Abstract
Vaccination is an effective strategy to prevent tetanus, and in Portugal this service is provided free of charge. Despite this, immigrants reported lower tetanus vaccination coverage than did Portuguese natives. The objective of this study was to identify sociodemographic, migration-related, and access-to-care factors associated with tetanus vaccination coverage among adult immigrants, using data from the Portuguese National Health Survey 2014. For the sample of 1277 immigrants aged ≥18 years, we estimated self-reported tetanus vaccination within the preceding 10 years and its determinants using complex samples logistic regression. The overall self-reported tetanus vaccination coverage was 79.5% (95% CI: 75.8–82.8). Age (adjusted odd ratio (aOR) per 1 year age increase = 0.97, 95% CI: 0.95–0.99), higher household income per adult (aOR = 0.42, 95% CI: 0.19–0.96), having Portuguese citizenship (aOR = 2.30, 95% CI: 1.25–4.24), having private health insurance (aOR = 1.99, 95% CI: 1.06–3.71), and contact with family/general physician in the last 12 months (aOR = 1.59, 95% CI: 1.01–2.51) were associated with self-reported tetanus vaccination coverage among adult immigrants. We also found significant disparities in coverage between regions of residence. This study identified several determinants associated with self-reported tetanus vaccination coverage among adult immigrants in Portugal. These findings may help policymakers to design specific interventions to increase tetanus vaccination coverage among this population.
Highlights
Widespread vaccination has greatly reduced the burden of tetanus, which is a potentially fatal disease
This vaccination coverage is below the ultimate goal of achieving 100% [3], but is higher than the self-reported tetanus vaccination coverage among immigrants found in other countries, which ranges from 17.0% to Vaccination coverage is an indicator used to measure the performance of immunization programs [19]
Our findings showed that age, household income per adult, region of residence, citizenship, private health insurance, and contact with family/general physician are associated with self-reported tetanus vaccination coverage among adult immigrants
Summary
Widespread vaccination has greatly reduced the burden of tetanus, which is a potentially fatal disease. In countries with a well-established immunization program, tetanus is a rare disease as a result of high vaccination coverage. In several parts of the world this disease remains a health problem where cases tend to occur in individuals without immunity against tetanus due to a lack of vaccination or waning immunity [1,2]. In Portugal, a tetanus-toxoid-containing vaccine was introduced in the national immunization program (NIP) in 1965; and the last case of neonatal tetanus was reported in 1997 [3]. In 2017, the NIP schedule was updated with longer intervals between booster doses with adults receiving Td boosters at 25, 45, and 65 years of age, followed by a dose every 10 years [5]
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