In response to an increase in pertussis cases beginning in 2010, Brazil introduced dTpa vaccine into the national immunization schedule for pregnant women in 2013. In the pre-maternal vaccination period (2011–2013), the average annual incidence of pertussis hospitalizations in children under 1 year old was 98.3/100,000 and in the post-maternal vaccination period (2015–2017) the average was 65.9/100,000, a decline of 32.9%.
Brazil
Immunization campaigns provide more equitable access to childhood vaccinations compared to maternal health services
An analysis of survey data in Latin America and Caribbean countries found that DPT3 coverage rates among indigenous children were significantly lower than in children of European or mixed ethnicity in three out of 14 countries, while significant inequities between these groups in coverage of maternal health services, such as antenatal care and delivery by a skilled birth attendant, existed in most of the countries. The greater equity in access to childhood vaccination by ethnic group may be because vaccinations are often delivered in the communities through immunization campaigns, whereas maternal health services require accessing health facilities, which may incur user fees and transportation costs.
Vaccinating pregnant women with Tdap vaccine in Brazil was 83% effective in preventing pertussis in infants
In a case-control study in the state of São Paulo, Brazil, vaccination of pregnant women with Tdap vaccine was 83% effective in preventing pertussis in their infants less than 2 months of age — before their first dose of DPT — and 81% effective after controlling for household income and mother’s age.
Vaccinating pregnant women in Brazil with Tdap vaccine would greatly reduce pertussis cases and deaths in infants
In Brazil, where pertussis cases have climbed, mainly in infants <4 months of age, vaccinating pregnant women with Tdap vaccine at the same coverage rate as influenza vaccination in pregnant women (57%) would reduce pertussis cases in children under 1 year of age by 41%, deaths by 43%, and would be cost-effective, according to the WHO thresholds.
Vaccination of infants against pneumonia greatly reduces hospitalizations, saving millions in healthcare costs
In a study using actual data on hospitalizations and costs before and after PCV-10 vaccine was introduced in Brazil, an estimated 463,000 hospitalizations from all causes of pneumonia were prevented in persons less than 65 years of age over 5 years following introduction of the vaccine — saving an estimated US$147 million in hospitalization costs. Half of the costs averted were due to fewer hospitalizations in children under five, who were targeted for the vaccine, while the remaining half were due to fewer hospitalizations in persons 5-49 years of age, as a result of herd protection.
Immunization can prevent costly meningitis outbreaks
Two meningococcal meningitis outbreaks in Brazil resulted in US$128,000 (9 cases, 2007) and US$34,000 (3 cases, 2011) in direct costs to the health system to investigate cases and manage the outbreak (including emergency vaccination). The investigation and response activities related to the 2011 outbreak alone cost $11,475 per case, and an additional $6,600 overall for supplemental disease surveillance activities.
Immunization can help reduce the risk of stunting caused by diarrhea in children
A pooled analysis of nine studies assessing the effects of diarrhea on stunting prior to the age of 24 months showed that the odds of stunting were significantly increased with each diarrheal episode. Each day of diarrhea prior to attaining 24 months of age also contributed to the risk of stunting. For each five episodes of diarrhea, the odds of stunting increased by 13%. In addition, once a child becomes stunted, only 6% of those stunted at 6 months of age recovered by 24 months of age.
Immunization with rotavirus vaccine may also reduce severe gastroenteritis cases in unimmunized children through herd immunity
A meta-analysis of studies measuring the impact of rotavirus vaccine (RVV) on severe gastroenteritis morbidity and mortality, found a 22% herd immunity effect for severe rotavirus gastroenteritis in children less than one year of age in US and El Salvador. In Latin America, severe gastroenteritis due to any cause was reduced by 25%.
Malnourished children are at a greater risk of death from vaccine-preventable diseases
Findings of a systematic review evaluating the relationship between pneumonia and malnourishment found that severely malnourished children in developing countries had 2.5 to 15 times the risk of death. For children with moderate malnutrition, the risk of death ranged from 1.2 to 36.
Diarrhea is associated with pneumonia in undernourished children
In a recent review of data from developing countries, researchers found that episodes of diarrhea may predispose undernourished children to pneumonia.