Vaccination coverage and factors associated with incomplete vaccination in a medium-sized municipality, São Paulo State, Brazil

Author(s)

Márcia de Cantuária Tauil

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Saúde Pública (FSP/CIR)
• Defense date: 2017-03-10

Examining board members

Eliseu Alves Waldman; Rita de Cassia Barradas Barata; Luiz Antonio Bastos Camacho; Ana Marli Christovam Sartori; Dirce Maria Trevisan Zanetta

• Advisor: Eliseu Alves Waldman

Abstract

Introduction: Araraquara (SP) has a successful vaccination program since the 80\'s, with the oldest Electronic Immunization Registry (EIR) in the country. Objectives: To estimate vaccination coverage (VC) at 12 and 24 months of life in children born in 2012 in the city of Araraquara, to investigate factors associated with incomplete vaccination and to analyze the adverse events following immunization (AEFI). Methods: An observational descriptive and analytical study comprising the cohort of children born in 2012, living in the city of Araraquara and recorded in the Live Births Information System (SINASC). Children who died in the first year of life or who moved from Araraquara were excluded. Study variables included vaccination data and characteristics of the mother, the antenatal/birth, the health unit (HU) and the area of residence. VC and the respective 95 per cent confidence intervals (95 per cent CI) were estimated for each vaccine and complete schedule, following the São Paulo\'s State recommendations in the years 2012/2013. The association between the incomplete vaccination schedule and the independent variables was investigated by estimating the crude and adjusted odds ratio (OR) by hierarchical non-conditional multiple logistic regression with the respective 95 per cent CI. Results: 2740 children were enrolled in the SINASC as residents and 99.6 per cent of them were in the EIR. After excluding 30 deaths (1.1 per cent ) and 98 children who moved (3.6 per cent ), 2612 children were studied. VC by received doses for the complete schedule at 12 months was 67.9 per cent and at 24 months was 79.7 per cent ; by timely doses was 46.2 per cent and 32.8 per cent , respectively. The measles, mumps and rubella vaccine had the lowest VC at 12 months per received dose (74.8 per cent ) and at 24 months per timely dose (53.5 per cent ). Vaccines with pertussis componente were responsible for 58.8 per cent (10/17) of AEFI cases and fever was the most common manifestation. The spatial distribution of VC of the complete schedule by area of residence did not present statistical difference. In the final model, incomplete vaccination was associated with mother between 14 and 19 years old [at 12 months (OR: 2.0); at 24 months (OR: 2.5)]; with 12 years or more of study [at 12 months (OR: 1.9), at 24 months (OR: 2.3) ]; with three or more children [at 12 months (OR: 3.2), at 24 months (OR: 2.1)]; with less than seven antenatal visits [at 12 months (OR: 1.7), at 24 months (OR: 2.3)]; the child has attended both public and private HU [at 12 months (OR: 6.0), at 24 months (OR: 8.0)], a HU without Family Health Strategy [at 24 months (OR: 1.5)]; and who had a weak link with the HU [at 24 months (OR: 1.4)]. Conclusion: VC per vaccine is not homogeneous in Araraquara and there is a vaccine delay. The use of RII for its monitoring can be an effective strategy. The lack of disparities in VC among the different areas of residence suggests the effectiveness of the immunization program in promoting health equity. It is recommended to prioritize actions to encourage children vaccination of mothers with high schooling and who have a more fragile link with public HU (AU)

• FAPESP's process: 14/11714-7 - Vaccination coverage and factors associated with incomplete vaccination in a medium-sized city, São Paulo State, Brazil
• Grantee: Márcia de Cantuária Tauil
• Support Opportunities: Scholarships in Brazil - Doctorate