Participação em dias nacionais de vacinação contra poliomielite: resultados de inquérito de cobertura vacinal em crianças nas 27 capitais brasileiras

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Abstract

No Brasil, os Dias Nacionais de Vacinação (DNV) são realizados duas vezes ao ano para manter a eliminação da poliomielite e prover a vacinação de rotina para crianças menores de cinco anos. Poucos estudos examinam fatores associados à participação das crianças brasileiras nos Dias Nacionais de Vacinação ou a contribuição desses dias de vacinação para a cobertura com as vacinas recomendadas. MÉTODOS: Inquérito domiciliar com amostragem por conglomerados realizado nas 26 capitais e no Distrito Federal. Foram estudadas as datas de aplicação das vacinas, verificando-se a participação das crianças entre 19 e 35 meses de idade no DNV mais recente, ou o motivo alegado para não fazê-lo. Os dados obtidos foram cotejados com dados administrativos. RESULTADOS: Das 17.749 crianças incluídas no inquérito, 16.213 (91%) participaram no último DNV. Crianças que receberam vacinas no setor privado tiveram menor participação (84%) no DNV. Em 13 capitais, as estimativas de cobertura baseadas no número de doses aplicadas foram superiores às do inquérito. Entre as crianças que não participaram no último DNV, os principais motivos de não participação foram decisão dos pais, orientação médica, a criança estar doente e fatores associados com a organização do DNV. No total, 15% das crianças incluídas receberam pelo menos uma dose de vacina além da vacina oral contra poliomielite no último DNV, incluindo vacinas contra febre amarela, hepatite B, tríplice viral (sarampo-rubéola-caxumba) e difteria-tétano-pertussis-Haemophilus influenzae tipo b. CONCLUSÕES: Nas capitais brasileiras, os dias nacionais de vacinação continuam tendo altos níveis de participação da população e oferecem oportunidades para recuperação da cobertura vacinal. Os motivos para não comparecer aos DNV evidenciam a necessidade de se estudar estratégias diferenciadas de comunicação para incorporação destas crianças.

Translated abstract

In Brazil, National Immunization Days (NIDs) are held twice a year to maintain the elimination of poliomyelitis and to provide routine immunization for children younger than five years of age. Few studies have examined factors associated with participation in National Immunization Days among Brazilian children, or the contribution of immunization days to the coverage of recommended vaccines. METHODS: We conducted a household cluster survey in 26 state capitals and the Federal District among children aged 19 to 35 months. Vaccination histories, including dates of vaccination, participation in the most recent NID or reasons for non-participation were obtained. Survey estimates were compared with official estimates based on doses administered. RESULTS: Among the 17,749 children surveyed, 16,213 (91%) participated in the most recent NID. Children who received vaccination in the private sector had the lowest participation (84%) in NIDs. In 13 capitals, official coverage estimates were higher than those from the survey. The main reasons given for non-participation the most recent NID included parent's decision not to participate, doctor's advice, child's illness, and factors associated with the organization of the NID. Overall, 15% of the children surveyed had received at least one immunization in addition to oral polio vaccine in the most recent NID, including yellow fever, hepatitis B, measles-mumps-rubella (MMR) and combined diphtheria-tetanus-pertussis-Haemophilus influenzae type b vaccines. CONCLUSIONS: In Brazilian capitals, National Immunization Days continue to enjoy high levels of acceptance by the population and offer opportunities to complete recommended immunization schedules. Reasons for non-participation suggest the need for different communication strategies to reach parents who do not bring their children for vaccination on NIDs.

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Knowledge, attitudes, and beliefs of school nurses and personnel and associations with nonmedical immunization exemptions.

D. Salmon, L H Moulton, S B Omer … (2004)

We studied school personnel involved in the review of student's immunization status to determine whether personnel training, immunization-related knowledge, attitudes, and beliefs, use of alternative medicine, and sources of vaccine information were associated with the vaccination status of school children. Surveys were mailed to a stratified and random sample of 1000 schools in Colorado, Massachusetts, Missouri, and Washington. School personnel reported their training and perceptions of disease susceptibility/severity, vaccine efficacy/safety, key immunization beliefs, use of alternative medicine, confidence in organizations, sources, and credibility of vaccine information, and the rates of vaccine exemptors in their schools. Logistic regression analysis was used to explore associations between personnel factors and beliefs (independent variables) with the likelihood of a child having an exemption (dependent variable). Regression models were adjusted for clustering of children in schools, type of school (public versus private), and state. Surveys were returned by 69.6% of eligible participants. A child attending a school with a respondent who was a nurse was significantly less likely to be have an exemption than a child attending a school with a respondent who was not a nurse (odds ratio [OR]: 0.39; 95% confidence interval [CI]: 0.28-0.56). The majority of respondents believed that children (95.6%) and the community (96.1%) benefit when children are vaccinated. Nurses were more likely than nonnurses to hold beliefs supporting the utility and safety of vaccination. Greater perceived disease susceptibility and severity and vaccine efficacy and safety were associated with a decreased likelihood of a child in the school having an exemption. Vaccine misconceptions were relatively common. For example, 19.0% of respondents were concerned that children's immune systems could be weakened by too many immunizations, and this belief was associated with an increased likelihood of a child in the school having an exemption (OR: 1.51; 95% CI: 1.00-2.28). Most respondents had a moderate amount or great deal of confidence in state health departments (91.4%), the Centers for Disease Control and Prevention (CDC) (93.9%), local health departments (88.8%), health care providers (88.5%), the Food and Drug Administration (73.6%), and the health care system (65.2%). Fewer respondents had a moderate amount or great deal of confidence in the media (17.4%). A child attending a school with a respondent who had a moderate amount or great deal of confidence in local and state health departments was less likely to have an exemption (OR: 0.47 and 0.44; 95% CI: 0.27-0.80 and 0.25-0.80, respectively) than a child attending a school with a respondent who did not have a moderate amount or great deal of confidence in local and state health departments. Confidence in other groups was not associated with the likelihood of a child in the school having an exemption. Nearly half (45.5%) of the respondents or their immediate family members had used some form of alternative medicine in the last 5 years. A child attending a school with a respondent who had (or had a family member[s] who) used an alternative medicine practitioner was more likely to have an exemption than a child attending a school with a respondent who had not used an alternative medicine practitioner. There were significant associations between sources used and perception of reliability for vaccine information with the likelihood of a child in the school having an exemption. Use of professional organizations, government resources, vaccine companies, and pharmacists for vaccine information were associated with a decreased likelihood of a child in the school having an exemption. Perceiving health departments and the CDC as a good or excellent source for vaccine information was associated with a decreased likelihood of a child in the school having an exemption. The training, knowledge, attitudes, and beliefs of school personnel who work with parents on immunrk with parents on immunization issues were associated with the likelihood of a child in the school having an exemption. Although respondents generally believed in vaccinations, misconceptions were common. Many school personnel seem to be unaware of the seriousness of some vaccine-preventable diseases and that unimmunized children are highly susceptible to diseases. These misperceptions were associated with an increased likelihood of a child having an exemption. This study of associations cannot determine causal associations. Nonetheless, the frequency of vaccine misconceptions among school personnel warrants vaccine communication programs for school employees who work with parents on immunization issues. An intervention study could determine whether such programs have an impact on parental decisions to claim exemptions for their children. Personnel without formal health care training who advice parents on immunization issues could be passing on misinformation to parents. Nurses or properly trained health personnel should be the primary school contacts for parents on immunization issues. Health departments and health care providers were used most often by school personnel for vaccine information. Providers, professional organizations, health departments, and the CDC were considered most credible. The CDC may be an underutilized source, given its high credibility; only 58.1% of respondents reported using the CDC for vaccine information. Greater visibility of CDC on vaccine information statements and communication efforts from the CDC directly to school personnel will likely be well received. Respondents who do not consider health departments and the CDC as credible sources were associated with a greater likelihood of a child in their school having an exemption. The CDC may need to consider working with other reliable sources to communicate with these personnel. Studies are needed to understand why some parents choose to forgo vaccination for children who do not have true medical contraindications to vaccines. School personnel trained in vaccine safety may serve as a valuable source of vaccine information for parents. Parents who have misconceptions about vaccines would likely benefit from discussions with health care providers. Additional public-information campaigns regarding misconceptions and the value of vaccination may be needed.

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National Immunization Day: a strategy to monitor health and nutrition indicators

Leonor Santos, Romulo Paes-Sousa, Jarbas Silva Junior … (2008)

PROBLEM: To achieve the Millennium Development Goals it is necessary to set up low-cost, real-time monitoring systems which can provide feedback to managers and policy-makers in a timely fashion. The gold-standard approach for monitoring nutritional situations is to conduct household surveys. However, they are costly, time consuming and do not furnish information about smaller disaggregated units. APPROACH: Brazil pioneered National Immunization Days (NIDs) in the 1980s, and later integrated them with vitamin A supplementation. This report discusses implementation of five large-scale Health and Nutrition Days (HNDs) using NIDs as a platform to monitor nutritional status and estimate coverage of health and social welfare services, including conditional cash transfer benefits. LOCAL SETING: Brazil is composed of 26 states, one federal district and 5564 municipalities, with around 18 million children under five years of age. It was decided that HNDs would be carried out among high-risk populations: children from the semi-arid north-eastern region; agrarian reform settlements; isolated rural black communities or quilombolas and municipalities of Amazonas state. RELEVANT CHANGES: It was possible to draw inferences for almost 3 million children from different subgroups of underprivileged populations who had never before been studied in such detail, including state-level data. LESSONS LEARNED: Implementation of large scale HNDs in conjunction with NIDs proved to be feasible in Brazil and resulted in data which are very relevant for policy-makers, obtained over a short period of time and at reasonably low cost. It is sensible to conclude that the experience reported here could be reproduced wherever NID coverage is very high.

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Cluster survey evaluation of coverage and risk factors for failure to be immunized during the 1995 National Immunization Days in Egypt.

Hebatallah Darwish, Nigel J Stevenson, S Oun … (1998)

In 1995, Egypt continued to experience endemic wild poliovirus transmission despite achieving high routine immunization coverage with at least three doses of oral poliovirus vaccine (OPV3) and implementing National Immunization Days (NIDs) annually for several years. Parents of 4188 children in 3216 households throughout Egypt were surveyed after the second round of the 1995 NIDs. Nationwide, 74% of children are estimated to have received both NID doses, 17% one NID dose, and 9% neither NID dose. Previously unimmunized (47%) or partially immunized (64%) children were less likely to receive two NID doses of OPV than were fully immunized children (76%) (P 10 minute walk (P < 0.001), not being informed about the NID at least one day in advance (P < 0.001), and residing in a household which does not watch television (P < 0.001). Based on these findings, subsequent NIDs in Egypt were modified to improve coverage, which has resulted in a marked decrease in the incidence of paralytic poliomyelitis in Egypt. In selected situations, surveys can provide important information that is useful for planning future NIDs.

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Author and article information

Contributors

Maria Lúcia Rocha Mello: Role: ND

José Cássio Moraes: Role: ND

Helena Aparecida Barbosa: Role: ND

Brendan Flannery: Role: ND

Journal

Journal ID (publisher): rbepid

Title: Revista Brasileira de Epidemiologia

Abbreviated Title: Rev. bras. epidemiol.

Publisher: Associação Brasileira de Pós -Graduação em Saúde Coletiva (São Paulo )

ISSN: 1415-790X

Publication date (Print): June 2010

Volume: 13

Issue: 2

Pages: 278-288

Affiliations

[1 ] Secretaria de Saúde do Estado de São Paulo Brazil

[2 ] Irmandade da Santa Casa de Misericórdia de São Paulo Brazil

[3 ] Organização Pan-Americana da Saúde Brazil

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Publisher ID: S1415-790X2010000200010

SO-VID: 130cbb95-f284-488b-9157-92291f646b72

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http://creativecommons.org/licenses/by/4.0/

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SciELO Brazil

Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=1415-790X&lng=en

Participação em dias nacionais de vacinação contra poliomielite: resultados de inquérito de cobertura vacinal em crianças nas 27 capitais brasileiras Translated title: Participation in national polio immunization days: results of a vaccine coverage survey among children in 27 Brazilian cities

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Most cited references 24

Knowledge, attitudes, and beliefs of school nurses and personnel and associations with nonmedical immunization exemptions.

National Immunization Day: a strategy to monitor health and nutrition indicators

Cluster survey evaluation of coverage and risk factors for failure to be immunized during the 1995 National Immunization Days in Egypt.

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