Análise da dinâmica espacial da cobertura vacinal da hepatite A nos Municípios do Estado de São Paulo de 2016 a 2022

Abstract

Introduction: Viral Hepatitis A (HAV) has a long history, with outbreaks documented since the 18th century. Transmission occurs mainly through the fecal-oral route, affecting populations living in poor sanitary conditions. Vaccination is the most effective means of prevention, significantly reducing the incidence of the disease. In Brazil, the HAV vaccine was included in the National Immunization Program (PNI) in 2014, leading to a decrease in cases. However, vaccine coverage still presents regional variations and faces challenges such as vaccine hesitancy and the impact of the COVID-19 pandemic. Objective: To analyze the spatial dynamics of Hepatitis A vaccine coverage in São Paulo from 2016 to 2022, identifying areas of high and low coverage. Methodology: This dissertation is part of a larger project titled ¿Spatial Analysis of Children's Vaccine Coverage and Its Relation to Socioeconomic and Health Characteristics in Brazil,¿ funded by the Bill and Melinda Gates Foundation and CNPq/Ministry of Health. It is a mixed ecological study using publicly available secondary data. Data on vaccine doses administered were obtained from the National Immunization Program Information System (SI-PNI), live births data from the Live Births Information System (SINASC), and mortality data from the Mortality Information System (SIM) in the Unified Health System (DATASUS) database; cartographic bases were obtained from the Brazilian Institute of Geography and Statistics (IBGE). Vaccine coverage was calculated based on immunobiological data. Descriptive analysis and Kruskal-Wallis tests with Dunn¿s multiple comparisons were performed. Spatial analysis, including Global and Local Moran¿s Index, was conducted. The significance level was set at 5%. The software used included SPSS 24.0 for Windows, Geoda, and QGis. Results: From 2016 to 2022, HAV vaccine coverage was analyzed in the 645 municipalities of São Paulo state, revealing significant variations (p<0.05). In 2017, average coverage reached adequate levels, but there was a decline in subsequent years, except in 2019, which showed inconsistent data. In 2022, coverage varied significantly among municipalities, with 26 municipalities showing very low coverage and 392 municipalities showing low coverage. Spatial analysis using the Global Moran Index (p<0.05) revealed variations in spatial autocorrelation over the years, indicating random and clustered patterns. Conclusion: These fluctuations highlight the need for effective public policies, intensified vaccination campaigns, and improved healthcare infrastructure to enhance vaccine coverage and ensure collective protection against HAV. The variations may be explained by vaccine availability, awareness initiatives, healthcare resources, and disease outbreaks. A thorough analysis of the data is crucial to detect regions requiring more attention and to design effective strategies to ensure high and sustained vaccine coverage.