Vaccination coverage of triple viral and poliomyelitis in Brazil, 2011-2021: temporal trend and spatial dependency

Palmieri, Isadora Gabriella Silva; Lima, Lucas Vinícius de; Pavinati, Gabriel; Silva, José Arthur Paschoalotto; Marcon, Sonia Silva; Sato, Ana Paula Sayuri; Magnabosco, Gabriela Tavares

doi:10.1590/1980-549720230047

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Revista Brasileira de Epidemiologia

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Original Article • Rev. bras. Epidemiol. 26 • 2023 • https://doi.org/10.1590/1980-549720230047 copy

Vaccination coverage of triple viral and poliomyelitis in Brazil, 2011-2021: temporal trend and spatial dependency

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the coverage of MMR and polio vaccines, the temporal trend and spatial dependence, in children up to one year of age in Brazil, between 2011 and 2021.

Methods:

Ecological study with secondary data on vaccination coverage rates, made available by the National Immunization Program Information System. Trend analysis was carried out using the joinpoint method, according to geographic regions, estimating the annual percentage change (APC) and its respective confidence interval (95%CI). Choropleth maps of distribution by health region were constructed and, subsequently, the spatial dependence was verified using Moran's statistics.

Results:

Between 2011 and 2021, vaccination coverage declined in Brazil, both for MMR (APC: −6.4%; 95%CI −9.0; −3.8) and for poliomyelitis (APC: −4. 5%; 95%CI −5.5; −3.6). There was a decline in coverage of both vaccines in all geographic regions over the years of the study, except in the South and Midwest for the MMR vaccine. Since 2015, few health regions in the country have achieved adequate vaccination coverage (≥95.0% to <120.0%). The North and Northeast health regions showed low-low clusters in the univariate analysis for both immunobiological.

Conclusions:

It is urgent to consider studies like this one for the planning of more effective strategies for immunizing children, especially in areas with higher falls. In this way, barriers to access to immunization can be broken, given Brazil's heterogeneity, and access to reliable information that increases confidence in vaccine efficacy can be expanded.

Keywords:
Vaccines; Vaccine-preventable diseases; Anti-vaccination movement; Public health surveillance

Location		2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021
North	RO	102.7	105.4	106.5	146.9	109.0	109.8	103.0	101.7	106.4	84.2	82.5
	AC	105.2	90.2	95.0	99.2	84.2	75.7	75.1	83.1	87.4	60.2	60.2
	AM	94.6	103.3	98.7	114.4	95.4	83.6	79.8	89.8	92.1	77.0	73.1
	RR	97.9	87.8	89.0	110.2	108.5	90.8	86.5	99.3	81.2	69.5	67.3
	PA	109.2	102.2	98.4	115.7	71.9	69.6	67.5	77.3	82.8	62.4	62.7
	AP	93.0	91.5	95.6	113.2	89.0	97.4	72.0	77.1	87.2	52.5	64.2
	TO	91.4	91.6	102.2	105.5	94.7	91.9	83.3	91.2	91.1	82.5	80.5
Northeast	MA	112.8	98.2	106.4	123.9	90.5	80.0	76.9	84.0	87.1	64.3	63.3
	PI	97.0	98.3	102.4	93.1	81.2	81.5	77.8	87.8	89.0	78.5	75.0
	CE	110.9	97.6	115.2	140.7	110.8	119.8	100.7	111.5	103.0	91.8	74.5
	RN	99.4	98.6	113.1	110.3	95.0	96.1	75.6	88.7	93.7	79.0	72.6
	PB	102.3	92.7	114.6	120.4	93.7	96.6	90.9	96.7	105.7	80.4	70.9
	PE	113.6	104.5	120.8	108.4	97.8	112.7	96.4	104.7	101.0	79.2	72.0
	AL	89.9	93.1	110.7	113.2	98.7	102.2	99.2	107.2	106.2	82.6	77.7
	SE	98.0	97.3	111.4	94.6	92.0	92.1	83.2	95.5	91.0	76.2	76.5
	BA	100.2	97.9	109.2	114.9	90.2	85.7	79.2	82.3	84.7	79.7	66.3
Southeast	MG	100.8	104.9	108.3	109.2	100.1	98.9	89.3	97.5	97.0	93.1	82.3
	ES	103.7	105.1	106.2	109.4	99.0	104.3	83.8	95.5	95.0	87.8	80.8
	RJ	107.1	97.2	108.2	112.5	105.4	109.3	94.3	99.7	96.6	61.6	59.5
	SP	100.3	99.5	103.4	105.0	97.9	93.0	86.7	91.5	91.8	86.8	77.9
South	PR	98.5	99.9	110.2	113.4	99.4	91.9	88.1	89.8	92.0	86.2	86.5
	SC	99.7	100.4	104.6	112.2	103.4	99.0	91.8	92.1	95.8	87.6	87.5
	RS	93.8	91.6	105.7	107.7	87.8	90.5	83.3	88.7	91.2	86.1	79.9
Center-West	MS	96.2	100.8	113.9	143.8	112.5	101.0	91.2	104.5	104.9	81.1	78.1
	MT	98.4	99.3	107.8	120.7	98.7	96.7	85.3	89.8	89.9	82.9	80.9
	GO	115.5	107.7	117.8	122.1	94.8	85.9	81.0	87.8	88.4	76.6	79.5
	DF	89.5	92.9	105.2	104.9	67.6	131.8	78.5	86.3	85.7	82.2	83.2

Location		2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021
North	RO	107.3	105.7	100.1	108.1	105.4	105.4	108.2	101.9	98.3	82.5	74.6
	AC	111.0	96.1	92.8	75.4	82.7	71.3	74.0	78.3	81.7	63.1	61.8
	AM	87.2	91.9	96.8	98.9	104.8	76.2	76.4	79.3	83.3	68.2	67.8
	RR	95.5	88.8	86.5	89.5	112.3	88.5	90.5	79.8	79.8	73.7	51.0
	PA	101.5	97.8	97.0	84.4	72.1	63.2	67.6	69.1	72.7	59.8	56.8
	AP	84.6	92.7	93.3	80.7	92.4	47.6	63.2	68.7	73.0	42.7	45.4
	TO	99.6	92.8	97.0	90.5	97.2	84.8	86.1	91.7	88.2	84.4	80.2
Northeast	MA	102.9	97.5	105.7	93.4	100.0	69.4	74.3	80.6	75.7	60.9	62.0
	PI	98.5	93.9	93.1	81.9	80.9	70.7	78.1	83.7	81.9	73.0	72.8
	CE	100.0	97.8	104.8	103.9	111.7	107.9	97.3	111.1	93.5	88.4	74.3
	RN	96.9	94.0	93.9	95.6	97.6	70.3	69.5	90.3	80.7	70.6	71.7
	PB	102.0	92.1	108.2	100.4	96.1	85.5	82.3	92.3	92.6	73.8	70.3
	PE	109.6	100.1	101.1	101.7	109.3	90.4	84.7	94.7	85.6	72.8	69.0
	AL	90.6	90.2	97.5	93.3	94.3	80.1	83.9	96.1	87.9	74.4	77.5
	SE	103.4	96.9	99.4	94.3	93.7	78.3	79.0	89.7	80.9	71.6	72.3
	BA	97.3	93.3	96.4	93.9	95.4	70.7	78.3	78.3	74.8	70.9	63.1
Southeast	MG	103.2	98.6	103.2	96.5	97.1	88.3	87.1	97.8	88.5	86.6	76.5
	ES	108.3	104.9	100.2	101.3	99.4	89.3	83.2	91.0	86.7	81.7	77.4
	RJ	112.2	96.9	100.0	100.9	107.0	89.9	88.8	87.5	73.6	56.8	55.8
	SP	100.3	96.4	99.0	95.7	99.7	83.8	87.7	92.6	86.6	82.3	74.4
South	PR	102.5	96.8	104.7	98.8	97.4	87.5	90.4	90.9	89.7	86.4	80.8
	SC	101.2	100.0	97.8	97.2	102.4	92.1	95.1	94.6	93.7	88.7	83.8
	RS	95.1	89.4	100.3	95.4	89.2	84.5	85.7	85.7	85.1	85.1	76.4
Center-West	MS	95.5	102.3	118.0	130.1	120.4	93.8	91.5	96.0	94.4	83.2	75.7
	MT	103.2	99.5	101.2	102.5	102.8	90.6	84.1	90.3	85.8	81.5	76.3
	GO	107.1	101.0	107.7	97.7	95.9	82.1	81.5	85.5	81.5	78.1	72.7
	DF	86.5	93.7	112.2	94.3	74.9	136.8	84.4	86.0	84.3	81.5	73.2

Location		Period	APC^* * value by Monte-Carlo permutation test; (95%CI^b)	p-value^* * value by Monte-Carlo permutation test;	Trend
MMR	Brazil	2011–2021	−6.4 (−9.0; −3.8)	<0.001^† † statistically significant value.	Decreasing
	North	2011–2021	−6.3 (−10.5; −1.9)	0.011^† † statistically significant value.	Decreasing
	Northeast	2011–2021	−8.2 (−10.8; −5.6)	<0.001^† † statistically significant value.	Decreasing
	Southeast	2011–2021	−6.8 (−9.2; −4.2)	<0.001^† † statistically significant value.	Decreasing
	South	2011–2021	−4.4 (−10.4; 1.9)	0.116	Stationary
	Center-West	2011–2021	−6.9 (−15.0; 1.8)	0.118	Stationary
Poliomyelitis	Brazil	2011–2021	−4.5 (−5.5; −3.6)	<0.001^† † statistically significant value.	Decreasing
	North	2011–2021	−6.3 (−6.7; −4.6)	<0.001^† † statistically significant value.	Decreasing
	Northeast	2011–2021	−5.9 (−7.2; −4.6)	<0.001^† † statistically significant value.	Decreasing
	Southeast	2011–2021	−4.1 (−5.0; −3.2)	<0.001^† † statistically significant value.	Decreasing
	South	2011–2021	−2.2 (−3.2; −1.3)	<0.001^† † statistically significant value.	Decreasing
	Center-West	2011–2021	−4.0 (−5.1; −2.8)	<0.001^† † statistically significant value.	Decreasing

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[1] CORRESPONDING AUTHOR: Isadora Gabriella Silva Palmieri. Rua Nardina Rodrigues Johansen, 405, Vila Bosque, CEP: 87005-002, Maringá (PR). E-mail: isaagabriella@gmail.com.