Hepatitis A vaccination coverage survey in 24-month-old children living in Brazilian capitals, 2020

Moura, Winny Éveny Alves; Caetano, Karlla Antonieta Amorim; Lima, Juliana de Oliveira Roque e; Campos, Lays Rosa; Silva, Grazielle Rosa da Costa e; Moraes, José Cássio de; França, Ana Paula; Domingues, Carla Magda Allan Santos; Teixeira, Maria da Gloria Lima Cruz; Teles, Sheila Araújo; ,; Silva, Adriana Ilha da; Ramos Jr., Alberto Novaes; França, Ana Paula; Oliveira, Andrea de Nazaré Marvão; Boing, Antonio Fernando; Domingues, Carla Magda Allan Santos; Oliveira, Consuelo Silva de; Maciel, Ethel Leonor Noia; Guibu, Ione Aquemi; Mirabal, Isabelle Ribeiro Barbosa; Barbosa, Jaqueline Caracas; Lima, Jaqueline Costa; Moraes, José Cássio de; Luhm, Karin Regina; Caetano, Karlla Antonieta Amorim; Lima, Luisa Helena de Oliveira; Antunes, Maria Bernadete de Cerqueira; Teixeira, Maria da Gloria; Teixeira, Maria Denise de Castro; Borges, Maria Fernanda de Sousa Oliveira; Queiroz, Rejane Christine de Sousa; Gurgel, Ricardo Queiroz; Barata, Rita Barradas; Azevedo, Roberta Nogueira Calandrini de; Oliveira, Sandra Maria do Valle Leone de; Teles, Sheila Araújo; Gama, Silvana Granado Nogueira da; Mengue, Sotero Serrate; Simões, Taynãna César; Nascimento, Valdir; Araújo, Wildo Navegantes de

doi:10.1590/S2237-96222024v33e20231162.en

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 33 (spe2) • 2024 • https://doi.org/10.1590/S2237-96222024v33e20231162.en linkcopy

Hepatitis A vaccination coverage survey in 24-month-old children living in Brazilian capitals, 2020

Encuesta de cobertura de vacunación contra la hepatitis A en niños de 24 meses residentes en las capitales de Brasil, 2020

Authorship Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective To estimate hepatitis A vaccination coverage in 24-month-old children and identify factors associated with non-vaccination.

Methods This was a survey involving a sample stratified by socioeconomic strata in capital cities (2020-2022), with coverage estimates and 95% confidence intervals (95%CI), the factor analysis was performed using the prevalence ratio (PR) by means of Poisson regression.

Results Among 31,001 children, hepatitis A coverage was 88.1% (95%CI 86.8;89.2). Regarding socioeconomic strata (A/B), the variable immigrant parents/guardians was associated with non-vaccination (PR = 1.91; 95%CI 1.09;3.37); in strata C/D, children of Asian race/skin color (PR = 4.69; 95%CI 2.30;9.57), fourth-born child or later (PR = 1.68; 95%CI 1.06;2 .66), not attending daycare/nursery (PR = 1.67; 95%CI 1.24;2.24) and mother with paid work (PR = 1.42; 95%CI 1.16;1.74) were associated with non-vaccination.

Conclusion Hepatitis A coverage was below the target (95%), suggesting that specificities of social strata should be taken into consideration.

Keywords Vaccination Coverage; Immunization Programs; Hepatitis A Vaccines; Child; Socioeconomic Factors; Epidemiological Surveys

Study contributions

Main results Hepatitis A vaccination coverage was 88%. Non-vaccination was greater in children with immigrant guardians (strata A/B); of Asian race/skin color, fourth-born child or later, those not attending daycare/nursery and mother with paid work (C/D strata).

Implications for services The results of this study contributed to the Ministry of Health and Health Departments in monitoring vaccination coverage and identifying factors that may negatively impact hepatitis A vaccination coverage.

Perspectives Further research is needed on the impact of migration on hepatitis A vaccination and vaccination in general. Health managers should be attentive to the different factors affecting vaccination among social strata.

Variable	%	Yes (%)	PR (95%CI)^a	p-value	Adjusted PR (95%CI )	p-value
Child’s sex
Male	14.8	85.2	1.00
Female	14.9	85.1	1.01 (0.74;1.36)	0.966
Birth order
First-born	13.4	86.6	1.00		1.00
Second-born	16.7	83.3	1.25 (0.88;1.76)		1.16 (0.79;1.70)
Third-born	15.1	84.9	1.13 (0.71;1.80)	0.159	1.14 (0.78;1.67)	0.115
Fourth-born or more	19.1	80.9	1.43 (0.83;2.46)		1.84 (1.06;3.18)
Child’s race/skin color
White	15.5	84.5	1.00
Black	11.7	88.3	0.75 (0.44;1.28)
Mixed-race	13.8	86.2	0.89 (0.68;1.17)	0.286
Asian	7.0	93.0	0.45 (0.13;1.55)
Indigenous	21.3	78.7	1.37 (0.59;3.20)
Attends daycare/school
Yes	13.5	86.5	1.00
No	16.3	83.7	1.21 (0.90;1.61)	0.199
Up to 1,000.00	13.8	86.2	1.00
1,001.00 - 3,000.00	16.9	83.1	1.23 (0.87;1.73)
3,001.00 - 8,000.00	10.0	90.0	0.72 (0.45;1.18)	0.100
> 8,000.00	11.1	88.9	0.81 (0.49;1.31)
Beneficiary of Bolsa Família Program
Yes	14.1	85.9	1.00
No	14.9	85.1	1.06 (0.78;1.45)	0.712
Mother’s schooling (years)
≤ 8	18.3	81.7	1.00
9 - 12	14.8	85.2	0.81 (0.44;1.49)
13 - 15	11.6	88.4	0.64 (0.36;1.12)	0.647
≥ 16	15.2	84.8	0.83 (0.47;1.45)
Mother’s age (years) at child’s birth
< 20	6.7	93.3	1.00
20 to 34	14.8	85.2	2.20 (0.99;4.90)	0.718
35 or more	14.9	85.1	2.22 (0.99;4.97)
Mother’s race/skin color
White	16.7	83.3	1.00		1.00
Black	6.8	93.2	0.40 (0.25;0.67)		0.34 (0.19;0.62)
Mixed-race	12.0	88.0	0.72 (0.53;0.98)	0.012	0.67 (0.48;0.95)	0.045
Asian	6.4	93.6	0.38 (0.14;1.02)		0.81 (0.30;2.16)
Indigenous	12.9	87.1	0.77 (0.28-2.11)		0.65 (0.23-1.81)
Mother has paid work
Yes	14.7	85.3	1.00
No	14.2	85.8	0.97 (0.67;1.40)	0.855
Immigrant guardian
No	14.6	85.4	1.00		1.00
Yes	36.5	63.5	2.49 (1.24;4.99)	0.010	1.91 (1.09;3.37)	0.037
Marital status
With a partner	14.1	85.9	1.00
Without a partner	15.0	85.0	1.06 (0.76;1.50)	0.719

Variable	%	Yes (%)	PR (95%CI ) ^a	p-value	Adjusted PR (95%CI )	p-value
Child’s sex
Male	10.7	89.3	1.00
Female	11.4	88.6	1.01 (0.86;1.32)	0.574
Birth order
First-born	9.5	90.5	1.00		1.00
Second-born	10.1	89.1	1.14 (0.90;1.44)		1.31 (1.05;1.64)
Third-born	12.3	87.7	1.29 (0.94;1.76)	0.002	1.54 (1.11; 2.13)	0.003
Fourth-born or more	16.9	83.1	1.77 (1.22;2.56)		1.68 (1.06;2.66)
Child’s race/skin color
White	9.5	90.5	1.00		1.00
Black	11.6	88.4	1.22 (0.87;1.70)		1.14 (0.79;1.65)
Mixed-race	12.2	87.8	1.28 (1.03;1.59)	0.007	1.03 (0.81;1.31)
Asian	35.3	64.7	3.70 (1.87;7.32)		4.69 (2.30;9.57)	0.371
Indigenous	7.7	92.3	0.81 (0.28;2.34)		0.57 (0.20;1.65)
Attends daycare/school
Yes	9.1	90.9	1.00		1.00
No	12.8	87.2	1.40 (1.09;1.79)	0.008	1.67 (1.24;2.24)	0.001
Family income (BRL)
Up to 1,000.00	12.2	87.8	1.00
1,001.00 - 3,000.00	10.1	89.9	0.82 (0.64;1.07)
3,001.00 - 8,000.00	8.4	91.6	0.69 (0.48;0.99)	0.003
> 8,000.00	6.1	93.9	0.50 (0.30;0.83)
Beneficiary of Bolsa Família Program
Yes	9.9	90.1	1.00
No	11.4	88.6	1.15 (0.92;1.44)	0.214
Mother’s schooling (years)
≤ 8	13.0	87.0	1.00
9 - 12	13.2	86.8	1.01 (0.74;1.39)
13 - 15	10.0	90.0	0.77 (0.54;1.10)	0.010
≥ 16	8.3	91.7	0.64 (0.41;0.98)
Mother’s age (years) at child’s birth
< 20 years	10.8	89.2	1.00
20 to 34 years old	12.4	87.6	1.15 (0.73;1.81)	0.009
35 years or older	8.8	91.2	0.81 (0.49;1.34)
Mother’s race/skin color
White	8.7	91.3	1.00		1.00
Black	11.7	88.3	0.40 (0.25;0.67)		1.34 (0.97;1.85)
Mixed-race	12.0	88.0	0.72 (0.53;0.98)		1.37 (1.07;1.76)
Asian	13.5	86.5	0.38 (0.14;1.02)	0.012	1.55 (0.59;4.08)
Indigenous	10.1	89.9	0.77 (0.28-2.11)		1.16 (0.46;2.91)
Mother has paid work
Yes	11.9	88.1	1.28 (1.05;1.55)	0.012	1.42 (1.16;1.74)	0.001
No	9.3	90.7	1.00		1.00
Immigrant guardian
No	11.0	89.0	1.00
Yes	17.9	82.1	1.63 (0.87;3.08)	0.128
Marital status
With a partner	10.4	89.6	1.00
Without a partner	11.1	88.9	1.07 (0.84;1.35)	0.576

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