[Vaccination coverage in the first year of life in 4 cities of the state of São Paulo, Brazil]

National Vaccine Coverage Survey 2020: methods and operational aspects

OBJECTIVE

The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016.

METHODS

A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy.

RESULTS

Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others.

CONCLUSION

There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.

Factors Associated with the Completeness of the Vaccination Schedule of Children at 12 and 24 Months of Age in a Brazilian Medium-Size Municipality

PURPOSE

To analyse the factors associated with the completeness of the vaccination schedule of children at 12 and 24 months of age, in a Brazilian municipality.

DESIGN AND METHODS

Cross-sectional study conducted in Araraquara-São Paulo with a probabilistic sample of 388 children born in 2015. The completeness of the vaccination schedule at 12 and 24 months of age was considered a dependent variable. Socioeconomic and demographic characteristics, use of health services and vaccination were the independent variables. For analysis, descriptive statistics and Poisson regression with robust variance were used.

RESULTS

The completeness of the vaccination schedule at 12 and 24 months of age was identified in 77.1% and 68.8% of children, respectively. Coverage at 12 months was greater among children of mothers who received guidance from health professionals on vaccination or had health problems during childbirth or in the first seven days. Those who reported a previous episode of adverse reaction to the vaccine, coverage was lower. Coverage at 24 months was greater among those who received guidance from health professionals on vaccination or had health problems during childbirth or in the first seven days. Those who reported a previous episode of adverse reaction to the vaccine, coverage was lower.

CONCLUSIONS

This study points to the importance of guiding health professionals, particulary nurses, on the vaccination and vaccine safety.

CLINICAL IMPLICATIONS

It is necessary the competent act of the health professionals in of immunization programs, as they are able to provide clear and accurate information of the vaccination.

Impact after 10-year use of pneumococcal conjugate vaccine in the Brazilian national immunization program: an updated systematic literature review from 2015 to 2020

In 2010, a 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) was introduced in the Brazilian national immunization program; the 3 + 1 dose schedule was replaced by a 2 + 1 dose schedule in 2016. This systematic review presents the latest published evidence (2015–2020) on the impact after 10-year use of PHiD-CV in Brazil from a total of 29 publications. Overall, the PHiD-CV program had a positive impact on the morbidity and mortality associated with invasive pneumococcal disease (IPD), pneumonia and acute otitis media (AOM) in children <5 years-old. A reduction in the vaccine-type invasive disease was observed in all-ages; suggesting indirect protection unvaccinated older children and adults. The occurrence of non-vaccine type disease was evidenced in some studies. Higher vaccination coverage is required at national and state level for sustained population impact. Given the change in the vaccination schedule and the dynamics of pneumococcal disease epidemiology, continuous surveillance is warranted.

GSK Study identifier: HO-18-19438

Mídia e saúde

Introdução: A mídia é um importante elemento na construção de significados sobre os acontecimentos de saúde, influenciando nas crenças e na formação da opinião popular, tendo especial papel nos processos epidêmicos. No atual cenário epidemiológico do Brasil, que está vivenciando o recrudescimento do sarampo, reintroduzido no país em 2018, os profissionais da Atenção Primária à Saúde (APS) devem estar instrumentalizados sobre os sentidos que estão sendo construídos pelos veículos de comunicação. Objetivo: Avaliar o conteúdo midiático que está sendo produzido acerca do atual cenário epidemiológico do sarampo no Brasil, observando que sentidos estão sendo construídos e analisando-os criticamente, traçando um paralelo com o papel que a APS ocupa neste cenário, principalmente no que diz respeito à educação em saúde. Métodos: Trata-se de pesquisa qualitativa, exploratória, na qual realizou-se duas buscas através da ferramenta de busca online Google Notícias. Buscou-se pelo termo ‘sarampo’ e pelos termos ‘sarampo’ e ‘autismo’. Foram catalogados os 50 primeiros resultados, sendo o critério de inclusão que fossem notícias. Utilizou-se a análise de conteúdo, inicialmente, para categorização e inferência, porém foi necessário utilizar instrumentos da análise de discurso para aprofundar algumas subjetividades encontradas. Resultados: A busca retornou resultados das cinco regiões do país, todos com postura pró-vacina. A APS foi citada em praticamente todos os resultados encontrados, que frisavam a disponibilidade da vacina gratuitamente neste nível de atenção. As três áreas temáticas encontradas a partir da análise do material foram: “gravidade, sequelas e morte: a produção do sentido do medo”; “vacinação, medidas e ações; e “justificativas para a queda da cobertura vacinal, responsabilização do indivíduo e atribuição do cenário ao movimento antivacina”. Conclusão: Conclui-se que o atual cenário epidemiológico do sarampo tem sido encarado como unicausal, o que precisa ser revisto para que as campanhas governamentais e as ações das Equipes de Saúde da Família tornem-se mais efetivas. A estratégia do convencimento pelo medo ou pela obediência mostra-se ineficaz. Pouco ou nada se discute sobre as recentes políticas de desmonte do Sistema Único de Saúde, que têm impacto direto na cobertura da Estratégia de Saúde da Família. Também pouco foi discutido sobre questões de acesso. A compreensão deste cenário sob uma ótica multifacetada e contextualizada ao momento sociocultural e histórico é o ponto central para o sucesso do desfecho.

Vaccine coverage within the first year of life and associated factors with incomplete immunization in a Brazilian birth cohort

Background

Immunization has been held as a major achievement for global health, however, still exist many children who are not completely vaccinated. Knowledge about factors contributing to the incomplete immunization is important to develop effective strategies and interventions to achieve universal coverage to control or eradicate vaccine-preventable diseases. This study aimed to describe immunization coverage within the first year of life and associated factors with incompleteness among participants of the 2015 Pelotas Birth Cohort, Brazil.

Methods

Cross-sectional analyses were performed using data from a population-based cohort. Information on vaccination status was collected from immunization cards and verbal mother's reports from 4014 children aged 24 months. Coverage was described for each vaccine, for the basic and the complete national schedule. Incomplete vaccination was defined as failure to receive the recommended number of doses by the National Immunization Program in 2015. Bivariate and multivariate Poisson regressions with robust variance were conducted to identify factors associated with incompleteness.

Results

Vaccine coverage of individual vaccines varied from 81% (Hepatitis A) to 97% (BCG). Full immunization coverage were 77% (95% CI: 75.8; 78.4) and 66.1% (95% CI: 64.6; 67.5), for basic and expanded indicators, relatively. Multivariate analyses showed that factors associated with incompleteness (for both basic and expanded coverage) were high family income, high parity, low number of prenatal consultations, not have done the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy, not have breastfeed the child until at age 12 months and not have used public health care services for child's vaccination.

Conclusion

Findings of our study show the need to develop and implement policies and programs to achieve complete immunization during the first year of life. Some strategies would include an increase in the primary health care services networks, improving their quality and access, the dissemination of scientific-based evidence about the benefits of vaccination, through communication campaigns and guidance provided by health professionals, especially those responsible for prenatal care.

[Areas with declining vaccination coverage for BCG, poliomyelitis, and MMR in Brazil (2006-2016): maps of regional heterogeneity]

Immunization is known to be one of the most successful and cost-effective health interventions, resulting in the eradication and control of various diseases in the world. However, Brazil has experienced a worrisome drop in vaccination coverage, associated with the resurgence of various previously controlled or eradicated diseases. This study thus conducted a situational diagnosis weighing Brazil's different regions and time trends in vaccination coverage in order to identify areas with reduction in vaccination coverage for BCG, poliomyelitis, and MMR. This ecological study collected data on the number of children up to one year of age who had been vaccinated with these three vaccines from 2006 to 2016, according to municipality (county). Data were obtained from the Brazilian Health Informatics Department. A spatial scan was performed, analyzing spatial variations in the time trends for vaccination coverage. Downward trends were seen in the number of immunizations in Brazil, with reductions of 0.9%, 1.3%, and 2.7% per year for BCG, poliomyelitis, and MMR, respectively. Significant decreases were also seen in all five major geographic regions with time trends in the reduction of vaccination coverage. The study evidenced an important reduction in vaccination coverage in recent years, with major heterogeneity between municipalities. Thus, focused attention and strategic planning in keeping with each local area's characteristics are necessary to address both the reduction of vaccination coverage and the resurgence of vaccine-preventable diseases in Brazil.

Pertussis in Latin America and the Hispanic Caribbean: a systematic review

Introduction: Pertussis in Latin America continues to cause periodic epidemics with substantial morbidity particularly among young children. The disease has persisted despite long-standing vaccination programs in the region. Areas covered: We conducted a systematic review to characterize the recent epidemiology of pertussis in Latin America and Hispanic Caribbean. We undertook a holistic approach and attempted to include all available data concerning pertussis that may explain the changing dynamics of the disease. Expert opinion: There are wide disparities in the reported annual incidence rates of pertussis both within and between countries in the region. General trends in pertussis incidence are difficult to ascertain due to the heterogeneity in the epidemiological data. Available data suggests that the disease burden has changed over the years such that now it predominantly affects those <1 year. Coverage with three doses of the pertussis vaccine has been highly variable, and very few countries have consistently achieved ≥90% coverage annually since 2000. There remain inequalities in vaccination coverage in some regions/localities and specific groups, which sustains the risk of pertussis dissemination. The WHO considers that maternal pertussis immunization provides protection to infants too young to be vaccinated; >10 Latin American countries currently recommend vaccination of pregnant women.

Missed Opportunities for Vaccination in the Dominican Republic: Results of an Operational Investigation

Background. Despite the success of the Dominican Republic's National Immunization Program, homogenous vaccine coverage has not been achieved. In October 2012, the country implemented a study on missed opportunities for vaccination (MOVs) in children aged <5 years. Methods. A cross-sectional study of 102 healthcare facilities was implemented in 30 high-risk municipalities. Overall, 1500 parents and guardians of children aged <5 years were interviewed. A MOV is defined as when a person who is eligible for vaccination and with no contraindications visits a health facility and does not receive a required vaccine. We evaluated the causes of MOVs and identified risk factors associated with MOVs in the Dominican Republic. Results. Of the 514 children with available and reliable vaccination histories, 293 (57.0%) were undervaccinated after contact with a health provider. Undervaccinated children had 836 opportunities to receive a needed vaccine. Of these, 358 (42.8%) qualified as MOVs, with at least one MOV observed in 225 children (43.7%). Factors associated with MOVs included urban geographic area (OR = 1.80; p = 0.02), age 1–4 years (OR = 3.63; p ≤ 0.0001), and the purpose of the health visit being a sick visit (OR = 1.65; p = 0.02). Conclusions. MOVs were associated primarily with health workers failing to request and review patients' immunization cards.

Decision-making on childhood vaccination by highly educated parents

OBJECTIVE

To analyze the sociocultural aspects involved in the decision-making process of vaccination in upper-class and highly educated families.

METHODS

A qualitative approach based on in-depth interviews with 15 couples from the city of Sao Paulo, Southeastern Brazil, falling into three categories: vaccinators, late or selective vaccinators, and nonvaccinators. The interpretation of produced empirical material was performed through content analysis.

RESULTS

The study showed diverse and particular aspects surrounding the three groups’ decisions whether to vaccinate their children. The vaccinators’ decision to vaccinate their children was spontaneous and raised no questions. Most late or selective vaccinators experienced a wide range of situations that were instrumental in the decision to delay or not apply certain vaccines. The nonvaccinator’s decision-making process expressed a broader context of both criticism of hegemonic obstetric practices in Brazil and access to information transmitted via social networks and the internet. The data showed that the problematization of vaccines (culminating in the decision to not vaccinate their children) occurred in the context of humanized birth, was protagonized by women and was greatly influenced by health information from the internet.

CONCLUSIONS

Sociocultural aspects of the singular Brazilian context and the contemporary society were involved in the decision-making on children’s vaccination. Understanding this process can provide a real basis for a deeper reflection on health and immunization practices in Brazil in light of the new contexts and challenges of the world today.

Cuidar e (não) vacinar no contexto de famílias de alta renda e escolaridade em São Paulo, SP, Brasil

O trabalho analisa a dimensão do cuidado parental e suas relações com as decisões de (não) vacinar os filhos no contexto de famílias de alta renda e escolaridade de São Paulo, SP. A pesquisa se orienta pela abordagem qualitativa, com uso de entrevista em profundidade, realizada com 15 casais alocados em três grupos: vacinadores, vacinadores seletivos e não vacinadores. O percurso analítico-interpretativo dos dados foi realizado por meio da análise de conteúdo e segundo os referenciais de cuidado em saúde e família. Para todos os casais do estudo, a escolha da (não) vacinação dos filhos é concebida como um cuidado parental e proteção ao filho, porém, para os vacinadores, proteger é vacinar os filhos; para os vacinadores seletivos, proteger é singularizar cada caso; e para os não vacinadores, proteger é não vacinar os filhos, é proteger contra os riscos da vacinação. O estudo revelou, também, que as justificativas da não vacinação e da seleção e/ou postergação do calendário vacinal foram semelhantes às encontradas na literatura internacional. O estudo aponta a importância da compreensão sociocultural da (não) aceitabilidade da vacinação no contexto do cuidado parental.

Socioeconomic inequalities are still a barrier to full child vaccine coverage in the Brazilian Amazon: a cross-sectional study in Assis Brasil, Acre, Brazil

Introduction

Vaccines are very important to reduce morbidity and mortality by preventable infectious diseases, especially during childhood. Optimal coverage is not always achieved, for several reasons. Here we assessed vaccine coverage for the first 12 months of age in children between 12 and 59 months old, residing in the urban area of a small Amazonian city, and factors associated with incomplete vaccination.

Methods

A census was performed in the urban area of Assis Brasil, in the Brazilian Amazon, in January 2010, with mothers of 282 children aged 12 to 59 months old, using structured interviews and data from vaccination cards. Mixed logistic regression was used to determine factors associated with incomplete vaccination schemes.

Results

Only 82.6% of all children had a completed the basic vaccine scheme for the first year of life. Vaccine coverage ranged from 52.7% coverage (oral rotavirus vaccine) to 99.7% coverage (for Bacille Calmette-Guérin). The major deficiencies occurred in doses administered after the first six months of life. Incomplete vaccination was associated with not having enough income to buy a house (aOR = 2.12, 95% CI 1.06-4.21), low maternal schooling (aOR = 2.60, 95% CI 1.28 – 5.29) , and time of residence of the child in the urban area of the city (aOR = 0.73, 95% CI 0.55 – 0.95).

Conclusions

This study showed that vaccine coverage in the first twelve months of life in Assis Brasil is similar to other areas in the Amazon and it is below the coverage postulated by the Brazilian Ministry of Health. Low vaccine coverage was associated with socioeconomic inequities that still prevail in the Brazilian Amazon. Short and long-term strategies must be taken to update child vaccines and increase vaccine coverage in the Amazon.

Desigualdades sociais e cobertura vacinal na cidade de Salvador, Bahia

Objetivo: Estimar as coberturas vacinais alcançadas em crianças nascidas na cidade de Salvador, analisando essas coberturas por condições socioeconômicas. Método: Foi realizado um inquérito domiciliar sobre cobertura vacinal, na cidade de Salvador, capital do Estado da Bahia, Nordeste do Brasil, sendo incluídas crianças nascidas em 2005, que no momento do estudo apresentavam 18 a 36 meses de idade. Foi realizada amostragem por conglomerados em múltiplas etapas. Os setores censitários foram estratificados utilizando-se dados do censo demográfico realizado em 2000. Foram coletados dados socioeconômicos dos domicílios. O tamanho da amostra foi definido a partir de metodologia específica para inquéritos de cobertura vacinal. O questionário foi aplicado tomando por base as informações constantes na caderneta de vacinação. Foi estimada a cobertura vacinal nos diversos estratos considerando o plano complexo de amostragem, ponderando as observações segundo a fração amostral, as perdas e o efeito do desenho. Resultados: Observou-se desigualdade socioeconômica nos diversos estratos, com um gradiente diretamente proporcional entre cobertura vacinal e nível socioeconômico. As diferenças mostram-se estatisticamente significantes entre os estratos D e E comparado ao estrato A. Em relação ao esquema completo, as crianças residentes nos estratos D e E apresentam cobertura significantemente menor que aquelas residentes no estrato B. Para vacinas não incluídas no esquema básico, as diferenças são muito acentuadas, sendo inferior a 3% nos estratos D e E. Conclusões: A cobertura vacinal pelo esquema completo ao final dos 18 meses de idade, com doses válidas, foi insatisfatória e foram observadas heterogeneidades entre os estratos socioeconômicos com pior cobertura nos grupos mais pobres.

Cobertura vacinal do esquema básico para o primeiro ano de vida nas capitais do Nordeste brasileiro

A cobertura vacinal nos chamados "países em desenvolvimento" ainda está aquém da esperada. Ela é um importante indicador de saúde das populações e da qualidade da atenção dispensada pelos serviços. O presente estudo descreve os resultados de um inquérito domiciliar para estimar a cobertura vacinal do esquema básico para o primeiro ano de vida nas capitais do Nordeste brasileiro, da coorte nascida em 2005. A metodologia usada é a preconizada pela Organização Pan-Americana da Saúde para a realização de inquéritos de cobertura vacinal. Os dados obtidos no presente estudo de cobertura vacinal demonstram que é baixa a proporção de crianças vacinadas, ao se considerarem as metas preconizadas pelo Programa Nacional de Imunização, na faixa etária de maior risco para as doenças imunizáveis. Para os estratos nas capitais do Nordeste, encontramos as piores coberturas nos dois extremos dos estratos socioeconômicos. A avaliação da cobertura vacinal contribui para detectar se a população infantil encontra-se imunizada, além da identificação de pontos frágeis das atividades de vacinação.

Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals, 2007-2008

BACKGROUND

Since 1988, Brazil's Unified Health System has sought to provide universal and equal access to immunisations. Inequalities in immunisation may be examined by contrasting vaccination coverage among children in the highest versus the lowest socioeconomic strata. The authors examined coverage with routine infant immunisations from a survey of Brazilian children according to socioeconomic stratum of residence census tract.

METHODS

The authors conducted a household cluster survey in census tracts systematically selected from five socioeconomic strata, according to average household income and head of household education, in 26 Brazilian capitals and the federal district. The authors calculated coverage with recommended vaccinations among children until 18 months of age, according to socioeconomic quintile of residence census tract, and examined factors associated with incomplete vaccination.

RESULTS

Among 17,295 children with immunisation cards, 14,538 (82.6%) had received all recommended vaccinations by 18 months of age. Among children residing in census tracts in the highest socioeconomic stratum, 77.2% were completely immunised by 18 months of age versus 81.2%-86.2% of children residing in the four census tract quintiles with lower socioeconomic indicators (p<0.01). Census tracts in the highest socioeconomic quintile had significantly lower coverage for bacille Calmette-Guérin, oral polio and hepatitis B vaccines than those with lower socioeconomic indicators. In multivariable analysis, higher birth order and residing in the highest socioeconomic quintile were associated with incomplete vaccination. After adjusting for interaction between socioeconomic strata of residence census tract and household wealth index, only birth order remained significant.

CONCLUSIONS

Evidence from Brazilian capitals shows success in achieving high immunisation coverage among poorer children. Strategies are needed to reach children in wealthier areas.

Immunization coverage and its determinants among children born in 2008-2009 by questionnaire survey in Zhejiang, China

The study aimed to assess the determinants of immunization coverage in children born in 2008-2009, living in Zhejiang Province. The World Health Organization's cluster sampling technique was applied. Immunization coverage of 5 vaccines was assessed: BCG vaccine, diphtheria and tetanus toxoids and pertussis vaccine, poliomyelitis vaccine, hepatitis B vaccine, and measles-containing vaccine. Determinants for age-appropriate immunization coverage rates were explored using logistic regression models. Immunization coverage of 5 vaccines were all greater than 90%, but the age-appropriate immunization coverage rates for 3 months and for first dose of measles-containing vaccine was 41.3% and 64.5%, respectively. Siblings in household, mother's education level, household registration, socioeconomic level of resident areas, satisfaction with clinical immunization service, and convenient access to local immunization clinic were associated with age-appropriate coverage rates. Age-appropriate immunization coverage rates should be given more attention and should be considered as a benchmark to strive for in the future intervention.

Avaliação do sistema brasileiro de vigilância de eventos adversos pós-vacinação

OBJETIVOS: Descrever e avaliar o Sistema brasileiro de vigilância passiva de eventos adversos pós-vacinação (SPVEAPV). MÉTODOS: A descrição e avaliação do SPVEAPV fundamentaram-se nas notificações de eventos adversos pós-vacina Tetravalente ou DTwP/Hib - vacina adsorvida difteria, tétano, pertussis e Haemophilus influenzae b (conjugada) - (EAPV-T), durante o período de 2002 a 2005. Empregou-se a metodologia proposta pelo Centers for Disease Control and Prevention. RESULTADOS: O SPVEAPV apresenta abrangência nacional, tem por objetivos identificar e padronizar condutas frente a casos de eventos adversos pós-vacinação (EAPV) e identificar lotes reatogênicos. A vigilância é útil, simples e flexível, sua sensibilidade é baixa, superestima os eventos mais graves, mas descreve de forma consistente os EAPV-T, identificando a convulsão, a febre e o episódio hipotônico-hiporresponsivo como os mais frequentes, apontando a maior proporção de EAPV na primeira dose (49,7%) e nas primeiras seis horas após a vacinação (72,8%); é útil ao subsidiar decisões e investigações complementares; 46,1% das notificações são feitas até 10 dias após a vacinação; sua completude varia de 70% a 90%, conforme o item. CONCLUSÕES: O SPVEAPV mostra-se útil no monitoramento da segurança da vacina DTwP/Hib, sendo, porém, recomendável a incorporação de novas metodologias como a de municípios e/ou hospitais sentinelas e a de sistemas informatizados de registros de imunização com a finalidade de elevar sua sensibilidade.

[Vaccines inquiry of enrolled medical and nursing students at School of Medicine of São José do Rio Preto (SP, Brazil), in the years of 2006 and 2007, and the possible involvements at pupil acting]

According to their susceptibility, health workers have higher risk to vaccine-preventable diseases (intramural transmission in hospitals), and can also be a source of infection to others professionals and patients. The aim of this article is to get and describe the vaccination status of the student population at Famerp (São José do Rio Preto, São Paulo, Brazil); to show the importance of keeping a vaccine protocol inquiry and immunization with recommended vaccines for students at Famerp, and others susceptible institutions. The methodology used was a population census of the enrolled medical and nursing students at Famerp, in 2006 and 2007, with application of a closed questionnaire to establish bio-psycho-socio-cultural characteristics of vaccinal relevance. It could be perceived that there isn't a specific immunization program for students at Famerp. We verified that among the 375 interviewed students (59.8%), the majority (59.7%) had related to know the possible adverse reactions, and 66.9% weren't afraid of adverse reactions. Only 69 students (11.0%) presented the vaccine register spontaneously. None of the students presented the vaccines of the adult or health professional routine. It's imperative to work in health planning and regulation, standardized at Famerp and higher education institutions, to protect the susceptible population.

Eventos adversos pós-vacinais no município de Campo Grande (MS, Brasil)

A implantação do Sistema de Eventos Adversos Pós-Vacinais possibilitou a formação de profissionais com conhecimentos que pudessem dar mais segurança aos pacientes e evitar falsas contraindicações. O objetivo deste estudo foi conhecer as principais ocorrências de reações adversas com vacinas no município de Campo Grande (MS). Os dados foram coletados mediante consulta às Fichas de Notificação de Eventos Adversos Pós-Vacinais, registradas no Centro de Referência de Imunobiológicos Especiais, no período de janeiro a julho de 2006. Observou-se que a maioria das pessoas que fizeram notificação tinha idade entre 0 e 10 anos (53,6%), sendo 63,4% do sexo feminino. A vacina isolada que mais causou reações foi a dupla adulto (26,8%), seguida da tetravalente (19,5%); dessas reações, 63,4% ocorreram nas primeiras 24 horas após a administração do imunobiológico. Os eventos adversos mais notificados foram dor, rubor e calor (22,4%), seguidos de enduração (18,4%); em 75,6% dos casos, foi adotada a conduta de manter o esquema vacinal. Sugere-se a necessidade de capacitação dos recursos humanos sobre a importância de se notificarem os eventos adversos pós-vacinais, contribuindo desta forma para o aperfeiçoamento constante de nossos imunobiológicos.

Vaccination in Brazilian HIV-infected adults: a cross-sectional study

HIV-infected patients are at risk for vaccine-preventable infections. The Brazilian National Immunization Program provided recommendations for this population. However, the vaccine coverage reached by this program is unknown. This study aimed at evaluating the vaccine coverage of HIV-infected adults followed at Hospital das Clínicas, University of São Paulo School of Medicine. Data were collected on age, gender, mode of HIV transmission, Centers for Disease Classification 1993 classification (CDC/93), antiretrovirals, CD4 count, HIV viral load, and immunization charts, from April 2003 to August 2004. We interviewed 144 randomly selected patients, 74% male; mean age, 39.95 years; CDC classification: A, 40.6%; B, 19.6%; and C, 39.9%. Most of patients were undergoing highly active antiretroviral therapy (HAART; 86.8%). Mean CD4 count 442.6 cells/mm3. Viral load less than 400 copies per milliliter in 59.4% of patients. Only 36.1% of patients were adequately immunized for diphtheria/tetanus, 54.9% for pneumococcus, 24.3% for flu, and 76.9% for hepatitis B. In relation to live attenuated vaccines, 5 patients received measles, mumps, and rubella vaccine and 7 patients yellow fever vaccine. Two patients were vaccinated against yellow fever despite CD4 less than 200 cell/mm3. We verified poor vaccine coverage in HIV-infected patients. Vaccination campaigns and incorporation of vaccine rooms in sexually transmitted disease (STD)/AIDS clinics could improve this situation.