Análise espacial: ferramenta inovadora para avaliação da cobertura vacinal em crianças de 1 a 2 anos na Paraíba em 2016 e 2017

Abstract

Introduction: Vaccination is one of the most cost-effective interventions with the greatest impact on the occurrence of immunopreventable diseases. The institutionalization of public vaccination policies in Brazil occurred with the creation of the National Immunization Program (PNI), which offers 19 vaccines universally and free of charge in its calendar. With the exception of booster doses, three vaccines (triple viral, chickenpox and hepatitis A) for 5 diseases (measles, mumps, rubella, chickenpox and hepatitis A) are administered in children aged 1 to 2 years. Objective: Analyze the spatial distribution of vaccination coverage of children aged 1 to 2 years in Paraíba in 2016 and 2017. Method: Mixed ecological study, with secondary data of applied doses obtained in the Information System of the National Immunization Program (SI-PNI), data on the number of livebirths obtained from the Information System on Live Births (SINASC) and number of infant deaths extracted from the Mortality Information System (SIM). Vaccination coverage was calculated by antigen, considering the vaccines of the National Calendar for children from 1 to 2 years, except for booster doses. Descriptive analysis of all variables was performed, as well as spatial analysis, using Moran's statistics, where scattering and cluster maps were constructed. SPSS 24.0 for Windows, R CORE TEAM, QGIZ 3.4 were used. The significance level was 5%. Results: In 2017 we observed an increase in vaccination coverage for all immunobiologicals studied (p<0.05). In 2016, according to the Global Moran Index, all vaccination coverage studied presented spatial autocorrelation (p< 0.05). In 2017, we observed persistence of spatial autocorrelation only for vaccination coverage of chickenpox and the 2nd dose of measles, rubella, and mumps. When studying the Local Moran Index, we evidenced municipalities with positive spatial autocorrelation, with high vaccination coverage and positive influence on their neighbors (p<0.05). We also characterized municipalities with low vaccination coverage, negatively influencing their neighbors (p<0.05), especially in the Zona da Mata region. Conclusion: Despite an increase in vaccination coverage in 2017, most vaccines did not reach the goal set by the PNI. Also, there was a heterogeneity of vaccination coverage between the municipalities of Paraíba.