{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T04:12:34Z","timestamp":1749096754482,"version":"3.41.0"},"reference-count":60,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>In 2016\u20132019, 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.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0519","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T14:06:11Z","timestamp":1743516371000},"page":"1302-1312","source":"Crossref","is-referenced-by-count":0,"title":["Perspective of Quilombola Communities in Brazil on a Yellow Fever Outbreak and Vaccination"],"prefix":"10.4269","volume":"112","author":[{"given":"Aline Carralas Queiroz","family":"Le\u00e3o","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sueli F.","family":"Raymundo","sequence":"additional","affiliation":[{"name":"Infection Control Department, Hospital das Cl\u00ednicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Fialkovitz","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciana Vilas Boas","family":"Casadio","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamar","family":"Roemer","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katia Regina","family":"Pisciotta","sequence":"additional","affiliation":[{"name":"Foundation for the Conservation and Forestry Production of the State of Sao Paulo\u2013Funda\u00e7\u00e3o Florestal, Sao Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna S.","family":"Levin","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;"},{"name":"Infection Control Department, Hospital das Cl\u00ednicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;"},{"name":"Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil"},{"name":"Department of Infectious Diseases, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;"},{"name":"Infection Control Department, Hospital das Cl\u00ednicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Clin Lab Med","first-page":"237","article-title":"Yellow fever: A reemerging threat","volume":"30","author":"Gardner","year":"2010"},{"key":"b2","series-title":"J Clin Virol Pul Virol","first-page":"160","article-title":"Yellow fever","volume":"64","author":"Monath","year":"2015"},{"key":"b3","series-title":"Rev Infect Dis","first-page":"165","article-title":"Yellow fever: A medically neglected disease. 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