Trend and spatial distribution of hepatitis B vaccine coverage in Brazilian children under one year of age and the repercussions of the COVID-19 pandemic

Abstract Introduction Hepatitis B accounted for more than half of the deaths from viral hepatitis in Brazil. Objective To analyze the trend and spatial distribution of Hepatitis B vaccine coverage in Brazilian children under one year of age and the repercussions of the COVID-19 pandemic. Methods This ecological time-series study used hepatitis B vaccination coverage data from the Brazilian National Immunization Program. Median coverage and period comparisons were calculated for January 2017–April 2025. Temporal trends were analyzed using Prais-Winsten regression through November 2024 to ensure stable estimates, and differences between periods were assessed using the Mann-Whitney U test. Spatial analysis used Global and Local Moran’s indices, extending the pre-pandemic baseline to 2014–2020 to improve spatial autocorrelation estimates. Results The 95% vaccination target was not achieved nationally or regionally; Rondônia was the only Federative Unit to meet the target in the pre-pandemic period. Coverage declined in most regions during the intra-pandemic period, with a post-pandemic increase observed only in the North (8.4%; p = 0.02). Trend analyses indicated an overall decline during the intra-pandemic study period, stability in the Northeast (β = −0.31; p = 0.064; adj. R² = 52.84%), and an increase during the post-pandemic study period, except in the Midwest, where the trend remained stable (β = 0.56; p = 0.081; adj. R² = 10.79%). Spatial analysis highlighted the North Region, which concentrated municipalities below the target and low-low clusters. Conclusion The COVID-19 pandemic reduced hepatitis B vaccination coverage in Brazil.