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A vacinação da gripe e da tuberculose: uma abordagem de saúde pública
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Objetivo. Formular hipóteses sobre o impacto do acesso à vacinação na morbi-mortalidade por gripe e tuberculose.
Métodos. Desenvolveu-se um estudo de análise política, através da realização de dois case studies, recorrendo a informação de diferentes fontes. Relativamente ao case study 1, os principais indicadores considerados foram a incidência do vírus influenza, cobertura vacinal, local de vacinação, hospitalizações, e mortes por gripe. O período de tempo considerado foi entre 1999 a 2016. As plataformas consultadas foram respetivamente: Direção-Geral da Sa-úde (DGS), Organização Mundial da Saúde (OMS), Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Instituto Nacional de Estatística (INE), European Centre for Di-sease Prevention and Control, Ordem dos Farmacêuticos (OF), PubMed. Para complementar esta análise realizou-se um estudo retrospetivo através de uma amostra de 29 028 doentes cedida pela Administração Central do Sistema de Saúde, I.P. A informação recolhida numa base de dados Excel, versão 2013, foi analisada em MySQL, versão 5.7, e SPSS, versão 22.0. Quanto ao segundo case study, os principais indicadores considerados foram a incidên-cia da tuberculose, estratégias de prevenção para a tuberculose, cobertura vacinal, hospitali-zações, mortes por tuberculose, estratégias de combate à tuberculose multirresistente (TB MR). O período de tempo considerado em estudo foi de 1950 a 2017. As plataformas con-sultadas e indicadores obtidos foram respetivamente: OMS, DGS, INE, PubMed, Pordata. Toda a informação foi recolhida e analisada numa base de dados Excel, versão 2013.
Resultados. Quanto ao case study 1, verificou-se que proximadamente 90% dos óbitos as-sociados à gripe pertencem à faixa etária igual ou superior a 65 anos, sendo esta prioritária à vacinação. Desde a autorização da vacinação nas farmácias comunitárias, no ano de 2007, que se atingiu 55,1% de vacinados para gripe em farmácias face a outros locais. Relativamen-te ao segundo case study, a vacina da tuberculose foi retirada do Plano Nacional de Vacina-ção (PNV) de 2017, dada a baixa incidência da doença. Contudo, a imigração de países en-démicos de tuberculose e a não adesão à terapêutica são problemas atuais no combate à do-ença.
Conclusões. De forma a diminuir a morbi-mortalidade associada à gripe será necessário assumir como prioridade o aumento da cobertura vacinal da população idosa. A atual desi-gualdade no sistema de financiamento da vacina entre diferentes locais de administração poderá condicionar a acessibilidade à vacinação, pelo que a disponibilização da vacinação gratuita a grupos de risco acrescido nas farmácias comunitárias deverá ser uma medida a considerar como prioritária. A localização estratégica das farmácias a nível nacional, assim como a sua proximidade ao cidadão, poderá auxiliar na prevenção da tuberculose e TB MR.
Objective. State hypotheses related to the impact of access to vaccination in morbidity and mortality due to flu and tuberculosis. Methods. A political-analysis study took place, by means of two case studies, and using data from diverse sources. Regarding case study number one, the main considered indicators were the influenza virus incidence, vaccination coverage, vaccination site, hospitalizations, and flu deaths. The considered period is comprised between 1999 and 2016 and the plat-forms used were Direção-Geral de Saúde (DGS), World Health Organization (WHO), Insti-tuto Nacional de Saúde Doutor Ricardo Jorge (INSA), Instituto Nacional de Estatística (INE), European Centre for Disease Prevention and Control, Ordem dos Farmacêuticos (OF), and PubMed. In order to enhance this analysis, a retrospective study took place by means of a sample containing 29 028 patients ceded by Administração Central dos Sistemas de Saúde I.P. All information was gathered on Excel sheets, version 2013, and analysed us-ing MySQL version 5.7 and SPSS, version 22.0. Additionally, regarding case study two, the main considered indicators were tuberculosis incidence and prevention strategies, vaccina-tion coverage, hospitalizations, tuberculosis deaths, and fighting strategies to Multi-Drug Resistant Tuberculosis (MDR-TB). The considered period is comprised between 1950 and 2017 and the platforms used were DGS, WHO, INE, PubMed and Pordata. All information was gathered and analysed using Excel, version 2013. Results. Regarding the first case study, it states that approximately 90% of the deaths due to influenza were amongst elderly people, making the vaccination of this group a priority. Since the allowance of vaccination at community pharmacies in 2007, that 55.1% of people were flu vaccinated at pharmacies in comparison to other sites. Regarding the second case study, tuberculosis vaccine was removed from the National Vaccine Plan (NVP) given the low incidence of the disease. However, immigration from endemic countries for tuberculosis and non-adhesion to therapy are current existent problems on the fight against the disease. Conclusions. To decrease the morbidity and mortality due to flu, it will be necessary to make the increasing of vaccination coverage to elderly population a priority. The existent inequality in the flu financing system between distinct administration sites could hinder the access to the vaccine, and therefore the free availability of it at community pharmacies to high-risk groups should be a priority. The strategic location of community pharmacies at na-tional scale, as well as their proximity to citizens, can help in the prevention of tuberculosis and MDR-TB. The identification of risk groups by pharmacies can be a complement to the NVP. Direct Observation Therapy for MDR-TB prevention is a strategy followed world-wide and that could be applied in Portugal.
Objective. State hypotheses related to the impact of access to vaccination in morbidity and mortality due to flu and tuberculosis. Methods. A political-analysis study took place, by means of two case studies, and using data from diverse sources. Regarding case study number one, the main considered indicators were the influenza virus incidence, vaccination coverage, vaccination site, hospitalizations, and flu deaths. The considered period is comprised between 1999 and 2016 and the plat-forms used were Direção-Geral de Saúde (DGS), World Health Organization (WHO), Insti-tuto Nacional de Saúde Doutor Ricardo Jorge (INSA), Instituto Nacional de Estatística (INE), European Centre for Disease Prevention and Control, Ordem dos Farmacêuticos (OF), and PubMed. In order to enhance this analysis, a retrospective study took place by means of a sample containing 29 028 patients ceded by Administração Central dos Sistemas de Saúde I.P. All information was gathered on Excel sheets, version 2013, and analysed us-ing MySQL version 5.7 and SPSS, version 22.0. Additionally, regarding case study two, the main considered indicators were tuberculosis incidence and prevention strategies, vaccina-tion coverage, hospitalizations, tuberculosis deaths, and fighting strategies to Multi-Drug Resistant Tuberculosis (MDR-TB). The considered period is comprised between 1950 and 2017 and the platforms used were DGS, WHO, INE, PubMed and Pordata. All information was gathered and analysed using Excel, version 2013. Results. Regarding the first case study, it states that approximately 90% of the deaths due to influenza were amongst elderly people, making the vaccination of this group a priority. Since the allowance of vaccination at community pharmacies in 2007, that 55.1% of people were flu vaccinated at pharmacies in comparison to other sites. Regarding the second case study, tuberculosis vaccine was removed from the National Vaccine Plan (NVP) given the low incidence of the disease. However, immigration from endemic countries for tuberculosis and non-adhesion to therapy are current existent problems on the fight against the disease. Conclusions. To decrease the morbidity and mortality due to flu, it will be necessary to make the increasing of vaccination coverage to elderly population a priority. The existent inequality in the flu financing system between distinct administration sites could hinder the access to the vaccine, and therefore the free availability of it at community pharmacies to high-risk groups should be a priority. The strategic location of community pharmacies at na-tional scale, as well as their proximity to citizens, can help in the prevention of tuberculosis and MDR-TB. The identification of risk groups by pharmacies can be a complement to the NVP. Direct Observation Therapy for MDR-TB prevention is a strategy followed world-wide and that could be applied in Portugal.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2017
Palavras-chave
Influenza Cobertura vacinal Local de vacinação Tuberculose Tuberculose multirresistente Mestrado Integrado - 2017