Buffarini Romina, Barros Fernando C, Silveira Mariângela F
1Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, Pelotas, RS 96020-220 Brazil.
2Catholic University of Pelotas, Gonçalves Chaves 373, Pelotas, RS 96015-560 Brazil.
Arch Public Health. 2020 Apr 8;78:21. doi: 10.1186/s13690-020-00403-4. eCollection 2020.
Immunization has been held as a major achievement for global health, however, still exist many children who are not completely vaccinated. Knowledge about factors contributing to the incomplete immunization is important to develop effective strategies and interventions to achieve universal coverage to control or eradicate vaccine-preventable diseases. This study aimed to describe immunization coverage within the first year of life and associated factors with incompleteness among participants of the 2015 Pelotas Birth Cohort, Brazil.
Cross-sectional analyses were performed using data from a population-based cohort. Information on vaccination status was collected from immunization cards and verbal mother's reports from 4014 children aged 24 months. Coverage was described for each vaccine, for the basic and the complete national schedule. Incomplete vaccination was defined as failure to receive the recommended number of doses by the National Immunization Program in 2015. Bivariate and multivariate Poisson regressions with robust variance were conducted to identify factors associated with incompleteness.
Vaccine coverage of individual vaccines varied from 81% (Hepatitis A) to 97% (BCG). Full immunization coverage were 77% (95% CI: 75.8; 78.4) and 66.1% (95% CI: 64.6; 67.5), for basic and expanded indicators, relatively. Multivariate analyses showed that factors associated with incompleteness (for both basic and expanded coverage) were high family income, high parity, low number of prenatal consultations, not have done the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy, not have breastfeed the child until at age 12 months and not have used public health care services for child's vaccination.
Findings of our study show the need to develop and implement policies and programs to achieve complete immunization during the first year of life. Some strategies would include an increase in the primary health care services networks, improving their quality and access, the dissemination of scientific-based evidence about the benefits of vaccination, through communication campaigns and guidance provided by health professionals, especially those responsible for prenatal care.
免疫接种一直被视为全球卫生领域的一项重大成就，然而，仍有许多儿童未完成全部疫苗接种。了解导致未完成免疫接种的因素对于制定有效的策略和干预措施以实现全面覆盖从而控制或根除疫苗可预防疾病至关重要。本研究旨在描述巴西2015年佩洛塔斯出生队列参与者一岁以内的免疫接种覆盖率以及与未完成接种相关的因素。
使用基于人群队列的数据进行横断面分析。从免疫接种卡和4014名24个月大儿童的母亲口头报告中收集疫苗接种状况信息。描述了每种疫苗、基本国家免疫程序和完整国家免疫程序的覆盖率。未完成疫苗接种被定义为未达到2015年国家免疫规划推荐的接种剂量数。进行了具有稳健方差的双变量和多变量泊松回归以确定与未完成接种相关的因素。
各疫苗的接种覆盖率从81%（甲型肝炎）到97%（卡介苗）不等。基本指标和扩展指标的全程免疫接种覆盖率分别为77%（95%置信区间：75.8；78.4）和66.1%（95%置信区间：64.6；67.5）。多变量分析表明，与未完成接种（基本指标和扩展指标）相关的因素包括家庭收入高、胎次多、产前检查次数少、孕期未接种破伤风类毒素、减少白喉类毒素和无细胞百日咳（Tdap）疫苗、孩子12个月前未进行母乳喂养以及未利用公共卫生保健服务为孩子接种疫苗。
我们的研究结果表明需要制定和实施政策及计划以在一岁以内实现全程免疫接种。一些策略包括增加初级卫生保健服务网络、提高其质量和可及性、通过宣传活动以及卫生专业人员（尤其是负责产前护理的人员）提供的指导传播关于疫苗接种益处的科学依据。
