Hepatitis B vaccination in adolescents living in Campinas, São Paulo,
               Brazil

Francisco, Priscila Maria Stolses Bergamo; Donalisio, Maria Rita; Gabriel, Filomena de Jesus Oliveira; Barros, Marilisa Berti de Azevedo

doi:10.1590/1980-5497201500030003

Brasil

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Original Articles • Rev. bras. epidemiol. 18 (3) • Sept 2015 • https://doi.org/10.1590/1980-5497201500030003 linkcopy

Hepatitis B vaccination in adolescents living in Campinas, São Paulo, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

INTRODUCTION: Viral hepatitis is an important public health problem in Brazil and around the world.

OBJECTIVE: To evaluate vaccination coverage against hepatitis B in adolescents and to identify the associated factors and reasons for non-adherence.

METHODS: A cross-sectional population-based study with sampling by clusters and in two stages, carried out from records of 702 adolescents aged 11 to 19 years old, non-institutionalized, living in an urban area of Campinas, São Paulo, Brazil, in 2008/2009. The data were obtained from the Health Survey in the city of Campinas (ISACamp).

RESULTS: The prevalence of vaccination (3 doses) was 72.2%. An independent and negative association with the vaccine was observed for the adolescents who were not born in the municipality. The orientation of a health care provider was positively and significantly associated with vaccination. The main reasons for non-adherence were the lack of orientation and not considering the vaccine necessary. Socioeconomic factors, health behaviors and conditions did not restrict the access to vaccination, but the coverage was below the target established by the Ministry of Health in Brazil.

CONCLUSION: Health education programs, addressing the importance of vaccination to prevent the disease; strategies to actively reach out adolescents that did not complete the schedule; as well as orientation from the health care professional about the benefits of the vaccine to the adolescents, parents and guardians can extend the vaccination coverage.

Hepatitis B; Vaccination; Prevalence; Adolescent health; Health Education; Health Surveys; Brazil

Variables and categories	n = 702	% (95%CI)
Demographic and socioeconomic
Gender
Male	347	49.9 (46.6 – 53.2)
Female	355	51.1 (46.8 – 53.4)
Age group
11 to 14	331	47.2 (43.4 – 51.0)
15 to 19	371	52.8 (49.0 – 56.6)
Skin color/race
White	450	65.0 (57.1 – 72.9)
Non-white	250	35.0 (27.1 – 42.9)
Educational level of the head of household
9 or more years	190	26.6 (19.6 – 33.6)
5 to 8 years	309	45.1 (35.6 – 54.6)
0 to 4 years	203	28.3 (22.9 – 33.7)
Per capita monthly income (minimum wages)
≥ 1	252	36.6 (28.4 – 44.9)
≥ 0.5 and <1	219	30.9 (25.3 – 36.2)
< 0.5	231	32.5 (24.5 – 40.6)
Place of birth
Campinas	532	75.7 (67.2 – 84.2)
Another city/State	170	24.3 (15.8 – 32.6)
Health-related behaviors
Passive smoker
No	551	84.3 (80.1 – 88.5)
Yes	103	15.7 (11.5 – 19.9)
Use of alcohol
No	559	84.3 (80.1 – 88.5)
Yes	120	15.7 (11.5 – 19.9)
Health conditions and characteristics related to the use of health services
Presence of chronic disease
No	563	80.6 (76.3 – 84.8)
Yes	138	19.4 (15.2 – 23.7)
Hospitalization in the last year
No	656	93.5 (91.7 – 95.2)
Yes	46	6.5 (4.8 – 8.3)
Medical health care plan
No	461	64.7 (54.6 – 74.8)
Yes	238	35.3 (25.2 – 45.4)
Orientation about vaccination
No	162	25.8 (19.0 – 32.5)
Yes	469	74.2 (67.5 – 80.9)

Variables and categories	n	Prevalence (%)	p-value*	PR (95%CI)
Gender
Male	337	71.1	0.57	1
Female	348	73.4	0.57	1.03 (0.92 – 1.15)
Age group
11 to 14	321	71.9	0.82	1
15 to 19	364	72.6	0.82	1.00 (0.93 – 1.10)
Skin color/race
White	439	72.4	0.95	1
Non-white	244	72.2	0.95	1.00 (0.94 – 1.06)
Educational level of the head of household
9 years or more	300	72.1	0.63	1
5 to 8 years	198	70.0		0.97 (0.83 – 1.13)
0 to 4 years	187	74.9		1.03 (0.92 – 1.17)
Per capita monthly income (minimum wages)
≥ 1	245	68.5	0.08	1
≥ 0.5 and < 1	213	69.1		1.01 (0.86 – 1.18)
< 0.5	227	79.3		1.16 (1.00 – 1.34)
No. of people in the residence
1 to 3	160	69.4	0.63	1
4 to 5	353	72.5		1.04 (0.91 – 1.20)
6 or more	172	74.4		1.07 (0.93 – 1.24)
Occupational activity
Yes	130	67.7	0.17	1
No	546	73.3	0.17	1.08 (0.96 – 1.22)
Goes to school
Yes, private	121	67.1	0.28	1
Yes, public	449	72.4		1.08 (0.90 – 1.29)
No	114	77.4		1.15 (0.96 – 1.39)
Place of birth
Campinas	519	74.3	0.06	1
Another city/State	166	66.0	0.06	0.89 (0.78 – 1.01)

Variables and categories	n	Prevalence (%)	p-value*	PR (95%CI)
Passive smoker
No	538	72.2	0.88	1
Yes	99	71.4	0.88	0.99 (0.86 – 1.14)
Use of alcohol
No	565	74.1	0.05	1
Yes	117	65.2	0.05	0.88 (0.77 – 1.00)
Body mass index
Underweight/eutrophic	477	71.8	0.71	1
Overweight/obese	143	70.2	0.71	0.98 (0.86 – 1.11)
Physical activity during leisure time
No	222	68.5	0.09	1
Yes	463	74.0	0.09	1.08 (0.94 – 1.23)

Variables and categories	n	Prevalence (%)	p-value*	PR (95%CI)
Morbidity in the last 15 days
No	560	73.7	0.14	1
Yes	125	66.0	0.14	0.90 (0.77 – 1.04)
Presence of chronic disease
No	548	72.2	0.88	1
Yes	134	71.7	0.88	0.99 (0.89 – 1.10)
Account of the following health problems/complaints**
Frequent headache/migraine	179	71.0	0.70	0.98 (0.86 – 1.10)
Allergy	276	70.5	0.48	0.96 (0.85 – 1.08)
Dizziness/vertigo	45	60.2	0.08	0.82 (0.64 – 1.06)
Search of service or professional for health problems in the last 15 days
No	588	72.2	0.90	1
Yes	97	72.8	0.90	1.01 (0.87 – 1.17)
Dental appointment in the last 12 months
No	282	70.5	0.48	1
Yes	402	73.4	0.48	1.04 (0.93 – 1.16)
Hospitalization in the last year
No	640	72.6	0.53	1
Yes	45	68.0	0.53	0.94 (0.75 – 1.16)
Medical health care plan
No	452	72.2	0.88	0.99 (0.86 – 1.13)
Yes	231	72.9	0.88	1
Orientation about vaccination
No	157	37.5	< 0.01	1
Yes	463	85.3	< 0.01	2.27 (1.68 – 3.08)

Variables	Adjusted PR (95%CI)	p-value	Standard error	Deff*
Place of birth
Campinas	1
Another city/State	0.89 (0.80 – 0.98)	0.02	0.04	0.73
Orientation about vaccination
No	1
Yes	2.26 (1.67 – 3.06)	< 0.01	0.34	2.05

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[TFN06] 95%CI: 95% confidence interval.