Measles resurgence in Brazil: analysis of the 2019 epidemic in the state of São Paulo

Makarenko, Cristina; San Pedro, Alexandre; Paiva, Natalia Santana; Santos, Jefferson Pereira Caldas dos; Medronho, Roberto de Andrade; Gibson, Gerusa

doi:10.11606/s1518-8787.2022056003805

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Sumário

Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056003805 copy

Measles resurgence in Brazil: analysis of the 2019 epidemic in the state of São Paulo

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the epidemiological profile of cases and the pattern of spatial diffusion of the largest measles epidemic in Brazil that occurred in the post-elimination period in the state of São Paulo.

METHOD

A cross-sectional study based on confirmed measles cases in 2019. Bivariate analysis was performed for socioeconomic, clinical, and epidemiological variables, according to prior vaccination and hospitalization, combined with an analysis of spatial diffusion of cases using the Inverse Distance Weighting (IDW) method.

RESULTS

Of the 15,598 confirmed cases, 2,039 were hospitalized and 17 progressed to death. The epidemic peak occurred in epidemiological week 33, after confirmation of the first case, in the epidemiological week 6. Most cases were male (52.1%), aged between 18 and 29 years (38.7%), identified as whites (70%). Young adults (39.7%) and children under five years (32.8%) were the most affected age groups. A higher proportion of previous vaccination was observed in whites as compared to Blacks, browns, yellows and indigenous people (p < 0.001), as well as in the most educated group compared to the other categories (p < 0.001). The risk of hospitalization was higher in children than in the older age group (RI = 2.19; 95%CI: 1.66–2.88), as well as in the unvaccinated than in the vaccinated (RI = 1.59; 95%CI: 1.45–1.75). The pattern of diffusion by contiguity combined with diffusion by relocation followed the urban hierarchy of the main cities’ regions of influence.

CONCLUSION

In addition to routine vaccination in children, the findings indicate the need for immunization campaigns for young adults. In addition, studies that seek to investigate the occurrence of clusters of vulnerable populations, prone to lower vaccination coverage, are essential to broaden the understanding of the dynamics of transmission and, thus, reorienting control strategies that ensure disease elimination.

Measles, epidemiology; Disease Transmission, Infectious; Epidemics; Communicable Disease Control; Vaccination Coverage

Notification month	Total cases	Imported cases^a (%)	Vaccinated(%)	Hospitalized (%)	Deaths	Affected municipalities(%)
Jan	0	0	0	0	0	0
Feb	5	0	4 (80.0)	0	0	3 (0.5)
Mar	11	0	4 (36.4)	2 (18.2)	0	2 (0.3)
Apr	24	1 (4.2)	12 (50.0)	2 (8.3)	0	7 (1.1)
May	57	2 (5.3)	24 (42.1)	10 (17.5)	0	11 (1.7)
Jun	460	0	198 (43.0)	59 (12.8)	0	34 (5.3)
Jul	2,957	4 (0.1)	1,199 (40.5)	373 (12.6)	2	101 (15.7)
Aug	5,539	11 (0.2)	2,237 (40.4)	759 (13.7)	5	175 (27.1)
Sept	3,765	8 (0.2)	1,502 (39.9)	467 (12.4)	8	178 (27.6)
Oct	1,429	3 (0.2)	571 (40.0)	189 (13.2)	1	139 (21.6)
Nov	843	3 (0.4)	338 (40.1)	111 (13.2)	0	96 (14.9)
Dec	508	1 (0.2)	213 (41.9)	67 (13.2)	1	74 (11.5)

Variables	Frequency^a		Prior vaccination		p
Variables	n	%	Yes^b	No^b
Gender					< 0.001
Male	8,123	52.1	3,074 (37.8)	3,380 (41.6)
Female	7,471	47.9	3,228 (43.2)	2,728 (36.5)
Age group					< 0.001
< 1 year	2,841	18.2	1,112 (39.1)	1,050 (36.9)
1–4 years	2,283	14.6	964 (42.2)	879 (38.5)
5–11 years	499	3.2	222 (44.4)	192 (38.4)
12–17 years	677	4.3	300 (44.3)	226 (33.3)
30–49 years	2,678	17.2	994 (37.1)	1,048 (39.1)
18–29 years	6,190	39.7	2,556 (41.2)	2,579 (41.6)
50 years or older	430	2.8	154 (35.8)	205 (47.6)
Schooling^c					< 0.001
< 4 years	198	5.6	87 (43.9)	85 (42.9)
4–9 years	852	24.1	281 (32.9)	438 (51.4)
10–12 years	1,987	56.1	695 (34.9)	947 (47.6)
13 years or more	504	14.2	224 (44.4)	188 (37.3)
Race/skin color					< 0.001
White	9,246	70.7	4,046 (43.7)	3,566 (38.5)
Black	427	3.3	156 (36.5)	198 (46.7)
Brown	3,241	24.8	1,195 (36.8)	1,505 (46.4)
Yellow	130	1.0	53 (40.7)	53 (40.7)
Indigenous	37	0.3	14 (37.8)	18 (48.6)
Source of transmission^d					0.02
Imported	33	0.3	20 (60.6)	10 (30.3)
Autochthonous – ESP	12,832	99.7	5,308 (41.3)	5,076 (39.5)
Evolution					0.04
Cure	13,019	99.9	5,387 (41.3)	5,225 (40.1)
Death	17	0.1	3 (17.6)	10 (58.8)

Variables	Total cases^a	Hospitalization		IR	95%CI
Variables	Total cases^a	n	incidence^a	IR	95%CI
Gender
Male	8,123	1,086	13.4	1
Female	7,471	952	12.7	0.95	(0.87–1.03)
Age group
50 or older	430	47	10.9	1
30–49	2,678	279	10.4	1.03	(0.77–1.38)
18–29	6,190	601	9.7	0.90	(0.68–1.19)
12–17	677	68	10.0	0.92	(0.65–1.30)
5–11	499	50	10.0	0.93	(0.64–1.36)
1–4	2,283	304	13.3	1.22	(0.92–1.63)
< 1	2,841	690	24.3	2.19	(1.66–2.88)
Schooling^b
< 4 years	198	10	5.1	1
4–9 years	852	44	5.2	1.07	(0.55–2.08)
10–12 years	1,987	118	5.9	1.20	(0.64–2.24)
13 years or more	504	45	8.9	1.14	(0.58–2.25)
Registered race/color
White	9,246	1,168	12.6	1
Black	427	44	10.3	0.82	(0.62–1.09)
Brown	3,241	389	12.0	0.96	(0.87–1.07)
Yellow	130	17	13.1	1.01	(0.64–1.56)
Indigenous	37	8	21.6	1.84	(1.01–3.34)
Prior vaccination
Yes	6,302	642	10.2	1
No	6,179	1,004	16.2	1.59	(1.45–1.75)

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E-mail: revsp@usp.br

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[1] Correspondence: Gerusa Gibson Avenida Horácio Macedo, s/n Ilha do Fundão - Cidade Universitária 21941-598 Rio de Janeiro, RJ, Brasil E-mail: gibson.gerusa@iesc.ufrj.br