Regional disparities in BCG vaccination coverage and tuberculosis incidence in infants among Brazilian states

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Guilherme S Procianoy¹, Renato S Procianoy², Rita C Silveira²

¹School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.

Journal of Tropical Pediatrics

|August 9, 2024

Insights

Bacillus Calmette-Guerin (BCG) vaccination coverage declined significantly in Brazil post-pandemic, showing regional disparities. This drop may increase tuberculosis incidence, necessitating targeted public health interventions.

Area of Science:

Public Health
Epidemiology
Immunization

Background:

Bacillus Calmette-Guerin (BCG) vaccination and tuberculosis (TB) incidence are key public health indicators in Brazil.
The COVID-19 pandemic impacted vaccination coverage (VC), potentially affecting TB rates in children under one year.

Purpose of the Study:

To analyze regional disparities in BCG VC and TB incidence in Brazil.
To assess the impact of the pandemic on BCG VC and its potential link to TB incidence.

Main Methods:

Observational, ecological study using national BCG VC (2019-21) and TB incidence (2020-22) data.
Data stratified by Brazilian state and analyzed using descriptive and analytical statistics.

Main Results:

Average BCG VC was 79.59% between 2019-2021, with significant state-level variation (P < .001).
Only four states met the >90% coverage recommendation; VC declined from 90.72% (2019) to 78.67% (2021) (P < .001).
TB incidence also showed significant regional variation (P = .003).

Conclusions:

Significant regional disparities exist in BCG VC and TB incidence across Brazilian states.
Declining post-pandemic VC poses a risk for increased TB incidence, requiring targeted interventions in underperforming states.
Sustaining vaccination programs and enhancing access are crucial, especially during public health crises.

Read full analysis

Abstract:

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.

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