Measles is a contagious viral disease that severely affects children; in the 1960s and 1970s it was the main cause of death among children under 4 years of age in Brazil. To evaluate measles vaccination coverage in municipalities of the state of São Paulo. Ecological, exploratory study with spatial analysis tools, on vaccination coverage (VC) against measles through the first dose of the MMR vaccine. Data were obtained from DATASUS for 644 municipalities in the state of São Paulo between 2018 and 2024. The digital map of municipalities was obtained from IBGE. VC values were categorized as Low (VC<90%), Medium (VC ≥90% to <95%) and Ideal (VC≥95%). The Global Moran Index (MI) was used to measure spatial autocorrelation, and the Local Moran Index (LISA) was used to analyze the spatial distribution pattern and intensity of clusters for each year studied. A 95% significance level and 499 permutations were used for both analyses. Socioeconomic variables were included: gross domestic product (GDP), per capita income (PCI) and the Índice Paulista de Desenvolvimento Municipal (IPDM) obtained from Fundação SEADE. Thematic maps of VC were constructed for each year, as well as BOXMaps identifying municipalities with high priority for intervention. The bivariate Moran index (IMB) was estimated, with VC as the dependent variable and socioeconomic variables as independent variables, in an attempt to identify possible autocorrelations between these variables and VC. Mean VC for the period and the respective indices were also estimated. TerraView and GeoDa software, publicly available, were used. As this study used secondary data, submission to research ethics committees was not required. Univariate MI values were positive, except for 2024, and significant for the entire period, including mean VC and non-significant for VCs in 2022 and 2024. A total of 160 municipalities with VC<90% and 81 with medium VC were located in Vale do Paraíba, Greater São Paulo and the regions of Sorocaba and Jaú. Bivariate Moran indices were IMB = –0.14 (VC–GDP), IMB = –0.06 (VC–PCI) and IMB = –0.13 (VC–IPDM). The BOXMap for mean VC identified 149 municipalities located in Vale do Paraíba, the northwestern and central regions of the state that merit investigation by municipal and regional managers regarding VC. It was possible to identify municipalities that require investigation by state health managers.
Nascimento et al. (2026) studied this question.