Vaccination coverage, vaccine hesitancy and factors associated with incomplete vaccination: a household survey conducted with children born between 2017 and 2018 in the inland municipalities of Northeastern Brazil Translated title: Cobertura de vacunación, indecisión vacunal y factores asociados a vacunación incompleta: encuesta de hogares en una cohorte de niños nacidos en el período 2017 y 2018 en municipios del interior del Nordeste brasileño

ABSTRACT

Objective

To analyze vaccination coverage and factors associated with incomplete vaccination in inland municipalities of Northeastern Brazil.

Methods

This was a household survey using cluster sampling conducted in Vitória da Conquista, Bahia state, Caruaru, Pernambuco state, Sobral, Ceará state and Imperatriz, Maranhão state between 2020 and 2022. Vaccination coverage by valid doses and vaccine hesitancy were analyzed, with the odds ratio (OR) estimated and adjusted using logistic regression.

Results

Among 1,847 children, complete vaccination coverage was 49.2% (95%CI 43.9;54.5). Factors associated with incomplete vaccination included: higher income (OR 1.53; 95%CI 1.02;2.31), residence in Sobral (OR 4.35; 95%CI 3.04; 6.21) and >1 child (OR 1.20; 95%CI 1.11;1.32). Parental decision not to vaccinate and difficulties in traveling to vaccination centers contributed to vaccine hesitancy.

Conclusion

Low vaccination coverage and incomplete vaccination were associated with social issues in the socioeconomic strata analyzed.

Study contributions

Main results

Vaccination coverage of nearly 50%, with incomplete vaccination associated with factors across different social strata, particularly higher income. Vaccine hesitancy is marked by parental decision not to vaccinate and access limitations.

Implications for services

Expanding vaccination coverage should be a priority goal within the healthcare and surveillance network of the SUS in inland municipalities of the Northeast region. Incomplete vaccination requires

Perspectives

The actions of the National Immunization Program need to be strengthened, with context-specific interventions in local territories through microplanning to increase vaccination coverage and reduce vaccine hesitancy.

RESUMEN

Objetivo

Analizar la cobertura de vacunación y factores asociados a vacunación incompleta en municipios del interior del Nordeste de Brasil.

Método

Se trata de una encuesta domiciliaria con muestreo por conglomerados realizada en Vitória da Conquista, Bahía, Caruaru, Pernambuco, Sobral, Ceará e Imperatriz, Maranhão entre 2020 y 2022. Se analizaron cobertura de vacunación por dosis válidas y la indecisión vacunal, con estimación de odds ratio (OR) ajustada por regresión logística.

Resultados

En 1.847 niños, la cobertura de vacunación completa fue del 49,2% (IC ₉₅% 43,9;54,5). Los factores asociados con vacunación incompleta incluyeron: mayores ingresos (OR 1,53; IC ₉₅% 1,02;2,31), vivir en Sobral (OR 4,35; IC ₉₅% 3,04;6,21) y >1 hijo (OR 1,20; IC ₉₅% 1,11;1,32). La decisión de padres de no vacunar y dificultades para desplazarse a unidades de vacunación demarcaron indecisión vacunal.

Conclusión

Hubo baja cobertura de vacunación y vacunación incompleta asociada a problemas sociales en los estratos socioeconómicos analizados.