Análise espacial da cobertura vacinal em crianças com até 12 meses de idade no estado do Rio de Janeiro entre 2016 a 2021

Abstract

Introduction: Immunization has a reduced cost when compared to health benefits, representing one of the most effective public policies, and a valuable tool in public health to prevent diseases preventable by immunization, second only to public policies related to basic hygiene and drinking water supply with regard to disease prevention. Objective: Spatial analysis of vaccination coverage of children up to 12 months of age in the state of Rio de Janeiro between 2016 and 2021. Methods: This is a mixed ecological study using secondary data in the public domain. Information on the doses administered was obtained through the National Immunization Program Information System (SI-PNI), while data on births were collected from the Live Birth Information System (SINASC) of the database of the informatics department of the Unified Health System. Information on socioeconomic and environmental data and thematic cartography were obtained from the Brazilian Institute of Geography and Statistics for public access. Information on prenatal coverage was obtained from the Observatory of Children and Adolescents, also with public access. Vaccination coverage (VC) was calculated considering the number of doses administered in the numerator and the live births multiplied by 100 in the denominator. VC was calculated based on immunobiologicals, and stratified according to the definition of the PNI into four categories. The homogeneity of vaccination coverage (HCV) was calculated taking into account the number of adequate vaccines in the numerator and the total number of adequate vaccines for children up to 12 months of age, multiplied by 100. HCV was considered adequate, according to the COAP criterion, if HCV greater than or equal to 75%. Descriptive analysis of all variables was performed, and the Kruskal-Wallis test and Dunn's multiple comparisons were performed. To identify factors related to inadequate HCV, the bivariate and multiple logistic regression model was used. Spatial analysis was performed using Moran's statistics. The level of significance adopted was 5% for all analyses. Result: In 2016, the best vaccination coverage was observed in the entire state of Rio de Janeiro. It is observed that vaccination coverage for BCG remained with high coverage until 2018, with a decrease from 2019 onwards (p<0.001). Hepatitis B 29 had a high coverage rate in 2016, in 2017 coverage began to fall, the year with the lowest coverage rate was 2019 (p<0.001), poliomyelitis dropped in 2017, with the worst index in 2021 (p<0.001), HIB dropped from 2017, with the worst rate in 2021 (p<0.001), DPT dropped in 2017 and its worst coverage was in 2019 (p<0.001). The analysis of the spatial dynamics of BCG vaccination coverage (VC) over the years of study for the state of Rio de Janeiro. During the pandemic, the chance of having inadequate HCV is almost 5 times higher than before the pandemic; and the regions of Center-South Fluminense and Middle Paraíba are places with the best CV. It is observed that from 2019 onwards there is a drop in the levels of adequate VC for all vaccines in the vaccination schedule of children up to 12 months of age, with low and very low VC prevailing, especially in the years 2020 and 2021 (p<0.001). Conclusion: This study highlights the importance of efficient public policies that contribute to increasing vaccination coverage as recommended by the National Immunization Program.