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Paschoalotto MAC, Cima J, Costa E, Valente de Almeida S, Gomes da Costa J, Santos JV, Passador CS, Passador JL, Barros PP. Politics and confidence toward the COVID-19 vaccination: A Brazilian cross-sectional study. Hum Vaccin Immunother 2024; 20:2318139. [PMID: 38407171 PMCID: PMC10900266 DOI: 10.1080/21645515.2024.2318139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
This study has the aim of assessing the Brazilian perceptions, influencing factors and political positioning on the confidence concerning COVID-19 vaccination. To achieve the objective, the methods rely on a cross-sectional survey of Brazilian citizens, distributed through different social networks. The sample is composed of 1,670 valid responses, collected from almost all Brazilian states and state capitals. To analyze the data and give a clear view of the variables' relationship, the study used bivariate and comparative graphs. Results show a higher level of confidence in vaccines from Pfizer and AstraZeneca, while the lower level of confidence is associated with vaccines from Sinopharm and Sputinik5. Vaccine efficacy is the most significant influencing factor that helps in the decision to get vaccinated. Also, individuals are less willing to get vaccinated if their political preferences are related to the right-wing. The results led to three main health and social implications: i) the vaccination strategy campaigns should take in count vaccine efficacy and political aspects; ii) the vaccination process should be adapted to regions with different political positions; and iii) a reinforcement in the educational policies of the vaccine's importance to the public health, to avoid the politization of a health issue.
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Affiliation(s)
- Marco Antonio Catussi Paschoalotto
- School of Economics and Management, University of Minho, Braga, Portugal
- Research Center in Political Science (CICP), University of Minho, Braga, Portugal
| | - Joana Cima
- Centre for Research in Economics and Management (NIPE), University of Minho, Braga, Portugal
| | - Eduardo Costa
- Nova School of Business and Economics, Nova University of Lisbon, Lisbon, Portugal
| | | | - Joana Gomes da Costa
- Center for Economics and Finance; School of Economics and Management, University of Porto, Porto, Portugal
| | - João Vasco Santos
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
- Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Porto, Portugal
| | - Claudia Souza Passador
- School of Economics, Business Administration and Accounting at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - João Luiz Passador
- School of Economics, Business Administration and Accounting at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Pedro Pita Barros
- Nova School of Business and Economics, Nova University of Lisbon, Lisbon, Portugal
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Seara-Morais GJ, Avelino-Silva TJ, Couto M, Avelino-Silva VI. The pervasive association between political ideology and COVID-19 vaccine uptake in Brazil: an ecologic study. BMC Public Health 2023; 23:1606. [PMID: 37612648 PMCID: PMC10464231 DOI: 10.1186/s12889-023-16409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Despite the unequivocal benefits of vaccination, vaccine coverage has been falling in several countries in the past few years. Studies suggest that vaccine hesitancy is an increasingly significant phenomenon affecting adherence to vaccines. More recently, during the COVID-19 pandemic, political views have emerged as an additional influencing factor for vaccine hesitancy. METHODS In this ecologic study, we used information from publicly available databases to investigate the association between political ideology, depicted by the percentage of votes for the right-wing candidate Jair Bolsonaro in the presidential elections of 2018 and 2022, and COVID-19 vaccination in Brazilian municipalities. The primary endpoint was the COVID-19 vaccination index, calculated as the number of COVID-19 vaccine doses administered up to September 2022 divided by the number of inhabitants in each municipality. The analysis was conducted using Pearson correlation coefficients and linear regression models adjusted for HDI, the percentage of male voters, the percentage of voters who were older than 50 years old, and the percentage of voters with a middle school education or less. In addition, we explored whether the effect of the percentage of Bolsonaro voters on the COVID-19 vaccination index was modified in different quartiles of HDI using an interaction term. RESULTS Five thousand five hundred sixty-three Brazilian municipalities were included in the analysis. For both the 2018 and 2022 elections, the percentage of votes for Jair Bolsonaro was significantly and inversely associated with COVID-19 vaccine uptake after adjustment for the sociodemographic characteristics of the voters (change in mean vaccination index in 2018 for each 1% increase in Bolsonaro voters -0.11, 95% confidence interval [CI] -0.13 to -0.08, p < 0.001; change in mean vaccination index in 2022 for each 1% increase in Bolsonaro voters -0.09, 95% CI -0.11 to -0.07, p < 0.001). We also found a statistically significant interaction between the primary predictor of interest and HDI scores, with a more significantly detrimental effect of the right-wing political stance in municipalities in the lower HDI quartiles (interaction p < 0.001 for the first HDI quartile; p = 0.001 for the second HDI quartile). CONCLUSION Our findings suggest that political ideologies have influenced COVID-19 vaccine hesitancy in Brazilian municipalities, affecting communities inequitably. The politicization of vaccines is a new challenge for vaccine programs. Strategies to face these challenges should include joint efforts from governments and civil society for a common public health goal.
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Affiliation(s)
- Gabriel J Seara-Morais
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Thiago J Avelino-Silva
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Laboratorio de Investigacao Medica Em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
- Atlantic Fellowship for Equity in Brain Health at the Global Brain Health Institute, University of California, San Francisco, CA, USA
| | - Marcia Couto
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Vivian I Avelino-Silva
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
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Gonçalves BA, Matos CCDSA, Ferreira JVDS, Itagyba RF, Moço VR, Couto MT. COVID-19 vaccine hesitancy in Latin America and Africa: a scoping review. CAD SAUDE PUBLICA 2023; 39:e00041423. [PMID: 37556613 PMCID: PMC10494688 DOI: 10.1590/0102-311xpt041423] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 08/11/2023] Open
Abstract
Vaccination has played an important role in the containment of COVID-19 pandemic advances. However, SARS-CoV-2 vaccine hesitancy has caused a global concern. This scoping review aims to map the scientific literature on COVID-19 vaccine hesitancy in Latin America and Africa from a Global Health perspective, observing the particularities of the Global South and using parameters validated by the World Health Organization (WHO). The review reporting observes the recommendations of the PRISMA for Scoping Reviews (PRISMA-ScR) model. Search was conducted in PubMed, Scopus, Web of Science, and Virtual Health Library (VHL) databases, selecting studies published from January 1, 2020 to January 22, 2022. Selected studies indicate that COVID-19 vaccine hesitancy involves factors such as political scenario, spread of misinformation, regional differences in each territory regarding Internet access, lack of access to information, history of vaccination resistance, lack of information about the disease and the vaccine, concern about adverse events, and vaccine efficacy and safety. Regarding the use of conceptual and methodology references from the WHO for vaccine hesitancy, few studies (6/94) use research instruments based on these references. Then, the replication in Global South of conceptual and methodological parameters developed by experts from the Global North contexts has been criticized from the perspective of Global Health because of it may not consider political and sociocultural particularities, the different nuances of vaccine hesitancy, and issues of access to vaccines.
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Avelino-Silva VI, Ferreira-Silva SN, Soares MEM, Vasconcelos R, Fujita L, Medeiros T, Barbieri CLA, Couto MT. Say it right: measuring the impact of different communication strategies on the decision to get vaccinated. BMC Public Health 2023; 23:1162. [PMID: 37322477 PMCID: PMC10273550 DOI: 10.1186/s12889-023-16047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Vaccine hesitancy is a concerning menace to the control of vaccine-preventable diseases. Effective health communication could promote an overall understanding of the importance, risks, and benefits of vaccination and reduce vaccine hesitancy. METHODS In this survey, four fictitious newspaper articles addressing an emerging bogus disease and its vaccine were randomly assigned to participants. The first version focused on information about the disease; the second was akin to the first, including a case description and image. The third version focused on vaccine safety/efficacy; the fourth version was like the third, including a case description and image. After reading a single version of the article, participants responded if they would take the vaccine and if they would vaccinate their children. We used chi-squared tests for comparisons and investigated interactions with vaccine-hesitant attitudes. RESULTS We included 5233 participants between August/2021 and January/2022; 790 were caregivers of a child ≤ 5 years old, and 15% had prior vaccine hesitancy. Although most declared intention to take the vaccine, the percentage was highest among those exposed to the newspaper article focusing on the vaccine safety/efficacy with the case description and picture (91%; 95% confidence interval 89-92%), and lowest among participants exposed to the article focusing on the disease with no case description (84%; 95% confidence interval 82-86%). Similar trends were observed in the intention of offspring vaccination. We found evidence of effect modification by vaccine-hesitant attitudes, with a higher impact of communication focusing on vaccine safety/efficacy compared to that focusing on disease characteristics among hesitant participants. CONCLUSION Communication strategies focusing on different aspects of the disease-vaccine duet may impact vaccine hesitancy, and storytelling/emotive imagery descriptions may improve risk perception and vaccine uptake. Moreover, the effect of message framing strategies may differ according to previous vaccine hesitant attitudes.
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Affiliation(s)
- Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, Cerqueira Cesar, Sao Paulo - SP, 01246-903, Brazil.
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, Cerqueira Cesar, Sao Paulo - SP, 01246-903, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Rua Comendador Elias Jafet, 755, Morumbi, Sao Paulo - SP, 05653-000, Brazil.
| | - Sofia Natalia Ferreira-Silva
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Rua Comendador Elias Jafet, 755, Morumbi, Sao Paulo - SP, 05653-000, Brazil
| | - Maria Eduarda Muniz Soares
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Rua Comendador Elias Jafet, 755, Morumbi, Sao Paulo - SP, 05653-000, Brazil
| | - Ricardo Vasconcelos
- Centro de Pesquisas Clínicas, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 225, Cerqueira Cesar, Sao Paulo - SP, 05403-010, Brazil
| | - Luiz Fujita
- Baioque, R. Augusta, 101 - Sala 109 - Consolacao, Sao Paulo - SP, 01305-000, Brazil
| | - Tainah Medeiros
- Baioque, R. Augusta, 101 - Sala 109 - Consolacao, Sao Paulo - SP, 01305-000, Brazil
| | | | - Marcia Thereza Couto
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, Cerqueira Cesar, Sao Paulo - SP, 01246-903, Brazil
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Pourrazavi S, Fathifar Z, Sharma M, Allahverdipour H. COVID-19 vaccine hesitancy: A Systematic review of cognitive determinants. Health Promot Perspect 2023; 13:21-35. [PMID: 37309435 PMCID: PMC10257562 DOI: 10.34172/hpp.2023.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 06/14/2023] Open
Abstract
Background: Although mass vaccination is considered one of the most effective public health strategies during the pandemic, in the COVID-19 era, many people considered vaccines unnecessary and, or doubted the effectiveness of the COVID-19 vaccine. This review aimed to tabulate cognitive causes of COVID-19 vaccination hesitancy, which may help public health policymakers overcome the barriers to mass vaccinations in future pandemics. Methods: For this systematic review, studies pertaining to COVID-19 vaccine hesitancy published up to June 2022 were retrieved from six online databases (Cochrane Library, Google Scholar Medline through PubMed, Scopus, and Web of Science). Inclusion criteria were the studies conducted on people who had a delay in accepting or refusing COVID-19 vaccines, reported the impact of cognitive determinants on vaccine hesitancy, and were written in English in the timeframe of 2020-2022. Results: This systematic review initially reviewed 1171 records. From these 91 articles met the inclusion criteria. The vaccination hesitation rate was 29.72% on average. This systematic review identified several cognitive determinants influencing vaccination hesitancy. Lack of confidence and complacency were the most frequent factors that predicted vaccine hesitancy. Conclusion: The identified prevailing cognitive determinants for COVID-19 vaccine hesitancy indicated that using initiative and effective communication strategies would be a determinant factor in building people's trust in vaccines during the pandemic and mass vaccinations.
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Affiliation(s)
- Sara Pourrazavi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Fathifar
- Department of Library, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Manoj Sharma
- Department of Social and Behavioral Health, University of Nevada, Las Vegas (UNLV), Las Vegas, NV 89119, USA
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89154, USA
| | - Hamid Allahverdipour
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
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Brazilian Adults’ Attitudes and Practices Regarding the Mandatory COVID-19 Vaccination and Their Hesitancy towards Childhood Vaccination. Vaccines (Basel) 2022; 10:vaccines10111853. [DOI: 10.3390/vaccines10111853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background: This study investigated the attitudes and practices of Brazilian adults regarding the mandatory COVID-19 vaccination and their hesitancy towards the vaccination of children. Methods: Between March and May 2022, Brazilian adults answered an online questionnaire distributed through social media. The SAGE-WG questionnaire was adapted to measure hesitancy to the vaccination of children. Results: Of the 1007 participants, 67.4% believed that adult COVID-19 vaccination should be mandatory. Just over half of the participants (51.5%) believed that parents and/or guardians should decide if their children should be vaccinated against COVID-19 or not and 9.1% were unsure. Individuals who were younger, non-religious and had higher awareness of COVID-19 risks and critics of the federal government’s performance in combating the pandemic were more likely to agree with mandatory adult vaccination. However, less agreement among parents and/or guardians concerning children’s vaccination was observed, with lower scores for hesitancy to the vaccination of children. Conclusion: In Brazil, there is still far from a consensus on mandatory COVID-19 vaccination for adults and a significant proportion of the population believes that parents and/or guardians should be free to decide on their children’s vaccination. These views are associated with age, religion, knowledge of COVID-19 risks and political inclination.
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The impact of an enhanced health surveillance system for COVID-19 management in Serrana, Brazil. PUBLIC HEALTH IN PRACTICE 2022; 4:100301. [PMID: 35946045 PMCID: PMC9354446 DOI: 10.1016/j.puhip.2022.100301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 01/03/2023] Open
Abstract
Objective To describe the successful implementation of an enhanced public health surveillance system based on early detection, tracing contacts, and patient follow-up and support. Study design A prospective observational cohort study conducted in Serrana, São Paulo State, Brazil. Methods The implementation was based on four axes: increasing the access to SARS-CoV-2 testing; correct swab collection; testing patients with mild symptoms; and patient follow-up. Positivity rate, patient demographic and clinical characteristics, dynamics of disease severity, SARS-CoV-2 genome evolution, and the impact on COVID-19 research were assessed from August 23, 2020 to February 6, 2021 (between epidemiological week 35/2020 and 5/2021, a total of 24 weeks). Results The number of sites collecting rt-PCR for SARS-CoV-2 was increased from one to seven points and staff was trained in the correct use of personal protective equipment and in the swab collection technique. During the study period, 6728 samples were collected from 6155 participants vs. 2770 collections in a similar period before. SARS-CoV-2 RNA was detected in 1758 (26.1%) swabs vs. 1117 (36.7%) before the implementation of the surveillance system (p < 0.001). Positivity rates varied widely between epidemiological weeks 35/2020 and 5/2021 (IQR, 12.8%-31.3%). Out of COVID-19 patients, 91.1% were adults at a median age of 35 years (IQR, 25-50 years), 42.6% were men and 57.4% were women, with a SARS-CoV-2 positivity rate of 28.6% and 24.4% (p < 0.001), respectively. The most common symptoms were headache (72.6%), myalgia (65.0%), and cough (61.7%). Comorbidities were found in 20.8% of patients, the most common being hypertension and diabetes. According to the World Health Organization clinical progression scale, 93.5% of patients had mild disease, 1.6% were hospitalized with moderate disease, 3.2% were hospitalized with severe disease, and 1.4% died. The enhanced surveillance system led to the development of COVID-19 related research. Conclusions The enhanced surveillance system in Serrana improved COVID-19 understanding and management. By integrating community and academic institutions, it was possible to monitor SARS-CoV-2 positive cases and variants, follow the epidemic trend, guide patients, and develop relevant research projects.
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Palma D, Hernández A, Picchio CA, Jodar G, Galbany-Estragués P, Simón P, Guillaumes M, Diez E, Rius C. Confidence in a Vaccine against COVID-19 among Registered Nurses in Barcelona, Spain across Two Time Periods. Vaccines (Basel) 2022; 10:873. [PMID: 35746481 PMCID: PMC9229357 DOI: 10.3390/vaccines10060873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To report the vaccine hesitancy (VH) for a vaccine against COVID-19 in registered nurses in Barcelona, with measurements taken at two stages, prior to the vaccination campaign and once 75% vaccination coverage had been reached. METHODS A self-completed online survey was administered in December 2020 and again in July 2021 through the College of Nurses of Barcelona. It measured the prevalence of VH against a government-approved vaccine recommended by their employer, their intention to be vaccinated, perceptions of disease risk and vaccine protection, attitudes and beliefs to vaccination and social norm. Bivariate analysis according to VH and application time are presented. RESULTS 2430 valid responses were obtained in the first measurement and 2027 in the second. At both times, 86% were women and 69% worked mainly in the public sector. Prior to the vaccine availability, VH was 34.2%, decreasing to 17.9%. Risk perceptions were significantly lower in those with VH compared to non-VH, in all groups studied and at both times, while safety and efficacy perceptions increased in all groups, significantly less in VH. The greatest benefit of the COVID-19 vaccine is perceived by pharmaceutical companies. VH nurses perceived a more hesitant social environment. CONCLUSION As the vaccination was rolled out, VH in nurses declined, with time improving the confidence in the safety and efficacy of the vaccines. Risk perceptions also decreased over time, except for the perception of severity in HCW where it increased. Trust in institutions impacts trust in vaccines.
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Affiliation(s)
- David Palma
- Servei d’Epidemiologia, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (A.H.); (P.S.); (M.G.); (E.D.); (C.R.)
- Consorcio de Investigació Biomèdica en Red en Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of International Health, Care and Public Health Research Institute—CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Anna Hernández
- Servei d’Epidemiologia, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (A.H.); (P.S.); (M.G.); (E.D.); (C.R.)
| | - Camila A. Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
| | - Glòria Jodar
- Col·legi Oficial d’Infermeres i Infermers de Barcelona, 08019 Barcelona, Spain; (G.J.); (P.G.-E.)
| | - Paola Galbany-Estragués
- Col·legi Oficial d’Infermeres i Infermers de Barcelona, 08019 Barcelona, Spain; (G.J.); (P.G.-E.)
| | - Pere Simón
- Servei d’Epidemiologia, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (A.H.); (P.S.); (M.G.); (E.D.); (C.R.)
| | - Montserrat Guillaumes
- Servei d’Epidemiologia, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (A.H.); (P.S.); (M.G.); (E.D.); (C.R.)
| | - Elia Diez
- Servei d’Epidemiologia, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (A.H.); (P.S.); (M.G.); (E.D.); (C.R.)
- Consorcio de Investigació Biomèdica en Red en Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Cristina Rius
- Servei d’Epidemiologia, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (A.H.); (P.S.); (M.G.); (E.D.); (C.R.)
- Consorcio de Investigació Biomèdica en Red en Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Experimental and Health Sciences, Faculty of Health and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
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Carvalho MS, Bastos LS, Fuller T, Cruz OG, Damasceno L, Calvet G, Resende PC, Smith C, Whitworth J, Siqueira M, Brasil P. Incidence of SARS-CoV-2 over four epidemic waves in a low-resource community in Rio de Janeiro, Brazil: A prospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2022; 12:100283. [PMID: 35663637 PMCID: PMC9135359 DOI: 10.1016/j.lana.2022.100283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Incidence rates of SARS-CoV-2 infections in low-resource communities can inform vaccination strategies and non-pharmaceutical interventions (NPIs). Our objective was to estimate incidence over four epidemic waves in a slum in Rio de Janeiro, a proxy for economically deprived areas in the Global South. Methods Prospective cohort of children and household contacts screened for SARS-CoV-2 by PCR and serology (IgG). The incidence density of PCR positive infections estimated for each wave - the first wave, Zeta, Gamma and Delta - was compared to an index combining NPIs and vaccination coverage. Findings 718 families and 2501 individuals were enrolled, from May 2020 to November 2021. The incidence density of SARS-CoV-2 infection due to the first wave was 2, 3 times that of the other waves. The incidence among children was lower than that of older participants, except in later waves, when vaccination of the elderly reached 90%. Household agglomeration was significantly associated with incidence only during the first wave. Interpretation The incidence of infection greatly exceeded rates reported in similar cohorts. The observed reduction in incidence in the elderly during the Delta variant wave, in spite of the rollback of NPIs, can be attributed to increased vaccine coverage. The high incidence in young people reinforces the importance of vaccination in this age group, a policy that has yet to receive the full support of some sectors of society. Funding UK Medical Research Council, Foundation for the Advancement of Science of the State of Rio de Janeiro, National Council for Scientific and Technological Development.
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Affiliation(s)
- Marilia Sa Carvalho
- Scientific Computation Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | - Trevon Fuller
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | | | - Luana Damasceno
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Guilherme Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Paola Cristina Resende
- Laboratory of Respiratory Viruses and Measles, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Brazil
| | - Chris Smith
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jimmy Whitworth
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marilda Siqueira
- Laboratory of Respiratory Viruses and Measles, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Brazil
| | - Patricia Brasil
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil,Corresponding author.
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