Análise espacial da cobertura vacinal da primeira e segunda dose da vacina contra o HPV em meninas de 9 a 14 anos no Estado de São Paulo (2016-2022)

Abstract

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection worldwide and is strongly associated with cervical cancer. To reduce its incidence, the World Health Organization (WHO) established a global elimination strategy by 2030, based on three pillars: vaccination of 90% of girls aged 9 to 15, screening of 70% of women, and treatment of 90% of those diagnosed. However, vaccination coverage remains below the targets, hindering the achievement of this goal. In the state of São Paulo, despite its pioneering history, studies indicate significant variations between municipalities, highlighting regional inequalities. This study aimed to analyze the spatial dynamics of HPV vaccine coverage for the first and second doses in girls aged 9 to 14 in the state of São Paulo between 2016 and 2022. This is an ecological study with a mixed-methods approach using secondary data. Information on applied doses (D1 and D2) was obtained from SI-PNI and systematized by DATASUS. Population estimates were extracted from the TabNet database. Vaccination coverage rates were calculated by municipality and year. Statistical analysis included Kruskal-Wallis, Dunn, and Wilcoxon tests. The influence of the COVID-19 pandemic was assessed by comparing three periods (pre-pandemic, pandemic, and post-pandemic). Spatial analysis employed thematic maps and Moran and LISA autocorrelation tests with a 5% significance level. Statistically significant differences were found between the years studied for both doses (p<0.001). The years 2016 and 2018 showed the lowest coverage rates; 2017 recorded the highest rate for the first dose, and 2020 for the second dose. There was a significant decline in second-dose coverage over the years (Wilcoxon test, p<0.001). The pandemic period differed significantly from the others (p<0.001), with a sharp reduction in the second dose. Spatial analysis revealed heterogeneity in vaccination coverage among municipalities and spatial autocorrelation in all years, with a predominance of high-high clusters for the first dose. Only in 2017 was a municipality classified as having adequate vaccination coverage. Finally, the COVID-19 pandemic was not the main factor responsible for the low vaccination coverage, which was already critical, especially for the second dose. The observed spatial heterogeneity highlights significant challenges for health management, reinforcing the need for more effective actions to achieve the WHO target of 90% vaccination coverage to eliminate cervical cancer by 2030.