Spatial distribution of human papillomavirus vaccination coverage in the state of Maranhão, Brazil.

The aim of this study was to describe the spatial distribution of human papillomavirus (HPV) vaccination coverage in the state of Maranhão, Brazil. We conducted a retrospective ecological study using data from three age cohorts of boys (age 16, 17 and 18) and girls (age 13, 14 and 15). The units of analysis were municipalities and health regions. A spatial analysis of distribution of adequate and inadequate coverage was conducted. 84.2% of the state's health regions achieved adequate coverage for the first dose among girls in cohort 1, but only 26.3% of these regions achieved the same coverage target for the second dose. This percentage was lower in boys across all cohorts, with only 26% of the health regions achieving adequate coverage in each dose. Spatial distribution of vaccination coverage was uneven. The study revealed important gaps in vaccination coverage in the state among both boys and girls. The heterogeneity of the spatial distribution of vaccination coverage reinforces the challenges that need to be overcome to ensure the effective implementation of the vaccination program across the state's municipalities.