Avaliação da cobertura vacinal da poliomielite nos estados da região sul, com foco no município de Pato Branco, entre os anos de 2009-2019 / Assessment of polio vaccination coverage in the southern states, focusing on the municipality of Pato Branco, from 2009-2019 / Evaluación de la cobertura de vacunación contra la poliomielitis en los estados de la región sur, con enfoque en el municipio de Pato Branco, entre los años 2009-2019

Objetivo: Analisar a taxa de cobertura vacinal da poliomielite em relação às metas de vacinação de 95% da população-alvo, estabelecidas pelo Ministério da Saúde, com base nos registros de imunização do DATASUS nos estados do Paraná, Santa Catarina e Rio Grande do Sul, que compõem a região sul do Brasil, e na cidade de Pato Branco, PR. Métodos: Estudo descritivo de abordagem quantitativa referente à cobertura vacinal da Poliomielite nos estados da região sul e no município de Pato Branco, PR com resultados da cobertura avaliados quanto ao alcance das metas estabelecidas pelo Ministério da Saúde e comparado o desempenho entre os estados e o município no período de 2009 a 2019. Os dados foram recolhidos da seção de Imunizações do DATASUS, o departamento de informática do Sistema Único de Saúde do Brasil. Resultados: No período analisado, o município de Pato Branco se manteve com uma taxa satisfatória em relação à meta estabelecida pelo Ministério da Saúde, exceto nos anos de 2017 e 2018, onde ficou abaixo da meta em cerca de 3% e 11%, respectivamente. Em relação aos estados do sul, o estado do Paraná mostrou-se abaixo da meta de cobertura vacinal recomendada na maioria dos anos estudados, com a menor cobertura ocorrendo em 2017, ficando 15% abaixo do esperado; o estado de Santa Catarina, apesar de apresentar queda desde o ano de 2014, apresentou os melhores índices de cobertura vacinal, com a maior taxa de queda de cobertura no ano de 2018 com cerca de 7%; e o estado do Rio Grande do Sul se apresentou como o estado com o pior desempenho na região, demonstrando quedas significativas da cobertura desde 2010, com menor taxa de vacinação em 2017, ficando 18% abaixo do esperado. Conclusões: Pode-se observar uma queda nos valores da cobertura vacinal entre os anos de 2009 a 2019, tanto no município de Pato Branco, PR, quanto nos estados do Paraná, Santa Catarina e Rio Grande do Sul, algo que é motivo de crescente preocupação pelos serviços de saúde do país devido à possibilidade de reintrodução da doença no território nacional. Ressalta-se, então, a necessidade de criação de estratégias eficazes para o combate das quedas das taxas de cobertura vacinal no país.

Objective: To analyze the rate of polio vaccination coverage in relation to the vaccination goals of 95% of the target population, set by the Ministry of Health, based on DATASUS immunization records in the states of Paraná, Santa Catarina, and Rio Grande do Sul, which make up the southern region of Brazil, and in the city of Pato Branco, PR. Methods: A descriptive study of quantitative approach regarding the vaccination coverage of Poliomyelitis in the states of the southern region and in the municipality of Pato Branco, PR with coverage results evaluated as to the achievement of the goals set by the Ministry of Health and compared performance between the states and the municipality in the period from 2009 to 2019. The data were collected from the Immunizations section of DATASUS, the computer department of the Brazilian Unified Health System. Results: In the period analyzed, the municipality of Pato Branco remained with a satisfactory rate in relation to the target set by the Ministry of Health, except in the years 2017 and 2018, where it was below the target by about 3% and 11%, respectively. Regarding the southern states, the state of Paraná showed below the recommended vaccine coverage target in most of the years studied, with the lowest coverage occurring in 2017, being 15% below expected; the state of Santa Catarina, despite showing a drop since the year 2014, showed the best rates of vaccine coverage, with the highest rate of drop in coverage in the year 2018 with about 7%; and the state of Rio Grande do Sul presented itself as the state with the worst performance in the region, showing significant drops in coverage since 2010, with the lowest rate of vaccination in 2017, being 18% below expectations. Conclusions: A drop in vaccination coverage values can be observed between the years 2009 and 2019, both in the municipality of Pato Branco, PR, and in the states of Paraná, Santa Catarina, and Rio Grande do Sul, something that is a cause of growing concern for the country's health services due to the possibility of reintroduction of the disease in the national territory. Therefore, the need to create effective strategies to combat the declines in vaccination coverage rates in the country is highlighted.

Objetivo: Analizar la tasa de cobertura de vacunación antipoliomielítica en relación con las metas de vacunación del 95% de la población objetivo, establecidas por el Ministerio de Salud, a partir de los registros de inmunización DATASUS en los estados de Paraná, Santa Catarina y Rio Grande do Sul, que conforman la región sur de Brasil, y en la ciudad de Pato Branco, PR. Métodos: Estudio descriptivo de abordaje cuantitativo referente a la cobertura vacunal de la Poliomielitis en los estados de la región sur y en el municipio de Pato Branco, PR con resultados de la cobertura evaluados en cuanto al alcance de las metas establecidas por el Ministerio de Salud y comparado el rendimiento entre los estados y el municipio en el período de 2009 a 2019. Los datos se recogieron de la sección de Inmunizaciones de DATASUS, el departamento de informática del Sistema Único de Salud de Brasil. Resultados: En el período analizado, el municipio de Pato Branco se mantuvo con una tasa satisfactoria en relación a la meta establecida por el Ministerio de Salud, excepto en los años 2017 y 2018, donde estuvo por debajo de la meta en cerca de 3% y 11%, respectivamente. En lo que respecta a los estados del sur, el estado de Paraná se mostró por debajo de la meta de cobertura vacunal recomendada en la mayoría de los años estudiados, siendo la cobertura más baja la que se produjo en el año 2017, estando un 15% por debajo de lo esperado; el estado de Santa Catarina, a pesar de mostrar una caída desde el año 2014, mostró los mejores índices de cobertura vacunal, siendo la mayor tasa de caída de la cobertura en el año 2018 con cerca de un 7%; y el estado de Río Grande do Sul se presentó como el estado con peor desempeño en la región, demostrando caídas significativas en la cobertura desde 2010, con la tasa de vacunación más baja en 2017, siendo un 18% por debajo de lo esperado. Conclusiones: Se observa una caída en los valores de las coberturas de vacunación entre los años 2009 y 2019, tanto en el municipio de Pato Branco, PR, como en los estados de Paraná, Santa Catarina y Rio Grande do Sul, algo que es motivo de creciente preocupación para los servicios de salud del país debido a la posibilidad de reintroducción de la enfermedad en el territorio nacional. Por lo tanto, se destaca la necesidad de crear estrategias eficaces para combatir el descenso de las tasas de cobertura de vacunación en el país.

Cobertura vacinal em crianças até 1 ano de idade no estado do Rio de Janeiro entre 2008 a 2020 / Vaccination coverage in children up to 1 year in the state of Rio de Janeiro from 2008 to 2020

O Programa Nacional de Imunizações (PNI) observa um declínio na cobertura vacinal (CV), que pode representar um risco para o retorno de doenças consideradas controladas. Objetivou-se avaliar a tendência temporal e a variação espacial das CV em crianças nos municípios do estado do Rio de Janeiro (ERJ) entre 2008 a 2020. Tratou-se de um estudo ecológico misto em que são analisadas as taxas de CV em cada município do ERJ. Utilizou-se dados secundários de doses aplicadas dos imunobiológicos das vacinas tríplice bacteriana (DTP) e tríplice viral (SCR) contidos no Sistema de Informação do Programa Nacional de Imunizações (SI-PNI) e dados de nascidos vivos do Sistema de Informação de Nascidos Vivos (SINASC). A CV foi calculada por antígeno para os 92 municípios e para as 9 regiões de saúde do ERJ. O município do RJ foi analisado separadamente. A análise da tendência temporal das CV foi realizada utilizando o programa Join Point Regression e a mudança percentual anual (APC). Para a análise descritiva foram construídos mapas temáticos com o software QGIS adotando cinco estratos de CV: <70%; 70-80%; 80-90%; 90-95% e 95% ou mais. As CV foram suavizadas através do estimador Bayes empírico global. Para avaliar as correlações espaciais, calculou-se o Índice Local de Associação Espacial (LISA). Foram elaborados 39 mapas de CV suavizados e 39 mapas com o indicador LISA, um para cada ano e para cada vacina de interesse. Os cálculos foram realizados por intermédio do software TerraView. O nível de significância foi de 5%. Os resultados demonstraram que para a primeira dose (D1) da DTP, entre os anos 2008 e 2014, as regiões do Médio Paraíba, Metropolitana I, II e o município do RJ não alcançam a meta de CV de 95%, em 2010; entre 2008 a 2010, o município do RJ não alcança a meta de CV. Entre os anos de 2015 e 2020, observamos redução da CV da D1 da DTP nas regiões da Baía de Ilha grande e Norte, iniciadas desde 2017. Para a terceira dose (D3) da DTP houve maior número de CV abaixo de 95% entre 2008 e 2014 em relação à D1. Entre os anos de 2015 a 2020, destaca-se a região Metropolitana I que, não alcança a meta de CV de 95% e a partir de 2016 têm redução progressiva das CV até 2020, chegando a apresentar CV de 30,45% nesse ano. Para a D1 da SCR entre os anos 2008 e 2014, Centro-Sul e Serrana alcançam as metas de CV em todos os anos. Em 2019, Baixada litorânea, Noroeste e Norte não alcançam a meta, as demais regiões mantêm altas CV nesse ano. Em 2020, nenhuma região alcança a meta de CV e Metropolitana I e II têm as menores CV. A análise da tendência mostrou que para D1 da DTP o ERJ apresentou tendência de queda da CV a partir de 2017 (APC: -14,25); para SCR, apresentou crescimento até 2018 (APC: 1,8) e redução da CV a partir de 2018 (APC: -16,56). Os mapas do LISA mostram a presença de clusters de alta CV para a D1 da DTP em 2008, 2013 e 2018 e baixa CV em 2014; de alta CV para a D3 da DTP em 2008 e 2016 e alta CV para SCR em 2016 e 2018. A distribuição da CV demonstra padrões distintos entre as regiões de saúde e interiormente nos municípios ao longo dos anos. A análise temporal e espacial é uma ferramenta útil para a localização de áreas geográficas com bolsões de baixa ou alta CV, visando identificar áreas de maior vulnerabilidade.

The National Immunization Program (PNI) observes a decline in vaccination coverage (CV), which may represent a risk for the return of diseases considered controlled. The objective was to evaluate the temporal trend and the spatial variation of CV in children in the municipalities of the state of Rio de Janeiro (ERJ) between 2008 and 2020. It was a mixed ecological study in which CV rates in each municipality are analyzed of the ERJ. Secondary data of applied doses of immunobiologicals of the triple bacterial (DTP) and triple viral (SCR) vaccines contained in the National Immunization Program Information System (SI-PNI) and live birth data from the Live Birth Information System were used. (SINASC). The CV was calculated by antigen for the 92 municipalities and for the 9 health regions of the ERJ. The municipality of RJ was analyzed separately. The analysis of the temporal trend of the CV was performed using the Join Point Regression program and the annual percentage change (APC). For the descriptive analysis, thematic maps were built with the QGIS software, adopting five CV strata: <70%; 70-80%; 80-90%; 90-95% and 95% or more. The CVs were smoothed using the global empirical Bayes estimator. To assess spatial correlations, the Local Spatial Association Index (LISA) was calculated. 39 smoothed CV maps and 39 maps with the LISA indicator were prepared, one for each year and for each vaccine of interest. The calculations were performed using the TerraView software. The significance level was 5%. The results showed that for the first dose (D1) of DTP, between 2008 and 2014, the regions of Médio Paraíba, Metropolitan I, II and the municipality of RJ did not reach the CV goal of 95% in 2010; between 2008 and 2010, the municipality of RJ did not reach the CV goal. Between 2015 and 2020, we observed a reduction in the CV of D1 of DTP in the regions of Ilha Grande and Norte Bay, which started since 2017. For the third dose (D3) of DTP, there was a greater number of CV below 95% between 2008 and 2014 in relation to D1. Between 2015 and 2020, the Metropolitan Region I stands out, which does not reach the CV goal of 95% and from 2016 onwards has a progressive reduction in CV until 2020, reaching a CV of 30.45% that year. For SCR's D1 between 2008 and 2014, Centro-Sul and Serrana achieve their CV goals every year. In 2019, Baixada Litorânea, Northwest and North did not reach the goal, the other regions maintain high CV this year. In 2020, no region achieves the CV target and Metropolitan I and II have the lowest CV. The trend analysis showed that for D1 of the DTP, the ERJ showed a downward trend in VC from 2017 onwards (APC: -14.25); for SCR, it showed growth until 2018 (APC: 1.8) and a reduction in CV from 2018 (APC: -16.56). The LISA maps show the presence of clusters of high CV for DTP D1 in 2008, 2013 and 2018 and low CV in 2014; of high VC for D3 of DTP in 2008 and 2016 and high VC for SCR in 2016 and 2018. The distribution of CV shows distinct patterns between health regions and within municipalities over the years. Temporal and spatial analysis is a useful tool for locating geographic areas with pockets of low or high CV, in order to identify areas of greater vulnerability.

Avaliação do Sistema de Vigilância do Programa Nacional de Imunizações - Módulo Registro do Vacinado, Brasil, 2017 / Evaluación del Sistema de Vigilancia del Programa Nacional de Inmunizaciones - Módulo Registro del Vacunado, Brasil, 2017 / Evaluation of the National Immunization Program Surveillance System - Vaccination Record Module, Brazil, 2017

Objetivo: Avaliar o Sistema de Vigilância em Imunizações considerando-se o módulo Registro do Vacinado, do Sistema de Informações do Programa Nacional de Imunizações, Brasil, 2017. Métodos: Estudo descritivo, utilizando-se do Guidelines for Evaluating Public Health Surveillance Systems, publicado pelo Centers for Disease Control and Prevention (CDC/Atlanta/GA/United States), para avaliar os atributos de simplicidade, flexibilidade, qualidade dos dados, sensibilidade, oportunidade e utilidade do sistema para seis vacinas do calendário de vacinação da criança. Resultados: O Sistema de Vigilância em Imunizações foi considerado complexo em sua descrição, flexível às mudanças no calendário vacinal, de baixa qualidade dos dados para as vacinas DTP e rotavírus, de aceitabilidade regular, com alta sensibilidade para a vacina BCG, inoportuno para a vacina contra hepatite B e útil às finalidades do Programa Nacional de Imunizações. Conclusão: Qualidade dos dados, aceitabilidade e oportunidade não apresentaram resultados satisfatórios, sendo necessárias ações pelo aprimoramento do sistema de informações.

Objetivo: Comparar estructura y proceso de trabajo en atención primaria para implementar la teleconsulta médica en municipios de diferentes regiones y tamaños (mil habitantes: <25; 25-100; >100). Métodos

Objetivo: To evaluate the National Immunization Program Immunization Surveillance System, based on its Vaccination Record module, for Brazil in 2017. Methods: This was a descriptive study using the Guidelines for Evaluating Public Health Surveillance Systems, published by the Centers for Disease Control and Prevention (CDC/Atlanta/GA/United States) to evaluate the attributes of simplicity, flexibility, data quality, sensitivity, timeliness and usefulness of the system for six vaccines on the child immunization schedule. Results: The Immunization Surveillance System was considered complex in its description; flexible to changes in the immunization schedule; of poor data quality for the DTP and rotavirus vaccines; regular acceptability; high sensitivity for the BCG vaccine; untimely for the hepatitis B vaccine and useful for the purposes of the National Immunization Program. Conclusion:The data quality, acceptability and timeliness results were not satisfactory, so that actions are needed to enhance the information system.

Farmacovigilancia de vacunas y su aplicación en Chile / Vaccine pharmacovigilance and its application in Chile

La inmunización se encuentra entre las intervenciones en salud pública más exitosas y costo efectivas de todas las épocas, siendo su beneficio tan importante como su seguridad. Las vacunas, como cualquier otro medicamento, pueden generar eventos adversos, los que deben ser monitorizados permanentemente por sistemas de vigilancia. Esta disciplina recibe el nombre de Farmacovigilancia de Vacunas (FVV), encargada de estudiar los Eventos Supuestamente Atribuidos a la Vacunación ó Inmunización (ESAVI). El objetivo de este trabajo es revisar la evolución del sistema de farmacovigilancia de vacunas en Chile. El sistema de FVV chileno se basa en la vigilancia pasiva, y contempla la notificación obligatoria al Instituto de Salud Pública (ISP) de todos los ESAVI detectados, por parte de profesionales de la salud, directores de establecimientos y titulares de registro sanitario, priorizando las notificaciones de ESAVI serios e incluyendo la monitorización de todas las vacunas usadas en el país, tanto las que se encuentran incorporadas al Programa Nacional de Inmunización (PNI), como las que se encuentran fuera de este. El sistema de FVV chileno se caracteriza por un trabajo colaborativo permanente entre el ISP y el PNI, y parte de sus desafíos incluyen generar capacidades y alianzas estratégicas con la academia para la realización de estudios post comercialización sobre seguridad de vacunas. Finalmente, es importante destacar que tanto el marco normativo promulgado el año 2010, como la elaboración de procedimientos, el trabajo permanente con el PNI, y la conformación de un comité de expertos de ESAVI, y las diferentes estrategias de retroalimentación, son medidas implementadas que han contribuido a mejorar la tasa de reporte nacional y el análisis de los casos.

Immunization is among the most successful and cost-effective public health interventions of all times, its benefits being as important as its safety. Vaccines, like any other medicine, can generate adverse events, which must be permanently monitored by surveillance systems. Vaccine Pharmacovigilance (VPV) is the discipline responsible for studying Adverse Events Following Immunization (AEFI). The objective of this article is to review the evolution of the pharmacovigilance system of vaccines in Chile. The Chilean VPV system is based on passive surveillance, and establishes the mandatory reporting of all AEFI detected by healthcare workers, directors of healthcare facilities, and Marketing Authorization holders, to the Public Health Institute of Chile (PHI), prioritizing the reporting of serious ESAVI and including the monitoring of all vaccines used in the country, both those that are incorporated into the National Immunization Program (NIP), and those that are outside of it. The Chilean VPV system is characterized by a permanent collaborative work between the PHI and the NIP, and its challenges include generating capacities and strategic alliances with the academy to carry out post-marketing studies on vaccine safety. Finally, it's important to point out that the regulatory framework promulgated in 2010, as well as the elaboration of procedures, the permanent work with the NIP, the formation of an AEFI expert committee, and the different feedback strategies implemented, have contributed in improving case analysis and the national reporting rate.

Monitoring inequality changes in full immunization coverage in infants in Latin America and the Caribbean / Seguimiento de los cambios en las desigualdades con respecto a la cobertura de la inmunización completa en lactantes en América Latina y el Caribe / Monitoramento do avanço das desigualdades na cobertura vacinal completa em lactentes na América Latina e no Caribe

ABSTRACT Objective. To compare inequalities in full infant vaccination coverage at two different time points between 1992 and 2016 in Latin American and Caribbean countries. Methods. Analysis is based on recent available data from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Reproductive Health Surveys conducted in 18 countries between 1992 and 2016. Full immunization data from children 12-23 months of age were disaggregated by wealth quintile. Absolute and relative inequalities between the richest and the poorest quintile were measured. Differences were measured for 14 countries with data available for two time points. Significance was determined using 95% confidence intervals. Results. The overall median full immunization coverage was 69.9%. Approximately one-third of the countries have a high-income inequality gap, with a median difference of 5.6 percentage points in 8 of 18 countries. Bolivia, Colombia, El Salvador, and Peru have achieved the greatest progress in improving coverage among the poorest quintiles of their population in recent years. Conclusion. Full immunization coverage in the countries in the study shows higher-income inequality gaps that are not seen by observing national coverage only, but these differences appear to be reduced over time. Actions monitoring immunization coverage based on income inequalities should be considered for inclusion in the assessment of public health policies to appropriately reduce the gaps in immunization for infants in the lowest-income quintile.(AU)

RESUMEN Objetivo. Comparar las desigualdades en cuanto a la cobertura de la inmunización completa en los lactantes en países de América Latina y el Caribe. en dos puntos diferentes en el tiempo: 1992 y el 2016. Métodos. El análisis se basa en datos obtenidos recientemente a partir de las encuestas demográficas y de salud, las encuestas de grupos de indicadores múltiples y las encuestas de salud reproductiva realizadas en 18 países entre 1992 y el 2016. Los datos de la cobertura de la inmunización completa en lactantes (de 12 a 23 meses de edad) fueron desglosados por quintil de riqueza. Se midieron las desigualdades absolutas y relativas entre el quintil de ingresos más altos y el quintil de ingresos más bajos. Se midieron las diferencias en 14 países a partir de los datos disponibles para dos puntos en el tiempo. Se determinó la significación mediante intervalos de confianza del 95%. Resultados. La mediana general de los niveles de cobertura de inmunización total fue de 69,9%. Aproximadamente un tercio de los países presentan una brecha de desigualdad con respecto al quintil de ingresos más altos, con una diferencia entre medianas de 5,6 puntos porcentuales en 8 de 18 países. En los últimos años, Bolivia, Colombia, Perú y El Salvador han logrado el mayor avance en cuanto a la mejora de la cobertura en términos de la población correspondiente al quintil de ingresos más bajos. Conclusiones. En este estudio, la cobertura de inmunización completa en los países muestra brechas de desigualdad con respecto al quintil de ingresos más altos que no se evidencian con tan solo observar el nivel de cobertura a nivel nacional. Sin embargo, estas desigualdades parecen disminuir con el transcurso del tiempo. Debería considerarse la posibilidad de que las medidas de seguimiento de la cobertura de inmunización con base en las desigualdades de los ingresos sean incluidas en la evaluación de las políticas de salud pública. Esto permitiría reducir de manera apropiada las brechas en cuanto a la inmunización en los lactantes en el quintil de ingresos más bajos.(AU)

RESUMO Objetivo. Comparar as desigualdades na cobertura vacinal completa infantil em dois momentos distintos entre 1992 e 2016 em países da América Latina e Caribe. Métodos. A análise se baseou em dados recentes provenientes de Pesquisas Nacionais de Demografia e Saúde, Inquéritos por Conglomerados de Múltiplos Indicadores e Pesquisas de Saúde Reprodutiva realizados em 18 países entre 1992 e 2016. Os dados de cobertura vacinal completa em crianças entre 12 e 23 meses de idade foram desagregados por quintis de renda. Foi mensurada a desigualdade absoluta e relativa entre os quintis de maior e menor renda. A magnitude destas diferenças foi avaliada em 14 países com dados disponíveis nos dois momentos considerados. O nível de significância foi determinado com o uso de intervalos de confiança de 95%. Resultados. A mediana global de cobertura vacinal completa foi de 69,9%. Cerca de um terço dos países apresenta alto nível de desigualdade de renda, com uma diferença mediana de 5,6 pontos percentuais em 8 dos 18 países. Bolívia, Colômbia, El Salvador e Peru obtiveram maior avanço nos últimos anos com o aumento do nível de cobertura na população nos quintis de menor renda destes países. Conclusões. A análise da cobertura vacinal completa infantil nos países estudados indica altos níveis de desigualdade de renda que não são evidentes quando se observa somente a cobertura nacional. No entanto, estas diferenças parecem que vêm diminuindo. Deve-se considerar incluir ações de monitoramento da cobertura vacinal com base nas desigualdades de renda ao se avaliar as políticas de saúde pública a fim de reduzir apropriadamente a disparidade na cobertura vacinal de lactentes pertencentes ao quintil de menor renda.(AU)

Clinical-epidemiological profile of deaths from influenza with a history of timely vaccination, Mexico 2010-2018

Introduction: Influenza epidemics are of higher risk at the extremes of life and in people with comorbidities. Effective vaccination prevents the occurrence of serious cases and decreases mortality. Objective: To describe deaths from influenza with a history of timely vaccination, from the 2010 to the 2018 season in Mexico. Method: Cross-sectional, descriptive study where the Influenza Epidemiological Surveillance System database was used. Results: From 2010 to 2018, 65 vaccinated individuals died from influenza, from which 55% of cases (n = 36) were due to type A (H1N1), 51% (n = 33) were females, median age was 57 years, 21 % (n = 14) did not meet the operational definition of influenza-like illness or severe acute respiratory infection, 83% (n = 54) had at least one comorbidity, with the most common being diabetes mellitus and hypertension (32% each); 55% (n = 36) of deaths received antiviral treatment and only 8% (n = 5) had no comorbidities and received treatment with oseltamivir. Conclusions: Deaths from influenza with timely vaccination represent a very low percentage of the totality. Vaccination against influenza has been a specific prevention strategy that decreases disease burden.

Spatial analysis of pneumococcal meningitis in São Paulo in the pre- and post-immunization era

ABSTRACT OBJECTIVE To analyze the pneumococcal meningitis incidence rates in the State of São Paulo, Brazil, by age group, municipalities and micro-regions, as well as the spatial distribution of pneumococcal meningitis incidence rates among children under 5 years old in the pre- (2005-2009) and post-vaccination (2011-2013) periods and its associations with socioeconomic variables and vaccination coverage. METHODS The data source was the Brazilian Notifiable Diseases Information System. For the pre- and post-vaccination periods, thematic maps were built for pneumococcal meningitis incidence in under-5 children, by São Paulo state micro-regions, vaccination coverage and socioeconomic variables, using QGIS 2.6.1 software. Scan statistics performed by the SatScan 9.2 software were used to analyze spatial and spatiotemporal clusters in São Paulo municipalities and micro-regions. A Bayesian inference for latent Gaussian model with zero-inflated Poisson model through the integrated nested Laplace approximation was used in the spatial analysis to evaluate associations between pneumococcal meningitis incidence rates and socioeconomic variables of interest in São Paulo micro-regions. RESULTS From 2005 to 2013, 3,963 pneumococcal meningitis cases were reported in São Paulo. Under-5 children were the most affected in the whole period. In the post-vaccination period, pneumococcal meningitis incidence rates decreased among this population, particularly among infants (from 4.17/100,000 in 2005 to 2.54/100,000 in 2013). Two clusters were found in pre-vaccination - one of low risk for pneumococcal meningitis, in the northwest of the state (OR = 0.45, p = 0.0003); and another of high risk in the southeast (OR = 1.62, p = 0.0000). In the post-vaccination period, only a high-risk cluster remained, in the southeast (RR = 1.97, p = 0.0570). In Bayesian analysis, wealth was the only variable positively associated to pneumococcal meningitis (RR = 1.026, 95%CI 1.002-1.052). CONCLUSIONS Pneumococcal meningitis is probably underdiagnosed and underreported in São Paulo. Differentiated rates of pneumococcal meningitis diagnosis and reporting in each microregion, according to the São Paulo Index of Social Responsibility, might explain our results.

Oportunidades ganadas en vacunación de los adultos. Implementación de una estrategia combinada para superar barreras / Gained opportunities in adult vaccination. Performing a combined strategy to overcome barriers

El Programa Nacional de Inmunizaciones en Argentina es-tablece la administración universal y obligatoria de las vacunas doble adultos (dT) y hepatitis B (HB) y las vacunas antigripal y antineumocó-cica para poblaciones especiales y mayores de 65 años. Son gratuitas y, excepto las vacunas antigripal y antineumocócica en personas en-tre 2-64 años, no requieren prescripción para su administración. Sin embargo, las tasas de vacunación en los adultos son bajas. Mejorar las coberturas vacunales en adultos es un desafío. Realizamos un estu-dio prospectivo de corte transversal para evaluar la implementación de una estrategia de vacunación combinada para aumentar la vacunación de los adultos de una institución. Esta se basó en el requerimiento obli-gatorio de dT en las cirugías programadas junto con el consejo médico en el vacunatorio y el acceso inmediato a la vacunación. Como resulta-do de esta estrategia se administraron 2.946 dosis extra que represen-tan un aumento de 312 % sobre las dosis sin intervención. Esta estrate-gia simple podría ser replicada fácilmente en otros centros

The National Immunization Program in Argentina recom-mends tetanus and diphtheria vaccine [Td] and hepatitis B for all healthy adults and influenza and pneumococcal vaccines for special populations. Despite the fact that these vaccines are free and without requirement for prescription, rates of vaccination remain low in adults.Improving vaccina-tion coverage among adults remains a major challenge. We performed a prospective cross-sectional study to assess a combined vaccination strat-egy in order to enhance compliance in a single institution. It was based on institutional requirement of Td vaccine for all elective surgery plus med-ical counseling provided by a trained physician at the Vaccination Room and immediate access to vaccination. As a result of this strategy, 2946 extra doses of vaccines were given. These doses represent an increase of 312% from the doses estimated without our intervention. This simple strategy may be easily replicated in other centers

Recommended Seasonal Influenza Vaccine for use in 2016-17

In February 2016, WHO has recommended influenza viruses for inclusion in the seasonal influenza vaccines for the countries of northern hemisphere for 2016-17. These recommendations are based on the antigenic and genetic analysis of the circulating seasonal influenza viruses shared by the countries with WHO through the Global Influenza Surveillance and Response System [GISRS]

Fatores associados à imunização contra Hepatite B entre trabalhadores da Estratégia Saúde da Família / Factores asociados con la vacunación contra la hepatitis B entre los trabajadores de la Estrategia Salud de la Familia / Factors associated with immunization against Hepatitis B among workers of the Family Health Strategy Program

Estudo transversal conduzido entre trabalhadores da Estratégia Saúde da Família de Montes Claros. Objetivo: investigar o relato de vacinação contra Hepatite B, a verificação da imunização e os fatores associados às dosagens de anti-HBs. Método: coletaram-se amostras de sangue daqueles que relataram ter recebido uma ou mais doses da vacina. Avaliou-se a associação da dosagem de anti-HBs com condições sociodemográficas, ocupacionais e comportamentais. As associações foram verificadas pelos testes Mann Whitney e Kruskal Wallis e correlação de Spermann seguida pela regressão linear, utilizou-se o SPSS® 17.0. Resultados: dentre os 761 entrevistados, 504 (66,1%) foram vacinados, 52,5% tomaram três doses, 30,4% verificaram a imunização. Dos 397 avaliados quanto à dosagem de anti-HBs, 16,4% estavam imunes. Conclusão: constatou-se que o maior tempo de trabalho foi associado a níveis mais elevados de anti-HBs, enquanto os níveis de tabagismo foram inversamente associados ao anti-HBs. Há necessidade de campanhas de vacinação entre esses trabalhadores. .

Estudio transversal realizado entre trabajadores de la Estrategia Salud de la Familia Montes Claros. Objetivo: investigar el informe de la vacunación contra la hepatitis B, la verificación de la inmunización y los factores asociados con la dosis de anti-HBs. Método: se recogieron muestras de sangre de los que informaron que tenían una o más dosis de la vacuna. Se evaluó la asociación entre la dosis de anti- HBs con las condiciones sociodemográficas, laborales y de comportamiento. Las asociaciones fueron verificadas por Mann Whitney y Kruskal Wallis y Spermann correlación seguida por regresión lineal utilizando el programa SPSS® 17.0. Resultado: entre los 761 encuestados, 504 (66,1%) fueron vacunados, el 52,5 % recibió tres dosis de vacunación, 30,4% verificado. De los 397 evaluados para la determinación de anticuerpos anti-HBs, 16,4 % eran inmunes. Conclusión: se encontró que la mayor duración de la obra se asoció con mayores niveles de anti- HBs, mientras que los niveles de tabaquismo se asoció inversamente con el anti- HBs. La necesidad de campañas de vacunación entre los trabajadores. .

Cross-sectional study conducted among workers of the Family Health Strategy Montes Claros. Objective: to investigate the report of vaccination against Hepatitis B, verification of immunization and the factors associated with dosages of anti-HBs. Method: we collected blood samples from those reported that they had one or more doses of the vaccine. We evaluated the association of the dosage of anti- HBs with sociodemographic conditions, occupational and behavioral. The associations were verified by Mann Whitney and Kruskal Wallis and correlation Spermann by linear regression using SPSS® 17.0. Results: among the 761 respondents, 504 (66.1%) were vaccinated, 52.5 % received three doses, 30.4 % verified immunization. Of the 397 evaluated for the determination of anti-Hbs, 16.4% were immune. Conclusion: it was found that longer duration of work was associated with higher levels of anti-HBs, while levels of smoking were inversely associated with anti-HBs. These workers need for vaccination campaigns. .

Knowledge and Acceptability about Adult Pertussis Immunization in Korean Women of Childbearing Age

PURPOSE: The adult tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine has been introduced in order to provide individual protection and reduce the risk of transmitting pertussis to infants. We assessed the knowledge and acceptability of the Tdap vaccine around pregnancy. MATERIALS AND METHODS: This study was a cross-sectional survey of women of childbearing age (20-45 years) who visited obstetrics and gynecologic units of primary, secondary, or tertiary hospitals. They were asked to fill in a questionnaire assessing their knowledge, attitudes, and acceptability of Tdap. RESULTS: The questionnaire was completed by 308 women; 293 (95.1%) had not received information from doctors about Tdap, and 250 (81.2%) did not know about the need for vaccination. A significantly important factor related to subjects' intention to be vaccinated, identified by stepwise multiple logistic regression, was the knowledge (OR 13.5, CI 3.92-46.33) that adult Tdap is effective in preventing pertussis for infants aged 0-6 months. Additionally, 276 (89.6%) considered the recommendation of obstetric doctors as the most influencing factor about Tdap vaccination. CONCLUSION: In Korea, most women of childbearing age seem to be neither recommended nor adequately informed about the vaccination, although our population was not a nationwide representative sample. Information given by healthcare workers may be critical for improving awareness and preventing pertussis.

Assessment of Sociodemographic Factors Affecting Immunization Status of Children in Age Group of 12-23 Months in a Rural Area.

Background: Immunization is a powerful and cost effective weapon against vaccine preventable diseases. In India ‘Expanded Programme of Immunization, (EPI) was launched in 1978. But today also immunization coverage in India is comparatively low and far from satisfaction. Objectives: 1. To assess immunization status of children in age group between 12-24 months. 2. To study the sociodemographic factors affecting immunization status. Method : 30*7 cluster sampling method was used to assess sociodemographic factors affecting immunization status of children in age group of 12-23 months in rural area of Beed district (Maharashtra) in India. Results : Out of total 210 children surveyed, 165 (78.57%) were fully immunized, 43(20.48%) were partially immunized and 2(0.95%) were unimmunized. Immunization status of child was found not to be associated with the gender and type of family of child. It was significantly associated with religion, place of birth and availability of immunization card. Immunization status of children went on significantly improving as their mother’s education level increased (p<0.05), but fathers education had no influence. Immunization status of children was found directly related to their socioeconomic class and inversely to birth order. The highest (86.25%) coverage for complete immunization was among the children having birth order II. Immunization status went on decreasing as birth order increased and was the lowest (50.00%) among those having birth order V. Conclusion : To improve immunization coverage in rural area improvement in female literacy and female education is necessary. Similarly improvement in socioeconomic status, limiting the family size and increasing hospital deliveries will lead to improvement in immunization coverage. Also parents should be encouraged to preserve immunization cards of their children as long as possible.

Study of Immunization Status and Outcome of Diphtheria Patients.

Background: With advent of EPI and UIP, most of the vaccine preventable diseases have shown a decline; however, Diphtheria continues to remain an endemic disease and has also shown resurgence nationally as well as internationally. Aims and Objectives: To study Diphtheria morbidity and mortality trends. To note variation with respect to age, sex, immunization status, seasonal variation and outcome. Materials and Method: A retrospective analysis of hospital records over the period of 3 years from Jan/2008 to Dec/2010 obtained with permission of hospital superintendent Dr. Jhala from infectious disease hospital in Ahmedabad, Gujarat. Details of 247 cases regarding age, sex, immunization status were taken as per the hospital case records. Results: Of 247 cases, 114 were male (46%), 133 (54%) Females, 71 (29%) were under 5 Years, 103 (42%) were in 6 – 12 years and 35 (14%) were in 13- 20yrs, 38 patients (15%) were noted within 21-60yrs group, a total of 73 (29.5%) patients were observed in adult and adolescent group. Mortality was 0.47%. Incidence was more in months of September to March. In the present study, 85 (34.4%) were completely immunized, 31 (12.55%) were partially immunized and for 18 (7.3%) vaccination status was unknown. 113 (45.75%) were not immunized. Conclusion: Diphtheria continues to remain a major public health concern in spite of being a vaccine preventable disease, though common in pediatric age it is increasingly common in adoloscent and adults. High level of clinical suspicion needed to keep the mortality rates on lower side. A strict implementation of vaccination programmes with follow up booster dose is necessary which will increase the herd immunity, leading to decrease in diphtheria prevalence.

Factors associated with influenza vaccination among US children in 2008

Relative to adults, children have a higher risk of influenza-related illnesses, and they play a major role in the spread of infections through a household. Because the primary caregiver is responsible for the overall health of the child, it is important to analyze the relationship between caregiver characteristics and childhood immunizations. This study examined the characteristics of the caregiver, household, and child to identify factors associated with childhood influenza immunizations. Data for children aged 19-35 months [n = 25,256] were collected from the 2008 National Immunization Survey [NIS]. The studied caregiver characteristics included age, education level, and marital status. Demographic variables included the child's age, sex, race/ethnicity, firstborn status, and insurance status in addition to household size, region, and poverty status. All analyses were weighted to reflect the complex sampling frame of the NIS. Overall, 56.39% of children aged 19-35 months had received a flu vaccination. Factors associated with an increased likelihood of vaccination included the primary caregiver being older, married, and more educated and living in the Northeast. A child with private insurance was more likely to be immunized than a child with any other type of insurance [public: OR 0.6483, 0.5589, 0.7521; no insurance: OR 0.6759, 0.4694, 0.9732]. Hispanic children [OR 1.1554, 1.0312, 1.2945] were more likely to be vaccinated than their counterparts. Understanding the characteristics related to the rates of childhood influenza immunization can help policy makers develop and tailor programs to improve immunization education and delivery, especially to the groups that are least likely to participate

Primer Centro de Medicina del Viajero en un hospital público de la Provincia de Buenos Aires, República Argentina: Dos años de experiencia / First Travel Medicine Center in a public hospital from Buenos Aires Province, Argentina Republic: The first 2 years of experience

Introduction: Although Buenos Aires is the biggest province in Argentina, there was no program for Travel Medicine in any public hospital until 2008, when the Travel Medicine Center (CEMEVI) was established in our hospital. Objective: To analyze the first 24 months of experience in the CEMEVI. Results: A total of 278 travelers were assisted. Most of them consulted before traveling (pre-travel visits). The most common destinations were countries in South America and urban as well as rural areas. Travelling to malaria and yellow fever endemic countries represented 35% and 16% of the total of destinations, respectively. Only 4% were post-travel interviews. Conclusion: It is feasible and frutful to implement a Travel Medicine Center in the public health system.

Introducción: La Provincia de Buenos Aires, a pesar de ser la mayor de nuestro país, no contaba con ningún sitio de asesoramiento al viajero instalado en un hospital público, hasta que en el año 2008 se crea el Centro de Medicina del Viajero (CEMEVI) en nuestro hospital. Objetivo: analizar de manera retrospectiva los primeros 24 meses de experiencia en el CEMEVI. Resultados: Recibimos un total de 278 consultas, la mayoría durante el pre-viaje, a países de América del Sur, a sitios urbanos- rurales, de los cuales 35 y 16% de los viajeros visitaron zonas de riesgo para malaria y fiebre amarilla, respectivamente. Sólo 4% de las consultas fueron en el post-viaje. Conclusión: Es posible y fructífero implementar un Centro de Medicina del Viajero en el sector público de salud.

Health Impact Assessment of Free Immunization Program in Jinju City, Korea / 예방의학회지

OBJECTIVES: This study was conducted to assess the potential health impacts and improve the quality of the free immunization program in Jinju City by maximizing the predicted positive health gains and minimizing the negative health risks. METHODS: A steering committee was established in September 2010 to carry out the health impact assessment (HIA) and began the screening and scoping stages. In the appraisal stage, analysis of secondary data, a literature review, case studies, geographic information systems analysis, a questionnaire, and expert consultations were used. The results of the data collection and analyses were discussed during a workshop, after which recommendations were finalized in a written report. RESULTS: Increased access to immunization, comprehensive services provided by physicians, the strengthened role of the public health center in increasing immunization rates and services, and the ripple effect to other neighboring communities were identified as potential positive impacts. On the other hand, the program might be inaccessible to rural regions with no private clinics where there are more at-risk children, vaccine management and quality control at the clinics may be poor, and vaccines may be misused. Recommendations to maximize health gains and minimize risks were separately developed for the public health center and private clinics. CONCLUSIONS: The HIA provided an opportunity for stakeholders to comprehensively overview the potential positive and negative impacts of the program before it was implemented. An HIA is a powerful tool that should be used when developing and implementing diverse health-related policies and programs in the community.

Vaccination coverage among children under two years of age based on electronic immunization registry in Southern Brazil / Cobertura vacinal em menores de dois anos a partir de registro informatizado de imunização em Curitiba, PR

OBJETIVO: Avaliar o programa de imunização de crianças de 12 e de 24 meses de idade, com base no registro informatizado de imunização. MÉTODOS: Estudo descritivo em amostra probabilística de 2.637 crianças nascidas em 2002 e residentes em Curitiba, PR. As fontes de dados foram: registro informatizado de imunização do município, Sistema de Informação de Nascidos Vivos e inquérito domiciliar para casos com registro incompleto. As coberturas foram estimadas aos 12 e aos 24 meses de vida e analisadas segundo características socioeconômicas de cada distrito sanitário e o vínculo das crianças aos serviços de saúde. Foram analisadas a abrangência, completude e duplicidades do registro informatizado de imunização. RESULTADOS: A cobertura do esquema de imunização foi de 95,3 por cento aos 12 meses sem diferenças entre os distritos e de 90,3 por cento aos 24 meses, tendo sido mais elevada em um distrito com piores indicadores socioeconômicos (p = 0,01). A proporção de vacinas, segundo o tipo, aplicadas antes e após a idade recomendada foi de até 0,9 por cento e até 32,2 por cento, respectivamente. A cobertura do registro informatizado de imunização foi de 98 por cento na amostra estudada, o sub-registro de doses de vacinas foi de 11 por cento e a duplicidade de registro foi de 20,6 por cento. Os grupos que apresentaram maiores coberturas foram: crianças com cadastro definitivo, aquelas com três ou mais consultas pelo Sistema Único de Saúde e as atendidas em Unidades Básicas de Saúde que adotam plenamente a Estratégia de Saúde da Família. CONCLUSÕES: A cobertura vacinal em Curitiba mostrou-se elevada e homogênea entre os distritos, e o vínculo com os serviços de saúde foi fator importante para tais resultados. O registro informatizado de imunização mostrou-se útil no monitoramento da cobertura vacinal; no entanto, é importante a prévia avaliação do seu custo-efetividade para que seja amplamente utilizado pelo Programa Nacional de Imunização.

OBJECTIVE: To evaluate the immunization program for 12 and 24-month-old children based on electronic immunization registry. METHODS: A descriptive study of a random sample of 2,637 children born in 2002 living in the city of Curitiba, Southern Brazil was performed. Data was collected from local electronic immunization registers and the National Live Birth Information System, as well as from a household survey for cases with incomplete records. Coverage at 12 and 24 months was estimated and analyzed according to the socioeconomic characteristics of each administrative district and the child's enrollment status in the health care service. The coverage, completeness, and record duplication in the registry were analyzed. RESULTS: Coverage of immunization was 95.3% at 12 months, with no disparities among administrative districts, and 90.3% at 24 months, with higher coverage in a district with lower socioeconomic conditions (p < 0.01). The proportion of vaccines, according to type, given before and after the recommended age reached 0.9% and 32.2%, respectively. In the surveyed sample, electronic immunization registry coverage was 98%, underreporting of vaccine doses was 11%, and record duplication was 20.6%. Groups with highest coverage included children with permanent records, children with three or more appointments through the National Unified Health Care System, and children seen within Primary Health Care Facilities fully adopting the Family Health Strategy. CONCLUSIONS: Vaccination coverage in Curitiba was high and homogeneous among districts, and health service enrollment status was an important factor in these results. The electronic immunization registry was a useful tool for monitoring vaccine coverage; however, it will be important to determine cost-effectiveness prior to wide-scale adoption by the National Immunization Program.

Atraso vacinal e seus determinantes: um estudo em localidade atendida pela Estratégia Saúde da Família / Immunization delay determinants: a study in a place attended by Family Health Strategy

O conhecimento dos determinantes da cobertura vacinal é relevante para o desenvolvimento de estratégias em Saúde Pública. Objetivou-se identificar a prevalência de sintomas depressivos, atraso vacinal e o perfil dos cuidadores em relação a escolaridade, situação sociodemográfica, estado civil e conhecimento sobre vacinação. A abordagem quantitativa foi escolhida utilizando-se um inquérito descritivo de base populacional, com a aplicação de um questionário e Inventário de Beck nos cuidadores de crianças na faixa etária de 0 a 5 anos, totalizando 339, numa equipe da Estratégia Saúde da Família no município de Cachoeirinha (RS). A prevalência de sintomas depressivos foi de 38,6 por cento. Não foi identificada associação significativa entre sintomas depressivos nos cuidadores e atraso vacinal nas crianças (RC=1,0, IC 95 por cento, 0,62-1,73). O percentual de atraso vacinal foi de 23,3 por cento. A alta prevalência de sintomas depressivos entre as mães e a alta percentagem de atraso vacinal indicam a necessidade de uma rede de apoio social e a busca de melhor efetividade da atenção primária em saúde.

It is relevant to understand every aspect, regarding to strategies that will determine immunization coverage. Thus the main objective in this research is to identify the prevalence of depressive symptoms as well as low immunization uptake, identifying the caretakers' profile, considering his/her level of education, social-demographic character, marital status and also knowledge about immunization in which a Beck Inventory questionnaire was applied to the children's caretakers. Children's age ranged from 0 to 5 years and the number of subjects was 339 enrolled in a group of Family Health Strategy at the city of Cachoeirinha, in the state of Rio Grande do Sul, Brazil. The depression symptoms prevalence was 38.6 percent. The association between depression symptoms and the low immunization uptake was not statistical significant (OR=1.0, CI 95 percent, 0.62-1.73). The low immunization uptake rate was 23.3 percent. The high prevalence of depressive symptoms between mothers and the high percentage of immunization delay means the need of social help and the search of better effectivity of primary attention in health.

Enfermagem e atenção à saúde do trabalhador: a experiência da ação de imunização na Fiocruz/Manguinhos / Nursing and healthcare for workers: the experience of the immunization action at Fiocruz/Manguinhos

O trabalhador, ao realizar atividades em que exista o contato com agentes patogênicos, se expõe ao risco de adquirir doenças que podem levá-lo à morte. A imunização aparece como uma das medidas de prevenção e proteção contra o seu adoecimento. Este artigo apresenta a experiência de imunização em trabalhadores, no período de 2005 a 2008, através da implantação do projeto Ações Integradas de Enfermagem em Vigilância da Saúde do Trabalhador na Fundação Oswaldo Cruz, campus Manguinhos, Rio de Janeiro (Fiocruz/Manguinhos). Trata-se de um estudo descritivo exploratório quantitativo, utilizando dados primários resultantes da construção do projeto de trabalho na linha temática da vigilância em saúde do trabalhador. Nesse período, aplicaram-se 12.904 doses de vacinas variadas em uma população de trabalhadores de atividades e faixas etárias diversificadas. Construção civil, segurança, jardinagem, manutenção e serviço de limpeza foram aquelas com maior mobilização e receptividade dos trabalhadores. A experiência possibilitou a instalação da sala de vacina no CST/DIREH, realização de campanhas nas unidades, realização de ações de imunização específicas para trabalhadores e de grupos operativos e palestras voltadas à educação em saúde.

The worker, while doing his activities in contact with patogenic agents, is exposed to the risk of getting diseases that could result in death. The immunizaton appears as one of the ways to preserve and protect against this contamination. This article presents an experience of workers immunization during the period of 2005 to 2008, by the implantation of the project Nursing Integral Actions of Worker's Health Vigilance at Fundação Oswaldo Cruz (Fiocruz), Manguinhos campus, Rio de Janeiro. This is a descriptive, explorative and quantitative study, using primary data from the construction of the project. During the project 12.904 doses of different vaccines were applied in a population with a variety of job activities and ages. Civil construction, security, gardenering, maintenence and clearing service teams were the most mobilized and receptive to the activities. With this experience it was possible the instalation of the vaccination room at CST/DIREH/Fiocruz, the implantation of campaigns at the unities, specific immunization actions to the workers and operative groups and lectures focused in health education.

Related Factors of Age-Appropriate Immunization among Urban-Rural Children Aged 24-35 Months in a 2005 Population-Based Survey in Nonsan, Korea

PURPOSE: This study was aimed to determine the status and related factors of age-appropriate immunization among urban-rural children aged 24-35 months in a 2005 population-based survey in Nonsan, Korea. MATERIALS AND METHODS: We conducted household survey and provider check using questionnaire and checklist to obtain data on immunization status for children, aged 24-35 months. Age-appropriate immunization was defined as status of receiving the fourth diphtheria-tetanus-pertussis (4 DTP), 3 Polio, the first measles-mumps-rubella (1 MMR) doses, and the 4 : 3 : 1 series. RESULTS: Age-appropriate immunization rates were 51.7% for 4 DPT, 88.0% for 3 Polio, 87.9% for 1 MMR, and 50.3% for the 4 : 3 : 1 series. First-born children, lower perceived barrier scores, and higher perception of immunization data were significantly related to age-appropriate immunization. CONCLUSION: The findings indicated that age-appropriate immunization rate could be improved by implementing reminder/recall service and providing the knowledge about immunization. Identification and consideration related factors would improve immunization rate and age-appropriate immunization.