RESUMO
This study examined the spatial distribution and social inequalities in COVID-19 vaccine coverage among children aged 5-11 in Brazil. First and second dose vaccine coverage was calculated for all Brazilian municipalities and analyzed by geographic region and deciles based on human development index (HDI-M) and expected years of schooling at 18 years of age. Multilevel models were used to determine the variance partition coefficient, and bivariate local Moran's I statistic was used to assess spatial association. Results showed significant differences in vaccine coverage rates among Brazilian municipalities, with lower coverage in the North and Midwest regions. Municipalities with lower HDI and expected years of schooling had consistently lower vaccine coverage rates. Bivariate clustering analysis identified extensive concentrations of municipalities in the Northern and Northeastern regions with low vaccine coverage and low human development, while some clusters of municipalities in the Southeast and South regions with low coverage were located in areas with high HDI-M. These findings highlight the persistent municipal-level inequalities in vaccine coverage among children in Brazil and the need for targeted interventions to improve vaccine access and coverage in underserved areas.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Fatores Socioeconômicos , Cobertura Vacinal , Humanos , Brasil , Criança , Vacinas contra COVID-19/administração & dosagem , Pré-Escolar , Cobertura Vacinal/estatística & dados numéricos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Análise por Conglomerados , Disparidades em Assistência à Saúde/estatística & dados numéricos , Análise EspacialRESUMO
Bacillus Calmette-Guerin (BCG) vaccination and tuberculosis (TB) incidence in children under 1 year of age are critical public health indicators in Brazil. The coronavirus disease 2019 pandemic disrupted vaccination coverage (VC), potentially impacting TB incidence. Understanding regional disparities in VC and TB incidence can inform targeted interventions. We conducted an observational and ecological study using BCG vaccination data (2019-21) and TB incidence (2020-22) for all births in Brazil. Data were collected from public health databases, stratified by state, and analyzed using descriptive and analytical statistics to explore VC and TB incidence. Between 2019 and 2021, average BCG VC was 79.59%, with significant variation among states (P < .001). Only four states achieved minimum recommended coverage (>90%). TB incidence varied significantly among states (P = .003). There was a notable decline in VC from 2019 (90.72%) to 2021 (78.67%) (P < .001). This study highlights regional disparities in BCG VC and TB incidence among Brazilian states. Lower VC post-pandemic may increase TB incidence, requiring targeted interventions in states with inadequate coverage. The findings underscore the importance of sustaining vaccination programs amidst public health crises and implementing strategies to enhance access and uptake.
Assuntos
Vacina BCG , COVID-19 , Tuberculose , Cobertura Vacinal , Humanos , Brasil/epidemiologia , Vacina BCG/administração & dosagem , Cobertura Vacinal/estatística & dados numéricos , Incidência , Lactente , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , COVID-19/prevenção & controle , COVID-19/epidemiologia , Feminino , Programas de Imunização , Masculino , Vacinação/estatística & dados numéricos , SARS-CoV-2 , Disparidades em Assistência à Saúde , Recém-NascidoRESUMO
The countries of the Americas, with support from PAHO, have made remarkable progress in providing children with an umbrella of protection against basic vaccine-preventable diseases. Sustained high national immunization coverage levels, the eradication of polio, the interruption of endemic measles virus transmission, and efforts towards rubella and congenital rubella syndrome elimination are hemispheric benchmarks of this progress. Since 2020, the Region has also been facing the COVID-19 pandemic and major efforts have been taken to ensure administration of COVID-19 vaccines across all countries. Countries are now vaccinating age groups outside those usually targeted in the traditional childhood immunization program. Introducing seasonal influenza vaccine in adult populations at risk, vaccinating adolescents and adults, men, and women for rubella elimination, and defining the disease burden of cervical cancer are activities that support the critical need for national immunization programs to transition from child to family immunization. In support to countries, one of PAHO's roles is to disseminate information that can highlight progress and challenges faced in the Region. To that end, PAHO regularly publishes several technical documents related to immunization. The annually published "Immunization in the Americas" brochure summarizes immunization coverage in the Region of the Americas, in addition to illustrating the work done by the Region’s immunization programs for that year. Immunization in the Americas: 2023 Summary includes tables with the Region's demographic, morbidity, program management, financing, and socioeconomic data, as well as reported immunization coverage and surveillance indicators, among other items.
Assuntos
Imunização , Vacinas , Doenças Preveníveis por Vacina , Cobertura Vacinal , AméricaRESUMO
OBJECTIVE: To assess the evolution of the COVID-19 pandemic in Brazil and its macro-regions, considering disease incidence and mortality rates, as well as identifying territories with still rising disease indices and evaluating vaccine coverage and population adherence to COVID-19 immunization. METHODS: An ecological study conducted in Brazil with COVID-19 cases and deaths reported between February 2020 and April 2024, obtained through the Coronavirus Panel. Historical series were constructed from incidence and mortality rates to assess the pandemic's evolution, and temporal trends were estimated using the Seasonal Trend Decomposition using Loess (STL) method. The Spatial Variation in Temporal Trends (SVTT) technique was employed to identify clusters with significant variations in temporal trends. Vaccination was analyzed considering the percentage of vaccinated and unvaccinated population in each municipality of the country. RESULTS: Brazil recorded a total of 38,795,966 cases and 712,038 deaths from COVID-19 during the study period. Incidence and mortality rates showed three waves of the disease, with a fourth wave of smaller amplitude. Four clusters with significant case growth and two with increased deaths were identified. Vaccine coverage varied among municipalities, with some regions showing low vaccination rates and others with high immunization adherence. CONCLUSION: The study provided a comprehensive overview of coronavirus behavior in Brazil, and its results highlight the ongoing importance of vaccination and the need to direct efforts and resources to areas of higher risk.
Assuntos
Vacinas contra COVID-19 , COVID-19 , SARS-CoV-2 , Cobertura Vacinal , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , COVID-19/mortalidade , Brasil/epidemiologia , Cobertura Vacinal/estatística & dados numéricos , Incidência , Vacinas contra COVID-19/administração & dosagem , Pandemias/prevenção & controle , Análise Espaço-Temporal , Vacinação/estatística & dados numéricosRESUMO
OBJECTIVES: No consensus exists about the best COVID-19 vaccination strategy to be adopted by low-income and middle-income countries. Brazil adopted an age-based calendar strategy to reduce mortality and the burden on the healthcare system. This study evaluates the impact of the vaccination campaign in Brazil on the progression of the reported COVID-19 deaths. METHODS: This ecological study analyses the dynamic of vaccination coverage and COVID-19 deaths in hospitalised adults (≥20 years) during the first year of the COVID-19 vaccination roll-out (January to December 2021) using nationwide data (DATASUS). We stratified the adult population into 20-49, 50-59, 60-69 and 70+ years. The dynamic effect of the vaccination campaign on mortality rates was estimated by applying a negative binomial regression. The prevented and possible preventable deaths (observed deaths higher than expected) and potential years of life lost (PYLL) for each age group were obtained in a counterfactual analysis. RESULTS: During the first year of COVID-19 vaccination, 266 153 517 doses were administered, achieving 91% first-dose coverage. A total of 380 594 deaths were reported, 154 091 (40%) in 70+ years and 136 804 (36%) from 50-59 or 20-49 years. The mortality rates of 70+ decreased by 52% (rate ratio [95% CI]: 0.48 [0.43-0.53]) in 6 months, whereas rates for 20-49 were still increasing due to low coverage (52%). The vaccination roll-out strategy prevented 59 618 deaths, 53 088 (89%) from those aged 70+ years. However, the strategy did not prevent 54 797 deaths, 85% from those under 60 years, being 26 344 (45%) only in 20-49, corresponding to 1 589 271 PYLL, being 1 080 104 PYLL (68%) from those aged 20-49 years. CONCLUSION: The adopted aged-based calendar vaccination strategy initially reduced mortality in the oldest but did not prevent the deaths of the youngest as effectively as compared with the older age group. Countries with a high burden, limited vaccine supply and young populations should consider other factors beyond the age to prioritise who should be vaccinated first.
Assuntos
Vacinas contra COVID-19 , COVID-19 , SARS-CoV-2 , Humanos , Brasil/epidemiologia , COVID-19/prevenção & controle , COVID-19/mortalidade , COVID-19/epidemiologia , Pessoa de Meia-Idade , Idoso , Vacinas contra COVID-19/administração & dosagem , Adulto , Masculino , Feminino , Adulto Jovem , Cobertura Vacinal/estatística & dados numéricos , Programas de Imunização , Vacinação/estatística & dados numéricosRESUMO
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.
Assuntos
Coorte de Nascimento , Vacinas contra COVID-19 , COVID-19 , Humanos , Criança , Feminino , COVID-19/prevenção & controle , COVID-19/epidemiologia , Vacinas contra COVID-19/administração & dosagem , Masculino , Brasil/epidemiologia , Vacinação/estatística & dados numéricos , SARS-CoV-2/imunologia , Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , Cobertura Vacinal/estatística & dados numéricos , Estudos de CoortesRESUMO
OBJECTIVE: To analyze vaccination coverage (VC) for polio in the municipalities of Vale do Paraíba in the State of São Paulo. METHODS: This is an ecological and exploratory study of VC in 35 municipalities using a spatial approach; VC data were obtained from the IT Department of the Unified Health System (DATASUS), for the years 2015 and 2019, and categorized into Low (VC<95%) and ideal (≥95%). Information was obtained on gross domestic product (GDP), professional rates and number of basic health units (UBS) and maternal data such as age, marital status (MS) and education. Univariate and bivariate Moran indices were estimated for the years 2015 and 2019, and thematic maps were created for CV values. RESULTS: The average VC values were 107.7%±27.2 in 2015, and 94.2%±27.8 in 2019 (p<0.05). In 2015 vs. 2019, there were 10 vs. 25 municipalities in the Low category. In 2015, the variables VC, number of UBS, age, education, and MS were spatially correlated, but in 2019 only maternal age and education were spatially correlated. The bivariate Moran was significant and negative for VC in 2019 with maternal education. There was an increase in municipalities with worsening VC values. CONCLUSIONS: The spatial approach identified a decrease in polio vaccination coverage in the studied region.
Assuntos
Poliomielite , Análise Espacial , Cobertura Vacinal , Humanos , Cobertura Vacinal/estatística & dados numéricos , Poliomielite/prevenção & controle , Poliomielite/epidemiologia , Brasil/epidemiologia , Vacinas contra Poliovirus/administração & dosagem , Feminino , Cidades , Lactente , Pré-EscolarRESUMO
INTRODUCTION: Argentina authorized COVID-19 vaccination for adolescents 12 years and older in August 2021, and then for children three years and older in October 2021. Children aged 6 months-2 years received a two-dose regimen beginning July 2022. OBJECTIVE: This study aims to analyze the impact of COVID-19 vaccination among children aged 0-17, considering vaccination status and mortality for the 2020-2022 period. METHODS: We conducted a population-level analysis examining all-cause mortality, COVID-19 cases, deaths, and vaccination records. We compared outcomes with child mortality for diseases for which vaccination is compulsory, before and after each vaccine rollout. RESULTS: A decrease in COVID-19-related deaths was observed in 2022 for pediatric age groups (3-11 and 12-17) with relatively higher vaccination coverage. However, no decrease was observed for the 0-2 year old age group, which had the longest delay in access to immunization and lowest vaccination coverage. When compared to unvaccinated populations in 2022, we observe an 8-15-fold reduction in cumulative death rates for pediatric populations vaccinated with 1 or more doses, and a 16-18-fold reduction for those vaccinated with 2 or more doses. Historical analysis shows that for diseases for which vaccination is now compulsory in many countries, pre-vaccine-rollout mortality was lower than COVID-19 deaths during 2020-2022. CONCLUSIONS AND RELEVANCE: SARS-CoV-2 immunization was associated with reduced COVID-19 deaths for children and adolescents in Argentina. Our findings suggest that greater efforts should be undertaken to ensure wider COVID-19 vaccine coverage in children and adolescents, especially infants.
Assuntos
Vacinas contra COVID-19 , COVID-19 , SARS-CoV-2 , Vacinação , Humanos , Argentina/epidemiologia , COVID-19/mortalidade , COVID-19/prevenção & controle , COVID-19/epidemiologia , Criança , Adolescente , Pré-Escolar , Lactente , Vacinas contra COVID-19/administração & dosagem , Vacinação/estatística & dados numéricos , Masculino , Feminino , SARS-CoV-2/imunologia , Cobertura Vacinal/estatística & dados numéricos , Recém-NascidoRESUMO
The 15th Meeting of the Regional Certification Commission for the Eradication of Poliomyelitis in the Region of the Americas (RCC) was held in Atlanta, Georgia, United States of America from 25-27 October 2022. All members of the RCC discussed and approved the validation results and the final report of the meeting. The objectives of the meeting were: meet with the National Poliovirus Containment Coordinators (NPCCs) of the countries that had not received validation of the survey/inventory process of facilities with poliovirus material; review the updated containment reports that were submitted by the countries; meet with representatives of the United States’ domestic polio program and the National Certification Committee (NCC) to discuss the current cVDPV2 outbreak situation in New York, United States of America; review annual reports from countries that did not submit the 2021 Annual Report on time for review during the 14th Meeting; and update the annual report format and review the validation questions. The Regional Certification Commission greatly appreciates the hard work of the NCCs and countries in preparing their reports to be reviewed by the Regional Certification Commission. The Regional Certification Commission would like to thank the Task Force for Global Health, which serves as the United States’ NCC Secretariat, for its kind support in preparing for and convening the meeting and for lending its facilities to the Regional Certification Commission for this meeting. The Regional Certification Commission also recognizes and values the work of PAHO in its ongoing support to the RCC.
Assuntos
Poliomielite , Vacinas contra Poliovirus , Cobertura Vacinal , Imunização , América , Região do CaribeRESUMO
OBJECTIVE: To analyze the vaccination coverage and abandonment rates among children under two years old in Brazil, from 2015 to 2021. METHODS: A time-series ecological study. The dependent variables of the research were "vaccination coverage" and "abandonment rate", both assessed by Brazilian region. The data were extracted in July 2022 from the Information System of the National Immunization Program. The Prais-Winsten technique was used for the trend analysis, with the aid of the STATA 16.0 software. RESULTS: The mean vaccination coverage in Brazil was 76.96%, with a decreasing trend during the period (Annual Percent Change=-5.12; confidence interval - CI95% -7.81; -2.34); in 2015, the rate was 88.85% and it dropped to 62.35% in 2021. In turn, the overall abandonment rate was 24.00% in 2015 and 9.01% in 2021, with a mean of 10.48% and a stationary trend (Annual Percentage Change=-9.54; CI95% -22.92; 6.12). In 2021, all the vaccines presented coverage values below 74.00% in the country. CONCLUSIONS: The vaccination coverage rate trend among children under two years old was stationary or decreasing for all the immunobiologicals in all Brazilian regions, with the exception of yellow fever in the South and Southeast regions. There was an increase in the abandonment rate trend for the Meningococcal C vaccine in the country and, specifically in relation to the regions, for BCG in the North, Northeast, and Midwest and for Meningococcal C in the North and Northeast.