Hesitação vacinal na região metropolitana da Baixada Santista e sua influência na vacinação de crianças de até dois anos de idade

Abstract

Introduction: Vaccine Hesitation puts health systems around the world on alert, as there is evidence that leads to a possible return of already eliminated diseases. In Brazil, the frequent drop in vaccination coverage levels worries the National Immunization Program of the Ministry of Health. Low coverage is multifactorial, one of which is vaccine hesitancy, which is defined as the delay in accepting or refusing the recommended vaccines even when they are available in the health system. Objective: To analyze vaccine hesitancy in the Metropolitan Region of Baixada Santista and its influence on the vaccination of children up to two years old. Methodology: This is a cross-sectional population epidemiological study carried out through a household survey of immunization coverage of the basic infant scheme (0 to 2 years of age) in the municipalities of the Metropolitan Region of Baixada Santista. The instrument used has a standardized structure. A random population probabilistic sample was used and a significance level of 5%; Power of 80% reaching a minimum sample number of 831 participants. The survey took place from November 2020 to April 2022. Descriptive analysis and association tests of all variables were performed. The Likert scale was used to measure the degree of vaccine hesitancy. Results: The sample carried out in the Metropolitan Region indicated that the majority of respondents are mothers (74%), married (51.1%) with complete high school / incomplete higher education (54%); age between 30 to 39 (44.5%) and working outside the home (53.5%). Children are described as white (56.2%) and taken by their mothers to be vaccinated (77.3%). The BCG vaccine was predominantly given at the maternity ward (74.0%) and that 13.7% and 12.9% failed to vaccinate in the 2019 and 2020 campaigns, respectively. Vaccination is carried out mostly in Basic Health Units (92.4%) and Covid-19 influenced the non-application of vaccines for 16.8% of respondents. The Chi-square Test indicates that there is an association between vaccine hesitancy in the cities of the Region and the areas surveyed, with the North Area having the highest number of questions with predominant percentages indicative of vaccine hesitancy, but in all Areas the indicative percentage is significant (p<0.05). Bonferroni's multiple comparison tests and the Kruskal-Wallis Test allowed us to test the equality or otherwise of vaccine hesitancy between regions. Conclusion: Vaccination hesitation is worrying in the Metropolitan Region of Baixada Santista and has characteristics of justifications in relation to different reasons in the Pole (Santos) and in the Central, South and North Areas. We identified that combating vaccine hesitancy is a complex challenge and understanding these relationships is essential to develop effective strategies to combat hesitation. Hesitation factors included in the 5Cs approach were found in all surveyed regions.