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Perspective of Quilombola Communities in Brazil on a Yellow Fever Outbreak and Vaccination
Aline Carralas Queiroz Leão
aleao@usp.br
Aline Carralas Queiroz Leão
Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;
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Sueli F. Raymundo
Sueli F. Raymundo
Infection Control Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;
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Gabriel Fialkovitz
Gabriel Fialkovitz
Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;
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Luciana Vilas Boas Casadio
Luciana Vilas Boas Casadio
Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;
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Tamar Roemer
Tamar Roemer
Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;
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Katia Regina Pisciotta
Katia Regina Pisciotta
Foundation for the Conservation and Forestry Production of the State of Sao Paulo–Fundação Florestal, Sao Paulo, Brazil;
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Anna S. Levin
on behalf of FASVALER Study Group
Anna S. Levin
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;
Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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;
Foundation for the Conservation and Forestry Production of the State of Sao Paulo–Fundação Florestal, Sao Paulo, Brazil;
Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Infection Control Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;
Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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;
Foundation for the Conservation and Forestry Production of the State of Sao Paulo–Fundação Florestal, Sao Paulo, Brazil;
Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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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.
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Author Notes
Financial support: This research was supported by Fundação Faculdade de Medicina, Universidade de Sao Paulo.
Disclosures: The authors declare they have no conflicts of interest. The study protocol was approved by the Ethics Committee for Analysis of Research Projects of the Clinical Board of HC (CAAE: 12124519.5.0000.0068). All procedures followed the Helsinki Declaration, the Brazilian ethical standards of scientific research involving human subjects and the good clinical practices.
Current contact information: Aline Carralas Queiroz Leão, Gabriel Fialkovitz, Luciana Vilas Boas Casadio, Tamar Roemer, and Anna S. Levin, Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil, E-mails: aleao@usp.br/alinecarralas@gmail.com, g.fialkovitz@gmail.com, luciana.vilasboas@gmail.com, tamar.roemer@gmail.com, and gcih.adm@hc.fm.usp.br. Sueli F. Raymundo, Infection Control Department, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil, E-mail: gcih.adm@hc.fm.usp.br. Katia Regina Pisciotta, Foundation for the Conservation and Forestry Production of the State of Sao Paulo–Fundação Florestal, Sao Paulo, Brazil, E-mail: katiapisciotta@gmail.com.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 85 | 85 | 85 |
| Full Text Views | 4 | 4 | 4 |
| PDF Downloads | 6 | 6 | 6 |