Evaluation of the impact of serogroup C meningococcal disease vaccination program in Brazil and its regions: a population-based study, 2001-2013

Moraes, Camile de; Moraes, José Cássio de; Silva, Gabriela Drummond Marques da; Duarte, Elisabeth Carmen

doi:10.1590/0074-02760160173

Acessibilidade / Reportar erro

Brasil

Memórias do Instituto Oswaldo Cruz

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ARTICLES • Mem. Inst. Oswaldo Cruz 112 (4) • Apr 2017 • https://doi.org/10.1590/0074-02760160173 copy

Evaluation of the impact of serogroup C meningococcal disease vaccination program in Brazil and its regions: a population-based study, 2001-2013

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND

Meningococcal C conjugate (MenC) vaccine was introduced as part of the Brazilian National Immunisation Program in 2010 for children < 1 year of age.

OBJECTIVES

The study objective was to evaluate the impact of this vaccination strategy.

METHODS

An observational, mixed ecological and analytical study was conducted, based on time series panel data from surveillance records (2001-2013).

FINDINGS

A total of 37,538 of meningococcal disease cases were recorded during the study period. Of these, 19,997 were attributed to serogroup C. A decrease in meningococcal disease serogroup C (MDC) incidence among children aged < 1 year [65.2%; 95% confidence interval (CI): 20.5-84.7%] and 1-4 years (46.9%; 95%CI: 14.6-79.1%) were found in the three years following vaccination introduction. Vaccination impact on the reduction of MDC incidence varied from 83.7% (95%CI: 51.1-100.0%) in the Midwest region to 56.7% (95%CI: 37.4-76.0%) in the Northeast region.

MAIN CONCLUSIONS

Vaccination against MDC in Brazil had a positive impact on the population of children aged < 1 year, across all regions, and on the 1-4 year-old cohort. Nevertheless, in our view there is scope for improving the vaccination strategy adopted in Brazil.

meningococcal disease; Neisseria meningitides; serogroup C conjugate vaccine; surveillance; vaccination impact

Region	Age group (years)	Meningococcal disease serogroup C incidence (cases/100,000)

		2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011*	2012*	2013*
	< 1	3.98	2.84	4.67	6.24	6.19	7.71	6.92	7.09	8.78	9.50	4.15	2.82	3.03
	1-4	2.26	1.85	2.18	2.77	2.96	3.13	2.78	3.40	3.89	3.68	3.16	1.70	0.89
Brazil	5-9	0.95	1.06	0.90	1.50	1.41	1.61	1.61	1.71	2.00	2.03	1.87	2.05	1.42
	≥ 10	0.23	0.25	0.26	0.37	0.36	0.38	0.43	0.54	0.62	0.71	0.70	0.71	0.58
	Total	0.53	0.50	0.54	0.76	0.75	0.81	0.81	0.95	1.09	1.15	1.01	0.91	0.70

	< 1	-	-	-	0.49	1.59	-	-	1.86	-	1.63	-	1.30	1.60
	1-4	0.48	0.68	0.27	0.33	0.20	1.21	0.54	-	0.92	0.48	0.70	0.42	0.22
North	5-9	0.18	0.70	0.69	1.16	-	0.23	1.06	0.22	0.56	-	0.22	0.42	0.22
	≥ 10	0.32	0.22	0.17	0.35	0.03	0.20	0.27	0.38	0.47	0.29	0.20	0.29	0.39
	Total	0.31	0.33	0.24	0.45	0.07	0.30	0.38	0.35	0.51	0.30	0.24	0.30	0.38

	< 1	0.00	0.26	1.69	1.47	2.09	3.14	2.37	2.62	4.90	3.11	2.64	1.32	2.55
	1-4	0.93	0.41	0.52	0.57	0.93	0.58	0.90	1.18	1.95	0.91	1.09	0.94	0.50
Northeast	5-9	0.63	0.80	0.41	0.32	0.68	0.71	0.87	0.64	1.45	1.06	1.01	1.19	0.53
	≥ 10	0.17	0.22	0.11	0.22	0.25	0.26	0.28	0.35	0.48	0.61	0.50	0.58	0.41
	Total	0.29	0.30	0.20	0.28	0.38	0.38	0.42	0.48	0.76	0.71	0.62	0.67	0.46

	< 1	4.40	0.00	3.02	4.88	5.66	7.22	8.05	7.64	9.08	4.53	2.65	2.39	1.49
	1-4	1.51	1.62	0.33	0.72	2.64	3.53	2.81	3.30	3.63	3.62	2.13	0.81	0.66
Midwest	5-9	0.42	0.20	0.37	0.74	0.18	0.55	0.98	0.59	1.38	1.21	1.10	0.88	0.41
	≥ 10	0.20	0.12	0.17	0.21	0.18	0.35	0.31	0.41	0.46	0.59	0.45	0.39	0.44
	Total	0.41	0.25	0.26	0.38	0.46	0.72	0.67	0.74	0.89	0.90	0.65	0.48	0.47

	< 1	8.48	6.59	9.17	12.10	11.06	14.93	13.72	12.86	15.65	18.97	7.62	5.16	4.19
	1-4	4.25	3.59	4.60	5.87	5.83	6.17	5.32	6.97	7.27	7.90	6.41	3.38	1.64
Southeast	5-9	1.75	1.85	1.56	2.75	2.86	2.75	2.79	3.48	3.56	3.96	3.61	4.10	3.09
	≥ 10	0.26	0.34	0.41	0.57	0.54	0.56	0.67	0.82	0.92	1.05	1.13	1.10	0.88
	Total	0.81	0.80	0.94	1.29	1.25	1.32	1.33	1.59	1.71	1.92	1.70	1.51	1.13

	< 1	2.24	1.51	2.77	5.00	5.26	3.42	2.05	4.55	4.20	4.85	1.32	0.44	2.79
	1-4	1.40	1.22	1.55	2.14	1.96	1.93	1.90	1.43	1.53	1.11	1.56	0.35	0.41
South	5-9	0.29	0.12	0.60	1.24	0.60	1.99	0.62	0.83	0.23	0.83	0.69	0.47	0.26
	≥ 10	0.20	0.14	0.18	0.16	0.25	0.19	0.17	0.22	0.19	0.19	0.19	0.17	0.18
	Total	0.32	0.24	0.35	0.46	0.47	0.50	0.34	0.40	0.32	0.35	0.32	0.20	0.23

Variables	< 1 year			1-4 years			5-9 years			≥ 10 years

	Coef.	CI 95%	p	Coef.	CI 95%	p	Coef.	CI 95%	p	Coef.	CI 95%	p
BRAZIL
Vaccination: pre-implantation (2001-2009; reference)
Implanted (2010)	-0.21	(-0.64, 0.22)	0.334	-0.09	(-0.20, 0.03)	0.136	0.01	(-0.09, 0.11)	0.873	0.02	(-0.003, 0.04)	0.094
Post-implantation (2011)	-1.13	(-1.59, -0.67)	0.000	-0.27	(-0.39, -0.15)	0.000	-0.06	(-0.17, 0.04)	0.251	-0.003	(-0.03, 0.02)	0.803
Post-implantation (2012)	-1.58	(-2.07, -1.09)	0.000	-0.64	(-0.77, -0.51)	0.000	-0.05	(-0.16, 0.06)	0.366	-0.01	(-0.04, 0.02)	0.448
Post-implantation (2013)	-1.49	(-2.00, -0.97)	0.000	-0.84	(-0.98, -0.70)	0.000	-0.22	(-0.34, -0.10)	0.000	-0.04	(-0.07, -0.005)	0.024
YEAR (2001-2013)	0.14	(0.09, 0.18)	0.000	0.05	(0.04, 0.07)	0.000	0.02	(0.01, 0.04)	0.000	0.01	(0.01, 0.01)	0.000
Trimester (January-March; reference)
2 (April-June)	-0.10	(-0.35, 0.16)	0.457	0.02	(-0.03, 0.07)	0.430	0.01	(-0.04, 0.06)	0.718	0.01	(0.005, 0.02)	0.003
3 (July-September)	0.40	(0.14, 0.66)	0.003	0.15	(0.10, 0.21)	0.000	0.08	(0.03, 0.13)	0.002	0.04	(0.03, 0.05)	0.000
4 (October-December)	0.08	(-0.18, 0.33)	0.560	0.00	(-0.05, 0.06)	0.881	0.01	(-0.03, 0.06)	0.555	0.01	(0.004, 0.02)	0.005
Region of residence (Northeast; reference)
Midwest	0.63	(0.30, 0.96)	0.000	0.30	(0.14, 0.46)	0.000	-0.03	(-0.09, 0.04)	0.411	0.00	(-0.02, 0.02)	0.769
Southeast	2.16	(1.87, 2.44)	0.000	1.10	(0.96, 1.25)	0.000	0.53	(0.46, 0.60)	0.000	0.09	(0.07, 0.11)	0.000
South	0.24	(-0.004, 0.48)	0.054	0.14	(0.02, 0.25)	0.018	-0.03	(-0.09, 0.03)	0.341	-0.04	(-0.05, -0.02)	0.000
NORTHEAST
Pre-implantation (2001-2009; reference)
Implanted (2010)	-0.31	(-0.63, 0.004)	0.053	-0.13	(-0.30, 0.03)	0.111	-0.01	(-0.15, 0.13)	0.881	0.05	(0.02, 0.08)	0.003
Post-implantation (2011-2013)	-0.82	(-1.10, -0.54)	0.000	-0.20	(-0.35, -0.05)	0.011	-0.06	(-0.19, 0.07)	0.351	0.00	(-0.02, 0.03)	0.763
YEAR (2001-2013)	0.12	(0.09, 0.15)	0.000	0.03	(0.01, 0.04)	0.003	0.02	(0.0004, 0.03)	0.044	0.01	(0.004, 0.01)	0.000
Trimester (January-March; reference)
2 (April-June)	-0.14	(-0.44, 0.15)	0.340	-0.08	(-0.17, 0.01)	0.084	-0.03	(-0.10, 0.03)	0.341	0.00	(-0.01, 0.02)	0.636
3 (July-September)	0.13	(-0.11, 0.37)	0.283	-0.03	(-0.13, 0.06)	0.477	0.00	(-0.08, 0.07)	0.930	0.02	(0.01, 0.04)	0.006
4 (October-December)	0.10	(-0.19, 0.40)	0.486	-0.08	(-0.17, 0.02)	0.110	-0.03	(-0.09, 0.04)	0.426	0.00	(-0.01, 0.02)	0.694
MIDWEST
Pre-implantation (2001-2009; reference)
Implanted (2010)	-1.27	(-2.29, -0.24)	0.016	-0.05	(-0.47, 0.37)	0.801	0.04	(-0.14, 0.22)	0.632	0.03	(-0.02, 0.08)	0.241
Post-implantation (2011-2013)	-2.33	(3.24, -1.43)	0.000	-0.82	(-1.20, -0.43)	0.000	-0.10	(-0.27, 0.06)	0.216	-0.03	(-0.08, 0.02)	0.265
YEAR (2001-2013)	0.21	(0.11, 0.32)	0.000	0.08	(0.04, 0.12)	0.000	0.02	(0.003, 0.04)	0.023	0.01	(0.004, 0.02)	0.001
Trimester (January-March; reference)
2 (April-June)	0.20	(-0.61, 1.01)	0.628	-0.09	(-0.35, 0.17)	0.499	-0.05	(-0.16, 0.06)	0.398	0.01	(-0.02, 0.03)	0.711
3 (July-September)	0.11	(-0.62, 0.84)	0.759	0.22	(-0.05, 0.48)	0.104	0.05	(-0.07, 0.16)	0.423	0.04	(0.01, 0.07)	0.014
4 (October-December)	-0.23	(-1.04, 0.57)	0.571	-0.12	(-0.38, 0.15)	0.385	-0.04	(-0.16, 0.07)	0.451	0.00	(-0.03, 0.03)	0.894
SOUTHEAST
Pre-implantation (2001-2009; reference)
Implanted (2010)	0.70	(-0.16, 1.56)	0.108	-0.04	(-0.53, 0.46)	0.883	0.08	(-0.13, 0.28)	0.469	0.02	(-0.03, 0.07)	0.374
Post-implantation (2011-2013)	-3.08	(-3.87, -2.29)	0.000	-0.86	(-1.44, -0.27)	0.004	-0.15	(-0.35, 0.05)	0.154	-0.02	(-0.08, 0.03)	0.424
YEAR (2001-2013)	0.23	(0.14, 0.32)	0.000	0.06	(-0.01, 0.13)	0.096	0.06	(0.03, 0.08)	0.000	0.02	(0.01, 0.02)	0.000
Trimester (January-March; reference)
2 (April-June)	-0.19	(-0.69, 0.30)	0.451	0.27	(0.11, 0.42)	0.001	0.15	(0.06, 0.25)	0.002	0.05	(0.03, 0.06)	0.000
3 (July-September)	0.88	(0.37, 1.40)	0.001	0.44	(0.27, 0.62)	0.000	0.30	(0.19, 0.40)	0.000	0.08	(0.06, 0.10)	0.000
4 (October-December)	0.04	(-0.45, 0.54)	0.865	0.15	(-0.01, 0.31)	0.059	0.15	(0.06, 0.25)	0.002	0.04	(0.02, 0.06)	0.000
SOUTH
Pre-implantation (2001-2009; reference)
Implanted (2010)	0.05	(-0.52, 0.62)	0.863	-0.15	(-0.42, 0.12)	0.274	0.01	(-0.19, 0.21)	0.945	0.00	(-0.03, 0.02)	0.718
Post-implantation (2011-2013)	-0.96	(-1.46, -0.45)	0.000	-0.24	(-0.48, 0.00)	0.052	-0.11	(-0.29, 0.08)	0.269	-0.01	(-0.03, 0.01)	0.514
YEAR (2001-2013)	0.06	(0.00, 0.12)	0.036	0.00	(-0.03, 0.03)	0.876	0.01	(-0.01, 0.03)	0.517	0.00	(-0.002, 0.003)	0.509
Trimester (January-March; reference)
2 (April-June)	-0.02	(-0.57, 0.52)	0.930	0.03	(-0.17, 0.22)	0.798	0.05	(-0.05, 0.15)	0.360	0.01	(-0.01, 0.02)	0.355
3 (July-September)	0.77	(0.34, 1.21)	0.000	0.14	(-0.05, 0.32)	0.140	0.13	(0.02, 0.24)	0.023	0.02	(0.01, 0.04)	0.002
4 (October-December)	0.21	(-0.33, 0.75)	0.452	0.16	(-0.04, 0.35)	0.113	0.06	(-0.04, 0.16)	0.258	0.01	(-0.01, 0.03)	0.173

Brazil	< 1 year		1-4 years

	Variation in MDC cases (%)	CI 95%	Variation in MDC cases (%)	CI 95%
2010	1.5	(119.6, 22.5)	-4.2	(-23.2, 14.8)
2011	-54.6	(-75.3, -33.8)	-21.8	(-40.8, -2.8)
2012	-70.9	(-91.7, -50.2)	-57.6	(-76.8, -38.4)
2013	-70.7	(-91.6, -49.8)	-74.5	(-92.7, -56.2)
2011-2013	-65.7	(-86.5, -44.9)	-51.8	(-70.6, -33.0)
Northeast
2010	-28.2	(-52.5, -3.9)	-44.8	(-90.9, 1.2)
2011-2013	-56.7	(-76.0, -37.4)	-55.0	(-97.2, -12.9)
Midwest
2010	-55.0	(-97.0, -13.1)	-9.4	(-46.5, 27.8)
2011-2013	-83.7	(-100.0, -51.1)	-73.4	(-100.0, -39.1)
Southeast
2010	13.5	(-2.7, 29.7)	4.5	(-6.8, 15.8)
2011-2013	-65.4	(-82.2, -12.2)	-42.9	(-72.3, -13.5)
South
2010	4.2	(-34.7, 43.0)	-32.6	(-75.5, 10.3)
2011-2013	-60.1	(-91.7, -28.5)	-44.0	(-88.4, 0.4)

Instituto Oswaldo Cruz, Ministério da Saúde Av. Brasil, 4365 - Pavilhão Mourisco, Manguinhos, 21040-900 Rio de Janeiro RJ Brazil, Tel.: (55 21) 2562-1222, Fax: (55 21) 2562 1220 - Rio de Janeiro - RJ - Brazil
E-mail: memorias@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] + Corresponding author: mcamile@gmail.com