Missed childhood immunizations during the COVID-19 pandemic in Brazil: Analyses of routine statistics and of a national household survey

Silveira, Mariângela F.; Tonial, Cristian Tedesco; Maranhão, Ana Goretti Kalume; Teixeira, Antônia Maria; Hallal, Pedro Curi; Hartwig, Fernando Pires; Barros, Aluísio J. D.; Victora, Cesar G

doi:10.1016/j.vaccine.2021.04.046

Cited by 65 publications

(61 citation statements)

References 20 publications

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“…The potential characteristics or factors, which were limited in our survey and might affect the non-vaccinations, are age of parents or level of education, which were not significantly correlated with the immunization coverage according to our results, but proportionally more mothers with high or secondary level of education had children with full immunization coverage. This appears to contradict the findings of Silveira et al [ 23 ], but our study did not evaluate the social-economic status of interviewed families. On the other hand, a study by Gebre Eyesus et al [ 24 ] indicated that parents who received immunization service more times were more likely to be knowledgeable about vaccines than parents who received the service only once.…”

Section: Discussioncontrasting

confidence: 99%

“…Therefore, it is critical to build parental the trust and confidence regarding children’s immunization and to reduce limitations where possible. Silveira et al [ 23 ] who analyzed the Brazilian population, showed that the coverage typically increased with family wealth, although VH was higher among the better-off and wealthiest families. The potential characteristics or factors, which were limited in our survey and might affect the non-vaccinations, are age of parents or level of education, which were not significantly correlated with the immunization coverage according to our results, but proportionally more mothers with high or secondary level of education had children with full immunization coverage.…”

Section: Discussionmentioning

confidence: 99%

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A National Cross-Sectional Study from the Republic of Kosovo on Lot Quality Assurance Sampling (LQAS) to Evaluate the Vaccination Status of Children Between 12 and 24 Months of Age During 2018 to 2020

Gllareva

Humolli

Rudhani

et al. 2021

Med Sci Monit Basic Res

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Background In the Republic of Kosovo, full vaccination status in children under age 2 years includes: 1 dose of Bacillus Calmette-Guérin (BCG) hepatitis B virus (HBV) vaccine; 3 doses of diphtheria, tetanus, pertussis, hepatitis B, polio, and Haemophilus influenzae type b (DTaP-HB-IPV-Hib) vaccine; 3 doses of inactivated polio vaccine (IPV); and 1 dose of measles, mumps, and rubella (MMR) vaccine. Lot quality assurance sampling (LQAS) is a method used to assess the performance of health quality indicators. Material/Methods A national cross-sectional study with children aged between 12 and 24 months from Kosovo was performed between 2018 and 2020. The vaccination status of children was assessed with lot quality assurance sampling (LQAS) using randomized samples. Results Among 430 children, more than 90% had completed the full immunization schedule. Delays in children’s immunizations were observed. Most vaccinations showed short delays of less than 1 month, followed by delays of up to 3 months. The main reason for vaccination delay was the COVID-19 pandemic, following by child’s illness at the scheduled time of vaccination or the parents were too busy to take the child to the vaccination site. Meanwhile, child age was the only parameter that showed difference among non-vaccinated and fully vaccinated ( P <0.001). Conclusions LQAS analysis showed that between 2018 and 2020 lack of full immunization was due to delay caused by the parent not taking the child to the vaccination site, which may be prevented by improving information given to parents and the use of vaccination reminders.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A National Cross-Sectional Study from the Republic of Kosovo on Lot Quality Assurance Sampling (LQAS) to Evaluate the Vaccination Status of Children Between 12 and 24 Months of Age During 2018 to 2020

Gllareva

Humolli

Rudhani

et al. 2021

Med Sci Monit Basic Res

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“…In Brazil, national data shows a reduction in key infant vaccination dosing in March/April 2020 (when restrictions were greatest) compared to previous years; dose 3 for pentavalent and polio vaccines given at 6 months of age declined by 18% and MMR dosing at 12 months was 27% lower. While rates subsequently improved in May/June, these have not accounted for the earlier shortfall [ 79 ]. Ancillary Brazilian data shows that while 20% of children ≥2 months had missed scheduled vaccinations, disparities exist; missed immunization was more common in poorer families, and more common in the Northern Amazon region and less common in the Southern regions [ 79 ].…”

Section: Disruption To Routine Immunization Servicesmentioning

confidence: 99%

“…While rates subsequently improved in May/June, these have not accounted for the earlier shortfall [ 79 ]. Ancillary Brazilian data shows that while 20% of children ≥2 months had missed scheduled vaccinations, disparities exist; missed immunization was more common in poorer families, and more common in the Northern Amazon region and less common in the Southern regions [ 79 ].…”

Section: Disruption To Routine Immunization Servicesmentioning

confidence: 99%

Impact of COVID-19 pandemic on routine immunization

Ota

Badur²,

Mazzotti

et al. 2021

Annals of Medicine

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The current COVID-19 global pandemic continues to impact healthcare services beyond those directly related to the management of SARS-CoV-2 transmission and disease. We reviewed the published literature to assess the pandemic impact on existing global immunization activities and how the impact may be addressed. Widespread global disruption in routine childhood immunization has impacted a majority of regions and countries, especially in the initial pandemic phases. While data indicate subsequent recovery in immunization rates, a substantial number of vulnerable people remain unvaccinated. The downstream impact may be even greater in resource-limited settings and economically poorer populations, and consequently there are growing concerns around the resurgence of vaccine-preventable diseases, particularly measles. Guidance on how to address immunization deficits are available and continue to evolve, emphasizing the importance of maintaining and restoring routine immunization and necessary mass vaccination campaigns during and after pandemics. In this, collaboration between a broad range of stakeholders (governments, industry, healthcare decision-makers and frontline healthcare professionals) and clear communication and engagement with the public can help achieve these goals. Key messages The COVID-19 pandemic has a substantial impact on essential immunization activities. Disruption to mass vaccination campaigns increase risk of VPD resurgence. Catch-up campaigns are necessary to limit existing shortfalls in vaccine uptake. Guidance to mitigate these effects continues to evolve.

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“…Breaking a trend of increasing childhood vaccination coverage, the poorly understood drop in coverage following 2016 has gained renewed importance due to the re-emergence of measles outbreaks 3. This drop was exacerbated in 2020, with the advent of SARS-CoV-2, when face-to-face attendance at health services dropped dramatically 4…”

Section: Introductionmentioning

confidence: 99%

Effect of a conditional cash transfer programme on infant up-to-date and timely vaccination

Souza

Ferreira

Waldman

et al. 2022

J Epidemiol Community Health

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BackgroundConditional cash transfer (CCT) programmes are one of the strategies to increase vaccination coverage among underprivileged families by conditioning cash transfer to the up-to-date immunisation of children. However, there are gaps in knowledge of its impact on vaccination at the recommended age (timely).MethodsWe performed two cross-sectional analyses of secondary data from a retrospective cohort, at the landmark ages of 12 and 24 months, to assess the effect of the Brazilian CCT on the up-to-date and timely vaccination in children born between 2014 and 2016 and resident in the city of Araraquara, São Paulo (Southeast Brazil). The Propensity Score Matching (PSM) was used to balance two pre-defined groups (beneficiaries and non-beneficiaries) according to the profile of socioeconomic and demographic characteristics.ResultsFrom a total of 7386 children within the cohort, 22.2% (1636) were from beneficiary families of the CCT. After the pairing by PSM, the final sample size included in the analyses was 1440 for each group. We found higher up-to-date vaccination coverage, at 12 (92.1%, 95% CI=90.6% to 93.5%) and 24 months (83.8%, 95% CI=81.8% to 85.7%), among the CCT beneficiaries compared with the non-beneficiaries (85.1%, 95% CI=83.2% to 86.9% at 12 months and 73.6%, 95% CI=71.2% to 75.8% at 24 months). The coverage of timely vaccination did not statistically differ between beneficiaries (41.5%, 95% CI=38.9% to 44.1% and 17.4%, 95% CI=15.4% to 19.4%) and non-beneficiaries (40.7%, 95% CI=38.1% to 43.3% and 17.1%, 95% CI=15.2% to 19.1%) at 12 and 24 months, respectively.ConclusionThe study highlights a positive effect of the CCT on vaccination coverage of the up-to-date infant vaccination schedule. However, there was no difference in timely vaccination.

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Missed childhood immunizations during the COVID-19 pandemic in Brazil: Analyses of routine statistics and of a national household survey

Cited by 65 publications

References 20 publications

A National Cross-Sectional Study from the Republic of Kosovo on Lot Quality Assurance Sampling (LQAS) to Evaluate the Vaccination Status of Children Between 12 and 24 Months of Age During 2018 to 2020

A National Cross-Sectional Study from the Republic of Kosovo on Lot Quality Assurance Sampling (LQAS) to Evaluate the Vaccination Status of Children Between 12 and 24 Months of Age During 2018 to 2020

Impact of COVID-19 pandemic on routine immunization

Effect of a conditional cash transfer programme on infant up-to-date and timely vaccination

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