[Temporal and spatial heterogeneities of childhood vaccination coverage in Brazilian state capitals: a methodological...

This study aimed to analyze vaccination coverage temporal and spatial heterogeneities in the basic children schedule in the Brazilian Unified National Health System (SUS) in state capitals and macroregions from 2010 to 2021 by a new monitoring indicator. This is an ecological study at the level of Brazilian capitals and year of registration of doses. An indicator based on the ratio between applied doses and the minimum expected number of doses (i.e., the recommended vaccination coverage in the complete basic vaccination schedule for children: BCG, hepatitis A and B, meningococcal conjugate C and its booster, pentavalent, pneumococcal 10-valent and its booster, poliomyelitis and its booster, human rotavirus, triple bacterial, and the first and second triple viral doses) was proposed. Dose ratios were temporally and spatially analyzed by generalized additive and conditional autoregressive models. This study found a significant drop in vaccination coverage for all immunobiologicals from 2015 onward. The coverage of most vaccines remained below the minimum targets of the Brazilian Ministry of Health. This study also observed differences in reduction magnitude (greater in Northern and Northeastern capitals in recent years, particularly during the COVID-19 pandemic). The proposed indicator facilitated statistical treatment, using only an information system and the recommended goals and making it possible to assess significant vaccination drops over time, with differences between capitals and macroregions. This study found priority regions for Brazilian National Immunization Program actions, such as intensifying and diversifying immunization campaigns to achieve the past high vaccination coverage.