Vaccination Coverage and Compliance with Three Recommended Schedules of 10-Valent Pneumococcal Conjugate Vaccine during the First Year of Its Introduction in Brazil: A Cross-Sectional Study.

Fabricia Oliveira Saraiva,Maria Aparecida Da Silva Vieira,Ana Lucia Andrade,Ana Luiza Bierrenbach,Ruth Minamisava,Ulla Kou Griffiths

doi:10.1371/journal.pone.0128656

Fabricia Oliveira Saraiva, Maria Aparecida Da Silva Vieira + Show 4 more

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https://doi.org/10.1371/journal.pone.0128656

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Journal: PloS one	Publication Date: Jun 10, 2015
Citations: 25	License type: CC BY 4.0

Affiliation: Universidade Federal de Goiás, Hospital Sírio-Libanês

Abstract

Pneumococcal 10-valent conjugate vaccine (PCV10) was introduced to Brazil’s National Immunization Program (NIP) in 2010. During the first year of vaccine introduction three schedules were used to deal with age at initiation of PCV for catch-up purposes: 3 primary doses + 1 booster (for children aged ≤6 months), a catch-up schedule of 2 doses + 1 booster (7-11 months), and a catch-up schedule of a single dose (12-15 months). The purpose of this study was to assess the magnitude and associated risk factors for under-vaccination or lack of on time vaccination six to eight months after PCV10 introduction. A household survey was conducted in the municipality of Goiania with 1,237 children, who were retroactively classified into one of three age groups, as a factor of the child’s age relatively to 30 days after PCV10 introduction. Socioeconomic characteristics and vaccination dates were obtained during home interviews. Vaccination coverage was defined as the percentage of children who completed the recommended number of doses. Compliance with recommended schedules was defined as the percentage of children who received all valid doses at the NIP recommended time interval. Adjusted prevalence ratios (PR) of variables independently associated with coverage and compliance were estimated by log binomial regression. Coverage of DTP-Hib was used for comparison purposes. Overall, vaccination coverage was 54.6% (95% CI 52.1-57.7%), lower than DTP-Hib coverage (93.0%; 95% CI 91.5-94.3%). Compliance with recommended schedules was 16.8% (95% CI: 14.7-18.6%). Children 7-11 months old had lower coverage (40.7%) and compliance (6.3%) compared to children aged 12-15 months (coverage: 88.8%; compliance: 35.6%) and ≤6 months old (coverage: 54%; compliance: 18.8%). Having private health insurance was associated with higher PCV10 coverage (PR=1.25; 95% CI: 1.06-1.47, p=0.007), and compliance (PR=1.09; 95% CI: 1.02-1.16, p=0.015). Although PCV10 coverage rapidly increased shortly after vaccination introduction, it was not matched by compliance with recommended schedules. Public initiatives should target compliance of PCV10 because of the burden of pneumococcal diseases on childhood morbidity and mortality.

Highlights

Infections caused by Streptococcus pneumoniae are a major cause of morbidity and mortality worldwide, being the leading cause of bacterial pneumonia, meningitis, and sepsis in children [1]
Administration of vaccines is recorded both in the child’s vaccination card and in Goiania’s immunization register immediately after vaccine administration, resulting in a real-time online database of individual-level vaccine uptake registered by all public immunization providers, which can be searched by vaccination staff, should the child’s parent or legal guardian come to the immunization room without the vaccination card
We found that a sample size of 594 children would be necessary to assess vaccination coverage, which is less than half the number of 1,237 children included in the final sample of this study

Summary

Introduction

Infections caused by Streptococcus pneumoniae are a major cause of morbidity and mortality worldwide, being the leading cause of bacterial pneumonia, meningitis, and sepsis in children [1]. Children living in lower socioeconomic conditions are at higher risk for pneumococcal diseases, especially pneumonia [2,3,4]. To reduce the burden of such diseases, the inclusion of pneumococcal conjugate vaccines in childhood immunization programs has been recommended as a priority strategy by the World Health Organization/WHO [5]. Following the WHO recommendation, Brazil’s National Immunization Program (NIP) included 10-valent pneumococcal conjugate vaccine (PCV10) in the routine immunization calendar free of charge for all children on June 2010. This vaccine includes 1, 4, 5, 6B 7F, 9V, 14, 18C, 19F, and 23F [5]. The 13 valent pneumococcal vaccine (PCV13) is available in Brazil at private services only, and includes all serotypes in PCV10, with the addition of 3, 6A and 19A [5]

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