Policy Approaches for Increasing Adolescent HPV Vaccination Coverage: A Systematic Review.

CONTEXT: US jurisdictions have enacted a wide range of policies to address low human papillomavirus (HPV) vaccination coverage among adolescents, but it is unclear which policies are effective. OBJECTIVE: To systematically review the impact of governmental policies on adolescent HPV vaccination coverage. DATA SOURCES: PubMed, Embase, and Scopus databases. STUDY SELECTION: Eligible studies, published from 2009 to 2022, evaluated the impact of governmental policies on HPV vaccination coverage among adolescents ages 9 to 18. DATA EXTRACTION: Two investigators independently extracted data on study sample, study design and quality, policy characteristics, and HPV vaccination outcomes. We summarized findings by policy type: school-entry requirements (SERs), federally-funded policies related to the Vaccines for Children program and Medicaid, educational requirements, and others. RESULTS: Our search yielded 36 eligible studies. A majority of studies evaluating HPV vaccine SERs found positive associations between SERs and HPV vaccination coverage (8 of 14), particularly for SERs in Rhode Island and Washington, DC. All studies evaluating SERs for other adolescent vaccines observed positive spillover effects for HPV vaccination (7 of 7). Federally-funded policies related to Vaccines for Children and Medicaid were consistently associated with higher HPV vaccination coverage (7 of 9). Relatively few studies found associations between educational requirements and HPV vaccination coverage (2 of 8). LIMITATIONS: Studies used limited vaccination data sources and non- or quasi-experimental designs. Some studies had no or poorly matched comparison groups. CONCLUSIONS: Our findings suggest promise for SERs and federally-funded policies, but not educational requirements, for increasing HPV vaccination coverage among adolescents.

Agrupamento dos municípios goianos pela cobertura vacinal / Grouping of municipalities in Goiás by vaccination coverage

Análise de agrupamento com o objetivo de proporcionar uma nova visualização da cobertura vacinal atingida pelos municípios e possibilitar uma maior flexibilidade na avaliação do alcance da meta proposta, de modo a canalizar os esforços para a solução de problemas relacionados à baixa cobertura, direcionando as ações para aqueles municípios que carecem de maior atenção. Trata-se de um método exploratório multivariado, cuja finalidade é explorar os grupos que naturalmente se formam dentro de um conjunto de dados conhecidos

Cluster analysis with the aim of providing a new visualization of the vaccination coverage achieved by municipalities and enabling greater flexibility in assessing the achievement of the proposed target, in order to channel efforts towards solving problems related to low coverage, directing actions towards those municipalities that require greater attention. This is a multivariate exploratory method, whose purpose is to explore the groups that naturally form within a set of known data

Human papillomavirus (HPV) vaccination: a call for action in Italy.

Human papillomavirus (HPV) is the most common sexually transmitted infection. The implementation of primary prevention aims to reduce the burden of HPV infection and HPV-related disease. However, HPV-related diseases are still a concern, even in high-income countries. Approximately 570 000 new cervical cancer cases are diagnosed in Italy every year. Prophylactic HPV vaccines have been developed to minimize the spread of HPV. Growing evidence supports the administration of HPV vaccines (even just one dose) in reducing the prevalence of HPV infection and HPV-related disease including cancers. HPV vaccines are characterized by a high level of efficacy (>95%) in women who are naïve to HPV; however, they do not increase clearance in patients with ongoing HPV infection. With more than 200 million doses administered to date, HPV vaccines are considered to be safe and effective at preventing HPV-related infections and cancers. In this review we aim to review the current evidence regarding HPV vaccination and to describe trends in HPV vaccination coverage in Italy. In Italy, vaccination against HPV has been included in the National Immunization Plan (NIP) since 2007-2008. Using data abstracted from the Italian Ministry of Health, we analyzed changes in HPV vaccination coverage. We observed that HPV vaccines are underutilized and coverage rates are decreasing. Looking at the target population (females and males aged 11-12 years) in Italy, a decrease in coverage rates was observed. A call for action, improved HPV awareness, and education are the key elements to enhance the widespread adoption of HPV vaccination.

Estratégias para aumentar a cobertura vacinal: overview de revisões sistemáticas / Strategies to increase vaccination coverage: overview of systematic reviews

A vacinação é a principal ferramenta de prevenção primária de doenças e uma das medidas mais bem-sucedidas em saúde pública, com melhor custo-efetividade (ABBAS et al , 2006; WHO, 2021a). Além disso, a imunização evita incapacidades e cerca de 2 a 3 milhões de mortes, em todo o mundo, a cada ano (UE, 2020; PAHO, 2022; WATSON et al., 2022). Não obstante os esforços implementados por organizações internacionais e locais, dados da OMS apontam que a cobertura vacinal global caiu de 86% em 2019 para 81% em 2021, o que significa que cerca de 25 milhões de crianças menores de 1 ano não receberam as vacinas básicas (WHO, 2021a). Já no Brasil (Figura 1), a cobertura manteve-se estável de 1999 a 2015 e em contrapartida, em 2016 e no último triênio, apresenta tendência de queda (BRASIL, 2022b). Diante dessa realidade, objetivou-se investigar as estratégias utilizadas para ampliar a vacinação, e assim, subsidiar a formulação e tomada de decisão em políticas públicas para mitigar a baixa cobertura vacinal

Vaccination is the main tool for primary disease prevention and one of the most successful and cost-effective public health measures (ABBAS et al , 2006; WHO, 2021a). In addition, immunization prevents disability and an estimated 2 to 3 million deaths worldwide each year (EU, 2020; PAHO, 2022; WATSON et al., 2022). Notwithstanding the efforts implemented by international and local organizations, WHO data indicate that global vaccination coverage dropped from 86% in 2019 to 81% in 2021, which means that about 25 million children under 1 year of age do not received the basic vaccines (WHO, 2021a). In Brazil (Figure 1), coverage remained stable from 1999 to 2015 and, on the other hand, in 2016 and in the last three years, it shows a downward trend (BRASIL, 2022b). Faced with this reality, the objective was to investigate the strategies used to expand vaccination, and thus subsidize the formulation and decision-making in public policies to mitigate the low vaccination coverage

Impacto de la pandemia por SARS-CoV-2 en la administración de vacunas del Calendario Nacional de Inmunizaciones en menores de 2 años / Impact of the SARS-CoV-2 pandemic on the administration of vaccines as per the national immunization schedule in children younger than 2 years

Introducción. El menor número de consultas a los centros de atención desde el comienzo de la pandemia por SARS-CoV-2podría afectar la vacunación obligatoria.Objetivo. Evaluar el impacto de la pandemia por SARS-CoV-2en la administración de vacunas pentavalente y triple viral a niños menores de 2 años en el vacunatorio de un hospital pediátrico de la Ciudad de Buenos Aires.Método. Estudio transversal, que utilizó registros informatizados del vacunatorio, de enero a mayo de 2019 y 2020.Resultados. Desde la segunda quincena de marzo de 2020, se observó un 64,2 % de disminución en la aplicación de vacunas. Al examinar la primera dosis de pentavalente y triple viral, la reducción fue del 74,9 % y del 55,1 %, respectivamente.Conclusión. A partir de la segunda quincena de marzo de 2020, se observó una disminución del 64,2 % en las vacunas aplicadas respecto del mismo período en el año anterio

Introduction. The reduction in the number of visits to health care centers since the onset of the SARS-CoV-2 pandemic may affect mandatory vaccination.Objective. To assess the impact of the SARS-CoV-2 pandemic on the administration of the pentavalent and the measles, mumps, and rubella (MMR) vaccines to children younger than 2 years at the vaccination center of a children's hospital in the Autonomous City of Buenos Aires.Method. Cross-sectional study using the vaccination center's digital records from January to May 2019 and 2020.Results. In the second fortnight of March 2020, vaccinations dropped by 64.2 %. When examining the first dose of the pentavalent and MMR vaccines, such reduction was 74.9 % and 55.1 %, respectively.Conclusion. As of the second fortnight of March 2020, vaccinations dropped by 64.2 % compared to the same period of the previous year.

Informe especial: Coberturas de vacunación en residentes de la CABA en contexto Covid-19: 2 de octubre de 2020 / Special report: Vaccination coverage in CABA residents in context of Covid19

La vacunación es considerada una actividad esencial durante la pandemia de COVID-19 y se han desarrollado diferentes estrategias para el sostenimiento de la vacunación en el contexto actual, facilitar el acceso a través de la adaptación y reorganización de los servicios de salud, el no requerimiento de permisos de circulación para la vacunación, vacunación en instituciones fuera de salud, así como la elaboración de recomendaciones para realizar la vacunación de manera segura protegiendo tanto al vacunador como la persona a vacunar, entre otros. Con el objetivo de realizar la medición del impacto en las actividades de vacunación, se realiza el análisis comparativo de las vacunas aplicadas durante el primer semestre de los años 2018-2020, con la información recibida en el nivel central del Programa de Inmunizaciones. Se excluye del presente análisis la información referida a la vacuna antigripal ya que tiene una modalidad diferente de aplicación. (AU)

Trends in Human Papillomavirus Vaccination in Commercially Insured Children in the United States.

OBJECTIVES: The human papillomavirus (HPV) vaccine was recommended in 2006 for girls and in 2011 for boys. The Healthy People 2020 goal for 2-dose HPV vaccination coverage is 80% by age 15 for girls and boys. We used nationwide population-based data to describe trends in HPV vaccination in children. METHODS: We conducted a cohort study nested within the MarketScan health care database between January 2003 and December 2017. Children were followed from the year they turned 9 until HPV vaccination, insurance disenrollment, or the end of the year when they turned 17, whichever came first. We estimated the cumulative incidence of at least 1- and 2-dose HPV vaccination, stratified by birth year, sex, and state. In secondary analyses, we evaluated the association between state-level vaccination policies and HPV vaccination coverage. RESULTS: This study included 7 837 480 children and 19.8 million person-years. The proportion of 15-year-old girls and boys with at least a 1-dose HPV vaccination increased from 38% and 5% in 2011 to 57% and 51% in 2017, respectively; the proportion with at least a 2-dose vaccination went from 30% and 2% in 2011 to 46% and 39% in 2017, respectively. By 2017, 2-dose HPV vaccination coverage varied from 80% in Washington, District of Columbia, among girls to 15% in Mississippi among boys and was positively correlated with legislation for HPV vaccine education and pediatrician availability. CONCLUSIONS: Despite the increasing trends in uptake, HPV vaccine coverage among commercially insured children in the United States remains behind target levels, with substantial disparities by state.

Contextualised strategies to increase childhood and adolescent vaccination coverage in South Africa: a mixed-methods study.

INTRODUCTION: Despite the unparalleled success of immunisation in the control of vaccine preventable diseases, immunisation coverage in South Africa remains suboptimal. While many evidence-based interventions have successfully improved vaccination coverage in other countries, they are not necessarily appropriate to the immunisation needs, barriers and facilitators of South Africa. The aim of this research is to investigate barriers and facilitators to optimal vaccination uptake, and develop contextualised strategies and implementation plans to increase childhood and adolescent vaccination coverage in South Africa. METHODS: The study will employ a mixed-methods research design. It will be conducted over three iterative phases and use the Adopt, Contextualise or Adapt (ACA) model as an overarching conceptual framework. Phase 1 will identify, and develop a sampling frame of, immunisation stakeholders involved in the design, planning and implementation of childhood and human papillomavirus immunisation programmes in South Africa. Phase 2 will identify the main barriers and facilitators to, and solutions for, increasing vaccination coverage. This phase will comprise exploratory qualitative research with stakeholders and a review of existing systematic reviews on interventions for improving vaccination coverage. Using the findings from Phase 2 and the ACA model, Phase 3 will develop a set of proposed interventions and implementation action plans for improving immunisation coverage in South Africa. These plans will be discussed, revised and finalised through a series of participatory stakeholder workshops and an online questionnaire, conducted as part of Phase 3. ETHICS: Ethical approval was obtained from the South African Medical Research Council (EC018-11/2018). No risks to participants are expected. Various steps will be taken to ensure the anonymity and confidentiality of participants. DISSEMINATION: The study findings will be shared at stakeholder workshops, the website of Cochrane South Africa and academic publications and conferences.

School-based delivery of routinely recommended vaccines and opportunities to check vaccination status at school, a global summary, 2008-2017.

School-based vaccination (SBV) and checking students' vaccination records at school have the potential to optimize vaccination coverage among school-aged children. The primary aim of this paper is to describe adoption of SBV by countries from 2008 to 2017, including target age groups and vaccines delivered in 2017, as reported annually through the World Health Organization (WHO)-United Nations Children's fund (UNICEF) Joint Reporting Form (JRF). Expanding upon previous analyses, country-specific rates of primary school enrollment and home-based record (HBR) ownership were linked to the WHO-UNICEF JRF data, to identify countries with high potential to implement vaccination record checks at school. The proportion of countries reporting delivery of at least one routinely recommended vaccine dose in school settings increased from 95 (of 163 reporting; 58%) in 2008 to 108 (of 181 reporting; 60%) in 2017. The 13 additional countries that reported using SBV in 2017 were among 31 countries for which SBV data from the JRF were unavailable in 2017. The most common antigens delivered through SBV in 2017 were tetanus (94 countries), diphtheria (89 countries), and human papillomavirus (52 countries). Among 93 countries with data available for net primary school enrollment and HBR ownership, 52 (56%) countries had both ≥80% net primary school enrollment and ≥80% of children aged 12-23 months ever owning an HBR; 33 (63%) of these used SBV. If not already doing so, these 33 countries represent an opportunity to introduce routine checking of vaccination status at entry to, or during primary school. With the growing number of new vaccines and booster doses of childhood vaccines targeting school-age children, implementation of SBV and checking of student vaccination records at school may help improve vaccination coverage; however, additional data are needed to assess global prevalence of checking vaccination status at school and to identify factors facilitating optimal implementation of this strategy.

Stopping the HPV vaccine crisis in Japan: Quantifying the benefits and risks of HPV vaccination in quality-adjusted life-years for appropriate decision-making.

BACKGROUND: The human papilloma virus (HPV) vaccination coverage rate in Japan has dropped dramatically from more than 70% to less than 1% since 2013. With conflicting information and a lack of quantification of the benefits and risks of the HPV vaccine, parents have been hindered in making their decision. We quantified the benefits and risks of the HPV vaccine in terms of quality-adjusted life-years (QALYs), to help their informed decision. METHOD: A literature search was performed to determine the incidence and burden of each outcome in a decision tree model. The benefits and the risks of the HPV vaccination were determined in QALY change with a sensitivity analysis. RESULT: The benefits of the HPV vaccine in terms of QALYs gained were 703.72, 14.45, and 30.83/100,000 persons for cervical cancer, cervical intraepithelial neoplasm 3 (CIN 3), and genital warts, respectively. The QALY loss due to acute adverse reactions, chronic adverse reactions without assistance needs, and chronic adverse reactions with assistance needs were 0.07, 5.83, and 5.82/100,000 persons, respectively. The risk/benefit ratio in QALY change in the base case was 0.0156. In all scenarios, the benefit of the HPV vaccine was significantly greater than the risk. CONCLUSION: The benefits are much greater than the risks, even if it is assumed that all reported adverse events were due to the vaccination. The Japanese government and health care providers should immediately recommend the HPV vaccine to all adolescent girls irrespective of any causal links between the vaccine and reported adverse events.

Assessing the Low Influenza Vaccination Coverage Rate Among Healthcare Personnel in India: A Review of Obstacles, Beliefs, and Strategies.

BACKGROUND: Most countries recommend that their healthcare personnel be vaccinated against influenza in order to protect themselves as well as their patients. However despite the strong scientific rationale, recommendations and advocacy from health organizations, influenza vaccination coverage among healthcare personnel remains low. This has been attributed to various obstacles and a range of strategies have been implemented to increase uptake with varying levels of success. OBJECTIVES: To highlight the vaccination coverage, beliefs, and obstacles among healthcare personnel in India and to discuss strategies that can be implemented to improve influenza vaccination coverage. CONCLUSIONS: Various barriers are responsible for the low influenza vaccination coverage among Indian healthcare personnel. Many interventions are being practiced, but they need to be multidimensional keeping in mind that healthcare personnel value their autonomy in making decisions about vaccinations.

HPV vaccine acceptance and hesitancy - lessons learned during 8 years of regional HPV prophylaxis program in Wroclaw, Poland.

In 2019, the WHO has announced that it will intensify efforts to eliminate cervical cancer worldwide by increasing coverage of the HPV (Human Papillomavirus) vaccine. Finding reasons for low HPV vaccine coverage and looking for solutions to address the problem should be the priorities for public health. The municipality of Wroclaw (Poland) attempted to meet the challenge earlier by introducing a Prophylaxis Program against HPV in 2010. The core of the program are educational meetings at schools and free vaccinations offered at GP offices. After five successful years (vaccination coverage >80% fully vaccinated), vaccination uptake declined to 61.8%. A survey was carried out in 2015 to verify the experience concerning the Program among 1360 volunteers. Three groups were surveyed: parents (n = 509), teenage girls (n = 748) and nurses who performed the vaccinations (n = 103). What is noteworthy in the results there are factors that positively influenced vaccine acceptance: education offered within the program; the fact that the vaccinations are offered free of charge and the experience of earlier vaccination. It turned out that fear of side effects and the lack of trust in vaccination effectiveness were the most common reasons for vaccination refusal. Most nurses underestimated their role in building vaccination acceptance and 7.1% of them felt uncertain administrating the vaccination. Conslusions: the vaccination delivery strategy should be reconsidered; interventions to raise the nurses' awareness of their role in building vaccine acceptance should be improved; the 13th year of life is the best moment to offer a vaccination.

Pandemic and vaccine coverage: challenges of returning to schools / Pandemia e coberturas vacinais: desafios para o retorno às escolas

ABSTRACT Since March 2020, Brazil has faced the pandemic of the coronavirus disease 2019 (Covid-19), which has severely modified the way in which the population lives and uses health services. As such, face-to-face attendance has dropped dramatically, even for child vaccination, due to measures of social distancing to mitigate the transmission of the virus. Several countries have recorded a substantial drop in vaccination coverage in children, especially of those under two years of age. In Brazil, administrative data indicate the impact of the covid-19 pandemic on this downward trend, which was already an important challenge of the National Immunization Program in recent years. Many children will be susceptible to immunopreventable diseases, which reinforces the need to assess the vaccine status of schoolchildren before returning to face-to-face classes.

RESUMO Desde março de 2020, o Brasil enfrenta a pandemia da doença do coronavírus 2019 (covid-19), que modificou intensamente o modo de viver da população e o uso dos serviços de saúde, nos quais o comparecimento presencial caiu drasticamente, inclusive para a vacinação infantil, devido às medidas de distanciamento social para mitigar a transmissão do vírus. Diversos países registraram queda substancial das coberturas vacinais em crianças, especialmente nas menores de dois anos de idade. No Brasil, dados administrativos apontam o impacto da pandemia de covid-19 no agravamento dessa queda, que já constituía um desafio importante do Programa Nacional de Imunizações nos últimos anos. Muitas crianças estarão suscetíveis a doenças imunopreveníveis, o que reforça a necessidade de avaliar a situação vacinal dos escolares antes do retorno às aulas presenciais.

Áreas com queda da cobertura vacinal para BCG, poliomielite e tríplice viral no Brasil (2006-2016): mapas da heterogeneidade regional / Areas with declining vaccination coverage for BCG, poliomyelitis, and MMR in Brazil (2006-2016): maps of regional heterogeneity / Áreas con una caída de la cobertura de vacunación para BCG, poliomielitis y triple vírica en Brasil (2006-2016): mapas de la heterogeneidad regional

A imunização é reconhecida como uma das intervenções mais bem-sucedidas e custo-efetivas, resultando na erradicação e no controle de diversas doenças em todo o mundo. Todavia, uma preocupante redução na cobertura vacinal tem sido observada no Brasil, trazendo o recrudescimento de algumas doenças até então superadas. Dessa forma, no intuito de realizar um diagnóstico situacional que pondere as diferentes regiões do país e a tendência temporal de cobertura vacinal, o presente estudo teve o objetivo de evidenciar áreas com queda da cobertura vacinal de BCG, poliomielite e tríplice viral no Brasil por meio de um estudo ecológico que coletou informações acerca do número crianças de até um ano de idade imunizadas para essas três vacinas, no período entre 2006 e 2016, por município brasileiro. Os dados foram adquiridos por meio do Departamento de Informática do SUS. Foi realizada uma varredura espacial, analisando as variações espaciais nas tendências temporais de cobertura vacinal. Foi observada uma tendência de redução no número de imunizações no Brasil, com quedas de 0,9%, 1,3% e 2,7% ao ano para BCG, poliomielite e tríplice viral, respectivamente. Ademais, aglomerados significativos com tendências temporais de redução da cobertura vacinal foram verificados em todas as cinco regiões brasileiras. O estudo evidencia uma importante redução na cobertura vacinal nos últimos anos, constatando heterogeneidades consideráveis entre os municípios. Dessa forma, uma atenção singular e planejamento estratégico condizente com as características de cada localidade são necessários para o controle tanto da redução de cobertura vacinal como do reaparecimento de doenças no Brasil.

Immunization is known to be one of the most successful and cost-effective health interventions, resulting in the eradication and control of various diseases in the world. However, Brazil has experienced a worrisome drop in vaccination coverage, associated with the resurgence of various previously controlled or eradicated diseases. This study thus conducted a situational diagnosis weighing Brazil's different regions and time trends in vaccination coverage in order to identify areas with reduction in vaccination coverage for BCG, poliomyelitis, and MMR. This ecological study collected data on the number of children up to one year of age who had been vaccinated with these three vaccines from 2006 to 2016, according to municipality (county). Data were obtained from the Brazilian Health Informatics Department. A spatial scan was performed, analyzing spatial variations in the time trends for vaccination coverage. Downward trends were seen in the number of immunizations in Brazil, with reductions of 0.9%, 1.3%, and 2.7% per year for BCG, poliomyelitis, and MMR, respectively. Significant decreases were also seen in all five major geographic regions with time trends in the reduction of vaccination coverage. The study evidenced an important reduction in vaccination coverage in recent years, with major heterogeneity between municipalities. Thus, focused attention and strategic planning in keeping with each local area's characteristics are necessary to address both the reduction of vaccination coverage and the resurgence of vaccine-preventable diseases in Brazil.

La inmunización está reconocida como una de las intervenciones más exitosas y costo-eficientes, consiguiendo la erradicación y control de diversas enfermedades en todo el mundo. Sin embargo, se ha observado una preocupante reducción en la cobertura de la vacunación en Brasil, conllevando el recrudecimiento de algunas enfermedades hasta entonces superadas. De esta forma, con el fin de realizar un diagnóstico situacional, que pondere las diferentes regiones del país y la tendencia temporal de cobertura vacunación, el presente estudio tuvo como objetivo evidenciar áreas con una caída de la cobertura vacunación respecto a BCG, poliomielitis y triple vírica en Brasil. Se trata de un estudio ecológico, que recabó información acerca del número de niños de hasta un año de edad inmunizados con estas tres vacunas, durante el período entre 2006 y 2016, por municipios brasileños. Los datos se consiguieron a través del Departamento de Informática del SUS. Se realizó un barrido espacial, analizando las variaciones espaciales en las tendencias temporales de cobertura de vacunación. Se observó una tendencia de reducción en el número de inmunizaciones en Brasil, con caídas de 0,9%, 1,3% y 2,7% al año, en el caso de BCG, poliomielitis y triple vírica, respectivamente. Además, se verificaron aglomerados significativos con tendencias temporales de reducción en la cobertura de vacunación dentro de las cinco regiones brasileñas. El estudio evidencia una importante reducción en la cobertura de vacunación durante los últimos años, constatando heterogeneidades considerables entre los municipios. De esta forma, una atención singular y planificación estratégica, acorde con las características de cada localidad, son necesarias para el control, tanto de la reducción de la cobertura de vacunación, como del resurgimiento de enfermedades en Brasil.

Tendencias en las coberturas de vacunación en niños de 12 a 23 y 24 a 35 meses en México / Trends in vaccination coverage among children aged 12-23 and 24-35 months in Mexico. Ensanut 2012 and Ensanut 100k

Resumen: Objetivo: Comparar coberturas de vacunación en niños de 12-23 y 24-35 meses de edad de localidades menores de 100 000 habitantes en México, entre 2012 (Encuesta Nacional de Salud y Nutrición 2012) y 2018 (Ensanut 100k). Material y métodos: Estimación de coberturas con ambas encuestas. Resultados: Entre 2012 y 2018, se mantuvo la cobertura del Esquema básico, con comprobante y autorreporte, en niños de 12-23 (51.6 vs. 60.2%) y 24-35 meses (51.4 vs. 50.0%), y sólo con comprobante (53.9 vs. 51.3% y 52.8 vs. 44.2%). Se mantuvo la cobertura del Esquema básico más refuerzos en niños de 24-35 meses, comprobante y autorreporte (30.9 vs. 34.0%) y sólo con comprobante (30.2 vs. 27.8%). Disminuyeron las coberturas con segunda y tercera dosis de hepatitis B en niños de 12-23 y 24-35 meses, y con primera dosis de triple viral (SRP) y tercera de pentavalente en niños de 24-35 meses. Conclusiones: Se mantuvieron las coberturas del Esquema básico y Esquema básico más refuerzos aunque disminuyeron las coberturas con hepatitis B, pentavalente y SRP.

Abstract: Objective: To evaluate and compare vaccination coverage among children aged 12-23 and 24-35 months living in localities with less than 100 000 inhabitants inEncuesta Nacional de Salud y Nutrición(Ensanut) 2012 and Ensanut 100k (2018). Materials and methods: Estimate of coverage with both surveys. Results: Between 2012 and 2018, according to proof and self-report, the coverage of the basic scheme was maintained in children aged 12-23 (51.6 vs. 60.2%) and 24-35 months (51.4 vs. 50.0%). Similarly, only with proof (53.9 vs. 51.3% and 52.8 vs. 44.2%). In children aged 24-35 months, the coverage of the reinforced basic scheme reinforcements with probative document and self-report (30.9 vs. 34.0%) and only with reinforcements (30.2 vs. 27.8%) was maintained. Coverage with second and third doses of hepatitis B in both age groups decreased; additionally, first dose of measles-mumps-rubella vaccine (SRP, in Spanish) and third dose of Pentavalent in children aged 24-35 months. Conclusions: Coverages were maintained by schemes, despite reductions in hepatitis B, pentavalent and SRP.

What isn't measured isn't done - eight years with no progress in Aboriginal and Torres Strait Islander adult influenza and pneumococcal vaccination.

OBJECTIVES: To describe and compare vaccination coverage for Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) adults in 2004-05 and 2012-13, including the impact of national vaccination funding initiatives. METHODS: National Aboriginal and Torres Strait Islander Health cross-sectional surveys - 2004-05 (n=5,757) and 2012-13 (n=5,482) - were compared. Self-reported influenza and pneumococcal vaccination coverage among Indigenous adults was analysed by age, remoteness, gender and risk factor status. RESULTS: Influenza vaccination coverage among Indigenous adults in 2004-05 and 2012-13 remained low. While coverage increased for those aged 18-49 years from 23% to 29%, it declined for those aged ≥65 years from 84% to 74%. For remote areas, influenza coverage among those aged 50-64 years declined from 76% to 66%. Pneumococcal vaccination coverage remained very low and declined across all age groups in 2004-05 and 2012-13 (50-64 years: 30% to 23%). For remote areas, pneumococcal coverage declined among those aged 50-64 years from 52% to 32%. CONCLUSIONS: Indigenous adult vaccination coverage for influenza and pneumococcal disease remains unacceptably low. Between 2004-05 and 2012-13, declines occurred in pneumococcal vaccination coverage across all age groups ≥18 years. Despite national funding of influenza vaccine in 2010, there was no increase in influenza coverage, except for the 18-49-year age group. Implications for public health: Current approaches to promote, deliver and monitor vaccination of Indigenous adults are inadequate.

Situação vacinal em crianças da educação infantil contra o Rotavírus Humano / Situación de la vacunación en niños de la educación infantil contra el Rotavirus Humano / Vaccination situation in children of childhood education against Human Rotavirus

Resumo 22. Objetiva-se analisar a situação vacinal da Vacina Oral do Rotavírus Humano em crianças da educação infantil. Utilizou-se o método de estudo epidemiológico, descritivo, retrospectivo e de abordagem quantitativa realizado a partir de informações coletadas em 1 434 cópias de cartões de vacinas de crianças matriculadas em Centros Municipais de Educação Infantil de Natal/RN. Os dados foram coletados de março e dezembro de 2015 por meio de lista de verificação. Os resultados expressam que 78,4% dos cartões analisados foram classificados como esquema vacinal completo quando possuíam duas doses da vacina e 11,9% apresentaram esquema vacinal incompleto, quando possuíam apenas uma dose e outros 9,7% classificados como não vacinado quando não apresentaram registro desta vacina. Conclui-se que houve aumento no número de doses administradas nos últimos anos. No entanto observou-se um número maior de crianças não imunizadas em faixa-etária maiores.

Resumen 26. El objetivo de este estudio fue analizar la situación vacunal de la Vacuna Oral del Rotavirus Humano en niños de la educación infantil. Se utilizó el método de estudio epidemiológico, descriptivo, retrospectivo y de abordaje cuantitativo realizado a partir de informaciones recogidas en 1 434 copias de tarjetas de vacunas de niños matriculados en Centros Municipales de Educación Infantil de Natal/RN. Los datos fueron recolectados de marzo y diciembre de 2015 a través de lista de chequeo. Los resultados expresan que el 78,4% de las tarjetas analizadas fueron clasificadas como esquema vacunal completo cuando tenían dos dosis de la vacuna y el 11,9% presentó un esquema vacunal incompleto, cuando poseían sólo una dosis y otro 9,7% clasificados como no vacunados cuando no presentaron registro de esta vacuna. Se concluye que hubo aumento en el número de dosis administradas en los últimos años. Sin embargo, se observó un número mayor de niños no inmunizados en grupo de mayor edad.

Abstract 30. The objective of this study was to analyze the vaccination status of the Human Rotavirus Oral Vaccine in children in early childhood education. The epidemiological, descriptive, retrospective and quantitative approach method was carried out based on information collected on 1 434 copies of vaccination cards of children enrolled in Natal / RN Municipalities for Early Childhood Education. Data were collected from March and December 2015 through the check list. The results show that 78,4% of the analyzed cards were classified as complete vaccination schedule when they had two doses of the vaccine and 11,9% had an incomplete vaccination schedule when they had only one dose and another 9,7% classified as not vaccinated when not registered this vaccine. It was concluded that there was an increase in the number of doses administered in the last years. However, a larger number of unimmunized children in the larger age group were observed.