas of University of São Paulo, during the yellow fever outbreak in São Paulo, Brazil. In order to optimize the yellow fever vaccine (YFV) supply, the fractional-dose (corresponding to one fifth) was adopted in the public vaccine campaign. This is the first study evaluating the primary vaccination with fractional-dose YFV in autoimmune rheumatic diseases(ARD) patients (n = 159) under low immunosuppression. Most vaccinated participants were able to produce enough neutralizing antibodies to be protected against yellow fever (seroconversion rate of 84% versus 96% in healthy controls). Neither activity of the rheumatic disease or serious adverse event was identified during the 30 days of followup after the vaccination.

As transfusões de sangue podem salvar vidas, principalmente para pacientes em choque hemorrágico, vítimas de trauma, entre outros. Entretanto, muitas vezes os estoques dos bancos de sangue estão em baixa e a demanda por transfusões de sangue, por outro lado, está em constante crescimento, principalmente nos países em desenvolvimento. A Organização Mundial da Saúde recomenda que 1% a 3% da população doe sangue regularmente, mas ainda assim não tem sido o suficiente para atender a demanda mundial. Com a pandemia por SARS-CoV-2, o número de doadores colapsou em todo o mundo, portanto, medidas para aumentar a captação e fidelização de doadores de sangue são mais do que bem-vindas e necessárias. O capital social é um termo que se refere à relação com o outro. Quando se fala em motivação, capital social e doação de sangue, é instintivo pensar que as pessoas mais motivadas e com alto grau de capital social doem mais sangue, mas essa associação nunca foi comprovada. Sabendo disso, esse projeto vai estudar o comportamento de um grupo de doadores de sangue e o impacto que os diferentes tipos de motivações e o capital social têm no seu comportamento de retorno. Em 2009, 5974 doadores, em três grandes hemocentros brasileiros, responderam a um questionário que continha perguntas sobre as diferentes motivações que os levavam a doar sangue e sobre capital social. Acompanhamos as doações subsequentes desses pacientes por um período de dois anos, onde examinamos as características demográficas, tipo de doação, status da doação, fatores motivacionais e níveis de capital e sua associação com o retorno dos doadores. Do total, 52,3% dos participantes do estudo retornaram para uma doação de sangue pelo menos uma vez durante os dois anos de acompanhamento. Os preditores do retorno dos doadores foram sexo masculino (odds ratio ajustada [AOR] = 1,6, 95%IC 1,3-1,9, para reposição e AOR = 1,3, 95%IC 1,2-1,6, para doadores comunitários), doação anterior (AOR = 2,7, 2,3-3,3, para reposição e AOR = 2,9, 95%IC 2,5-3,5, para doadores comunitários) e alto nível de altruísmo (AOR = 1,3, 95%IC 1,1-1,7, para reposição e AOR = 1,2, 95%IC 1,0-1,5, para doadores comunitários). O altruísmo foi o único motivador associado ao comportamento de maior chance de retorno. Doadores de primeira vez com escores mais baixos de capital social cognitivo e mais altos de interesse próprio apresentaram menor chance de retornar para novas doações. Doadores de Recife e São Paulo eram mais propensos a retornar para reposição e/ou para doações comunitárias do que doadores de Belo Horizonte. Não houve associação entre pontuação de capital social e comportamento de retorno do doador. A probabilidade de retorno para posterior doação de sangue depende das características individuais do doador e também varia nas diferentes regiões do Brasil. No entanto, na população geral, o capital social não foi associado a maior probabilidade de retorno. Os hemocentros necessitam tornarem-se mais conhecidos para a população de doadores, principalmente entre doadores de primeira vez. Uma melhor compreensão das categorias e apelos altruístas pode ajudar a melhorar o recrutamento e retenção de doadores Blood transfusions can save lives, mainly for patients in hemorrhagic shock, victims of trauma, among others. However, blood banks stocks are often below average as the demand for blood transfusions is constantly growing, especially in developing countries. The World Health Organization recommends that 1% to 3% of population should donate blood regularly but even though some countries reached this level, sometimes the stocks are not enough to meet the demand. With the SARS-CoV-2 pandemic the number of donors has collapsed worldwide. Therefore, measures to increase the recruitment and retention of blood donors are welcome and necessary. Social capital is a term that refers to a relationship with another. When we talk about motivation, social capital and blood donation, it is instinctive to think that people who are more motivated and those with higher social capital are more likely to return to new donations but this association has never been proven. This project will study the behavior of a group of blood donors and the impact on different types of motivations and social capital with the return behavior. From the total, 5974 donors, in three large Brazilians blood centers through 2009, were interviewed about motivations factors to donate and cognitive and structural social capital just before an effective donation. We assessed the return to a new donation along two years for each of these donors. Demographic characteristics, type of donation, donation status, motivators and levels of social capital and their association with donor´s returned were examined. Overall, 3123 (52.3%) of the study subjects returned for a blood donation at least once. Predictors of donors\' return were male gender (adjusted odds ratio [AOR] = 1.6, 95%CI 1.3-1.9, for replacement and AOR = 1.3, 95%CI 1.2-1,6, for community donors), previous donation.(AOR=2.7, 95%CI 2.3-3.3, for replacement and AOR = 2.9, 95%CI 2.5-3.5, for community donors) and high altruism (AOR = 1.3, 95%CI 1.1-1.7, for replacement and AOR = 1.2, 95%CI 1.0-1.5, for community donors). Altruism was the only motivator associated with a greater chance of return behavior. First time donors with low cognitive social capital scores and high self-interest are less likely to return for a new donation. Donors from Recife and São Paulo were more likely to return for replacement and/or for community donations than donors from Belo Horizonte. There was no association between social capital scores and donor return behavior. The likelihood to return for a subsequent blood donation is dependent upon of individual characteristics of the donors and regional differences. However, in the general population, the social capital was not associated with the higher probability of return. Blood centers need to become better known to the donor population, especially among first time donors. A better understanding of altruistic categories and appeals may help to improve donor recruitment and retention