The COVID-19 pandemic and vaccination abandonment in children: spatial heterogeneity maps

Abstract

Objective: to identify spatial clusters corresponding to abandonment of routine vaccines in children. Method: an ecological study, according to data from the 853 municipalities of a Brazilian state. The records analyzed were those of the multidose pentavalent, pneumococcal 10-valent, inactivated poliomyelitis and oral human rotavirus vaccines of 781,489 children aged less than one year old. The spatial scan statistics was used to identify spatial clusters and assess the relative risk based on the vaccination abandonment indicator. Results: the spatial scan statistics detected the presence of statistically significant clusters for abandonment regarding the four vaccines in all the years analyzed. However, the highest number of clusters with high relative risk estimates was identified in 2020. The Vale do Aço and West, North and West, and Southwest regions stand out for the pentavalent, poliomyelitis and rotavirus vaccines, respectively. Conclusion: in an attempt to mitigate the devastating impact of the COVID-19 pandemic, the immunization program experienced setbacks. The presence of clusters points to the need to implement integrated strategies that may involve different sectors for an active search for children and prevent outbreaks of vaccine-preventable diseases in the near future.

Impacto de uma pesquisa-ação nos indicadores vacinais em Minas Gerais

“…Regarding the DR of the human rotavirus oral vaccine, it was evident that, with the project workshops, there was a decrease in the “medium” and “high” rating and a statistically significant increase in the “low” classification. High DRs are a reality in Minas Gerais and some regions of Brazi 21 , a state with a sizeable territorial extension and very heterogeneous socioeconomic conditions in the municipalities. Several challenges to reducing DR in Brazilian municipalities 1 , 20 , and socioeconomic and environmental factors hinder the population’s equal access to vaccination rooms, contributing to high DR in the vaccination schedule 6 , 21 .…”

“…High DRs are a reality in Minas Gerais and some regions of Brazi 21 , a state with a sizeable territorial extension and very heterogeneous socioeconomic conditions in the municipalities. Several challenges to reducing DR in Brazilian municipalities 1 , 20 , and socioeconomic and environmental factors hinder the population’s equal access to vaccination rooms, contributing to high DR in the vaccination schedule 6 , 21 . Concerning the other vaccines that showed no change in DR, the justification may have been the concern of parents or guardians with the pain and suffering of children—inherent to administering vaccines with needles 24 —different from immunization against human rotavirus, which is administered orally.…”

“…Quanto à TA da vacina oral de rotavírus humano, evidenciou-se que, com a realização das oficinas do projeto, houve diminuição da classificação “média” e “alta” e incremento estatisticamente significativo da classificação “baixa”. As altas TA são realidade em Minas Gerais – bem como em algumas regiões do Brasil 21 –, estado com uma extensão territorial alta e condições socioeconômicas dos municípios bastante heterogêneas. Diversos são os desafios para reduzir a TA nos municípios brasileiros 1 , 20 , e fatores socioeconômicos e ambientais prejudicam o acesso de forma igualitária da população às salas de vacinas, o que pode contribuir para altas TA do esquema vacinal 6 , 21 .…”

“…As altas TA são realidade em Minas Gerais – bem como em algumas regiões do Brasil 21 –, estado com uma extensão territorial alta e condições socioeconômicas dos municípios bastante heterogêneas. Diversos são os desafios para reduzir a TA nos municípios brasileiros 1 , 20 , e fatores socioeconômicos e ambientais prejudicam o acesso de forma igualitária da população às salas de vacinas, o que pode contribuir para altas TA do esquema vacinal 6 , 21 . Em relação às demais vacinas que não apresentaram mudança na TA, a justificativa pode ter sido a preocupação dos pais ou responsáveis com a dor e o sofrimento das crianças inerente ao processo de administração de vacinas com agulhas 24 –, diferente da imunização contra o rotavírus humano, que é administrada por via oral.…”