Peer-reviewed article

Prevalence and factors associated with non-vaccination: a vaccination coverage survey among children born in Ceará, Brazil, 2017-2018

Adjoane Maurício Silva Maciel, Carla Magda Allan Santos Domingues, Anderson Fuentes Ferreira, Ana Paula França, Nádia Maria Girão Saraiva de Almeida et al. · 1 Jan 2026

Abstract

BACKGROUND: The current prevalence and factors associated with non-vaccination in children born between 2017 and 2018, considering vaccination status up to 24 months of age in the State of Ceará, should be assessed to justify the need to identify the population eligible for timely vaccination with valid doses to ensure optimal protection against vaccine-preventable diseases. This study aimed to estimate the prevalence and analyze the sociodemographic factors associated with non-vaccination among children born between 2017 and 2018 residing in Fortaleza and Sobral, Ceará State, Northeast Brazil. METHODS: A population-based household survey of the 2017-2018 birth cohort was conducted using cluster sampling in Fortaleza and Sobral. The prevalence of non-vaccination, including no-dose and incomplete-dose categories, was estimated using prevalence ratios from Poisson regression with robust variance and survey design adjustment. RESULTS: Of the children, 54.55% were not fully vaccinated, and 9.91% did not receive a single valid dose of any vaccine (Fortaleza: 10.46%; Sobral: 2.71%). Missing doses were mainly for meningitis (29.14%), rotavirus diarrhea (25.46%), and pneumonia and meningitis (24.44%). Non-vaccination was associated with maternal ethnicity, specifically White (Caucasian) (aPR, 2.07; 95% CI, 1.08-3.94; p = 0.028), and with the use of private vaccination services (aPR, 1.72; 95% CI, 1.46-2.04; p < 0.001). CONCLUSIONS: Non-vaccination was highly prevalent among children born between 2017 and 2018 in Ceará. The findings highlight the need to strengthen and reorient vaccination efforts across sectors and to implement catch-up strategies for children who missed valid doses.