ORIGINAL ARTICLE

doi 10.1590/S2237-96222024v33e20231308.especial2.en

Vaccine coverage by social strata in state capitals in

the Brazilian Midwest region: a household survey of
children born in 2017 and 2018

Coberturas vacinais por estrato social nas capitais da região Centro-Oeste do

Brasil: inquérito domiciliar em coorte de crianças nascidas em 2017 e 2018
Cobertura vacunal por estrato social en las capitales de la región
Centro-Oeste de Brasil: encuesta de hogares en una cohorte de niños nacidos
en 2017 y 2018

Jaqueline Costa Lima1 , Érica Marvila Garcia2 , Sandra Maria do Valle Leone de Oliveira3 ,
Wildo Navegantes de Araújo 4
, Emmanuela Maria de Freitas Lopes 5
, Sheila Araújo Teles 6
,
Karlla Antonieta Amorim Caetano6 , Ana Izabel Passarela Teixeira7 ,
Bárbara Manuella Cardoso Sodré Alves8 , Ana Paula França9 , José Cássio de Moraes9 ,
Carla Magda Allan Santos Domingues10 , ICV 2020 Group*

1
Universidade Federal de Mato Grosso, Faculdade de Enfermagem, Cuiabá, MT, Brazil
2
Secretaria de Saúde de Marataízes, Vigilância em Saúde, Espírito Santo, ES, Brazil
3
Fundação Oswaldo Cruz, Campo Grande, MS, Brazil
4
Universidade de Brasília, Faculdade de Ceilândia, Brasília, DF, Brazil
Secretaria Municipal de Saúde, Programa de Pós-graduação em Doenças Infecciosas e Parasitárias,
5

Campo Grande, MS, Brazil

6
Universidade Federal de Goiás, Goiânia, GO, Brazil
7
Universidade Federal de Mato Grosso do Sul, Paranaíba, MS, Brazil
8
Laboratório de Estudos Farmacêuticos, Universidade de Brasília, Brasília, DF, Brazil
9
Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Saúde Coletiva, São
Paulo, SP, Brazil
10
Organização Pan-Americana da Saúde, Brasília, DF, Brazil

ABSTRACT

Objective: To analyze full vaccination coverage in live births in 2017 and 2018 in the capitals of the
Midwest region of Brazil, according to social strata. Methods: Population-based household survey
with cluster sampling. Full coverage in children at 12 and 24 months of age and sociodemographic
factors were analyzed. Results: 5,715 children were analyzed. Full coverage at 12 months of age was
67.9% (95%CI 65.4;70.4), while at 24 months it was 48.2% (95%CI 45.3;51.1). Pneumococcal vaccine
had the highest vaccination coverage (91.3%), while the second dose of rotavirus vaccine had the
lowest (74.2%). In Campo Grande, no vaccine reached coverage above 90%, with BCG (82.9%) and
hepatitis B (82.1%) standing out. Campo Grande and Brasília had the worst vaccination coverage in
the high social stratum (24 months of age). Conclusion: Vaccination coverage in the Midwest was
below 80%, falling short of the recommended target and associated with socioeconomic factors.
Keywords: Immunization Programs; Vaccination Coverage; Socioeconomic Factors; Socioeconomic
Disparities in Health; Population Surveys.

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Vaccination coverage in the Brazilian Midwest region ORIGINAL ARTICLE

INTRODUCTION

Reduction in vaccination coverage (VC) has

Study contributions
been seen worldwide in the last decade.1 Despite
the existence of a Global Vaccine Action Plan, Vaccination coverage at
24 months old among
proposed by the World Health Organization
the Midwest state capitals
(WHO) in 2022, around 14 million children ranged between 39.9% in
living in low- and middle-income countries, Main results Campo Grande and 54.5%
such as Angola, Brazil, Democratic Republic of in Brasília. All vaccination
coverage was below the target
Congo, Ethiopia, India, Indonesia, Mozambique, recommended by the National
Nigeria, Pakistan and the Philippines, did not Immunization Program.
complete their vaccination schedule.2 The results found point to
In Brazil, the drop in vaccination coverage the urgent need for planning
began in 2012, and worsened during the actions aimed at improving
Implications vaccination coverage with
COVID-19 pandemic.3 Between 2019 and 2021, for services targeted approaches,
the 90% desired vaccination coverage for considering social strata and
DPT, measles and pneumococcal vaccination vaccines with lower vaccination
coverage.
was not achieved,3 this being an important
global monitoring indicator def ined by the Future research that
investigates vaccination
2030 Immunization Agenda.4 The cause of
coverage in the Midwest region
such a reduction in vaccination coverage is may assist in understanding
Perspectives
multifaceted and requires an understanding of the low vaccination coverage
public health interventions in Brazil, operability found for most recommended
vaccines, especially in the first
of actions, as well as the regional, national and
24 months of life.
international geographic and political context.5
The history of vaccination implementation
in Brazil dates back to the beginning of the 19th studies have shown large discrepancies
century, when the gradual and free introduction between administrative data and survey data.7,8
of immunobiological products took place. The As such, more than ten years after the last
creation of the National Immunization Program vaccination coverage household survey carried
(PNI), in 1973, was a milestone for public health out in the Brazilian state capital cities,9 there is
in Brazil and changed the epidemiological a need to understand the current panorama
scenario of transmissible infections throughout of vaccination coverage in the Midwest region
the country. After the introduction of the of the country which, although it is a strategic
program, systematized actions to eradicate region, is lacking in scientif ic production.10
vaccine-preventable diseases began, with the We believe that validating these data will
expansion of the supply of vaccines to the entire allow us to identify possible opportunities
Brazilian population.5,6 for improvements in vaccination coverage
Despite signif icant reductions in social indicators, generate hypotheses for new
disparities and improvements in health research and expand knowledge about the
indicators over the last few decades in Brazil, factors that may be related to vaccination. The
administrative data show intra-regional and objective of this study was therefore to analyze
inter-regional differences in vaccination vaccination coverage among children born
coverage in different regions of the country. On in 2017 and 2018, in the state capitals of the
the other hand, validating these results through Midwest region of Brazil, according to social
household surveys is desirable, since previous strata.

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Jaqueline Costa Lima et al. ORIGINAL ARTICLE

METHODS Variables

Study design The study variables were complete and

incomplete valid vaccination coverage at
This is a population-based survey, using
12 and 24 months old, and socioeconomic
data from the Vaccination Coverage Survey
and demographic characteristics, such as:
(Inquérito de Cobertura Vacinal - ICV), on valid
social stratum (A – high, B – medium, C – low,
dose vaccination coverage in the Midwest
D – very low) – defined according to head of
region of Brazil. The ICV survey was conducted
family income and schooling data;12 family
in Brazil’s 26 states and Federal District between
consumption level (high, medium, low, very
September 2020 and Mach 2022.11
low and did not answer) – defined according
to the following cutoff points: high (42 points
Background
and more), medium (27-41 points), low (16-26
The Midwest region is Brazil’s second largest points) and very low (< 16 points);14 household
region in terms of territorial extension and crowding (more than three dwellers sharing
has an estimated population of 16.3 million the same room used as a bedroom); monthly
inhabitants and a population density that varies family income (up to BRL 1,000, BRL 1001 -
from 97.22 inhabitants/km2 in Campo Grande BRL 3,000, BRL 3,001 - BRL 8,000, more than
to 1,776.8 inhabitants/km2 in Goiânia (Box 1).12 Its BRL 8.000, and did not answer); percentage
economy is based on agriculture, livestock and of grandmothers living in the household;
mineral extraction, with significant growth in maternal characteristics: schooling in years of
several sectors.13
study (up to 8 years, 9 - 12 years, 13 - 15 years, 16
years or more, unable or refused to answer);
Participants age group (< 20 years, 20 - 34 years, 35 years
The study population was comprised of or more, unable or refused to answer); self-
children born in 2017 and 2018, who lived in the reported race/skin color (White, Black, mixed
urban area of the state capitals Campo Grande, race, Asian, Indigenous, unable or refused to
Cuiabá and Goiânia, as well as in the urban area answer); percentage of mothers with paid work,
of the Federal District. percentage of mothers with a partner; number

Box 1 – Description of the socioeconomic and demographic characteristics of the four state
capital cities in the Midwest region of Brazil

Sociodemographic characteristics Cuiabá Campo Grande Goiânia Federal District

Populationa 650,912 897,938 1,437,237 2,817,068

Population ≤ 4 years old a

43,647 59,766 83,676 166,848

0.785 0.784 0.799 0.824

HDIa
(very high) (high) (very high) (very high)

GINI indexb 0.5293 0.5070 0.4751 0.6370

Per capita GDPa 42,918.31 33,243.63 33,826.84 87,016.16

Population density a
150.41 111.09 1,970.72 489.01

Infant mortality rate a

12.92 10.29 9.26 9.76

Social Vulnerability Index 0.261 0.27 0.291 0.294

a) 2022 census; b) 2010 census.

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Vaccination coverage in the Brazilian Midwest region ORIGINAL ARTICLE

of children (1 - 3 children, 4 - 7 children and > 7 vaccination coverage (chickenpox and

children); children’s characteristics: sex (female tetravalent); poliomyelitis booster dose (OPV,
and male); birth order (first, second, third, fourth IPV or hexavalent doses administered after
or more, did not answer); race/skin color (White, 1 year old – doses not used in the basic IPV
Black, mixed race, Asian, Indigenous, unable or
schedule); 1st DPT vaccine booster (DPT, 5-in-1,
refused to answer) and percentage of children
hexavalent or Acel administered after 1 year
attending daycare.
old and not used in the basic 5-in-1 vaccine
The following definitions as per Barata et al.
schedule).
(2023) were used in order to analyze vaccination
coverage:11
Data source
– Valid dose: compliance with the schedule
in force taking into account the ages The data sources we used were the
recommended by the official PNI schedule questionnaire prepared to conduct the ICV
and correct intervals between doses. survey, containing the socioeconomic and
– Full vaccination coverage for the f irst 12 demographic variables described above, and
months of life (“basic schedule”) consisted photographs of the children’s vaccination cards,
of the following vaccines: Bacillus Calmette-
containing information about the vaccines
Guérin (BCG), hepatitis B, three doses of
administered.11
5-in-1 vaccine (diphtheria, pertussis, tetanus
+ Hemophilus influenzae type B + hepatitis
B) and three doses of inactivated poliovirus Sample
vaccine (IPV), two doses each of rotavirus, A previously defined complex sample was
meningitis C and pneumococcal vaccine, and
adopted, depending on the number of live
one dose of yellow fever vaccine.
births registered on the Live Birth Information
– Full vaccination coverage at 24 months,
System in 2017 and 2018, the sampling weights
included, in addition to the basic schedule
for which were calculated for each household
vaccines, two doses of MMR (measles,
interviewed. Initially, basic sampling weights
mumps and rubella), one dose each of
hepatitis A, chickenpox and bivalent oral were obtained (inverse of the probabilities
poliovirus vaccine (bOPV); and one dose each of inclusion of the interviewed households),
of DPT booster (diphtheria, pertussis and and then these weights were calibrated to
tetanus), meningitis C, and pneumococcal known population totals. Two to four surveys
vaccine. were conducted in each state capital city in
– When calculating vaccination coverage it Midwest region, namely two in Cuiabá, three
was necessary to group together several in Campo Grande and four in Goiânia and
immunobiological products, as some are Brasília. Refusals, impossibility of conducting
only administered in private services, which the interview after three attempts at different
were also included in the present research.11
times and on different days and impossibility of
Vaccines grouped together were described
locating the expected number of children after
as follows: 5-in-1 vaccination coverage (5-in-1,
an active search throughout the area of the
hexavalent and acellular); IPV vaccination
coverage (IPV and hexavalent); meningitis selected clusters were considered to be losses.11
C vaccination coverage (meningitis C The ICV survey operational procedures, sample
and meningitis ACWY); MMR vaccination calculation and other technical information are
coverage (MMR and tetravalent); chickenpox described in Barata et al., 2023.11

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Jaqueline Costa Lima et al. ORIGINAL ARTICLE

Statistical analysis Brasília, 22.4% (1,281/5,715) from Campo Grande

and 14.3% (814/5,715) from Cuiabá. Of the total,
Vaccination coverage (valid doses) was
22.7% (1,297) belonged to socioeconomic
calculated taking the numerator to be those
stratum A, 25.4% (1,451) to stratum B, 25.9%
children who received all recommended
(1,480) to stratum C and 26.0% (1,487) to stratum
vaccines in the first year of life (including the
D. Of the state capitals studied, losses occurred
yellow fever vaccine), and the denominator
in Cuiabá (9.8%) and in Campo Grande (5.4%).
to be those children born in 2017 and 2018
included in the study, then multiplying by The sociodemographic characteristics of the
100 for the Midwest region state capitals, at 12 participating families, mothers and children
and 24 months old, by social stratum. A 95% included in this study are presented in Table 1.
confidence interval (95%CI) was considered Vaccination coverage for all vaccines in the
when calculating vaccination coverage. The chi- first 12 and 24 months of life in each of the four
square test was used to assess the difference participating cities and by social stratum is
between vaccination coverage in the Midwest shown in Table 2.
region state capitals, at 12 and 24 months Overall valid vaccination coverage for the
old, by social stratum. P-values of < 0.05 were state capitals of the Midwest region in relation
considered to be statistically significant. The to the vaccine schedule recommended for the
difference between the vaccination coverage first 12 months of life, including doses of yellow
for each vaccine was estimated by subtracting fever vaccine, was 67.9% (95%CI 65.4;70.4). When
the Midwest region vaccination coverage as a analyzing by participating cities, the highest
whole from the vaccination coverage of each vaccination coverage was found in Brasília
state capital in the region (referred to as “dif”). (76.3%) (95%CI 72.5;79.8), while the lowest
We used the Stata (version 17) survey data vaccination coverage was found in Cuiabá
analysis module to analyze the data. (60.4%) (95%CI 54.3;66.3). Contrary to what was
observed at 24 months, overall there was no
Ethical aspects statistical difference in vaccination coverage
between social strata.
This study was approved by the Human
Overall valid vaccination coverage for the
Research Ethics Committee of the Instituto de
state capitals of the Midwest region in relation
Saúde Coletiva of the Universidade Federal da
to the vaccine schedule recommended at 24
Bahia, as per Opinion No. 3.366.818, on June
months, including doses of yellow fever vaccine,
4th 2019, and as per Certificate of Submission
was 48.2% (95%CI 45.3;51.1). When analyzing by
for Ethical Appraisal No. 4306919.5.0000.5030;
participating cities, the highest vaccination
and by the Human Research Ethics Committee
coverage for the first 24 months of life was
of the Irmandade da Santa Casa de São Paulo,
found in Brasília (54.5%) (95%CI 49.8;59.1), while
as per Opinion No. 4.380.019, on November 4th
the lowest vaccination coverage was found in
2020, and as per Certificate of Submission for
Campo Grande (39.9%) (95%CI 35.0;45.1) (Table 2).
Ethical Appraisal No. 39412020.0.0000.5479. All
interviewees signed an informed consent form When considering social strata, a statistical
to be interviewed and signed an authorization difference in vaccination coverage at 24 months
for the vaccination cards to be photographed. was found for Campo Grande and Brasília.
In Campo Grande and Brasília, the lowest
vaccination coverage levels were found in
RESULTS
stratum A. In Cuiabá and Goiânia, the poorest
This study included 5,715 children: 31.7% vaccination coverage was in stratum C (31.8%)
(1,811/5,715) from Goiânia, 31.6% (1,809/5,715) from (95%CI 23.5;41.5) and stratum B (37.1 %) (95%CI

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Vaccination coverage in the Brazilian Midwest region ORIGINAL ARTICLE

Table 1 – Sociodemographic characteristics of the families, mothers and children taking part
in the four state capital cities of the Midwest region, Brazil, 2020-2022
Campo Grande Cuiabá Goiânia Brasília
N (%) N (%) N (%) N (%)
Number of families included 1,281 814 1,811 1,809

Social stratum

A 271 (20.4) 131 (21.6) 445 (10.9) 450 (8.6)

B 324 (12.9) 226 (13.7) 447 (14.5) 454 (10.6)

C 343 (9.4) 230 (17.4) 452 (20.7) 455 (31.0)

D 343 (57.3) 227 (47.3) 467 (53.9) 450 (49.8)

Family consumption level

High 61 (5.1) 15 (2.2) 37 (1.8) 286 (8.0)

Medium 431 (23.7) 145 (24.1) 509 (16.0) 765 (31.4)

Low 422 (31.2) 342 (33.9) 770 (51.5) 441 (32.3)

Very low 324 (35.0) 295 (37.4) 445 (28.1) 244 (24.6)

Did not answer 43 (5.0) 17 (2.4) 50 (2.6) 73 (3.7)

Household crowding 87 (7.5) 71 (10.2) 59 (6.9) 84 (9.0)

Monthly family income

Up to BRL 1,000 156 (20.1) 196 (23.7) 85 (12.1) 205 (19.6)

BRL 1,001 - BRL 3,000 419 (34.6) 297 (34.6) 631 (41.1) 368 (30.3)

BRL 3,001 - BRL 8,000 404 (25.0) 147 (26.8) 741 (33.1) 370 (21.4)

Above BRL 8,000 172 (10.5) 57 (6.0) 165 (7.1) 689 (22.1)

Did not answer 130 (9.8) 117 (8.9) 189 (6.6) 177 (6.6)

Grandmother living together 327 (29.2) 231 (24.5) 322 (21.1) 449 (31.1)

Maternal characteristics

Years of schooling

Up to 8 85 (10.0) 36 (5.0) 84 (4.5) 60 (4.7)

9 - 12 152 (16.2) 137 (18.5) 215 (13.) 121 (12.3)

13 - 15 435 (35.2) 367 (42.4) 820 (47.7) 483 (37.5)

16 or more 572 (34.0) 257 (31.7) 642 (31.4) 1091 (42.2)

Unable or refused to answer 37 (4.6) 17 (2.4) 50 (2.6) 54 (3.3)

Age group (years)

< 20 35 (4.5) 22 (3.9) 33 (4.9) 20 (3.2)

20 - 34 689 (55.9) 516 (63.1) 1.172 (68.5) 787 (53.0)

35 or over 553 (39.3) 275 (32.8) 583 (25.4) 997 (43.7)

Unable or refused to answer 4 (0.3) 1 (0.2) 23 (1.2) 5 (0.1)

To be continued

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Jaqueline Costa Lima et al. ORIGINAL ARTICLE

Continuation
Table 1 – Sociodemographic characteristics of the families, mothers and children taking part in
the four state capital cities of the Midwest region, Brazil, 2020-2022
Campo Grande Cuiabá Goiânia Brasília
N (%) N (%) N (%) N (%)
Mother’s self-reported race/skin color

White 690 (46.6) 163 (18.1) 684 (39.6) 838 (36.1)

Black 55 (7.0) 154 (22.8) 117 (8.0) 141 (10.7)

Mixed race 465 (39.5) 473 (55.8) 949 (48.7) 746 (49.7)

Asian 27 (1.6) 8 (0.5) 13 (1.4) 25 (0.8)

Indigenous 6 (0.8) 4 (0.9) 2 (0.4) 6 (0.4)

Unable or refused to answer 38 (4.5) 12 (1.9) 46 (1.9) 53 (2.3)

Paid work 779 (56.0) 429 (56.7) 1,087 (52.4) 1,158 (59.2)

Has a partner 994 (74.2) 618 (82.5) 1,471 (81.8) 1,457 (75.7)

Number of children

1-3 1,159 (87.3) 700 (82.3) 1,650 (89.4) 1,690 (91.3)

4-7 120 (12.6) 110 (17.6) 151 (10.4) 112 (8.3)

>7 1 (0.1) 4 (0.1) 8 (0.2) 2 (0.4)

Children’s characteristics

Sex

Male 651 (53.6) 424 (50.3) 891 (48.4) 909 (50.8)

Female 630 (46.4) 390 (49.7) 920 (51.6) 900 (49.2)

Birth order

First 576 (38.4) 337 (37.9) 841 (44.1) 891 (49.3)

Segundo 441 (35.0) 249 (33.5) 633 (35.3) 621 (30.1)

Third 169 (16.4) 139 (15.6) 212 (13.3) 210 (14.4)

Fourth or more 94 (10.1) 89 (13.0) 124 (6.7) 83 (6.0)

Did not answer 1 (0.02) 0 (0.0) 1 (0.6) 4 (0.2)

Child’s race/skin color

White 834 (59.8) 257 (28.2) 837 (46.9) 1.012 (45.5)

Black 27 (4.1) 91 (11.2) 57 (4.9) 80 (6.4)

Mixed race 396 (34.0) 457 (57.3) 905 (47.0) 687 (47.0)

Asian 16 (1.3) 8 (3.2) 10 (1.1) 16 (0.6)

Indigenous 7 (0.8) 1 (0.04) 1 (0.06) 2 (0.2)

Unable or refused to answer 1 (0.01) 0 (0.0) 1 (0.0) 12 (0.3)

Attends daycare 617 (46.0) 372 (45.2) 678 (31.1) 870 (39.8)

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Vaccination coverage in the Brazilian Midwest region ORIGINAL ARTICLE

Table 2 – Vaccination coverage at the first 12 and 24 months of life, by social strata, in the four
state capitals of the Midwest region of Brazil, 2020-2022
Vaccination coverage Vaccination coverage
at 12 months p-valueb at 24 months p-valueb
(%) (95%CI)a (%) (95%CI)a

Campo Grande 60.7 (54.6;66.5) 39.9 (35.0;45.1)

A 58.4 (44.6;70.9) 25.0 (17.5;34.6)

B 78.1 (65.7;86.8) 0.076 48.3 (38.0;58.7) 0.002

C 59.3 (47.9;69.8) 40.4 (31.5;49.2)

D 57.9 (49.6;65.7) 43.4 (36.6;50.4)

Cuiabá 60.4 (54.3;66.3) 46.2 (39.4;53.2)

A 72.4 (59.4;82.5) 55.9 (42.1;68.9)

B 50.3 (35.7;64.8) 0.055 47.1 (39.1;55.2) 0.050

C 53.6 (42.3;64.6 31.8 (23.5;41.5)

D 62.1 (56.2;67.6) 46.8 (37.3;56.5)

Goiânia 62.1 (57.3;66.6) 47.2 (40.8;53.8)

A 64.7 (44.9;80.5) 43.2 (22.9;66.1)

B 58.2 (51.8;64.4) 0.805 37.1 (29.3;45.6) 0.427

C 60.9 (53.6;67.8) 45.8 (41.0;50.8)

D 63.0 (55.7;69.8) 51.3 (40.8;53.8)

Brasília 76.3 (72.5;79.8) 54.5 (49.8;59.1)

A 75.9 (70.0;80.8) 28.2 (22.7;34.3)

B 73.6 (65.9;80.1) 0.238 29.8 (22.9;37.9) < 0.001

C 80.7 (73.8;86.2) 59.4 (49.5;68.6)

D 74.2 (67.8;79.7) 61.1 (54.3;67.5)

a) (95%CI): 95% confidence interval; b) Pearson’s chi-square test.

29.3;45.6), respectively, while there was no all the Midwest capitals as a whole in relation
statistical signif icance according to social to each of the capitals separately.
stratum in Goiânia (Table 2). We found that in Campo Grande no vaccine
Vaccination coverage for each of the vaccines achieved coverage above 90%, in particular
is shown in Table 3. The highest vaccination vaccines administered at birth: BCG (82.9%; dif
coverage was found for the first dose of the -5.5) and hepatitis B (82.1%; dif -5.3). In Goiânia
pneumococcal vaccine (91.3%) and the lowest and Cuiabá, the second dose of the rotavirus
for the second dose of the rotavirus vaccine vaccine had the poorest coverage (68.7%; dif
(74.2%). We compared vaccination coverage for -5.5 and 74.2%; dif -5.5). In Brasília, coverage of

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Jaqueline Costa Lima et al. ORIGINAL ARTICLE

Table 3 – Vaccination coverage updated for vaccine schedule and differences between coverage in the state capitals and coverage in the
Midwest region of Brazil, 2020-2022
Cities Midwest
PNI Target
Brasília Campo Grande Cuiabá Goiânia Region
Vaccines Vaccination Vaccination Vaccination Vaccination Vaccination Vaccination Difa
coverage Dif a
coverage Difa
coverage Dif a
coverage Dif a
coverage coverage
(%) (%) (%) (%) (%) (%)
BCG 90.9 2.5 82.9 -5.5 90.0 1.6 89.1 0.7 88.4 90 -1.6
Hepatitis B at birth 89.9 2.5 82.1 -5.3 88.9 1.5 87.9 0.5 87.4 95 -7.6
Pentavalent (1st dose) 90.6 -0.1 88.8 -1.9 92.5 1.8 91.4 0.7 90.7 95 -4.3
Pentavalent (2nd dose) 90.1 1.0 86.2 -2.9 90.4 1.3 89.5 0.4 89.1 95 -5.9
Pentavalent (3rd dose) 88.8 2.6 82.5 -3.7 86.1 -0.1 86.3 0.1 86.2 95 -8.8
Inactivated poliovirus vaccine
91.2 0.3 89.7 -1.2 91.8 0.9 91.1 0.2 90.9 95 -4.1
(1st dose)
Inactivated poliovirus vaccine
90.4 0.9 87.6 -1.9 90.5 1.0 89.5 0.0 89.5 95 -5.5
(2nd dose)
Inactivated poliovirus vaccine
89.1 2.0 84.3 -2.8 81.1 -6.0 87.0 -0.1 87.1 95 -7.9
3 (3rd dose)
Rotavirus (1st dose) 88.5 1.6 85.9 -1.0 87.6 0.7 85.8 -1.1 86.9 95 -8.1
Rotavirus (2nd dose) 80.4 6.2 74.6 0.4 72.2 -2.0 68.7 -5.5 74.2 90 -15.8
Meningococcal C (1st dose) 91.4 0.3 89.6 -1.5 93.2 2.1 91.0 -0.1 91.1 95 -4.4
Meningococcal C (2nd dose) 89.6 1.2 86.6 -1.8 88.0 -0.4 88.7 0.3 88.4 95 -6.6
Meningococcal C (3rd dose) 77.5 0.4 72.8 -4.4 78.9 1.8 79.0 1.9 77.1 95 -17.9
Pneumococcal (1st dose) 91.4 0.1 89.9 -1.4 93.2 1.9 91.2 -0.1 91.3 95 -3.7
Pneumococcal (2nd dose) 90.8 1.0 88.1 -1.7 90.5 0.7 89.7 -0.1 89.8 95 -5.2
Pneumococcal (3rd dose) 66.8 -6.0 69.4 -3.4 81.2 8.4 77.3 4.5 72.8 95 -22.2
Yellow fever (1 dose)
st
88.9 2.3 86.3 -1.3 87.8 0.2 87.2 -0.4 87.6 95 -7.4
Measles, mumps and rubella
89.7 1.1 87.2 -1.4 91.2 2.6 87.4 -1.2 88.6 95 -6.4
(1st dose)
Measles, mumps and rubella
86.9 5.2 78.1 -3.6 78.4 -3.3 80.5 -1.2 81.7 95 -13.3
(2nd dose)
Chickenpox (1st dose) 78.1 -0.7 76.8 -2.0 80.3 1.5 80.3 1.5 78.8 95 -16.2
Hepatitis A 89.6 2.5 85.1 -2.0 87.6 0.5 85.8 -2.7 87.1 95 -7.9
Oral poliovirus vaccine (OPV) 84.9 3.3 78.4 -3.2 82.6 1.0 80.2 -1.4 81.6 95 -13.4
Diphtheria, pertussis and
83.4 2.4 80.9 -0.1 79.5 -1.5 79.4 -0.6 81.0 95 -14.0
tetanus (DPT)
a) Difference.

Epidemiol. Serv. Saúde, 33(esp2):e20231308, 2024 9

Vaccination coverage in the Brazilian Midwest region ORIGINAL ARTICLE

the third dose of pneumococcal vaccine (66.8%; vaccination coverage in different regions
dif -6.0) had the poorest performance (Table 3). contributes to the development of strategies
that consider the specificities and needs of
DISCUSSION each location and is in line with the National
Movement for Vaccination, the objective of
Full schedule vaccination coverage at 12 and which is to return to high vaccination coverage
24 months old, with valid doses among children levels in Brazil.19 A study conducted carried out
living in the state capitals of Midwest region by Arroyo et al.,20 investigated areas with a drop
of Brazil, was less than 80% and presented in BCG, polio and MMR vaccination coverage
significant differences between the highest in Brazil and also identified, like this study, a
social strata in Campo Grande and Brasília, at reduction in the number of people vaccinated
24 months. In Goiânia, vaccination coverage at
in the Midwest region, although with a smaller
24 months was not significant, while in Cuiabá
drop than in the rest of Brazil.
it was lower in stratum C, demonstrating
In general, lower vaccination coverage
the region’s heterogeneity. We found that
levels were found in those segments of the
vaccination coverage at 24 months reduced
population with the best living conditions, a
as income increased, except in Cuiabá, where
phenomenon different f rom that found for
the highest vaccination coverage was found in
decades in Brazil in relation to vaccination
socioeconomic stratum A. Similar vaccination
coverage, whereby the population segments
coverage heterogeneity was found by the ICV
survey conducted in 2007 between social strata with poorer living conditions used to have lower
in 13 state capitals of the five Brazilian regions.9,15 vaccination coverage.15,21,22

The Midwest region has shown continuous Socioeconomic and intraregional differences,
development over the last few decades, with a as well as differences in the characteristics of
growth rate of 1.23% per year, more than double children, families and mothers can be seen
the average of 0.52% for Brazil as a whole, with between groups within socioeconomic strata
a high Human Development Index and high and this can impact adherence to vaccination
per capita Gross Domestic Product.12 Despite and, consequently, vaccination coverage.11
these favorable indicators, low vaccination Considering the set of capital cities presented
coverage levels were found in all social strata in this study, the highest vaccination coverage
in the region, with differences between the for the f irst 12 and 24 months of life was
highest and lowest vaccination coverage per found in the city of Brasília. In turn, the lowest
stratum in the same capital. For some authors, vaccination coverage was found in Campo
individuals f rom higher social strata fail to Grande. Brasília is the capital of Brazil and the
vaccinate or vaccinate their children due to most populous city in the Midwest region, with
vaccination hesitancy or recommendations better performance regarding HDI, Gini Index
made by health professionals.15,16 On the other and per capita GDP indicators, in addition
hand, those belonging to lower social strata to having greater health service coverage.12,13
do not get vaccinated due to lack of access These characteristics may have contributed
to health services and lack of knowledge that to its better performance regarding overall
vaccines are important.17,18 vaccination coverage and for most vaccines
Low vaccination coverage was found at 12 recommended for children under 24 months
and 24 months old in all Midwest region state old.
capitals, confirming the risk of resurgence of Valid vaccination coverage for the vaccination
eliminated or controlled diseases and the threat schedule recommended for the first 12 months
to health services in Brazil. Understanding of life, including doses of yellow fever vaccine,

Epidemiol. Serv. Saúde, 33(esp2):e20231308, 2024 10

Jaqueline Costa Lima et al. ORIGINAL ARTICLE

was better than at 24 months of age. The where urban transformation has been more
Brazilian Ministry of Health recommends that intense. The family level data used may help
children have seven medical consultations in to identify these problems to a certain extent,
their first year of life (in the 1st week, in the 1st given the limitations of the classif ication
month, in the 2nd month, in the 4th month, in used.11 Collecting data during the COVID-19
the 6th month, in the 9th month and in the 12th pandemic also impacted response rates. Even
month), and two consultations in their second so, it is noteworthy that the calculation of post-
year of life (in the 12th and 15th months). This stratification sample weights took into account
provides the opportunity for children to be differences in responses between population
vaccinated at the time of medical consultations groups and minimized such differences. The
and consequently improves vaccination study’s strengths include its large sample
coverage performance in the first year of life.23
size, in addition to the methodological rigor
Notwithstanding, a reduction in vaccination
involved in collecting vaccination information.11
coverage was found for those vaccines for
Taking photographs of vaccination cards with
which two or three doses are recommended,
subsequent data entry by professionals with
such as rotavirus, 5-in-1, meningococcal C and
experience in the National Immunization
pneumococcal vaccine, administered in the
Program enabled excellent quality of this
first year of life.
information.
Campo Grande had the poorest vaccination
However, such limitations do not invalidate
coverage at 24 months old age, and the
the results of this study, which point to the
poorest performance for each recommended
great heterogeneity that exists in vaccination
vaccine. Low coverage of vaccines that should
be administered at birth (BCG and hepatitis coverage among children f rom different
B) can be attributed to absence of vaccination social strata living in the capital cities of
rooms in that city’s maternity wards.24 The anti- the Midwest region of Brazil. Furthermore,
vaccine infodemic, characterized by the wide differences were found between the highest
dissemination of false information, with great and lowest vaccination coverage levels per
potential to impact the population’s adherence stratum within the same capitals. It is also
to vaccination, especially after its significant important to emphasize the low vaccination
increase during and after the COVID-19 coverage levels found for the vast majority of
pandemic,25 may also have contributed to the vaccines recommended up to 24 months of
scenario of lower vaccination coverage among life. Investigating factors intrinsic to economic
the Midwest region capital cities. and social variables can contribute to assertive
The results of this study need to be intervention and, consequently, improve
considered in light of its limitations, such as immunization indicators in the Midwest
the demographic census not taking place region of Brazil. Therefore, there is a need for
in 2020, which obliged us to use old data to targeted approaches, taking into consideration
define the socioeconomic strata, which may economic strata and vaccines with lower
have altered the comparisons in some cities coverage.

Epidemiol. Serv. Saúde, 33(esp2):e20231308, 2024 11

Vaccination coverage in the Brazilian Midwest region ORIGINAL ARTICLE

AUTHOR CONTRIBUTIONS
Moraes JC, Santos CMA, França AP, Lima JC, Garcia EM, Araújo WN, Caetano KAAC and Teles SA
contributed to the study concept and design, analysis and interpretation of the results, drafting and critically
reviewing the contents of the manuscript. Oliveira SMVL and Lopes EMF contributed to the study concept,
drafting and critically reviewing the contents of the manuscript. Teixeira AIP and Alves BMCS contributed
to data analysis and interpretation, drafting and critically reviewing the contents of the manuscript. All
the authors have approved the final version of the manuscript and are responsible for all aspects thereof,
including the guarantee of its accuracy and integrity.

CONFLICTS OF INTEREST
The authors have no conflicts of interest to declare.

FUNDING
Brazilian Ministry of Health Department of Science and Technology and Conselho Nacional de
Desenvolvimento Científico e Tecnológico (File No. 404131), grantholder José Cássio de Moraes.

*ICV 2020 GROUP

Adriana Ilha da Silva
Universidade Federal do Espírito Santo, Vitória, ES, Brazil

Alberto Novaes Ramos Jr.

Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil

Ana Paula França

Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil

Andrea de Nazaré Marvão Oliveira

Secretaria de Estado da Saúde do Amapá, Macapá, AP, Brazil

Antonio Fernando Boing

Universidade Federal de Santa Catarina, SC, Brazil

Carla Magda Allan Santos Domingues

Organização Pan-Americana da Saúde, Brasília, DF, Brazil

Consuelo Silva de Oliveira

Instituto Evandro Chagas, Belém, PA, Brazil

Ethel Leonor Noia Maciel

Universidade Federal do Espírito Santo, Vitória, ES, Brazil

Ione Aquemi Guibu

Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Saúde Coletiva, São Paulo, SP, Brazil

Isabelle Ribeiro Barbosa Mirabal

Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil

Jaqueline Caracas Barbosa

Universidade Federal do Ceará, Programa de Pós-Graduação em Saúde Pública, Fortaleza, CE, Brazil

Jaqueline Costa Lima

Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil

José Cássio de Moraes

Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil

Karin Regina Luhm

Universidade Federal do Paraná, Curitiba, PR, Brazil

Karlla Antonieta Amorim Caetano

Universidade Federal de Goiás, Goiânia, GO, Brazil

Epidemiol. Serv. Saúde, 33(esp2):e20231308, 2024 12

Jaqueline Costa Lima et al. ORIGINAL ARTICLE

Luisa Helena de Oliveira Lima

Universidade Federal do Piauí, Teresina, PI, Brazil

Maria Bernadete de Cerqueira Antunes

Universidade de Pernambuco, Faculdade de Ciências Médicas, Pernambuco, PE, Brazil

Maria da Gloria Teixeira

Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil

Maria Denise de Castro Teixeira

Secretaria de Estado da Saúde de Alagoas, Maceió, AL, Brazil

Maria Fernanda de Sousa Oliveira Borges

Universidade Federal do Acre, Rio Branco, AC, Brazil

Rejane Christine de Sousa Queiroz

Universidade Federal do Maranhão, Departamento de Saúde Pública, São Luís, MA, Brazil

Ricardo Queiroz Gurgel

Universidade Federal de Sergipe, Aracaju, SE, Brazil

Rita Barradas Barata

Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Saúde Coletiva, São Paulo, SP, Brazil

Roberta Nogueira Calandrini de Azevedo

Secretaria Municipal de Saúde, Boa Vista, RR, Brazil

Sandra Maria do Valle Leone de Oliveira

Fundação Oswaldo Cruz, Mato Grosso do Sul, Campo Grande, MS, Brazil

Sheila Araújo Teles

Universidade Federal de Goiás, Goiânia, GO, Brazil

Silvana Granado Nogueira da Gama

Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, RJ, Brazil

Sotero Serrate Mengue

Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

Taynãna César Simões

Fundação Oswaldo Cruz, Instituto de Pesquisa René Rachou, Belo Horizonte, MG, Brazil

Valdir Nascimento
Secretaria de Desenvolvimento Ambiental de Rondônia, Porto Velho, RO, Brazil

Wildo Navegantes de Araújo

Universidade de Brasília, Brasília, DF, Brazil

Correspondence: Jaqueline Costa Lima jaquelinelima.ufmt@gmail.com

Received on: 02/02/2024 | Approved on: 30/04/2024
Associate editor: Laylla Ribeiro Macedo

Epidemiol. Serv. Saúde, 33(esp2):e20231308, 2024 13

Vaccination coverage in the Brazilian Midwest region ORIGINAL ARTICLE

REFERENCES
1. World Health Organization (WHO). Progress and Challenges with Achieving Universal Immunization
Coverage. [Internet] Washington: WHO; 2023 [citado em 8 de fevereiro de 2024]. Disponível em:
https://cdn.who.int/media/docs/default-source/immunization/wuenic-progress-and-challenges.
pdf?sfvrsn=b5eb9141_10&download=true
2. World Health Organization (WHO). Immunization Coverage. [Internet] Washington: WHO; 2022
[citado em 25 de março de 2024]. Disponível em: https://www.who.int/news-room/fact-sheets/detail/
immunization-coverage
3. Homma A, Maia MLS, Azevedo ICA, Figueiredo IL, Gomes LB, Pereira CVC, et al. Pela reconquista das
altas vaccination coverage. Cad. Saúde Pública. 2023;39(3);e00240022. doi: https://doi.org/10.1590/0102-
311XPT240022
4. Immunization Agenda 2030 (IA2030). Implementing The Immunization Agenda 2030. [Internet]
Washington: WHO; 2022 [citado em 25 de março de 2024]. Disponível em: https://cdn.who.int/
media/docs/default-source/immunization/strategy/ia2030/ia2030_frameworkforactionv04.
pdf?sfvrsn=e5374082_1&download=true
5. Domingues CMAS, Maranhão AGK, Teixeira AM, Fantinato FFS, Domingues RAS. 46 anos do Programa
Nacional de Imunizações: uma história repleta de conquistas e desafios a serem superados. Cad.
Saúde Pública. 2020;36:e00222919. doi:10.1590/0102-311X00222919
6. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Programa Nacional de Imunizações 30
anos. [Internet] Ministério da Saúde, Secretaria de Vigilância em Saúde – Brasília: Ministério da Saúde,
2003 [citado em 25 de março de 2024]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/
livro_30_anos_pni.pdf
7. Mota E. Inquérito domiciliar de cobertura vacinal: a perspectiva do estudo das desigualdades
sociais no acesso à imunização básica infantil. Rev. bras. epidemiol. 2008. doi: doi:10.1590/S1415-
790X2008000500012
8. Mello MLR, Moraes JC, Barbosa HA, Flannery B. Participação em dias nacionais de vacinação contra
poliomielite: resultados de inquérito de cobertura vacinal em crianças nas 27 capitais brasileiras. Rev.
bras. epidemiol. 2010Jun;13(2):278-88. doi: doi:10.1590/S1415-790X2010000200010
9. Moraes JC et al. Inquérito de Cobertura vacinal nas áreas urbanas das capitais. Centro de Estudos
Augusto Leopoldo Ayrosa Galvão (CEALAG). [Internet]. 2007 [citado em 25 de março de 2024]
Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/inquerito_cobertura_vacinal_urbanas.pdf
10. Alves SMC, Delduque MC, Ginani V, Montagner MI. A expressão da Saúde Coletiva a partir das
instituições do Centro-Oeste: múltiplos olhares. Saude soc. 2023;32:e230355pt. doi: doi:10.1590/S0104-
12902023230355pt
11. Barata RB, França AP, Guibu IA, Vasconcellos MTL, Moraes JC, et al. National Vaccine Coverage Survey
2020: methods and operational aspects. Rev Bras Epidemiol. 2023;26:e230031. doi: 10.1590/1980-
549720230031
12. Instituto Brasileiro de Geografia e Estatística. Censo Brasileiro de 2022. Rio de Janeiro: Instituto
Brasileiro de Geografia e Estatística. 2023 [citado em 30 de outubro de 2023]. Disponível em: https://
cidades.ibge.gov.br/brasil
13. IPEA. Instituto de Pesquisa Econômica e Aplicada. Atlas do Desenvolvimento Humano. [citado em 25
de outubro de 2023]. Disponível em: http://www.atlasbrasil.org.br/.
14. Associação Brasileira de Empresas de Pesquisa (ABEP). Critério de classificação econômica Brasil. 2018
[citado em 13 de fevereiro de 2024]. Disponível em: www.abep.org

Epidemiol. Serv. Saúde, 33(esp2):e20231308, 2024 14

Jaqueline Costa Lima et al. ORIGINAL ARTICLE

15. Barata RB, Ribeiro MCSA, Moraes JC, Flannery B, Group, behalf of the V. C. S. 2007. Socioeconomic
inequalities and vaccination coverage: Results of an immunisation coverage survey in 27 Brazilian
capitals, 2007 e 2008. J Epidemiol Community Health. 2012;66(10);934-941. doi: doi.org/10.1136/jech2011-
200341.
16. Glatman-Freedman A, Nichols K. The effect of social determinants on immunization programs.
Human Vaccines & Immunotherapeutics. 2012;8(3);293-301. doi: 10.4161/hv.19003
17. Buffarini R, Barros FC, Silveira MF. Vaccine coverage within the first year of life and associated factors
with incomplete immunization in a Brazilian birth cohort. Arch Public Health. 2020 Apr 8;78;21. doi:
10.1186/s13690-020-00403-4.
18. Garcia ÉM, Nery Teixeira Palombo C, Waldman EA, Sato APS. Factors Associated with the
Completeness of the Vaccination Schedule of Children at 12 and 24 Months of Age in a Brazilian
Medium-Size Municipality. J Pediatr Nurs. 2021 Sep-Oct;60:e46-e53. doi: 10.1016/j.pedn.2021.02.028.
19. Ministério da Saúde. Ministério da Saúde lança Movimento Nacional pela Vacinação [citado em 7 de
novembro de 2023]. Disponível em: https://www.gov.br/saude/pt-br/assuntos/noticias/2023/fevereiro/
ministerio-da-saude-lanca-movimento-nacional-pela-vacinacao
20. Arroyo LH, Ramos ACV, Yamamura M, Weiller TH, Crispim JA, Cartagena-Ramos D, et al. Áreas com
queda da cobertura vacinal para BCG, poliomielite e tríplice viral no Brasil (2006-2016): mapas da
heterogeneidade regional. Cad Saúde Pública. 2020;36(4):e00015619. doi: 10.1590/0102-311X00015619
21. Pereira MAD, Arroyo LH, Gallardo MDPS, Arcêncio RA, Gusmão JD, Amaral GG, et al. Vaccination
coverage in children under one year of age and associated socioeconomic factors: maps of spatial
heterogeneity. Rev Bras Enferm. 2023 Sep 18;76(4):e20220734. doi: 10.1590/0034-7167-2022-0734.
22. Barata RB, Pereira SM. Desigualdades sociais e cobertura vacinal na cidade de Salvador, Bahia. Rev
bras epidemiol. 2013 Jun;16(2):266-77. doi: 10.1590/S1415-790X2013000200004
23. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Saúde
da criança: crescimento e desenvolvimento [Internet]. Brasília, Brasil. 2012 [citado em 30 de outubro
de 2023]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/saude_crianca_crescimento_
desenvolvimento.pdf
24. Prefeitura de Campo Grande. Locais de vacinação. 2024 [citado em 25 de março de2024]. Disponível
em: https://cartadeservicos.campogrande.ms.gov.br/servicos/?tax=perfil%253D6
25. Garett R, Young SD. Online misinformation and vaccine hesitancy. Transl Behav Med. 2021 Dec
14;11(12):2194-2199. doi: 10.1093/tbm/ibab128.

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Vaccination coverage in the Brazilian Midwest region ORIGINAL ARTICLE

RESUMO

Objetivo: Analisar a cobertura vacinal completa em nascidos vivos em 2017 e 2018, nas capitais
da região Centro-Oeste do Brasil, segundo estratos sociais. Métodos: Inquérito domiciliar de base
populacional com amostragem por conglomerados. Analisou-se a cobertura vacinal completa
em crianças aos 12 e 24 meses de idade e os fatores sociodemográficos. Resultados: Foram
analisadas 5.715 crianças. A cobertura completa aos 12 meses de idade foi 67,9% (IC95% 65,4;70,4)
e aos 24 meses de idade foi 48,2% (IC95% 45,3;51,1). A maior cobertura foi da vacina pneumococo
(91,3%) e a pior da segunda dose da vacina rotavírus (74,2%). Em Campo Grande, nenhuma vacina
alcançou cobertura acima de 90%, destacando-se as vacinas BCG (82,9%) e hepatite B (82,1%).
Campo Grande e Brasília tiveram piores coberturas vacinais no estrato social alto (24 meses de
idade). Conclusão: A cobertura vacinal na região Centro-Oeste foi inferior a 80%, abaixo da meta
preconizada e associada com fatores socioeconômicos.
Palavras-chave: Programas de Imunização; Cobertura Vacinal; Fatores Socioeconômicos;
Desigualdades Sociais em Saúde; Inquéritos Populacionais.

RESUMEN

Objetivo: Evaluar la cobertura vacunal completa en nacidos vivos en 2017 y 2018, en las capitales
de la región Centro-Oeste de Brasil, según estrato social. Métodos: Encuesta poblacional de
hogares con muestreo por conglomerados. Se analizó la cobertura vacunal completo de niños
de 12 y 24 meses de edad e indicadores sociodemográficos. Resultados: Se analizaron 5.715
niños. La cobertura vacunal completa a los 12 meses de edad fue de 67,9% (IC95% 65,4;70,4) y a los
24 meses de edad fue de 48,2% (IC95% 45,3;51,1). La cobertura vacunal más alta fue de la vacuna
antineumocócica (91,3%) y la más baja fue la segunda dosis de la vacuna contra rotavirus (74,2%).
En Campo Grande, ninguna vacuna logró coberturas superiores al 90%, destacándose la vacuna
BCG (82,9%) y la hepatitis B (82,1%). Campo Grande y Brasilia tuvieron las peores coberturas
vacunales en el estrato social alto (24 meses de edad). Conclusión: La cobertura vacunal en la
región Centro-Oeste fue inferior al 80%, por debajo de la meta recomendada y asociada a factores
socioeconómicos.
Palabras clave: Programas de Inmunización; Cobertura vacunal; Factores socioeconómicos;
Desigualdades Sociales en Salud; Encuestas de Población.

Epidemiol. Serv. Saúde, 33(esp2):e20231308, 2024 16