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The emergence of vaccine hesitancy among upper-class Brazilians: Results from four birth cohorts, 1982–2015

•From 1982 to 2015, vaccine coverage increased and then declined in a Brazilian city.•Low coverage was most common among poor children in 1982 and rich children in 2015.•The increasing number of vaccines and underfunding likely explain the overall decline.•Vaccine hesitancy may account for lower cov... Full description

Journal Title: Vaccine 2020-01-16, Vol.38 (3), p.482-488
Main Author: Silveira, Mariangela F
Other Authors: Buffarini, Romina , Bertoldi, Andrea D , Santos, Iná S , Barros, Aluísio J.D , Matijasevich, Alicia , Menezes, Ana Maria B , Gonçalves, Helen , Horta, Bernardo L , Barros, Fernando C , Barata, Rita B , Victora, Cesar G
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: Netherlands: Elsevier Ltd
ID: ISSN: 0264-410X
Link: https://www.ncbi.nlm.nih.gov/pubmed/31718899
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recordid: cdi_proquest_miscellaneous_2314254485
title: The emergence of vaccine hesitancy among upper-class Brazilians: Results from four birth cohorts, 1982–2015
format: Article
creator:
  • Silveira, Mariangela F
  • Buffarini, Romina
  • Bertoldi, Andrea D
  • Santos, Iná S
  • Barros, Aluísio J.D
  • Matijasevich, Alicia
  • Menezes, Ana Maria B
  • Gonçalves, Helen
  • Horta, Bernardo L
  • Barros, Fernando C
  • Barata, Rita B
  • Victora, Cesar G
subjects:
  • Brazil - epidemiology
  • Cohort Studies
  • Economic status
  • Educational Status
  • Female
  • Humans
  • Immunization coverage
  • Infant
  • Infant, Newborn
  • Male
  • Patient Acceptance of Health Care - psychology
  • Public health
  • Socioeconomic Factors
  • Vaccination - economics
  • Vaccination - psychology
  • Vaccination - trends
  • Vaccination Coverage - economics
  • Vaccination Coverage - trends
  • Vaccination hesitancy
  • Vaccines - administration & dosage
ispartof: Vaccine, 2020-01-16, Vol.38 (3), p.482-488
description: •From 1982 to 2015, vaccine coverage increased and then declined in a Brazilian city.•Low coverage was most common among poor children in 1982 and rich children in 2015.•The increasing number of vaccines and underfunding likely explain the overall decline.•Vaccine hesitancy may account for lower coverage among wealthy children. Vaccine hesitancy has been increasingly reported in Brazil. We describe secular trends and socioeconomic disparities from 1982 to 2015, using data from four population-based birth cohorts carried out in the city of Pelotas. Full immunization coverage (FIC) was defined as having received four basic vaccines (one dose of BCG and measles, and three doses of polio and DTP) scheduled for the first year of life. Information on income was collected through standardized questionnaires, and the slope index of inequality (SII) was calculated to express the difference in percent points between the rich and poor extremes of the income distribution. Full immunization coverage was 80.9% (95% CI 79.8%; 82.0%) in 1982, 97.2% (96.1%; 98.0%) in 1993, 87.8% (86.7%; 88.8%) in 2004 and 77.2% (75.8%; 78.4%) in 2015. In 1982 there was a strong social gradient with higher coverage among children from wealthy families (SII = 25.0, P 
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0264-410X
fulltext: fulltext
issn:
  • 0264-410X
  • 1873-2518
url: Link


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titleThe emergence of vaccine hesitancy among upper-class Brazilians: Results from four birth cohorts, 1982–2015
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creatorSilveira, Mariangela F ; Buffarini, Romina ; Bertoldi, Andrea D ; Santos, Iná S ; Barros, Aluísio J.D ; Matijasevich, Alicia ; Menezes, Ana Maria B ; Gonçalves, Helen ; Horta, Bernardo L ; Barros, Fernando C ; Barata, Rita B ; Victora, Cesar G
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description•From 1982 to 2015, vaccine coverage increased and then declined in a Brazilian city.•Low coverage was most common among poor children in 1982 and rich children in 2015.•The increasing number of vaccines and underfunding likely explain the overall decline.•Vaccine hesitancy may account for lower coverage among wealthy children. Vaccine hesitancy has been increasingly reported in Brazil. We describe secular trends and socioeconomic disparities from 1982 to 2015, using data from four population-based birth cohorts carried out in the city of Pelotas. Full immunization coverage (FIC) was defined as having received four basic vaccines (one dose of BCG and measles, and three doses of polio and DTP) scheduled for the first year of life. Information on income was collected through standardized questionnaires, and the slope index of inequality (SII) was calculated to express the difference in percent points between the rich and poor extremes of the income distribution. Full immunization coverage was 80.9% (95% CI 79.8%; 82.0%) in 1982, 97.2% (96.1%; 98.0%) in 1993, 87.8% (86.7%; 88.8%) in 2004 and 77.2% (75.8%; 78.4%) in 2015. In 1982 there was a strong social gradient with higher coverage among children from wealthy families (SII = 25.0, P < 0.001); by 2015, the pattern was inverted with higher coverage among poor children (SII = −6.0; P = 0.01). Vertical immunization programs in the 1980s and creation of the National Health Services in 1980 eliminated the social gradient that had been present up to the 1980s, to reach near universal coverage. The recent decline in coverage is likely associated with the growing complexity of the vaccination schedule and underfunding of the health sector. In addition, the faster decline observed among children from wealthy families is probably due to vaccine hesitancy.
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subjectBrazil - epidemiology ; Cohort Studies ; Economic status ; Educational Status ; Female ; Humans ; Immunization coverage ; Infant ; Infant, Newborn ; Male ; Patient Acceptance of Health Care - psychology ; Public health ; Socioeconomic Factors ; Vaccination - economics ; Vaccination - psychology ; Vaccination - trends ; Vaccination Coverage - economics ; Vaccination Coverage - trends ; Vaccination hesitancy ; Vaccines - administration & dosage
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titleThe emergence of vaccine hesitancy among upper-class Brazilians: Results from four birth cohorts, 1982–2015
authorSilveira, Mariangela F ; Buffarini, Romina ; Bertoldi, Andrea D ; Santos, Iná S ; Barros, Aluísio J.D ; Matijasevich, Alicia ; Menezes, Ana Maria B ; Gonçalves, Helen ; Horta, Bernardo L ; Barros, Fernando C ; Barata, Rita B ; Victora, Cesar G
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abstract•From 1982 to 2015, vaccine coverage increased and then declined in a Brazilian city.•Low coverage was most common among poor children in 1982 and rich children in 2015.•The increasing number of vaccines and underfunding likely explain the overall decline.•Vaccine hesitancy may account for lower coverage among wealthy children. Vaccine hesitancy has been increasingly reported in Brazil. We describe secular trends and socioeconomic disparities from 1982 to 2015, using data from four population-based birth cohorts carried out in the city of Pelotas. Full immunization coverage (FIC) was defined as having received four basic vaccines (one dose of BCG and measles, and three doses of polio and DTP) scheduled for the first year of life. Information on income was collected through standardized questionnaires, and the slope index of inequality (SII) was calculated to express the difference in percent points between the rich and poor extremes of the income distribution. Full immunization coverage was 80.9% (95% CI 79.8%; 82.0%) in 1982, 97.2% (96.1%; 98.0%) in 1993, 87.8% (86.7%; 88.8%) in 2004 and 77.2% (75.8%; 78.4%) in 2015. In 1982 there was a strong social gradient with higher coverage among children from wealthy families (SII = 25.0, P < 0.001); by 2015, the pattern was inverted with higher coverage among poor children (SII = −6.0; P = 0.01). Vertical immunization programs in the 1980s and creation of the National Health Services in 1980 eliminated the social gradient that had been present up to the 1980s, to reach near universal coverage. The recent decline in coverage is likely associated with the growing complexity of the vaccination schedule and underfunding of the health sector. In addition, the faster decline observed among children from wealthy families is probably due to vaccine hesitancy.
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