Peer-reviewed article
[Temporal and spatial heterogeneities of childhood vaccination coverage in Brazilian state capitals: a methodological proposal using an applied and expected dose ratio].
Mateus Henrique Silva Alves, Orozimbo Henriques Campos Neto, Karina Cardoso Meira, Isabel Silva Mitraud Ruas, Taynãna César Simões ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed vaccination coverage patterns across Brazilian state capitals from 2010 to 2021 using a new indicator based on the ratio of doses given to doses expected. The researchers found a significant decline in childhood vaccination coverage for all vaccines starting in 2015, with most vaccines falling below Brazilian Ministry of Health targets. The decline was more severe in Northern and Northeastern regions, particularly during the COVID-19 pandemic. The study identifies priority regions where immunization campaigns need to be intensified to restore vaccination rates to previous levels.
Key points
- Significant drop in vaccination coverage for all immunobiologicals from 2015 onward
- Most vaccines remained below minimum targets of the Brazilian Ministry of Health
- Greater reductions in Northern and Northeastern state capitals in recent years, particularly during COVID-19
- A new dose ratio indicator was proposed to facilitate statistical monitoring of vaccination coverage
- Priority regions identified for targeted National Immunization Program interventions
Limitations
This is an ecological study at the level of state capitals and does not provide individual-level data or explain the causes of the vaccination coverage decline. The study cannot determine whether observed patterns reflect actual immunization gaps, reporting delays, or data quality issues in the information system.
Abstract
This study aimed to analyze vaccination coverage temporal and spatial heterogeneities in the basic children schedule in the Brazilian Unified National Health System (SUS) in state capitals and macroregions from 2010 to 2021 by a new monitoring indicator. This is an ecological study at the level of Brazilian capitals and year of registration of doses. An indicator based on the ratio between applied doses and the minimum expected number of doses (i.e., the recommended vaccination coverage in the complete basic vaccination schedule for children: BCG, hepatitis A and B, meningococcal conjugate C and its booster, pentavalent, pneumococcal 10-valent and its booster, poliomyelitis and its booster, human rotavirus, triple bacterial, and the first and second triple viral doses) was proposed. Dose ratios were temporally and spatially analyzed by generalized additive and conditional autoregressive models. This study found a significant drop in vaccination coverage for all immunobiologicals from 2015 onward. The coverage of most vaccines remained below the minimum targets of the Brazilian Ministry of Health. This study also observed differences in reduction magnitude (greater in Northern and Northeastern capitals in recent years, particularly during the COVID-19 pandemic). The proposed indicator facilitated statistical treatment, using only an information system and the recommended goals and making it possible to assess significant vaccination drops over time, with differences between capitals and macroregions. This study found priority regions for Brazilian National Immunization Program actions, such as intensifying and diversifying immunization campaigns to achieve the past high vaccination coverage.