Challenges in the fight against measles could make losing the certificate of eradication in Brazil in 2019 | Science and health

For this reason, the country had in 2017 the lowest vaccination rate among children under one year of age over 16 years. All vaccines recommended for adults are below target for optimal coverage.

In addition, in December 2018, the country had registered more than 10,000 cases of measles. The disease has been eradicated in Brazil, but the importation of the virus from Venezuela has caused two epidemics: one in the Amazon and another in Roraima.

If the country still has new cases until February 2019, it may lose the certificate of eradication of the disease issued by the World Health Organization.

But what explains the low coverage and, therefore, the previously eradicated disease outbreaks?

Through the Access to Information Act, G1 obtained data on investments in vaccine production and distribution and campaign expenditures.

The G1 interviewed the Department of Health on the history of campaign expenses over the last ten years, but the department claimed that it had no system able to search the data between 2008 and 2014 only partially.

G1 also asked how much was spent specifically on television advertising, banners and Internet campaigns. The ministry did not say how much it was for everyone.

Investments in overall immunization campaigns have evolved between 2015 and 2018. By the end of 2018, spending on immunization campaigns will reach $ 58 million, the highest value in four years. In 2015, for example, an additional $ 33 million was spent between the multi-activity campaign and the specific HPV campaign.

This year, more than 20 million pesos have been set aside for a joint campaign on polio and measles already planned as part of what the ministry calls a "follow-up campaign".

This type of campaign aims on average every three or five years to strengthen the protection of children against diseases and to maintain Brazil without widespread transmission of viruses. That's why each year the campaigns have a different goal and schedule.

In 2017, for example, there was no specific campaign against measles and poliomyelitis.

The 2018 campaign was already planned even before the epidemics in Roraima and the Amazon. According to the Ministry of Health, in the most affected areas, vaccination was only advanced.

Renato Kfouri, Vice President of the Brazilian Society of Immunization, vaccination in general should be practiced regularly, respecting the appropriate schedule for each phase of life.

"The campaigns we conduct periodically have intentions and schedule for vaccination, whether it be the child, the teenager or the adult, should not live in campaigns, otherwise we would campaign for measles, polio, meningitis … And we would have a campaign every two weeks and that kind of strategy will not work, "he says. -he.

In 2018, the vaccination campaign against measles and poliomyelitis in children from one to five years old reached the goal of 95% after prolongation, but the coverage for adults remains lower than the average. goal. The same goes for the cumulative coverage of other important vaccines.

For example, the coverage rate is very low: 4.7% cumulatively between 1994 and 2018. The goal is to reach 95% of the viral load (measles, mumps and rubella).

For Kfouri, the measles outbreak is directly badociated with a small number of people vaccinated.

"Our last epidemic took place in Ceará in 2016. It is at the end of this epidemic that we have received the certification of the elimination of the virus .That was our situation up to # 39, to the epidemic in Venezuela and the migration of our border to Roraima first, then to the Amazon. "

" Vaccination coverage was not adequate, Venezuelan people with measles have found several sensitive topics.This reflects our low coverage and this is not the fault of the Venezuelans, that it 's an Italian, a Russian or a foreigner. 39, an American … it is our responsibility not to have been properly vaccinated. "- Renato Kfouri, vice president of the Brazilian Society of Vaccination [19659021] Measles cases increase by 30% worldwide, says WHO

Production and Distribution of Vaccines

Brazil is currently producing measles and polio vaccines used in Biomanguinhos / Fiocruz Institutes. According to the Ministry of Health, there is no problem of shortage of health posts, but the distribution is in charge of state governments and municipalities.

The numbers are not regular. Over the years, the amount of annual doses received by states has fluctuated.

In Roraima, for example, in 2012, more than 16 million doses of MMR vaccine and polio vaccine were received. By 2018, there were about 5 million doses.

Amazons reached more than 55 million doses in 2008. In 2018, the number is slightly over 22 million doses.

In response to the measles outbreak of 2018, the ministry announced that it had sent 14.8 million doses of MMR vaccine to the states of Rondônia, Amazonas, Roraima, Pará, Rio de Janeiro , São Paulo and Rio Grande do Sul. Sul, Pernambuco, Sergipe and the Federal District to meet the demand for routine services and carry out blocking actions.

Brazil has 36,654 vaccination rooms open and operating in 2018 between the public and private sectors. From 2012 to 2018, the number of rooms in the country increased by 8%, an increase of 2,817 rooms.

The number is considered good because Brazil does not provide vaccines in the public network and all must be available to the population at all times for the vaccination schedule to be completed.

At that time, only 6 states lost rooms: Pará (9 rooms less), Amapá (12 rooms less), Espirito Santo (82 rooms less), Paraná (3 rooms less), Rio Grande do Sul less 1 bedroom) and Mato Grosso do Sul (31 rooms less).

Why is the coverage still low?

The ministry claims that part of the problem is the lack of knowledge of part of the population who has not lived with diseases such as measles and polio and ignores the after-effects that they leave.

"Currently, the Ministry of Health's National Immunization Schedule includes all vaccines recommended by the World Health Organization (WHO), which are proposed by the SUS to the general population has resulted in the elimination of polio, measles, rubella and conbad rubella syndrome – has caused some people in the population and even some health professionals the wrong feeling that it is It was no longer necessary to get vaccinated, "said the note.

The vast vaccination program, a conquest of scientific advances, also leads some people not to return to complete the necessary doses in some cases or not to favor one or the other vaccine.

False news about vaccines and their suspected adverse effects is also a problem. In August 2018, the Ministry of Health created an exclusive channel to fight against false calls for news. Through a Whatsapp number, the person can transmit a questionable message that has been received and check directly with the department.

A ministry page also adds a compilation of articles with rumors received.

In addition, the vaccine control system in Brazil is still not ideal and the portfolio of vaccinations on paper is still a reality. The idea is to computerize the registration system throughout the national territory so that all Brazilians can access their vaccination data with the possibility to recover them.

The computerization of the system would facilitate the collection of data by the Ministry of Health and avoid the "pockets" of unvaccinated persons.

A vaccination beneficial to many

Kfouri recalls that there were 12 deaths from measles in Brazil as a result of the new outbreak in the states of Roraima and Amazonas, half of all deaths children under one year old.

"In other words, children who were not yet candidates for immunization, these people would benefit, that is, they would not get measles if all around them." was vaccinated, thus reinforcing the idea of ​​vaccination not only as a protection for the person receiving the vaccine, but also for those who can not get the vaccine because they are less than a year old, pregnant and people whose immune system is impaired, "he says.

"You have a population that can not get the vaccine or do not have an adequate response.They benefit from vaccination by a third of the vaccinated community.Vaccination coverage is fundamental and we must seek it to eliminate or stop the circulation of the virus among us. "- Renato Kfouri, vice president of the Brazilian Society of Vaccination

In a statement, the ministry informed G1 who considers the vaccination campaign of 2018 children as one of the most important of the year.

"The 2018 campaign exceeded the vaccination target of at least 95% of the target population and reached a coverage of 98%, which is no longer the case since 2014 The recommendation of a homogeneous vaccination coverage in the country is a constant and priority work of the Ministry of Health ".