Vaccination coverage, vaccine hesitancy and factors associated with incomplete vaccination: a household survey conducted with children born between 2017 and 2018 in the inland municipalities of Northeastern Brazil

Cobertura de vacunación, indecisión vacunal y factores asociados a vacunación incompleta: encuesta de hogares en una cohorte de niños nacidos en el período 2017 y 2018 en municipios del interior del Nordeste brasileño

Objective  To analyze vaccination coverage and factors associated with incomplete vaccination in inland municipalities of Northeastern Brazil.

Methods  This was a household survey using cluster sampling conducted in Vitória da Conquista, Bahia state, Caruaru, Pernambuco state, Sobral, Ceará state and Imperatriz, Maranhão state between 2020 and 2022. Vaccination coverage by valid doses and vaccine hesitancy were analyzed, with the odds ratio (OR) estimated and adjusted using logistic regression.

Results  Among 1,847 children, complete vaccination coverage was 49.2% (95%CI 43.9;54.5). Factors associated with incomplete vaccination included: higher income (OR 1.53; 95%CI 1.02;2.31), residence in Sobral (OR 4.35; 95%CI 3.04; 6.21) and >1 child (OR 1.20; 95%CI 1.11;1.32). Parental decision not to vaccinate and difficulties in traveling to vaccination centers contributed to vaccine hesitancy.

Conclusion  Low vaccination coverage and incomplete vaccination were associated with social issues in the socioeconomic strata analyzed.

Keywords
Vaccination Coverage; Vaccine Hesitancy; Mass Vaccination; Immunization Programs; Epidemiological Surveys

Main results  Vaccination coverage of nearly 50%, with incomplete vaccination associated with factors across different social strata, particularly higher income. Vaccine hesitancy is marked by parental decision not to vaccinate and access limitations.

Implications for services  Expanding vaccination coverage should be a priority goal within the healthcare and surveillance network of the SUS in inland municipalities of the Northeast region. Incomplete vaccination requires

Perspectives  The actions of the National Immunization Program need to be strengthened, with context-specific interventions in local territories through microplanning to increase vaccination coverage and reduce vaccine hesitancy.