Jul 2026· Revista brasileira de epidemiologia = Brazilian journal of epidemiology· Vol 29· 0 citations· 47 references
Medicine
TL;DR
The decline in childhood vaccination in the Northern region is a spatially structured phenomenon that reflects and deepens socioeconomic inequalities and demands territorially focused public health policies.
Abstract
ABSTRACT Objective: To evaluate the spatio-temporal variation of childhood immunobiological vaccine coverage in the municipalities of the Northern region of Brazil, comparing cross-sectional data from 2018 and 2022, and its association with socioeconomic and maternal variables. Methods: This is a comparative ecological study with coverage data for seven immunobiologicals in the municipalities of the Northern region for the years 2018 and 2022. Data were obtained from the Department of Informatics of the Unified Health System. Spatial analysis (global, bivariate, and local Moran’s Index) was used to verify the association between vaccine coverage and independent variables (GDP per capita, Brazilian Deprivation Index, maternal schooling, proportion of indigenous people, full-term births, and birth weight). Results: There was a widespread decline in vaccine coverage when comparing the two periods, except for the meningococcal C vaccine. Vaccination was positively associated with GDP per capita and maternal schooling, and negatively associated with the Deprivation Index, with these associations intensifying over the period. The spatial correlation between immunization and the proportion of the indigenous population, previously not significant, became strongly negative in 2022. Clusters of low immunization and socioeconomic vulnerability were identified mostly in the states of Pará and Amazonas, and clusters of high immunization and better indicators in Tocantins and Rondônia. Conclusion: The decline in childhood vaccination in the Northern region is a spatially structured phenomenon that reflects and deepens socioeconomic inequalities. The formation of vulnerability clusters, especially in areas near the Brazilian border, represents a risk for the re-emergence of vaccine-preventable diseases and demands territorially focused public health policies.
Multiple socioeconomic, structural and operational factors were associated with unvaccinated rates, highlighting the relevance of healthcare service organization even in favorable social contexts and classifying municipalities into risk profiles may help guide interventions to improve coverage.
I. N. Schrarstzhaupt, F. A. Diaz-Quijano, F. Fontana Sutile Tardetti Fantinato et al.· medRxiv· 0 citations
The analysis reveals the complex interplay of various factors influencing COVID-19 vaccination decisions, emphasizing the importance of residential areas and urbanization.
Neda Firouraghi, Ève Dubé, B. Thierry et al.· Journal of urban health· 0 citations
Abstract Objective To identify space-time risk clusters for cases and deaths from severe acute respiratory syndrome (SARS) caused by COVID-19 and to characterize the spatial distribution of vaccination coverage among children and adolescents aged 0–19 years in Brazil. Methods Spatial analysis study using secondary data from the 5,570 municipalities in Brazil. Cases and deaths from SARS caused by COVID-19 among children and adolescents aged 0–19 years reported between March 2020 and December 2024 in the Influenza Epidemiological Surveillance Information System (Sistema de Informação da Vigilância Epidemiológica da Gripe, SIVEP-Gripe) were included. Vaccination records from January 2021 to December 2024 were analyzed. Vaccination coverage rates were calculated by age group and vaccination schedule. Space-time clusters were identified using the spatial scan technique. Results A total of 74,470 cases and 3,749 deaths were recorded in the population aged 0–19 years. Significant clusters of high and low risk were identified, including one protective cluster for cases among individuals aged 0–19 years (relative risk [RR] 0.28; 95% confidence interval [95%CI] 0.27; 0.29) and another high-risk cluster for deaths in the North, Northeast, and Central-West regions (RR 3.28; 95%CI 3.00; 3.59). Primary vaccination reached high coverage (85.2%), especially among adolescents aged 15–19 years (96.8%), whereas booster dose coverage remained insufficient (23.1%). The spatial distribution showed heterogeneity, with lower vaccination coverage in the North and Central-West regions. Conclusion Space-time inequalities were observed in cases and deaths from severe acute respiratory syndrome (SARS) caused by COVID-19 among children and adolescents, with risk clusters and heterogeneity in vaccination coverage, characterized by high primary coverage and low booster coverage, especially in the North and Central-West regions..
Reginaldo Bazon Vaz Tavares, Y. M. Alves, Nathália Zini et al.· Epidemiologia e Serviços de...· 0 citations
The aim of this study was to describe the spatial distribution of human papillomavirus (HPV) vaccination coverage in the state of Maranhão, Brazil. We conducted a retrospective ecological study using data from three age cohorts of boys (age 16, 17 and 18) and girls (age 13, 14 and 15). The units of analysis were municipalities and health regions. A spatial analysis of distribution of adequate and inadequate coverage was conducted. 84.2% of the state's health regions achieved adequate coverage for the first dose among girls in cohort 1, but only 26.3% of these regions achieved the same coverage target for the second dose. This percentage was lower in boys across all cohorts, with only 26% of the health regions achieving adequate coverage in each dose. Spatial distribution of vaccination coverage was uneven. The study revealed important gaps in vaccination coverage in the state among both boys and girls. The heterogeneity of the spatial distribution of vaccination coverage reinforces the challenges that need to be overcome to ensure the effective implementation of the vaccination program across the state's municipalities.
Renata Pinheiro Pedra Fernandes, Nair Portela Silva Coutinho, A. Caldas et al.· Ciência & Saúde Coletiva· 0 citations
BACKGROUND
Achieving the goals of Immunisation Agenda 2030 (IA2030) requires a clear understanding of vaccination timeliness and its determinants. We assessed vaccination timeliness and associated factors in two rural districts of northern Ghana.
METHODS
We conducted a community-based analytical cross-sectional study among 3371 caregivers of children aged 0-59 months in Gushegu (n = 1361) and Nanumba South (n = 2010) Districts, Northern Ghana, from 24 April to 4 May 2025. The study examined the timeliness of 19 vaccine doses in Ghana's national immunisation schedule. Vaccination status was classified as early, age-appropriate, delayed, unvaccinated, or up to date based on recommended age windows. Cox proportional hazards models were used to identify factors associated with vaccination timeliness.
RESULTS
Timely vaccination declined progressively across the immunisation schedule in both districts. Bacille Calmette-Guérin had the highest age-appropriate coverage (64.2% in Gushegu and 52.6% in Nanumba South), whereas timeliness decreased across multi-dose vaccine series. Age-appropriate coverage for pneumococcal conjugate vaccine declined from 60.9% to 20.5% in Gushegu and from 51.1% to 21.5% in Nanumba South between the first and third doses. Similarly, timely Pentavalent vaccination declined from 59.6% to 19.8% and from 52.1% to 23.0%, respectively. Rotavirus vaccine age-appropriate coverage dropped to 8.6% in Gushegu and 9.4% in Nanumba South for the third dose. Delays increased with successive doses and were greater in Nanumba South. Possession of a vaccination card was the strongest predictor of timely vaccination (Gushegu: aHR 30.82, 95% CI 12.02-79.03; Nanumba South: aHR 19.09, 95% CI 6.84-53.26). Higher caregiver education improved timeliness, while home or traditional birth attendant delivery reduced timeliness.
CONCLUSION
Timely vaccination remains suboptimal in both districts, with marked declines across the immunisation schedule. Strategies to improve vaccination card retention, caregiver education, access to vaccination services, and facility-based deliveries may enhance vaccination timeliness.
M. Konlan, R. Bhandari, M. Adjei et al.· Vaccine· 0 citations
This article aims to analyze the temporal trend of Family Health Strategy (FHS) coverage and its associated factors in Brazilian twin cities between 2016 and 2020. This is a retrospective ecological study of a temporal analysis conducted on the 33 twin cities of Brazil. Secondary data were collected from e-Gestor AB, and variables regarding FHS coverage, population size, border arcs, and temporality were used. Descriptive measures were used in the statistical analysis, which were arcived, tabulated, and analyzed using Microsoft Excel 2019. It was observed that the Northern arc had the highest coverage, followed by the Southern and Midwestern arcs, respectively, with small twin cities standing out in terms of population size. As regards coverage evolution, the Southern arc stood out with a growing trend, while the Northern and Midwestern arcs showed a decrease in the last year of the study. FHS coverage in twin cities varied among the three arcs, likely due to the sociodemographic characteristics of each arc and the particularities in the management of basic care services in municipalities.
Olga Lucía Mosquera Conde, Yury Lizeth Cardozo Prada, G. Derrosso et al.· Ciência & Saúde Coletiva· 0 citations