Baixa cobertura da vacina contra COVID-19 e altas taxas de mortalidade por COVID-19 em idosos no Brazil

Introduction: In 2021, Brazil started a nationwide vaccination against COVID-19 but the emergence of the P.1 variant of SARS-CoV-2, more transmissible and resistant to immunity from the previous infection, rapidly led to a record increase in COVID-19 mortality. Methods: Secondary data on COVID-19 deaths and vaccination coverage were retrieved to examine COVID-19 mortality rate (MR) evolution as anti-COVID-19 vaccination advanced in Brazil in 2021. Poisson regression with adjustment for age and federal states was used to calculate the MR. Results; By mid-April 2021, MR increased 2-3 times compared to the already high level in January for the people of 60 years or older, reaching the highest epidemic level of 5-15 per 100.000 in this age group. Despite a declining time trend followed, by the end of May, the MR level was still about 50% and 80% higher for the 40-79 and 80 years or older. The first dose of anti-COVID-19 coverage reached 80% for the 60-69 years old and exceeded 95% for those of 70 years or older, but the second dose was applied to only 26%, 76%, and 64% of the 60-69, 70-79, and 80 years or older, respectively. The average age-standardized MR over the study time was the highest in northern Brazilian states of Rondônia, Amazonas, Acre, and Roraima (range 6-8.4 per 100.000). Conclusion: Anti-COVID-19 vaccination coverage was below the level necessary to protect Brazilians from rising MR between January and May 2021. Urgent measures are needed to increase the vaccine supply and the adherence to non-pharmacological protective measures.Introdução: Brasil começou vacinar contra COVID-19 em 2021, mas o surgimento da variante P.1 do SARS-Cov-2, mais transmissível e resistente, rapidamente levou a aumento recorde em mortalidade por COVID-19. Métodos – Foram levantados dados secundários sobre mortes e cobertura vacinal relacionadas a COVID-19, para examinar a evolução da taxa de mortalidade (TM) com avanço da vacinação. Utilizou-se a regressão de Poisson com ajuste para idade e as unidades federadas. Resultados – Em abril, a TM aumentou 2-3 vezes comparado com começo do ano 2021 em pessoas com 60 ou mais anos de idade (60+), atingindo o nível recorde de 5-15 por 100.000. Apesar do subsequente declínio, no final de maio a taxa ainda estava aproximadamente 50% e 80% mais alta que no começo do ano para faixas etárias de 40-79 e 80+ anos, respectivamente. As pessoas com 70+ anos ultrapassaram a cobertura vacinal de 95%, enquanto aqueles de 60-69 anos chegaram à 80% da cobertura com a primeira dose da vacina. Porém, a segunda dose foi aplicada a somente 26%, 76%, e 64% das pessoas com 60-69, 70-79, e 80+ anos, respectivamente. As mais altas taxas de 6 a 8.4 per 100.000, ajustadas por faixa etária, foram registradas em Rondônia, Amazonas, Acre, e Roraima. Conclusão – Cobertura vacinal contra COVID-19 não atingiu os níveis necessários para proteger os Brasileiros contra crescente mortalidade por esta doença entre janeiro e maio de 2021. É preciso tomar medidas urgentes para aumentar o suprimento das vacinas e aderência às medidas preventivas não farmacológicas

An ecological study

Funding Information: This work is part of the Grand Challenges ICODA pilot initiative, delivered by Health Data Research UK and funded by the Bill & Melinda Gates Foundation and the Minderoo Foundation. This study was also supported by the National Council for Scientific and Technological Development (CNPq), the Coordination for the Improvement of Higher Education Personnel (CAPES) - Finance Code 001, Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ), the Pontifical Catholic University of Rio de Janeiro. OR is funded by a Sara Borrell grant from the Instituto de Salud Carlos III (CD19/00110). PM acknowledges suppor from the CNPq (Grant 311519/2022-9). OR acknowledges support from the Spanish Ministry of Science and Innovation and State Research Agency through the \u2018Centro de Excelencia Severo Ochoa 2019-2023\u2019 programme (CEX2018-000806-S) and support from the Generalitat de Catalunya through the CERCA programme. All authors carried out the research independently of the funding bodies. The findings and conclusions in this manuscript reflect the opinions of the authors alone. Funding Information: SH and FAB are funded by the CNPq and FAPERJ. PM is funded by CNPq (422470/2021-0) and FAPERJ (E-26/211.645/2021 and E-26/201.348/2022). OR is funded by a Sara Borrell fellowship from the Instituto de Salud Carlos III (CD19/00110), acknowledges support from the Spanish Ministry of Science and Innovation and State Research Agency through the \u2018Centro de Excelencia Severo Ochoa 2019\u20132023\u2019 programme (CEX2018-000806-S), support from the Generalitat de Catalunya through the CERCA programme and received a research grant from the Health Effects Institute for research unrelated to this manuscript. OR was also a member of the Data Safety Monitoring Board in the REVOLUTION and STOP-COVID trials, testing treatments against COVID-19, and is currently a member of the Data Safety Monitoring Board of the RENOVATE trial, testing respiratory support strategies in patients with acute respiratory hypoxaemic failure. Publisher Copyright: © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.Objectives No consensus exists about the best COVID-19 vaccination strategy to be adopted by low-income and middle-income countries. Brazil adopted an age-based calendar strategy to reduce mortality and the burden on the healthcare system. This study evaluates the impact of the vaccination campaign in Brazil on the progression of the reported COVID-19 deaths. Methods This ecological study analyses the dynamic of vaccination coverage and COVID-19 deaths in hospitalised adults (≥20 years) during the first year of the COVID-19 vaccination roll-out (January to December 2021) using nationwide data (DATASUS). We stratified the adult population into 20-49, 50-59, 60-69 and 70+ years. The dynamic effect of the vaccination campaign on mortality rates was estimated by applying a negative binomial regression. The prevented and possible preventable deaths (observed deaths higher than expected) and potential years of life lost (PYLL) for each age group were obtained in a counterfactual analysis. Results During the first year of COVID-19 vaccination, 266 153 517 doses were administered, achieving 91% first-dose coverage. A total of 380 594 deaths were reported, 154 091 (40%) in 70+ years and 136 804 (36%) from 50-59 or 20-49 years. The mortality rates of 70+ decreased by 52% (rate ratio [95% CI]: 0.48 [0.43-0.53]) in 6 months, whereas rates for 20-49 were still increasing due to low coverage (52%). The vaccination roll-out strategy prevented 59 618 deaths, 53 088 (89%) from those aged 70+ years. However, the strategy did not prevent 54 797 deaths, 85% from those under 60 years, being 26 344 (45%) only in 20-49, corresponding to 1 589 271 PYLL, being 1 080 104 PYLL (68%) from those aged 20-49 years. Conclusion The adopted aged-based calendar vaccination strategy initially reduced mortality in the oldest but did not prevent the deaths of the youngest as effectively as compared with the older age group. Countries with a high burden, limited vaccine supply and young populations should consider other factors beyond the age to prioritise who should be vaccinated first.publishersversionpublishe

Economic Evaluation of vaccination program against covid-19 among children and elderly population in European Countries : A Systematic Literature Review

Background – The COVID-19 pandemic caused by the novel coronavirus, SARS-CoV-2, has had a significant global impact, with severe implications for public health and economies worldwide. As the virus spreads and new variants emerge, effective vaccination strategies are crucial in controlling the pandemic and mitigating its burden on healthcare systems. Understanding the cost-effectiveness of different vaccination approaches is essential for decision-makers to allocate limited resources efficiently and prioritize interventions for which a systematic literature review was used. Objectives- In this systematic literature review, we aim to report and synthesize health economic evaluations of vaccination programs against Covid-19 in European countries among children compared with an elderly population. Methods- According to Mandrik et al. (2021), a Systematic Literature Review consists of six stages, (i) planning and development, (ii) evidence search, (iii) study selection, (iv) quality assessment, (v) data extraction, and synthesis, (vi) presenting results. This SLR used CINAHL, MEDLINE, PsychInfo, and EMBASE databases. Use of health-economic databases and grey literature were also used. Results- Through search identification, 6053 articles were found, of which 333 were removed because of duplication. Then after the title and abstract screening, 162 articles were selected for the full-text screening, and the rest were excluded for multiple reasons. No potentially relevant study was included in the final inclusion. Conclusion- We did not find any relevant articles that reported an economic evaluation of covid-19 vaccination program among the children population compared to the elderly population in European countries. More evidence is required for the children population to evaluate the vaccination program economically

Age reporting for the oldest old in the Brazilian COVID-19 vaccination database: What can we learn from it?

Background: Age misreporting affects population estimates at older ages. In Brazil, every citizen must be registered and show an identity document to vaccinate against COVID-19. This requirement to present proof of age provides a unique opportunity for measuring the oldest-old population using novel administrative data. Objective: To offer critically assessed estimates of the Brazilian population aged 80 and older based on data from the vaccination registration system (VRS). To uncover discrepancies between the number of vaccinated oldest-old people and the projections used to estimate target populations for COVID-19 vaccination. Methods: We calculate data quality indicators based on data from the VRS - namely, 100+/80+ and 90+/80+ population proportions, sex ratios, and the Myers blended index - and compare them to those based on data on target populations from Brazilian censuses and demographic projections, and from Sweden - a country with high-quality data. We also estimate vaccination coverage ratios using population projections adjusted to excess deaths as the denominators. Results: Requiring documentation reduces age heaping, age exaggeration, and sex ratios marginally. However, it cannot solve the problem of the misreporting of birth dates due to the absence of long-standing birth registration systems in Brazil, particularly in the northern and central regions. In addition, we find a mismatch between the projected populations and numbers of vaccinated people across regions. Conclusions: Despite improvements in data quality in Brazil, we are still not confident about the accuracy of age reporting among the oldest old in the less advantaged Brazilian regions. The postponement of the 2020 census reduced the ability of authorities to define the target populations for vaccinations against COVID-19 and other diseases. Contribution: This is the first study to compare population estimates for the oldest old in administrative data and census data in Brazil. Age misreporting resulted in discrepancies that may have compromised the efficacy of the COVID-19 vaccination campaign

COVID-19 incidence, severity, medication use, and vaccination among dentists: Staggering body of evidence obtained from a survey during the second wave in Brazil

This cross-sectional survey investigated the pandemic impact on dental practice in May 2021 (second wave in Brazil). COVID-19 incidence and severity among respondents, vaccination status, and level of confidence in vaccines were surveyed, in addition to medications used for preventing or treating COVID-19, including controversial drugs/substances (vitamin D, ivermectin, zinc, and chloroquine). Dentists were recruited by email and responded to a pretested questionnaire until May 31, 2021. In total, 1,907 responses were received (21.2% return rate). Bivariate and multivariate regression analyses were performed (α=0.05). Prevalence Ratios were calculated for the association between professional characteristics and two outcomes: report of SARS-CoV-2 infection and use of controversial drugs. One third of dentists reported intermediate levels of confidence in safety/efficacy of vaccines, but 96% received at least one vaccine dose, mainly CoronaVac. The impact of the pandemic on dental practice was rated as lower/much lower compared with one-year before (first wave) by 46% of respondents; 27% of dentists reported to have had a positive COVID-19 test, ~50% had relatives or friends who had been hospitalized or died from COVID-19. At least one medication was used by 59% of respondents, 43% used two or more drugs and substances. Vitamin D (41%), (35%), and zinc (29%) were the most frequent drugs/substances. More experienced dentists (≥21 years in practice) were 42% more likely to use controversial medications than less experienced respondents. Dentists with residency/advanced training as postgraduate education had 30% higher prevalence of controversial medication use than respondents holding MSc/PhD degrees. Respondents with low confidence in vaccines were 2.1 times more likely to use controversial medications than participants with very high confidence. The overall findings of this survey highlight the high severity of the pandemic in Brazil, and raised questions about the use of scientific evidence by dentists in their decision to take controversial COVID-19 medications

Modeling the impact of child vaccination (5–11 y) on overall COVID-19 related hospitalizations and mortality in a context of omicron variant predominance and different vaccination coverage paces in Brazil

Background Developing countries have experienced significant COVID-19 disease burden. With the emergence of new variants, particularly omicron, the disease burden in children has increased. When the first COVID-19 vaccine was approved for use in children aged 5–11 years of age, very few countries recommended vaccination due to limited risk-benefit evidence for vaccination of this population. In Brazil, ranking second in the global COVID-19 death toll, the childhood COVID-19 disease burden increased significantly in early 2022. This prompted a risk-benefit assessment of the introduction and scaling-up of COVID-19 vaccination of children. Methods To estimate the potential impact of vaccinating children aged 5–11 years with mRNA-based COVID-19 vaccine in the context of omicron dominance, we developed a discrete-time SEIR-like model stratified in age groups, considering a three-month time horizon. We considered three scenarios: No vaccination, slow, and maximum vaccination paces. In each scenario, we estimated the potential reduction in total COVID-19 cases, hospitalizations, deaths, hospitalization costs, and potential years of life lost, considering the absence of vaccination as the base-case scenario. Findings We estimated that vaccinating at a maximum pace could prevent, between mid-January and April 2022, about 26,000 COVID-19 hospitalizations, and 4200 deaths in all age groups; of which 5400 hospitalizations and 410 deaths in children aged 5–11 years. Continuing vaccination at a slow/current pace would prevent 1450 deaths and 9700 COVID-19 hospitalizations in all age groups in this same time period; of which 180 deaths and 2390 hospitalizations in children only. Interpretation Maximum vaccination of children results in a significant reduction of COVID-19 hospitalizations and deaths and should be enforced in developing countries with significant disease incidence in children

COVID-19 incidence, severity, medication use, and vaccination among dentists: survey during the second wave in Brazil

Objective: This cross-sectional study with dentists in Brazil assessed the COVID-19 incidence and severity, its vaccination status, and the level of confidence in vaccines in May 2021 (COVID-19 second wave). The medications used to prevent or treat COVID-19, including controversial substances (vitamin D, ivermectin, zinc, and chloroquine), were analyzed. Methodology: Dentists were recruited by email and responded to a pretested questionnaire until May 31, 2021. Bivariate and multivariate regression analyses were performed (α=0.05). Prevalence ratios were calculated for the association between professional characteristics and two outcomes: SARS-CoV-2 infection and use of controversial substances. Results: In total, 1,907 responses were received (return rate of 21.2%). One third of dentists reported intermediate levels of confidence in the safety and efficacy of COVID-19 vaccines, but 96% had received at least one vaccine dose, mainly CoronaVac. The effect of the pandemic on dental practice was classified as lower/much lower, in comparison with the first wave, by 46% of participants. Moreover, 27% of dentists had already tested positive for SARS-CoV-2 and about 50% had relatives or friends who had been hospitalized or died from COVID-19. At least one medication was used by 59% of participants and 43% used two or more substances. Vitamin D (41%), ivermectin (35%), and zinc (29%) were the most frequent substances. More experienced dentists (≥21 years of professional experience) were 42% more likely to use controversial substances than less experienced dentists. The prevalence of use of controversial substances was 30% higher among dentists with residency or advanced training, such as postgraduate degrees, in comparison with participants holding MSc or PhD degrees. Participants with low confidence in vaccines were 2.1 times more likely to use controversial substances than participants with a very high confidence. Conclusion: The results of this study show the high severity of the COVID-19 pandemic in Brazil and raised questions about the use of scientific evidence by dentists in their decision to use controversial substances

Impact of vaccination on COVID-19 morbidity and mortality among aged people

Objective: to correlate COVID-19 incidence and mortality rates in elderly people before and after vaccination. Methods: an ecological study with data collected from the official platforms of the State Data Analysis System Foundation and the Prefeitura Municipal de Araraquara (Araraquara City Hall). The data was analyzed using a regression model with a negative binomial distribution and a logarithmic link function. We analyzed 3,188 COVID-19 records in people aged 60 or over, of which 3,137 were eligible for analysis. Results: there was a significant reduction in the incidence of the disease among vaccinated-aged people. No significant differences were observed in the mortality coefficient; however, there was a 67.7% decline in deaths when comparing the periods. Conclusion: the findings indicate a correlation between the vaccination of older individuals and the reduction in COVID-19 incidence and mortality rates, thereby demonstrating and underscoring the significance of adhering to vaccinations. Contributions to practice include the expansion of the theoretical framework regarding the significance of vaccination in reducing morbidity and mortality from COVID-19, particularly in the elderly population. This is especially important considering the endemicity of the disease and the unlimited availability of false information