# Maternal Vaccination Coverage in Brazil From 2018 to 2022: A Cross-Sectional Descriptive Analysis Using Minimum and Maximum Estimates

## TL;DR

This study tracks maternal vaccination coverage in Brazil from 2018 to 2022, showing recovery after pandemic disruptions and regional differences in progress.

## Contribution

The study provides a detailed analysis of maternal vaccination coverage trends in Brazil using minimum and maximum estimates across regions.

## Key findings

- Minimum vaccination coverage increased in all regions, reaching over 70% in some areas by 2020.
- The North region had the largest relative gain in minimum coverage, while the South and Southeast saw temporary declines in 2021.
- Maximum coverage remained low, highlighting the need for improved strategies to increase uptake of additional vaccines.

## Abstract

Background: Brazil has historically achieved high immunization coverage through its National Immunization Program (PNI). Vaccination during pregnancy is essential to protect both mothers and infants, yet routine immunization services were disrupted during the COVID-19 pandemic. Monitoring maternal vaccination coverage is crucial to inform public health strategies.

Methods: This cross-sectional descriptive study analyzed publicly available data from the Department of Information and Informatics of the Unified Health System (DATASUS) for 2018-2022. Pregnant women aged 18-49 years were included. Vaccination coverage was estimated using two scenarios: minimum coverage (two doses: influenza and Tdap (tetanus, diphtheria, and acellular pertussis)) and maximum coverage (five doses: influenza, Tdap, and three doses of hepatitis B). Coverage was calculated as the ratio of doses administered to expected doses, using live births as the denominator.

Results: Minimum coverage increased in all regions, ranging from 35.7-43.0% in 2018 to 44.5-86.6% in 2022. Maximum coverage ranged from 14.3-17.2% in 2018 to 17.8-34.6% in 2022. The North region showed the largest relative gain in minimum coverage (+43.4 percentage points), while the South and Southeast regions experienced temporary declines in 2021 compared to 2020 (-12 to -13 points), followed by a recovery in 2022.

Conclusions: Maternal vaccination coverage in Brazil demonstrated resilience after the initial decline during the COVID-19 pandemic, with minimum coverage exceeding 70% in the North, Northeast, and Midwest regions by 2020, while the South and Southeast regions remained below this threshold. Regional heterogeneity, particularly lower recovery in the Southeast, highlights the need for tailored strategies to sustain and expand maternal immunization. These findings provide evidence to guide public health interventions and reinforce the importance of continuous monitoring of maternal vaccination.