Evolução das taxas de hospitalização e mortalidade por doença pneumocócica invasiva em municípios da Região Sudeste do Brasil, no período de 2005 a 2015.

Abstract

The present study evaluated the evolution of hospitalization and mortality rates due to invasive pneumococcal disease (IPD) in children under one year of age in the municipalities of the southeastern region of the country. The evolution of rates between 2005 and 2015, before and after vaccination in the national immunization program, was described in municipalities with more than 100 thousand inhabitants and were analyzed the effects of socioeconomic factors, access to health services, vaccination coverage and vaccination schedule adopted. It is an ecological study in which the joinpoint regression model was used to describe potential changes in rate trends over years and the Poisson multilevel regression model to analyze the effects of the independent variables on rates. The decreasing trends were identified for both hospitalization and mortality rates. The introduction of the vaccine was associated with a reduction of 14% (RR =0.86, 95% confidence interval: [0.85-0.86]) in the hospitalization rate and 6% (RR = 0.94 [0.90-0.97]) in mortality. In the post-vaccination period, after 2010, the results showed that municipal human development index was associated with lower rates of hospitalization and mortality (RR = 0.738 [0.577-0.943] and RR = 0.467 [0.386-0.565], respectively). Higher vaccine coverage was associated with lower hospitalization rates (RR = 0.995 [0.992-0.998]), while access to health services was directly related to hospitalization (RR = 1.22 [1.118-1.331]). The vaccination schedule with doses at 3-5-7 months compared to the schedule at 2-4-6 months was associated with higher mortality (RR = 1.921 [1.62-2.278]), while access to health services was associated with lower mortality (RR = 0.906 [0.839-0.979]). The Mortality rates did not show a time evolution pattern similar to those of hospitalization, with a decrease observed in the pre-vaccination period, which can be related to other socioeconomic aspects. The results highlight the importance and the difficulties to investigate data from the currently available health information systems and point out to the need for continuity of studies that seek to understand the phenomenon through different approaches, contributing to the improvement of surveillance services and for the consolidation of public health policies.