Leão Aline Carralas Queiroz, Raymundo Sueli F, Fialkovitz Gabriel, Casadio Luciana Vilas Boas, Roemer Tamar, Pisciotta Katia Regina, Levin Anna S
Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Infection Control Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Am J Trop Med Hyg. 2025 Apr 1;112(6):1302-1312. doi: 10.4269/ajtmh.24-0519. Print 2025 Jun 4.
In 2016-2019, Brazil faced the most important yellow fever (YF) outbreak in recent decades. In 2019, cases were concentrated in Ribeira Valley, in the southeast region of Brazil, and largely affected rural Quilombola communities, which can trace their origins to escaped, freed, or abandoned slaves in the mid-1800s, and which traditionally practice subsistence agriculture. We aimed to explore aspects of the YF outbreak and vaccination from the perspective of the Quilombola communities. This was a cross-sectional descriptive study conducted in two Quilombola communities in Ribeira Valley (Sapatu and Nhunguara), using an interviewer-administered questionnaire that included both closed and open-ended questions. Thematic reflective analysis principles were applied for qualitative analysis. We adopted a theoretical domains framework to identify and categorize reported facilitators and barriers to YF vaccination. A total of 226 participants were enrolled: 46% male, median age 44 years. Eighty participants reported acute illness during the outbreak; fever, headache, myalgia, and nausea were the most common symptoms. Only eight participants reported laboratory-confirmed YF. Almost all participants (96.5%) reported YF vaccination. Less than two-thirds of the participants were vaccinated before the first case in the Ribeira Valley; over a third were vaccinated after the death of a community leader. The themes were: concerns about the vaccine, difficulty in accessing healthcare, perception of disease risk, knowledge about disease severity, cultural beliefs, and influence of leaders. The outbreak in the Ribeira Valley may have been averted with an understanding of the vaccination decision-making process, influenced by individual, sociocultural, and contextual factors.
2016年至2019年期间，巴西面临了近几十年来最重要的黄热病疫情。2019年，病例集中在巴西东南部的里贝拉谷地，主要影响了基隆波拉农村社区，这些社区的起源可追溯到19世纪中叶逃脱、获得自由或被遗弃的奴隶，传统上从事自给农业。我们旨在从基隆波拉社区的角度探讨黄热病疫情和疫苗接种的相关方面。这是一项横断面描述性研究，在里贝拉谷地的两个基隆波拉社区（萨帕图和恩温瓜拉）开展，使用了由访谈员进行询问的问卷，其中包括封闭式和开放式问题。采用主题反思分析原则进行定性分析。我们采用理论领域框架来识别和分类报告的黄热病疫苗接种的促进因素和障碍。总共招募了226名参与者：46%为男性，年龄中位数为44岁。80名参与者报告在疫情期间患了急性病；发热、头痛、肌痛和恶心是最常见的症状。只有8名参与者报告经实验室确诊感染黄热病。几乎所有参与者（96.5%）都报告接种了黄热病疫苗。不到三分之二的参与者在里贝拉谷地出现首例病例之前接种了疫苗；超过三分之一的参与者在一名社区领袖去世后接种了疫苗。主题包括：对疫苗的担忧、获得医疗保健的困难、对疾病风险的认知、对疾病严重程度的了解、文化信仰以及领袖的影响。如果能够理解受个人、社会文化和背景因素影响的疫苗接种决策过程，里贝拉谷地的疫情或许可以避免。
