Assessing the best time interval between doses in a two-dose vaccination regimen to reduce the number of deaths in an ongoing epidemic of SARS-CoV-2.

The SARS-CoV-2 pandemic is a major concern all over the world and, as vaccines became available at the end of 2020, optimal vaccination strategies were subjected to intense investigation. Considering their critical role in reducing disease burden, the increasing demand outpacing production, and that most currently approved vaccines follow a two-dose regimen, the cost-effectiveness of delaying the second dose to increment the coverage of the population receiving the first dose is often debated. Finding the best solution is complex due to the trade-off between vaccinating more people with lower level of protection and guaranteeing higher protection to a fewer number of individuals. Here we present a novel extended age-structured SEIR mathematical model that includes a two-dose vaccination schedule with a between-doses delay modelled through delay differential equations and linear optimization of vaccination rates. By maintaining the minimum stock of vaccines under a given production rate, we evaluate the dose interval that minimizes the number of deaths. We found that the best strategy depends on an interplay between the vaccine production rate and the relative efficacy of the first dose. In the scenario of low first-dose efficacy, it is always better to vaccinate the second dose as soon as possible, while for high first-dose efficacy, the best strategy of time window depends on the production rate and also on second-dose efficacy provided by each type of vaccine. We also found that the rate of spread of the infection does not affect significantly the thresholds of the best window, but is an important factor in the absolute number of total deaths. These conclusions point to the need to carefully take into account both vaccine characteristics and roll-out speed to optimize the outcome of vaccination strategies

Perfil sociodemográfico e estado de saúde auto-referido entre idosas de uma localidade de baixa renda Perfil sociodemográfico y estado de salud auto-referido entre ancianas de una comunidad de escasos recursos Socio-demographic profile and self-reported health status of elderly women in a low-income community

Os objetivos foram elaborar diagnóstico sociodemográfico e identificar a auto-percepção quanto ao estado de saúde de mulheres idosas de uma localidade de baixa renda do município do Rio de Janeiro, Brasil. Trata-se de estudo descritivo, de corte seccional, desenvolvido em três momentos: grupos focais exploratórios; Censo da População Idosa e inquérito domiciliar com as idosas identificadas no Censo. Os sujeitos foram 369 idosas, correspondendo a 83,5% da população elegível. As mulheres corresponderam a 62,8% do total de idosos da comunidade, apresentando uma condição social nada favorável (49,3% são analfabetas, 44,7% estão viúvas, 62,3% tem renda mensal de até um salário mínimo e 22,0% declararam não ter renda). Apesar de 62,0% afirmarem que têm uma boa saúde, 80,5% referiram apresentar algum problema de saúde. Pela sua própria condição (idosa, mulher e pobre), o grupo já se encontra potencialmente numa situação de risco e de desvantagem social em relação a outros grupos.<br>El objetivo fue elaborar un perfil sociodemográfico e identificar la auto-percepción en relación al estado de salud de mujeres ancianas que viven en una comunidad de escasos recursos de un municipio de Rio de Janeiro, Brasil. Se trata de un estudo de tipo descriptivo, de corte seccional, desarrollado en tres momentos: grupos focales exploratórios; Censo de la población anciana y encuestas en los domicilios con las ancianas identificadas en el Censo. Los sujetos del estudio fueron 369 ancianas, lo que corresponde a 83,5% de la población elegible . Las mujeres correspondieron a 62,8% del total de ancianos de la comunidad y presentan una condición social nada favorable (49,3% son analfabetas, 44,7% son viudas, 62,3% tienen una renta mensual de hasta un salario mínimo y 22,0% declararon no tener ningún ingreso ). A pesar de que 62,0% de las ancianas aseguren contar con una buena salud, 80,5% afirmaron que tienen algún problema de salud. Por su condición propia (anciana, mujer y pobre), el grupo ya se encuentra potencialmente en una situación de riesgo y desventaja social en lo referente a otros grupos.<br>The main objective of the present study is to develop a socio-demographic diagnosis to identify the self-perception of the state of health of elderly women in a community of low income in a county of the city of Rio de Janeiro, Brazil. It is a descriptive study, developed in three stages: exploratory focus groups; a Census of the elderly population and a survey with the elderly women identified in the Census. The subjects were 369 elderly women, number that corresponds to 83.5% of the eligible population. Women accounted for 62.8% of the total of the elderly in thecommunity, presenting a disfavorable social condition (49.3% are illiterate, 44.7% are widows, 62.3% have a monthly income of up to a minimum wage and 22,0% reported not having an income at all). Even though 62.0% say they have good health, 80.5% say they have some type of health problem. Due to their condition (elderly, women and poor), the group is already potentially in a situation of risk and social disadvantage compared to other groups

The "AMA-Brazil" cooperative project: a nation-wide assessment of the clinical and epidemiological profile of AIDS-related deaths in Brazil in the antiretroviral treatment era Projeto cooperativo AMA-Brasil: um estudo nacional do perfil clinico e epidemiológico dos óbitos relacionados à AIDS na era da terapia antirretroviral

The objective of this study was to assess the profile of AIDS-related deaths in the post antiretroviral therapy (ART) scale up period in Brazil. A case-control study was conducted including a nationally probabilistic sample of AIDS deaths and living controls. Data were abstracted from medical records and nation-wide databases of AIDS cases, mortality, ART care, and laboratory testing. Interrupted (adjusted odds ratio - AOR 4.35, 95%CI: 3.15-6.00) or no use of ART (AOR 2.39, 95%CI: 1.57-3.65) was the strongest predictor of death, followed by late diagnosis (AOR 3.95, 95%CI: 2.68-5.82). Criterion other than CD4 < 350 had a higher likelihood of death (AOR 1.65, 95%CI: 1.14-2.40). Not receiving recommended vaccines (AOR, 1.76, 95%CI: 1.21-2.56), presenting AIDS-related diseases (AOR 2.19, 95%CI: 1.22-3.93) and tuberculosis (AOR 1.50, 95%CI: 1.14-1.97) had higher odds of death. Being an injecting drug user (IDU) had a borderline association with higher odds of death, while homo/bisexual exposure showed a protective effect. Despite remarkable successes, Brazilians continue to die of AIDS in the post-ART scale up period. Many factors contributing to continued mortality are preventable<br>Analisou-se o perfil clínico e epidemiológico dos óbitos relacionados à AIDS no período posterior à implementação da terapia antirretroviral (TARV) no Brasil, em um estudo caso-controle, com amostra representativa de óbitos por AIDS e de pessoas vivendo com AIDS, utilizando dados secundários. Abandono (odds ratio ajustada - AOR = 4,35, IC95%: 3,15-6,00) ou não uso da TARV (AOR = 2,39, IC95%: 1,57-3,65) foi o mais forte preditor de morte, seguido de diagnóstico tardio (AOR = 3,95, IC95%: 2,68-5,82). Critério de definição de AIDS que não o "CD4 < 350" esteve associado a uma maior probabilidade de morte (AOR = 1,65, IC95%: 1,14-2,40). Pacientes que não receberam vacinas recomendadas (AOR = 1,76, 95%CI: 1,21-2,56), apresentando doenças associadas à AIDS (AOR = 2,19, IC95%: 1,22-3,93) e com tuberculose (AOR = 1,50, IC95%: 1,14-1,97), tiveram maior risco de morte. A categoria de exposição UDI apresentou maior chance de óbito. Apesar do sucesso com as introduções precoces da TARV, brasileiros continuaram a morrer de AIDS no período posterior à implementação da terapia, e muitas das causas subjacentes a essa mortalidade são preveníveis