Vaccine coverage within the first year of life and associated factors with incomplete immunization in a Brazilian birth cohort

Child COVID-19 vaccine uptake among participants of the 2015 Pelotas (Brazil) Birth Cohort Study

OBJECTIVE

To analyze COVID-19 vaccine uptake in children and to investigate factors associated with two outcomes variables: (a) not even beginning; (b) not completing the COVID-19 vaccine series.

METHODS

We used data of children aged 6-7 years from the 2015 Pelotas c Birth Cohort Study. COVID-19 vaccination status was collected from immunization cards and National Immunization Program Information System. Adjusted analyses were performed using a hierarchical model to identify factors associated with the two study outcomes.

RESULTS

Among 3867 children, 20.7 % (95 % CI, 19.5 %-22.0 %) did not even begin the 2-dose primary COVID-19 vaccine series, and 28.2 % (95 % CI, 26.6 %-29.8 %) did not complete the series with the second dose. Children not even beginning the COVID-19 vaccine series were more likely to have a White mother, not to have obesity, to have a history of COVID-19 infection, to have received non-recommended drugs for COVID-19, to be afraid of needles, and to have an incomplete diphtheria-tetanus-pertussis (DTP) and poliovirus immunization schedule. Not completing the 2-dose series was associated with lower maternal age and education, mother's self-identification as White or Brown, lower household income, lack of access to health services, not having completed the DTP and poliovirus immunization schedule and living with a person with a history of infection with COVID-19.

CONCLUSION

The results highlight a vaccine-hesitant parents' group who chose not beginning the COVID-19 vaccine series of their children and, another group of parents who failure to complete the child's series due to difficulty accessing health services.

Mapping geographical inequalities of incomplete immunization in Ethiopia: a spatial with multilevel analysis

Background

Immunization is one of the most cost-effective interventions, averting 3.5-5 million deaths every year worldwide. However, incomplete immunization remains a major public health concern, particularly in Ethiopia. The objective of this study is to investigate the geographical inequalities and determinants of incomplete immunization in Ethiopia.

Methods

A secondary analysis of the mini-Ethiopian Demographic Health Survey (EDHS 2019) was performed, utilizing a weighted sample of 3,865 children aged 12-23 months. A spatial auto-correlation (Global Moran's I) statistic was computed using ArcGIS version 10.7.1 to assess the geographical distribution of incomplete immunization. Hot-spot (areas with a high proportion of incomplete immunization), and cold spot areas were identified through Getis-Ord Gi* hot spot analysis. Additionally, a Bernoulli probability-based spatial scan statistics was conducted in SaTScan version 9.6 software to determine purely statistically significant clusters of incomplete immunization. Finally, a multilevel fixed-effects logistic regression model was employed to identify factors determining the status of incomplete immunization.

Results

Overall, in Ethiopia, more than half (54%, 95% CI: 48-58%) of children aged 12-23 months were not fully immunized. The spatial analysis revealed that the distribution of incomplete immunization was highly clustered in certain areas of Ethiopia (Z-score value = 8.379419, p-value < 0.001). Hotspot areas of incomplete immunization were observed in the Afar, Somali, and southwestern parts of Ethiopia. The SaTScan spatial analysis detected a total of 55 statistically significant clusters of incomplete immunization, with the primary SaTScan cluster found in the Afar region (zones 1, 3, and 4), and the most likely secondary clusters detected in Jarar, Doola, Korahe, Shabelle, Nogob, and Afdar administrative zones of the Somali region of Ethiopia. Indeed, in the multilevel mixed-effect logistic regression analysis, the respondent's age (AOR: 0.92; 95% CI: 0.86-0.98), residence (AOR: 3.11, 95% CI: 1.36-7.14), living in a pastoralist region (AOR: 3.41; 95% CI: 1.29-9.00), educational status (AOR: 0.26; 95% CI: 0.08-0.88), place of delivery (AOR: 2.44; 95% CI: 1.15-5.16), and having PNC utilization status (AOR: 2.70; 95% CI: 1.4-5.29) were identified as significant predictors of incomplete immunization.

Conclusion and recommendation

In Ethiopia, incomplete immunization is not randomly distributed. Various factors at both individual and community levels significantly influence childhood immunization status in the country. It is crucial to reduce disparities in socio-demographic status through enhanced collaboration across multiple sectors and by bolstering the utilization of maternal health care services. This requires concerted efforts from stakeholders.

[Brazilian Ministry of Health strategy to increase vaccination coverage at bordersEstrategia del Ministerio de Salud de Brasil para aumentar las tasas de cobertura de vacunación en las fronteras]

Objective

Evaluate the implementation of the Ministry of Health's "Action Plan: Border Vaccination Strategy - Agenda 2022" in the Brazil's 33 twin cities and evaluate the increase in the country's vaccination coverage (VC).

Methodology

Pre-post community clinical trial. Implementation of the strategy was analyzed, and pre- and post-intervention VC were compared in two stages: P1 (pre-intervention) and P2 (post-intervention). Based on statistical analyses of P1 and P2 coverage, calculations were made of municipal averages, standard deviation, and difference in VC between the two periods.

Results

Integration was observed between the primary health care (PHC), surveillance, immunization, and special indigenous health district (DSEI) teams, although there were difficulties, for example, in relation to migratory flows. While immigration flows present challenges in the areas of immunization, PHC, and DSEI, the difficulties are compounded by the polarization of these services, which hinders intersectoral integration. After carrying out the workshops, a total of 50 977 doses were administered in the general population in the 33 twin cities. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, which may be relevant in terms of increasing VC in Brazil.

Conclusion

There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, helping to increase VC in Brazil.

The effects of a large-scale home visiting programme for child development on use of health services in Brazil

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.

Health Literacy in Pediatric Consultations on Allergy Prevention

BACKGROUND

The first 3 years of life offer an opportunity to prevent allergic diseases. Pediatricians are an important source of health information for parents. However, a certain degree of health literacy is necessary to understand, appraise, and apply preventive behavior, which can be supported by health literacy (HL) sensitive consultations and a HL friendly environment.

OBJECTIVE

In this study, we want to shed light on how pediatricians in outpatient care in Germany advise on early childhood allergy prevention (ECAP) and how they consider parental HL.

METHODS

We conducted 19 semi-standardized telephone interviews with pediatricians from North-Rhine-Westphalia and Bavaria. The interviews were audio-recorded, transcribed, pseudonymized, and subjected to content analysis.

KEY RESULTS

Current ECAP recommendations were well known among our sample. Despite the shift of evidence from avoidance of allergens toward early exposure, providing advice on ECAP was considered non-controversial and it was widely assumed that recommendations were easy to understand and apply for parents. However, ECAP was treated as an implicit topic resonating among others like infant nutrition and hygiene. Regarding HL, our interview partners were not aware of HL as a concept. However, they deemed it necessary to somehow assess parental information level and ability to understand provided information. Formal HL screening was not applied, but implicit strategies based on intuition and experience. Concerning effective HL-sensitive communication techniques, interviewees named the adaptation of language and visual support of explanations. More advanced techniques like Teach Back were considered too time-consuming. Medical assistants were considered important in providing an HL-sensitive environment. Time constraints and the high amount of information were considered major barriers regarding HL-sensitive ECAP counseling.

CONCLUSION

It seems warranted to enhance professional education and training for pediatricians in HL and HL-sensitive communication, to reach all parents with HL-sensitive ECAP counseling. [HLRP: Health Literacy Research and Practice. 2024;8(2):e47-e61.].

Studies on the Child Handbook in Brazil: a scoping review

OBJECTIVE

To systematically identify and map studies involving the Caderneta da Criança (Child Handbook - CH) in Brazil.

METHODS

A scoping review using the methodology proposed by the Joanna Briggs Institute. The databases PubMed, Biblioteca Virtual em Saúde (BVS), Biblioteca Digital Brasileira de Teses e Dissertações, Periódicos Capes and Google Scholar were consulted. Primary and secondary studies that mentioned the use of CH were included, without restrictions regarding design, year of publication or population, published in Portuguese, English or Spanish and gray literature (theses and dissertations).

RESULTS

A total of 129 studies were included, mostly descriptive, published as scientific papers. The Northeast region, the population of caregivers of children and the Primary Care scenario were observed in most studies; 47% of the studies used the CH as a source of data, the majority on vaccination. Despite the different criteria to define adequacy of completing the CH, the studies identified weaknesses in filling out all of its items, except for immunization. The utilization and/or completion of the CH were linked to various factors, including the availability of the CH, characteristics of the children (such as sex, age, prematurity and well-child appointments), attributes of the family members and caregivers (such as age, education, income, parity, work status, prenatal care, reading, note-taking and bringing CH to appointments) and features of the professionals (such as workplace, medical specialty, communication style, knowledge about the CH, requesting, guiding and note-taking).

CONCLUSIONS

The results reinforce the need to better understand which factors affect the distribution of the CH in the population, as well as pointing to the need for understanding its use and completion by the different care points. The need for intervention studies to improve the implementation of this tool and to include training on the use of the CH in the context of continuing health education becomes evident.

Temporal and spatial distribution trends of polio vaccine coverage in less than one-year old children in Brazil, 2011-2021

BACKGROUND

Low polio vaccine coverage can result in the spread of Poliovirus to areas free from viral circulation. This study analyzed the temporal trends and spatial distribution of polio vaccine coverage in one year-old children in Brazil, between 2011 and 2021.

METHODS

This was an ecological, time-series study (2011 to 2021) with annual vaccine coverages against poliomyelitis, extracted from the Information System of the National Immunization Program from the 26 States and the Distrito Federal (DF). The percentage reductions in vaccination coverage in Brazil and in the Regions were calculated. Prais-Winsten regression models were used to analyze time series for the Regions and States, and spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of vaccination coverages across Brazilian municipalities, using a 5% significance level.

RESULTS

From 2011 to 2021, the coverage of polio vaccines decreased by 29,9%. There was a progressive increase observed in clusters resulting in low vaccination coverages (140 low-low Brazilian municipalities in 2011 vs. 403 in 2021), mostly reported in the North and Northeast regions of the country. There was a downward trend in vaccination coverages in 24 of the 26 States and DF (p ≤ 0.05).

CONCLUSIONS

The reduction in polio vaccine coverage, as observed in the North and Northeast regions of Brazil, may favor the spread of Poliovirus. Therefore, vaccination strategies should be prioritized for children residing in areas with sharp and recurrent declines in vaccination coverages, including travelers, migrants, and refugees.

Complete childhood vaccination and associated factors among children aged 12-23 months in Dabat demographic and health survey site, Ethiopia, 2022

INTRODUCTION

Childhood immunization is one of the most cost-effective public health strategies to prevent children's mortality and morbidity from infectious diseases, but the Covid-19 pandemic and associated disruptions have strained health systems, and worldwide 25 million children missing out on vaccination in 2021. Of the 25 million, more than 60% of these children live in 10 countries including Ethiopia. Therefore, this study aimed to assess complete childhood vaccination coverage and associated factors in the Dabat district.

METHOD

A community-based cross-sectional study was conducted from December 10/2020 to January 10/2021Gregorian Calendar. The data for this study was extracted from information collected for the assessment of maternal, Neonatal, and Child Health and health services utilization in the Dabat demographic and health survey site. Vaccine-related data were collected using an interviewer-administered questionnaire. An adjusted odds ratio with a 95% confidence interval was used to identify the presence and the direction of the association.

RESULTS

Based on vaccination cards and mothers/caretakers' recall 30.9% (95%CI: 27.9-34.1%) of children aged 12-23 months in the Dabat district were completely immunized. Urban residency [AOR 1.813, 95% CI: (1.143, 2.878)], delivered in the health facility [AOR = 5.925, 95% CI: (3.680, 9.540)], ANC follow-up during their pregnancy [AOR 2.023, 95% CI: (1.352, 3.027)], rich wealth index [AOR = 2.392, 95% CI: (1.296, 4.415)], and parity [AOR 2.737, 95% CI: (1.664, 4.500)] were significantly associated with complete child vaccination.

RECOMMENDATION AND CONCLUSION

Complete vaccination coverage among children aged 12-23 months in the Dabat district was lower than the Global vaccine plan and Ethiopian ministry of health goal in 2020. Therefore, Health care providers and other stakeholders should mobilize the community to improve mothers' health-seeking behavior toward pregnancy follow-up and health facility delivery to improve childhood vaccination. Besides, expanding the service to remote areas are necessary to increase the immunization access.

Low Vaccine Coverage and Factors Associated with Incomplete Childhood Immunization in Racial/Ethnic Minorities and Rural Groups, Central Brazil

Discrimination and limited access to healthcare services in remote areas can affect vaccination coverage. Therefore, this study aimed to estimate vaccination coverage for children living in quilombola communities and rural settlements in the central region of Brazil during their first year of life and to analyze the factors associated with incomplete vaccination. An analytical cross-sectional study was conducted on children born between 2015 and 2017. The percentage of children who received all vaccines recommended by the National Immunization Program in Brazil by 11 months and 29 days was used to calculate immunization coverage. Children who received the following vaccines were considered as having a complete basic vaccination schedule: one dose of BCG; three doses of Hepatitis B, of Diphtheria-Tetanus-Pertussis (DPT), of Haemophilus influenzae type b (Hib), and of Poliovirus (Polio); two doses of Rotavirus, of 10-valent pneumococcal (PCV10), and of Serogroup C meningococcal conjugate (MenC); and one dose of Yellow Fever (YF). Measles-mumps-rubella (MMR) and other doses recommended at or after 12 months were not included. Consolidated logistic regression was used to identify factors associated with incomplete vaccination coverage. Overall vaccination coverage was 52.8% (95% CI: 45.5-59.9%) and ranged from 70.4% for the Yellow Fever vaccine to 78.3% for the Rotavirus vaccine, with no significant differences between the quilombola and settler groups. Notably, the likelihood of incomplete general vaccination coverage was higher among children who did not receive a visit from a healthcare professional. Urgent strategies are required to achieve and ensure health equity for this unique and traditionally distinct group with low vaccination coverage.

[Transmission risk classification for vaccine-preventable diseases in Minas Gerais, Brazil: two years since the onset of the COVID-19 pandemic]

The scope of this study is to analyze the risk classification of transmission of vaccine-preventable diseases (VPDs) in the 853 municipalities in the state of Minas Gerais (MG) two years after the onset of the COVID-19 pandemic. It is an epidemiological study with secondary data on vaccination coverage and dropout rate of ten immuno-biologicals recommended for under 2-year-old children in 2021 in MG. With respect to the dropout rate, this indicator was only evaluated for the multidose vaccines. After calculating all the indicators, the municipalities of the state were classified according to the transmission risk of VPDs into five categories: very low, low, medium, high, and very high risk. Minas Gerais had 80.9% of municipalities classified as high transmission risk for VPDs. Regarding the homogeneity of vaccination coverage (HCV), large municipalities had the highest percentage of HCV classified as very low, and 100% of these municipalities were classified as high or very high risk for transmission of VPDs, with statistical significance. The use of immunization indicators by municipality is effective for the classification of the scenario of each territory and the proposal of public policies seeking to increase vaccination coverage.

Factors associated with incomplete vaccination and negative antibody test results for measles, mumps, and hepatitis A among children followed in the MINA-BRAZIL cohort

Vaccination coverage has been dropping in Brazil and other countries. In addition, immune responses after vaccination may not be homogeneous, varying according to sociodemographic and clinical factors. Understanding the determinants of incomplete vaccination and negative antibody test results may contribute to the development of strategies to improve vaccination effectiveness. In this study, we aimed to investigate the frequency of vaccine adherence, factors associated with incomplete vaccination for measles, mumps, rubella (MMR) and hepatitis A, and factors associated with the seronegative test results for measles, mumps and hepatitis A at 2 years of age. This was a population-based cohort that addressed health conditions and mother/infant nutrition in Cruzeiro do Sul city, Brazil. Vaccination data were obtained from official certificates of immunization. The children underwent blood collection at the two-year-old follow-up visit; the samples were analyzed using commercially available kits to measure seropositivity for measles, mumps, and hepatitis A. We used modified Poisson regression models adjusted for covariates to identify factors associated with incomplete vaccination and negative serology after vaccination. Out of the 825 children included in the study, adherence to the vaccine was 90.6% for MMR, 76.7% for the MMRV (MMR + varicella), and 74.9% for the hepatitis A vaccine. For MMR, after the adjustment for covariates, factors associated with incomplete vaccination included: white-skinned mother; paid maternity leave; raising more than one child; lower number of antenatal consultations; and attending childcare. For hepatitis A, the factors included: white-skinned mother and not having a cohabiting partner. The factors with statistically significant association with a negative antibody test result included: receiving Bolsa Familia allowance for measles and mumps; incomplete vaccination for measles; and vitamin A deficiency for mumps. Strategies to improve the efficiency of vaccine programs are urgently needed. These include improvements in communication about vaccine safety and efficacy, and amplification of access to primary care facilities, prioritizing children exposed to the sociodemographic factors identified in this study. Additionally, sociodemographic factors and vitamin A deficiency may impact the immune responses to vaccines, leading to an increased risk of potentially severe and preventable diseases.

The COVID-19 pandemic and vaccination abandonment in children: spatial heterogeneity maps

OBJECTIVE

to identify spatial clusters corresponding to abandonment of routine vaccines in children.

METHOD

an ecological study, according to data from the 853 municipalities of a Brazilian state. The records analyzed were those of the multidose pentavalent, pneumococcal 10-valent, inactivated poliomyelitis and oral human rotavirus vaccines of 781,489 children aged less than one year old. The spatial scan statistics was used to identify spatial clusters and assess the relative risk based on the vaccination abandonment indicator.

RESULTS

the spatial scan statistics detected the presence of statistically significant clusters for abandonment regarding the four vaccines in all the years analyzed. However, the highest number of clusters with high relative risk estimates was identified in 2020. The Vale do Aço and West, North and West, and Southwest regions stand out for the pentavalent, poliomyelitis and rotavirus vaccines, respectively.

CONCLUSION

in an attempt to mitigate the devastating impact of the COVID-19 pandemic, the immunization program experienced setbacks. The presence of clusters points to the need to implement integrated strategies that may involve different sectors for an active search for children and prevent outbreaks of vaccine-preventable diseases in the near future.

[Vaccination coverage in children under one year of age in Minas Gerais state, Brazil]

The scope of this article is to analyze vaccination coverage rates in children under one year of age during the period from 2015 to 2020 in the state of Minas Gerais (MG). It involved an ecological, time-series study on vaccination coverage in children under 1 year of age, considering the 28 Regional Health Management/Superintendencies (GRS/SRS) of MG as the unit of analysis. The following immunobiological vaccine coverage was analyzed: Bacillus Calmette and Guérin, human rotavirus, pneumococcal 10, pentavalent, meningococcus C, yellow fever, and polio vaccines. The Prais-Winsten autoregressive model was employed for trend analysis. The year 2020 stands out, as it presented the lowest proportion of GRS and SRS that reached the recommended vaccine coverage goals for the immunobiologicals analyzed. Regarding the analysis of the coverage trend, 8 of the 28 GRS/SRS showed a decreasing trend for at least 5 of the 7 immunobiologicals evaluated. We observed a downward trend in the vaccination coverage of at least five immunobiologicals in eight of the GRS/SRS, with emphasis on the Pentavalent vaccine, which showed a downward trend in vaccination coverage in 60.71% of the GRS and SRS.

Impact of COVID-19 pandemic on vaccination against meningococcal C infection in Brazil

Objective

Analyzing the impact of COVID-19 pandemic on meningococcal C conjugate vaccination in Brazil.

Methods

Ecological study, based on interrupted time series, carried out with data collected through the Information System of the National Immunization Program (IS-NIP). Collected data refer to the number of meningococcal C conjugate vaccine doses administered from March 2019 to December 2020.

Results

In total, 14,832,054 meningococcal C conjugate vaccine doses were administered throughout the investigated period; 66.30% of them, from March 2019 to February 2020 and 33.70%, from March to December 2020. Statistically significant steps were observed, i.e., the COVID-19 pandemic had negative impact on the number of MenC vaccine doses administered in the North and South regions (26,98% and 41.47%, respectively) and in the eleven Brazilian States.

Conclusion

The current study has shown that the COVID-19 pandemic had negative impact on the number of MenC vaccine doses administered in the Northern and Southern Brazil, and in eleven Brazilian states. Among all challenges experienced during the COVID-19 pandemic, one finds reduced MenC vaccine coverage, which, consequently, may lead to increased meningococcal infection rates in Brazil.

Impact of the COVID-19 Pandemic on Human Papillomavirus Vaccination in Brazil

Objective: To analyze the number of applied HPV vaccine doses before (from April 2019 to March 2020) and after (from April 2020 to September 2020) social distancing measures in response to the COVID-19 pandemic in states and regions of Brazil. Methods: Ecological time-series study, using data from the Brazilian National Immunization Program (PNI). Using the Mann-Whitney test, we evaluated the difference between the median number of applied doses during the periods April 2019 to March 2020 and from April 2020 to September 2020. Spatial analysis identified clusters with a high or low percentage reduction in the median applied doses. Prais-Winsten regression models identified temporal trends in the applieddoses from both periods. Results: There was a significant reduction in the median HPV vaccine doses applied, formation of spatial clusters and, after a sharp drop in the number of applieddoses during the months following social distancing. There was a tendency to increase the applied vaccines doses. Conclusion: The COVID-19 pandemic resulted in reduction of the number of HPV vaccine doses applied as a possible effect of restrictive measures caused by the pandemic.

Cobertura vacinal infantil de hepatite A, tríplice viral e varicela: análise de tendência temporal em Minas Gerais, Brasil

RESUMO: Objetivo: Analisar a tendência temporal da cobertura vacinal de hepatite A, tríplice viral e varicela em um estado brasileiro no período de 2014 a 2020. Métodos: Estudo ecológico de séries temporais, que considerou dados dos 853 municípios de Minas Gerais que compõem as 14 regiões do estado, sendo estas as unidades territoriais de análise. Foram analisados registros de doses aplicadas das vacinas hepatite A, tríplice viral e varicela registrados no Sistema de Informação de Imunização do Brasil. As tendências foram estimadas pela regressão de Prais-Winsten e calculados os intervalos de confiança 95% das medidas de variação. Resultados: Identificaram-se baixas coberturas vacinais de hepatite A, tríplice viral e varicela. Coberturas acima de 95% foram observadas somente no ano de 2015 para a vacina contra hepatite A (98,8%) e, em 2016, para a varicela (98,4%). A vacina tríplice viral apresentou cobertura inferior a 95% em todos os anos analisados. Uma queda de 13,6 e 4,3% entre os anos de 2019 e 2020 foi identificada para as vacinas tríplice viral e hepatite A, respectivamente. Observou-se tendência decrescente na cobertura vacinal da hepatite A nas regiões Sul (p=0,041), Leste (p=0,030) e Norte (p=0,045); para a tríplice viral, nas regiões Jequitinhonha (p=0,002), Leste (p=0,004) e Norte (p=0,024). A cobertura crescente foi observada somente para a varicela em oito regiões do estado. Conclusões: Os dados apontam heterogeneidade no comportamento temporal das coberturas vacinais em Minas Gerais. A tendência decrescente em algumas regiões desperta preocupação pela possibilidade do recrudescimento de doenças, como o sarampo, até então controladas.

Childhood vaccination coverage of hepatitis A, measles, mumps and rubella, and varicella: temporal trend analysis in Minas Gerais, Brazil

ABSTRACT: Objective: To analyze the temporal trend of vaccination coverage for hepatitis A, measles, mumps and rubella, and varicella in a Brazilian state from 2014 to 2020. Methods: An ecological, time-series study that considered data from 853 municipalities in the state of Minas Gerais that compose the 14 regions of the state, these being the territorial units of analysis. Records of applied doses of hepatitis A, measles, mumps and rubella, and varicella vaccines registered in the Brazilian Immunization Information System were analyzed. Trends were estimated by Prais-Winsten regression and 95% confidence intervals of measures of variation were calculated. Results: Low vaccine coverage of hepatitis A, measles, mumps and rubella, and varicella was identified. Coverages above 95% were observed only in 2015 for the vaccine against hepatitis A (98.8%) and, in 2016, for varicella (98.4%). The measles, mumps and rubella vaccine showed coverage of less than 95% in all analyzed years. Decreases of 13.6 and 4.3% between the years 2019 and 2020 were identified for the measles, mumps and rubella, and hepatitis A vaccines, respectively. There was a decreasing trend in hepatitis A vaccination coverage in the South (p=0.041), East (p=0.030), and North (p=0.045) regions; and for the measles, mumps and rubella in Jequitinhonha Valley (p=0.002), East (p=0.004), and North (p=0.024) regions. Increasing coverage was observed only for varicella in eight regions of the state. Conclusions: The data point to heterogeneity in the temporal behavior of vaccination coverage in Minas Gerais. The downward trend in some regions causes concern about the possibility of resurgence of diseases, such as measles, which until then had been controlled.

Pandemia de COVID-19 y abandono de la vacunación en niños: mapas de heterogeneidad espacial

Resumen Objetivo: identificar grupos espaciales que abandonaron la vacunación de rutina de los niños. Método: estudio ecológico, basado en los datos de 853 municipios de un Estado brasileño. Se analizaron los registros de vacunas multidosis pentavalente, antineumocócica 10-valente y antipoliomielítica inactivada y vacuna oral contra el rotavirus humano de 781.489 niños menores de un año de edad. Se utilizó la estadística scan espacial para identificar agrupaciones espaciales y medir el riesgo relativo del indicador abandono de la vacunación. Resultados: la estadística scan espacial detectó la presencia de grupos estadísticamente significativos para el abandono de las cuatro vacunas en todos los años analizados. Sin embargo, el mayor número de grupos con estimaciones altas de riesgos relativos se identificó en 2020. Se destacan las macrorregiones del Vale do Aço y Oeste; Norte y Oeste; y Sudeste para las vacunas pentavalente, antipoliomielítica y contra el rotavirus, respectivamente. Conclusión: mientras se intentaba disminuir el impacto devastador de la pandemia de COVID-19, retrocedió el programa de inmunización. La presencia de grupos indica que es necesario implementar estrategias integradas que puedan involucrar a diferentes sectores para la búsqueda activa de niños y evitar brotes de enfermedades inmunoprevenibles en el futuro próximo.

Number of doses of Measles-Mumps-Rubella vaccine applied in Brazil before and during the COVID-19 pandemic

Background

Due to the social isolation measures adopted in an attempt to mitigate the risk of transmission of SARS-CoV-2, there has been a reduction in vaccination coverage of children and adolescents in several countries and regions of the world.

Objective

Analyze the number of doses of vaccine against Measles-Mumps-Rubella (MMR) applied before and after the beginning of mitigation measures due to COVID-19 pandemic in Brazil.

Methods

The data collected refer to the number of doses of the MMR vaccine applied monthly to the target population residing in Brazil: cahildren, aged 12 months (first dose) and children, aged 9 years (second dose), from April 2019 to December 2020. Differences in MMR vaccine doses from April 2019 to March 2020 (before the start of mitigation measures) and April 2020 to September 2020 (after the start of the mitigation measures) were evaluated. Spatial analysis identified clusters with a high percentage of reduction in the median of applied doses no Brazil.

Results

There was a reduction in the median of doses applied in the Regions North (− 33.03%), Northeast (− 43.49%) and South (− 39.01%) e nos Estados Acre (− 48.46%), Amazonas (− 28.96%), Roraima (− 61.91%), Paraíba (− 41.58%), Sergipe (− 47.52%), Rio de Janeiro (-59.31%) and Santa Catarina (− 49.32) (p < 0.05). High-high type spatial clusters (reduction between 34.00 and 90.00%) were formed in the five regions of Brazil (Moran’s I = 0.055; p = 0.01).

Conclusion

A reduction in the number of MMR vaccine doses was evidenced as a possible effect by the restrictive actions of COVID-19 in Brazil.

Effect of educational video on newborn care for the knowledge of pregnant and postpartum women and their families

OBJECTIVES

to evaluate the effect of educational video on newborn care to increase the knowledge of pregnant, postpartum, and family members.

METHODS

a quasi-experimental study, with pre-intervention and post-intervention evaluation with a single group. Fifty-eight pregnant, postpartum, and family members treated in basic health units and a hospital in Ceará, Brazil, participated. The study used the McNemar and binomial tests for the analysis.

RESULTS

after the intervention, there was an increase in the frequency of hits, from 70.82% to 92.97%. Most of the questions presented a significant increase of hits (p < 0.05) with an emphasis on sleeping position, drying of clothes, free demand for breastfeeding, and things to avoid (such as accessories in the sleeping place and talc in diaper change).

CONCLUSIONS

the educational video was effective to participants in acquiring knowledge on the care of newborns and can assist in health education activities carried out by nurses.

Computerized immunization record agreement in Araraquara, São Paulo, Brazil, 2018

OBJECTIVE

To describe agreement between the Juarez System immunization data and information in vaccination record booklets and vaccination coverage in children aged 12 to 24 months.

METHODS

This was a descriptive study to assess the vaccination status at 12 and 24 months of age of children born in 2015 and recorded on the Juarez System. The levels of agreement between the Juarez System data and the information in vaccination record booklets were verified.

RESULTS

429 children were included. It was found that agreement ranged between 84.1% and 99.1%. The vaccine survey found that coverage for each vaccine ranged from 86.01% to 100% and for the full schedule, from 77.1% (12 months) to 68.8% (24 months). The spatial distributions of vaccine coverage ranged from 28% to 100%.

CONCLUSION

There was excellent agreement between the data, with high vaccination coverage, but heterogeneity in their spatial distributions.

Post-partum Hospital Stay and Mothers' Choices on Breastfeeding and Vaccines: A Chance We Should Not Miss

Parents' education and knowledge regarding major topics of children's health, such as nutrition and vaccines, have a paramount role. However, breastfeeding rates in first year of life are lower than recommended, and vaccine hesitancy is progressively spreading. To reverse this harmful trend, healthcare professionals are challenged to promote correct health information. This study aimed to assess newly mothers' knowledge of breastfeeding and vaccinations, and education received on both topics during hospital stay. We performed a cross-sectional survey in the Postnatal Unit of our Center. Mothers of full-term babies with a birthweight >2,500 g were enrolled. Two different questionnaires, one about breastfeeding and one about vaccines, were proposed to the 140 enrolled mothers. Ninety-nine percent of mothers enrolled were aware of breastfeeding benefits, and 92% felt adequately supported by maternity staff. Less than 25% stated to have received sufficient information regarding breastfeeding. Only 20% of mothers received information about vaccines during hospital stay. Healthcare providers were identified as primary, secondary, and tertiary source of information on vaccines by 55, 15, and 30% of mothers, respectively. Healthcare professionals are crucial in informing and educating mothers on breastfeeding and vaccinations. Post-partum hospital stay could be the right time for this critical responsibility.

Vaccine uptake and associated factors in an irregular urban settlement in northeastern Brazil: a cross-sectional study

Background

Globally, childhood immunization saves the lives of 2–3 million children annually by protecting them against vaccine-preventable diseases. In 2017, 116.2 million children were vaccinated worldwide according to the World Health Organization. Nevertheless, figures suggest that 19.5 million children around the world fail to receive the benefits of complete immunization.

Methods

This cross-sectional study analyzed vaccine uptake and the factors associated with incomplete vaccination schedule in children of up to 36 months of age assisted by the family health strategy in an irregular settlement located in a state capital city in northeastern Brazil. This study was nested within a larger study entitled “Health, nutrition and healthcare services in an urban slum population in Recife, Pernambuco”, conducted in 2015. A census included 309 children, with vaccination data obtained, exclusively, from their vaccination cards records. An ad hoc database was constructed with variables of interest. Absolute and relative values were calculated for the socioeconomic, demographic, obstetric and biological data. To identify possible factors associated with incomplete vaccination schedule, crude and multivariable Poisson regression analyses were performed, and conducted in accordance with the forward selection method with robust variance and the adjusted prevalence ratio was calculated with the 95% CI. Variables with p-values < 0.20 in the unadjusted stage were included in the multivariable analysis. The statistical significance of each variable was evaluated using the Wald test, with p-values < 0.05.

Results

Just half of the children (52,1%) was classified as complete vaccination schedule. In the final model, the factors associated with incomplete vaccination schedule were age 12–36 months and the mother who did not complete high school.

Conclusion

The percentage of vaccine uptake found was far below the recommendation of the National Childhood Immunization Schedule and was associated with child’s age and mother’s education level. Based on these findings, the family healthcare teams may elaborate vaccination strategies aimed at reaching the coverage rates established by the national immunization program. Optimizing coverage will ultimately prevent the resurgence, at epidemic level, of infectious diseases that are already under control in this country.