TY - JOUR
T1 - Missed childhood immunizations during the COVID-19 pandemic in Brazil
T2 - Analyses of routine statistics and of a national household survey
AU - Silveira, Mariangela F.
AU - Tonial, Cristian T.
AU - Goretti K. Maranhão, Ana
AU - Teixeira, Antonia M.S.
AU - Hallal, Pedro C.
AU - Maria B. Menezes, Ana
AU - Horta, Bernardo L.
AU - Hartwig, Fernando P.
AU - Barros, Aluisio J.D.
AU - Victora, Cesar G.
N1 - Funding Information:
The study was funded by the Brazilian Ministry of Health, “Todos pela Saúde” Group, Instituto Serrapilheira, Brazilian Collective Health Association (ABRASCO) and the JBS S.A. initiative ‘Fazer o Bem Faz Bem’.
Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/6/8
Y1 - 2021/6/8
N2 - Introduction: There is widespread concern that disruption to health services during the COVID-19 pandemic has led to declines in immunization coverage among young children, but there is limited information on the magnitude of such impact. High immunization coverage is essential for reducing the risk of vaccine preventable diseases. Methods: We used data from two nationwide sources covering the whole of Brazil. Data from the Information System of the National Immunization Program (SIPNI) on the monthly number of vaccine doses administered to young children were analyzed. The second source was a survey in 133 large cities in the 27 states in the country, carried out from August 24–27. Respondents answered a question on whether children under the age of three years had missed any scheduled vaccinations during the pandemic, and available vaccination cards were photographed for later examination. Results: SIPNI data showed that, relative to January and February 2020, there was a decline of about 20% in vaccines administered to children aged two months or older during March and April, when social distancing was at the highest level in the country. After May, vaccination levels returned to pre-pandemic values. Survey data, based on the interviews and on examination of the vaccine cards, showed that 19.0% (95% CI 17.0;21.1%) and 20.6% (95% CI 19.0;23.1%) of children, respectively, had missed immunizations. Missed doses were most common in the North (Amazon) region and least common in the South and Southeast, and also more common among children from poor than from wealthy families. Interpretation: Our results show that the pandemic was associated with a reduction of about 20% in child vaccinations, but this was reverted in recent months. Children from poor families and from the least developed regions of the country were most affected. There is an urgent need to booster immunization activities in the country to compensate for missed doses, and to reduce geographic and socioeconomic inequalities.
AB - Introduction: There is widespread concern that disruption to health services during the COVID-19 pandemic has led to declines in immunization coverage among young children, but there is limited information on the magnitude of such impact. High immunization coverage is essential for reducing the risk of vaccine preventable diseases. Methods: We used data from two nationwide sources covering the whole of Brazil. Data from the Information System of the National Immunization Program (SIPNI) on the monthly number of vaccine doses administered to young children were analyzed. The second source was a survey in 133 large cities in the 27 states in the country, carried out from August 24–27. Respondents answered a question on whether children under the age of three years had missed any scheduled vaccinations during the pandemic, and available vaccination cards were photographed for later examination. Results: SIPNI data showed that, relative to January and February 2020, there was a decline of about 20% in vaccines administered to children aged two months or older during March and April, when social distancing was at the highest level in the country. After May, vaccination levels returned to pre-pandemic values. Survey data, based on the interviews and on examination of the vaccine cards, showed that 19.0% (95% CI 17.0;21.1%) and 20.6% (95% CI 19.0;23.1%) of children, respectively, had missed immunizations. Missed doses were most common in the North (Amazon) region and least common in the South and Southeast, and also more common among children from poor than from wealthy families. Interpretation: Our results show that the pandemic was associated with a reduction of about 20% in child vaccinations, but this was reverted in recent months. Children from poor families and from the least developed regions of the country were most affected. There is an urgent need to booster immunization activities in the country to compensate for missed doses, and to reduce geographic and socioeconomic inequalities.
KW - Covid – 19
KW - Economic status
KW - Immunization coverage
KW - Public health
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U2 - 10.1016/j.vaccine.2021.04.046
DO - 10.1016/j.vaccine.2021.04.046
M3 - Article
C2 - 33941406
AN - SCOPUS:85105026058
SN - 0264-410X
VL - 39
SP - 3404
EP - 3409
JO - Vaccine
JF - Vaccine
IS - 25
ER -