Estratégias para otimizar o acesso à vacina pneumocócica polissacarídica 23-valente junto à população de adultos com indicação clínica no SUS.
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Data
2019-07-30
Autores
Martins, João Paulo [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: O Streptococcus Pneumoniae é o agente infeccioso mais frequentemente associado à ocorrência de pneumonia bacteriana e a vacinação é considerada a principal estratégia para a prevenção dessa doença. De acordo com o Programa Nacional de Imunização (PNI) a vacina pneumocócica polissacarídica 23-valente (Pn23) não faz parte do calendário básico de vacinação e deve ser dispensada a indivíduos a partir de 2 anos de idade desde que portadores de um conjunto de doenças e condições de alto risco para infecções pneumocócicas. A forma de operacionalização atual do PNI em relação à Pn23 se dá de modo que essa vacina não se encontra disponível nas Unidades Básicas de Saúde (UBS) e sua liberação se dá mediante solicitação aos Centros de Referência em Imunobiológicos Especiais (CRIEs), através de uma ficha de Solicitação de Imunobiológicos Especiais (SIBE). Acredita-se que tal formatação da logística de dispensação da vacina constitui um elemento limitador do acesso da população adulta à mesma. O objetivo da presente pesquisa foi avaliar a efetividade de uma intervenção piloto no município de Jahu de caráter multifatorial sobre a frequência de dispensação da Pn23 para a população adulta com indicação clínica conforme definida pelo PNI. Métodos: A intervenção foi composta por um componente caracterizado pela descentralização do fluxo de dispensação da vacina, de modo que esta passasse a estar disponível diretamente nas UBS, como é feito com as demais vacinas do calendário básico de vacinação. Adicionalmente, a intervenção também envolveu componentes de educação dos profissionais das UBS sobre a vacina e de divulgação da mesma enquanto direito dos usuários. Foram comparados os registros de dispensação de vacinas de Jahu e de outros 69 municípios abastecidos pelo CRIE do Hospital das Clínicas de Botucatu por um período de 12 meses anteriores à intervenção e 12 meses após. Resultados: No ano anterior à intervenção, Jahu havia aplicado um total de 107 doses de Pn23 por 100.000 habitantes adultos, enquanto que o total de 69 municípios controle haviam aplicado 141 doses de Pn23 por 100.000 adultos (Diferença de Incidência [DI] de -34 doses por 100.000 (IC 95%; -65 a -3, P: 0.03). No ano seguinte à intervenção estas proporções passaram para 909 por 100.000 em Jahu e 110 por 100.000 nos demais municípios (DI: 799 doses por 100.000, IC95%: 737 a 861, P < 0,001). A DI de aplicação da Pn23 entre o município da intervenção e os demais municípios controle no período pós intervenção ajustada pela DI existente no período pré-intervenção correspondeu a 833 doses por 100.0000 habitantes adultos (IC95%: 779 a 887, P < 0,001). Conclusões: Os resultados apresentados representam evidência de que uma intervenção multifatorial simples envolvendo a descentralização da logística de dispensação da vacina, a informação de profissionais de saúde e divulgação para a população pode aumentar significativamente a frequência de dispensação da Pn23 entre a população adulta. Registro Brasileiro de Ensaios Clínicos: RBR-7ymz2q .
Introduction: Streptococcus Pneumoniae is the infectious agent most commonly associated with bacterial pneumonia and vaccination against it is considered the main strategy to prevent its occurrence. According to the Brazilian National Immunization Program (NIP) the 23-valent pneumococcal polysaccharide vaccine (Pn23) is not part of the country’s basic vaccination program and is recommended only for individuals aged 2 years and older who suffer from a variety of high-risk diseases and conditions for pneumococcal infections. The current operationalization of the NIP regarding the Pn23 vaccine determines that that vaccine is not available at Primary Healthcare Units (PHU) and that its distribution to those units is conditional to the receipt of a special vaccine request form by the regional Reference Centers for Special Immunobiologic Products (RCSIP). We believed that such centralized system of distribution of the Pn23 vaccine constituted a barrier for the eligible adult population to have access the vaccine. The aim of the present study was to assess the effectiveness of a multifactorial intervention on the frequency of use of the Pn23 vaccine among adults of the municipality of Jahu with a clinical indication for the vaccine according to the NIP. Methods: The intervention consisted of the decentralization of the Pn23 vaccine distribution so that doses of that vaccine were made available at each PHU as if it were part of the country’s basic vaccination program. Additionally, the intervention also involved an educational component whereby PHU healthcare professionals participated in group education sessions about the vaccine and a dissemination component aimed at users of PHU where the vaccine was construed as a right of individuals fulfilling any of the NIP criteria. We compared the distribution records of Pn23 from the RCSIP to the municipality of Jahu with the remaining 69 municipalities belonging to the reference are of the same RCSIP 12 months before and 12 months after the intervention. Results: During the 12 months before the intervention, a total of 107 doses of Pn23 per 100,000 adult inhabitants were distributed to Jahu while 141 doses of Pn23 per 100,000 adults were distributed from the same RCSIP to the composite of the remaining 69 control municipalities, yielding an incidence difference (ID) of -34 doses per 100,000 (95% CI; -65 to -3, P: 0.03). During the year after the intervention, 909 doses per 100,000 were distributed to Jahu and 110 per 100,000 were distributed to the 69 control municipalities (ID: 799 doses per 100,000, 95% CI: 737 to 861, P <0.001). The ID regarding the distribution of Pn23 doses between Jahu and the composite of control municipalities in the post-intervention period adjusted by the ID in the pre-intervention period amounted to 833 doses per 100.000 adults (95% CI: 779 to 887, P < 0.001). Conclusions: Our results provide evidence that a simple multifactorial intervention involving the decentralization of distribution of Pn23, the education of healthcare professionals at PHU and the dissemination of information of vaccination as a right to users of the healthcare system can significantly increase the use of the Pn23 vaccine in adults. Brazilian Registry of Clinical Trials: RBR-7ymz2q .
Introduction: Streptococcus Pneumoniae is the infectious agent most commonly associated with bacterial pneumonia and vaccination against it is considered the main strategy to prevent its occurrence. According to the Brazilian National Immunization Program (NIP) the 23-valent pneumococcal polysaccharide vaccine (Pn23) is not part of the country’s basic vaccination program and is recommended only for individuals aged 2 years and older who suffer from a variety of high-risk diseases and conditions for pneumococcal infections. The current operationalization of the NIP regarding the Pn23 vaccine determines that that vaccine is not available at Primary Healthcare Units (PHU) and that its distribution to those units is conditional to the receipt of a special vaccine request form by the regional Reference Centers for Special Immunobiologic Products (RCSIP). We believed that such centralized system of distribution of the Pn23 vaccine constituted a barrier for the eligible adult population to have access the vaccine. The aim of the present study was to assess the effectiveness of a multifactorial intervention on the frequency of use of the Pn23 vaccine among adults of the municipality of Jahu with a clinical indication for the vaccine according to the NIP. Methods: The intervention consisted of the decentralization of the Pn23 vaccine distribution so that doses of that vaccine were made available at each PHU as if it were part of the country’s basic vaccination program. Additionally, the intervention also involved an educational component whereby PHU healthcare professionals participated in group education sessions about the vaccine and a dissemination component aimed at users of PHU where the vaccine was construed as a right of individuals fulfilling any of the NIP criteria. We compared the distribution records of Pn23 from the RCSIP to the municipality of Jahu with the remaining 69 municipalities belonging to the reference are of the same RCSIP 12 months before and 12 months after the intervention. Results: During the 12 months before the intervention, a total of 107 doses of Pn23 per 100,000 adult inhabitants were distributed to Jahu while 141 doses of Pn23 per 100,000 adults were distributed from the same RCSIP to the composite of the remaining 69 control municipalities, yielding an incidence difference (ID) of -34 doses per 100,000 (95% CI; -65 to -3, P: 0.03). During the year after the intervention, 909 doses per 100,000 were distributed to Jahu and 110 per 100,000 were distributed to the 69 control municipalities (ID: 799 doses per 100,000, 95% CI: 737 to 861, P <0.001). The ID regarding the distribution of Pn23 doses between Jahu and the composite of control municipalities in the post-intervention period adjusted by the ID in the pre-intervention period amounted to 833 doses per 100.000 adults (95% CI: 779 to 887, P < 0.001). Conclusions: Our results provide evidence that a simple multifactorial intervention involving the decentralization of distribution of Pn23, the education of healthcare professionals at PHU and the dissemination of information of vaccination as a right to users of the healthcare system can significantly increase the use of the Pn23 vaccine in adults. Brazilian Registry of Clinical Trials: RBR-7ymz2q .
Descrição
Palavras-chave
Streptococcus pneumoniae, pneumonia, vacinação, Adultos, Cobertura vacinal, adults, vaccination coverage,