Análise da dinâmica espacial da cobertura vacinal de recém-nascidos no Estado de São Paulo

Abstract

Most vaccines are distributed to the population by SUS, despite this there was a relevant drop in vaccine coverage. Newborns are a subgroup of the population with greater vulnerability due to the premature immune system and the physiology of extrauterine adaptation. The Ministry of Health recommends BCG and hepatitis B vaccination in the first 24 hours of life or within 30 days after birth, necessary for the development of antibodies in order to prevent the spread of vaccine-preventable diseases. The present study aims to analyze the spatial dynamics of the vaccination coverage rate of newborns in the state of São Paulo from 2016 to 2021. This is an ecological study of the spatial distribution of vaccination coverage in the state of São Paulo, secondary data on applied doses obtained from the National Immunization Program Information System (SI-PNI), live birth data obtained from the live birth information system (SINASC) and information on the percentage of mothers who underwent seven or more prenatal appointments obtained from the Children's Observatory. Vaccination coverage of each immunobiological that included newborns (less than 28 days of life) were classified according to the goals recommended by the PNI, being 90% for BCG and 95% for Hepatitis B. A descriptive analysis of coverage was carried out vaccine and mothers who attended seven or more prenatal consultations per year of study, the Kruskall-Walli’s test and the DUNN multiple comparison test were used to compare the variables, considering p<0.05. To identify the degree of association between years and VC, the chi-square test was used, the results were stratified into four categories, such as: very low, low, adequate and very high. The spatial distribution was carried out by year of study and immunobiological and presented in the thematic maps. SPSS 24.0 for Windows and QGIS were used. Only the Hepatitis B vaccine in the year 2020 reached the CV target. There was little variation in the means of live births whose mothers had seven or more prenatal consultations, with a total mean of 82.54%. There was an inverse correlation between BCG CV and prenatal coverage and a direct correlation between Hepatitis B CV and prenatal coverage (p<0.05). From 2016 to 2018 there was a gradual increase in adequate BCG indices with a progressive decrease from 2019 to 2021, and in the last two years approximately 50% of the municipalities of São Paulo did not reach 50% of the VC. Regarding Hepatitis B, despite the progressive decline between years, we found better rates of vaccination coverage in relation to BCG. It is concluded that the state of São Paulo did not reach homogeneity in the VC of BCG and Hepatitis B in NBs in the period from 2016 to 2018.