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ABSTRACT Objective To analyze measles, mumps, and rubella vaccination coverage among children up to 24 months old and factors associated with non-vaccination in a 2017−2018 live birth cohort, in state capitals and large interior region cities in Northeast Brazil. Methods Population-based survey analyzing vaccination coverage and sociodemographic factors through logistic regression. Results For 12,137 children, vaccination coverage was 79.3% (95%CI 76.5;81.8), and the dropout rate was 10.6%. Association with non-vaccination: socioeconomic stratum A (OR-a 1.29; 95%CI 1.10;1.50), living in the interior region (OR-a 1.22; 95%CI 1.07;1.39), no access to the Bolsa Família Program (OR-a 1.19, 95%CI 1.05;1.34), family income ≤BRL 1,000 (OR-a 1.17, 95%CI 1.03;1.31), mother not working (OR-a 1.28, 95%CI 1.15;1.42), >1 child per mother (OR-a 1.12, 95%CI 1.08;1.17), and no vaccination card (OR-a 10.69, 95%CI 6.27;18.20). Conclusion Low vaccination coverage and a high dropout rate in state capitals and municipalities in the interior region of Northeast Brazil.

ABSTRACT Objective To analyze factors associated with full vaccination coverage with valid doses, in children from four state capitals and three other cities in Southeast Brazil. Method Analysis of a population survey conducted in 2020-2021, with a sample stratified according to socioeconomic levels of children born in 2017-2018, with data collected through photographic records of their vaccination cards. Odds ratios (OR) and 95% confidence intervals (95%CI) for full vaccination coverage were estimated based on the characteristics of the family, mother and child. Results Among 8703 children, lowest coverage occurred in strata A and B (OR=0.39; 95%CI 0.23;0.67 and OR=0.38; 95%CI 0.25;0.58); in consumption level A/B (OR=0.38; 95CI% 0.28;0.52); among those with income >BRL8000/month (OR=0.23; 95%CI 0.12;0.42); in children of mothers with higher education (OR=0.47; 95%CI 0.32;0.71); in children not vaccinated exclusively in the public service (OR=0.37; 95%CI 0.26;0.51) and in children with a vaccination delay of up to 6 months (OR=0.28; 95%CI 0.22;0.37). Conclusion Coverage did not reach the targets for controlling vaccine-preventable diseases and was negatively associated with higher socioeconomic status.

ABSTRACT Objective To estimate measles-mumps-rubella vaccination coverage, delay and loss to follow-up in children up to 24 months old living in Brazilian cities. Methods Surveys and questionnaires with a retrospective cohort of live births in 2017-2018, analyzing vaccination coverage and sociodemographic data of children and families, based on vaccination card records and interviews. Results Valid coverage of first dose was 90.0% (95%CI 88.9;91.0) and 81.1% for the second dose (95%CI 79.8;82.4). Delay for both doses was 23.2% (95%CI 21.9;24.5) and loss to follow-up was 10.8% (95%CI 9.9;11.8). Socioeconomic stratum A had the lowest vaccination coverage and the higher the child’s birth order, the lower the vaccination coverage for the second dose. Children whose mothers had 13 to 15 years of education had higher vaccination coverage. Conclusion Coverage did not meet the recommended target. Differentiated strategies to resolve difficulties in access, misinformation, and vaccination hesitancy will help improve vaccination coverage.

ABSTRACT Objective To describe the polio vaccination status in 26 state capitals, the Federal District, and 12 municipalities in Brazil, among children born between 2017 and 2018. Methods This was a population-based household survey conducted from 2020 to 2022, which assessed polio vaccination coverage in children, considering valid, administered, and timely doses by municipality. Results Data were collected from 37,801 children. Vaccination coverage for the complete valid dose schedule was 87.5% (95%CI 86.2;88.7), dropping to 79.6% (95%CI 78.1;81.0), when the booster dose was considered. The dropout rate was 4.5% for the complete schedule, and 11.7% for the first booster. There was no correlation between campaign implementation and high coverage. Conclusion Vaccination coverage for the complete valid dose schedule and the first booster did not meet the 95.0% target. Regional disparities and the association between vaccination coverage and social indicators should be taken into consideration in strategies to increase coverage.

ABSTRACT Objective To analyse vaccination coverage and factors associated with incomplete polio vaccination in a cohort of children born in 2017-2018, in state capitals and interior region municipalities of Northeast Brazil. Methods Household survey of children aged ≤24 months conducted between 2020 and 2022. Vaccination coverage and dropout rates were estimated, as well as factors associated with incomplete vaccination, analyzed by calculating odds ratios (OR) and 95% confidence intervals (95%CI). Results : Among 12,137 children, vaccination coverage (4 doses) was 80.9% (95%CI 78.4;83.1); 8.4% were not vaccinated. Not having a vaccination card (OR=18.06; 95%CI 10.01;32.61) and use of private services (OR=1.46; 95%CI 1.23;1.74) were associated with incomplete vaccination. Higher dropout rates were found for the booster dose, especially in the highest stratum. Conclusion Low vaccination coverage, poor dose follow-up and high dropout rates were found for polio vaccines in the areas studied.

ABSTRACT Objective To estimate vaccination coverage in children born between 2017-2018, living in urban areas of state capitals, the Federal District and 12 inland municipalities in Brazil, and to identify associated factors. Methods This was a household survey conducted between 2020-2022, among children up to 24 months old. Vaccination coverage was estimated according to family, maternal and child characteristics. Results Among the 37,801 children in the sample, complete coverage (doses administered) was 60.1% (95%CI 58.6;61.6) and 6.1% (95%CI 5.4;7.0) had not received any vaccines. Coverage was lower among children of mothers with lower level of education (OR = 0.70; 95%CI 0.54;0.90) and in those who experienced delays in receiving any vaccine by 6 months old (OR = 0.28; 95%CI 0.24;0.32). Conclusion Vaccination coverage is below the expected levels. Effective communication strategies are needed to reinforce the importance of routine vaccination, prevent delays and abandonment of the vaccination schedule, in order to recover the high coverage levels achieved in past decades.

ABSTRACT Objective To estimate vaccination coverage and analyze sociodemographic factors associated with non-vaccination in children born in 2017 and 2018 in the state capitals of Northeast Brazil. Methods A household survey using cluster sampling was conducted from 2020-2022 to estimate vaccination coverage and hesitancy. Factors associated with non-vaccination were analyzed using logistic regression to calculate Odds Ratios (OR) and their Confidence Intervals (95%CI). Results Natal was the capital with the lowest vaccination coverage, below 75.0% for most immunizers. Teresina had rates equal to or greater than 90.0% for all vaccines. Among those interviewed, 99.1% (95%CI 98.9;99.3) believe that vaccines are important for health; 95.4% (95%CI 95.0;95.8) trust immunobiologicals and 79.6% (95%CI% 78.8;80.3) are not afraid of reactions. Belonging to the highest socioeconomic stratum (adjusted OR: 1.34 – 95%CI 1.20;1.50) was as a factor associated with non-vaccination. Conclusion Low coverage highlights the need for a better understanding of regional specificities and social inequalities.

ABSTRACT Objective To estimate vaccination coverage, identify barriers and hesitancy to vaccinating children up to 24 months, born between 2017-2018, living in the urban area of Rio Branco, Acre, Brazil. Methods Population survey carried out from 2020 to 2021, which assessed sociodemographic characteristics and vaccination status among children. Results Among 451 included children, vaccination coverage was below 80%. Meningococcal C vaccine had the lowest coverage for administered doses (76.3%; 95%CI 70.5;81.3) and doses on time (27.4%; 95%CI 23.1;32.1). The statements “vaccines cause serious adverse reactions” (26.4%; 95%CI 18.1;36.8) and “you don’t need vaccination for diseases that no longer exist” (22%; 95%CI 15.7;29.8) were the most frequent regarding vaccination hesitancy. Lack of vaccines was the main barrier to care (86.6%; 95%CI 71.8;94.3). Conclusion Vaccination coverage in children born in 2017-2018 was below the target recommended for the full schedule of administered doses, both valid and timely administered.

ABSTRACT Objective To analyze full vaccination coverage in live births in 2017 and 2018 in the capitals of the Midwest region of Brazil, according to social strata. Methods Population-based household survey with cluster sampling. Full coverage in children at 12 and 24 months of age and sociodemographic factors were analyzed. Results 5,715 children were analyzed. Full coverage at 12 months of age was 67.9% (95%CI 65.4;70.4), while at 24 months it was 48.2% (95%CI 45.3;51.1). Pneumococcal vaccine had the highest vaccination coverage (91.3%), while the second dose of rotavirus vaccine had the lowest (74.2%). In Campo Grande, no vaccine reached coverage above 90%, with BCG (82.9%) and hepatitis B (82.1%) standing out. Campo Grande and Brasília had the worst vaccination coverage in the high social stratum (24 months of age). Conclusion Vaccination coverage in the Midwest was below 80%, falling short of the recommended target and associated with socioeconomic factors.

ABSTRACT Objective To characterize the use of private services in infant vaccination and assess vaccination coverage according to the service used. Methods : This was a national vaccination survey conducted in 2020 that estimated the use of private vaccination services and vaccination coverage among infants residing in state capitals and 12 inland municipalities. Results : Of the 37,801 participants, 25.1% (95%CI 23.2;27.2) used private services at least once, with higher proportions in capitals, larger cities and in the South and Southeast regions. Socioeconomic and demographic differences were identified among families, based on the service used. The coverage for the set of vaccines administered up to 24 months was 60.3% (95%CI 58.6;62.0) in the public service and 59.5% (95%CI 55.9;63.0) in private services, and up-to-date vaccines, 10.3% (95%CI 9.1;11.6) and 9.4% (95%CI 7.4;11.8), respectively. Conclusion The use of private services was frequent, with low coverage for the set of vaccines, regardless of the type of service used, especially for up-to-date vaccines.

ABSTRACT Objective To analyze vaccination coverage according to social strata in children up to 24 months old, living in the municipality of Londrina (PR), Brazil. Methods This was a population-based survey conducted between 2021 and 2022, in which vaccination coverage and sociodemographic aspects of mothers and families were evaluated using Pearson’s chi-square test. Results In a sample of 456 children, complete vaccination coverage varied according to social strata, being 36.0% (95%CI 26.8;57.8); in stratum A; 59.5% (95%CI 26.1;86); in stratum B; 66.2% (95%CI 51.7;78.1); in stratum C; and 70.0% (95%CI 56.1;81.0) in stratum D. Conclusion The analysis of vaccination coverage indicated that social stratum A is at highest risk for vaccine-preventable diseases.

ABSTRACT Objective To estimate hepatitis A vaccination coverage in 24-month-old children and identify factors associated with non-vaccination. Methods This was a survey involving a sample stratified by socioeconomic strata in capital cities (2020-2022), with coverage estimates and 95% confidence intervals (95%CI), the factor analysis was performed using the prevalence ratio (PR) by means of Poisson regression. Results Among 31,001 children, hepatitis A coverage was 88.1% (95%CI 86.8;89.2). Regarding socioeconomic strata (A/B), the variable immigrant parents/guardians was associated with non-vaccination (PR = 1.91; 95%CI 1.09;3.37); in strata C/D, children of Asian race/skin color (PR = 4.69; 95%CI 2.30;9.57), fourth-born child or later (PR = 1.68; 95%CI 1.06;2 .66), not attending daycare/nursery (PR = 1.67; 95%CI 1.24;2.24) and mother with paid work (PR = 1.42; 95%CI 1.16;1.74) were associated with non-vaccination. Conclusion Hepatitis A coverage was below the target (95%), suggesting that specificities of social strata should be taken into consideration.

ABSTRACT Objective To analyze the reliability of records held on the National Immunization Program Information System (SI-PNI) in a subsample of children included in the national vaccination coverage survey in Brazilian state capitals and Federal District in 2020. Methods This was a study of agreement between data recorded on vaccination cards (doses and dates) and on the SI-PNI for 4050 children with full coverage at 24 months. Results Data on 3587 children were held on the SI-PNI, with losses of 11% (95%CI: 10;12). Total agreement between doses and dates in the two sources was 86% (95%CI: 86;87), however taking each dose and vaccine individually, variation was greater, with 32% of data in only one source. Conclusion Part of the information was not recorded, but the discrepancy can be considered small. Nonetheless, underrecording of doses and children can compromise vaccination coverage estimates, altering the numerator and denominator data.

ABSTRACT Objective To evaluate vaccination coverage and delay in vaccine dose administration in infants in six municipalities in the Southern region of Brazil. Methodology National Vaccination Coverage Survey 2020, with infants born alive in 2017 and 2018, carried out from September 2020 to March 2022. Coverage of doses administered, doses administered on time and delay in dose administration were evaluated. Results For 4681 infants analyzed, coverage for vaccines recommended up to 24 months was 68.0% (95%CI 63.9;71.8%) for doses administered and 3.9% (95%CI 2.7%;5.7%) for doses administered on time. Delay time for the majority of late vaccinations was ≤ 3 months. For some boosters, 25% of vaccine administration was delayed by ≥ 6 months. Conclusion In addition to tracking vaccine defaulters, strategies are needed to encourage compliance with the vaccination schedule at the recommended ages.

ABSTRACT Objective To describe vaccination coverage and hesitation for the basic children’s schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. Methods Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. Results Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. Conclusion Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities.

ABSTRACT Objective To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Methods Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. Results 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. Conclusion There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil.

Resumo Objetivo Avaliar o Sistema de Vigilância em Imunizações considerando-se o módulo Registro do Vacinado, do Sistema de Informações do Programa Nacional de Imunizações, Brasil, 2017. Métodos Estudo descritivo, utilizando-se do Guidelines for Evaluating Public Health Surveillance Systems, publicado pelo Centers for Disease Control and Prevention (CDC/Atlanta/GA/United States), para avaliar os atributos de simplicidade, flexibilidade, qualidade dos dados, sensibilidade, oportunidade e utilidade do sistema para seis vacinas do calendário de vacinação da criança. Resultados O Sistema de Vigilância em Imunizações foi considerado complexo em sua descrição, flexível às mudanças no calendário vacinal, de baixa qualidade dos dados para as vacinas DTP e rotavírus, de aceitabilidade regular, com alta sensibilidade para a vacina BCG, inoportuno para a vacina contra hepatite B e útil às finalidades do Programa Nacional de Imunizações. Conclusão Qualidade dos dados, aceitabilidade e oportunidade não apresentaram resultados satisfatórios, sendo necessárias ações pelo aprimoramento do sistema de informações.

Resumo Objetivo: analisar características, incidência e fatores associados aos eventos adversos graves (EAGs) pós-vacinação contra febre amarela durante surto da doença no Brasil (2016-2017). Métodos: estudo de caso-controle, com dados do Sistema de Informações do Programa Nacional de Imunizações (SI-PNI); foram considerados casos os EAGs, e controles os eventos adversos não graves (EANGs). Resultados: foram analisados 135 casos de EAG e 1.058 controles; dos 135 EAGs, 79 (58,5%) eram homens, e a mediana de idade dos casos, 28 anos (intervalo interquartílico: 9-49); a incidência de EAG em janeiro de 2017 chegou a 1,3 caso por 100 mil doses aplicadas; houve associação estatística com o sexo masculino (odds ratio [OR]=1,73; IC95% 1,20;2,48), ser primovacinado (OR=1,65; IC95% 1,01;2,71), e ter idade ≥60 anos, tomando-se por referência os menores de 5 anos (OR=4,4; p-valor