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| Photo: Arquivo / Agncia Brasil |
In Brazil, 20% of children vaccinated against meningitis do not receive the booster dose and last year 5% gave up vaccination. In adolescents, the incomplete immunization rate is 40%. In 2018, the Ministry of Health was responsible for more than 3,000 deaths due to the disease, out of a total of 15,706 cases over the year. Meningitis is the name given to the inflammation of the membranes that line the brain and spinal cord. In the country, the disease is considered rare, but the causes of the bacteria are afraid to be serious and unpredictable.
The inflammation is caused by the manifestation of various agents, such as bacteria and viruses. The less common bacterial form is more disturbing because of its severity. "Bacterial contagion is feared by unpredictability and the impact it has on the population," says Marco Aurélio Sáfadi, a member of the technical committee responsible for reviewing the Society's vaccination schedules. Brazilian Institute of Immunology (SBIm). According to the Notification Information System (SINAN), out of 16,700 cases of the disease in 2018, 4,664 were bacterial.
More than 90% of bacterial meningitis cases are caused by meningococcal disease. "One in five people with meningococcal disease die, even if the patient is treated in time," he says. According to the doctor, among the 80% who have survived, 20% have sequelae, such as limb amputation, deafness, blindness or other neurological complications.
Everyone can catch the disease. In 95% of cases, contagion is by air. Fever, vomiting, headache and neck stiffness are the symptoms. The diagnosis is made through the liquid of the spinal cord. However, according to Sáfadi, the sample does not always indicate the presence of the bacteria. "Sometimes the meningococcus can be so aggressive that it causes a systemic disease quickly enough not to allow time for the liquid to appear with the change," he says.
According to Sáfadi, as a rare disease, meningococcal meningitis presents a state of frequent colonization. About 10% of teens have meningococci in the throat. "These people can transmit the bacteria to other people who are healthy and vulnerable to disease, so it is important that healthy people are subject to prevention to protect all those present, "he said.
fight
The meningococcal C vaccine is meningococcus B and ACWY conjugated with C. Meningococcal C has been part of the National Immunization Program (NIP) national vaccination schedule since 2010. The first dose is recommended between two and three months and is the Unified Health System (UAS). As the bacteria is present in 10% of adolescents, NBP recommends a booster dose to this public aged 11 to 14 years.
Before starting the free application of the vaccine in children under five, meningococcal meningitis accounted for more than 80% of cases in Brazil. According to SBIM, with the free application of meningococcus C, there was a 70% drop in children under two years old and accounted for 59% of the total. Therefore, the Ministry of Health has decided to extend the dose of the vaccine to the group favorable to the bacteria, adolescents.
For Carla Domingues, coordinator of the NIP, the extra dose is a way to control the disease. "Vaccination of adults and adolescents is complementary to eradication," he said. The ideal is to vaccinate at the very first moment of life because the baby has not yet been in contact with the agent, but the reinforcement is necessary. "It is not worth it to start, we will only have an adequate vaccination if we have the full schedule," he says.
Today, the Ministry of Health focuses on this age group and, despite this, 40% of young people do not get the vaccine. Isabella Ballalai, vice president of SBIM, reveals that in 2018, the amount of vaccine distributed was greater than that applied. "It's not good for the government to make it available and the population is not getting vaccinated," he says.
ACWY vaccine reaches SUS
The Brazilian Society of Immunization (SBIM) announced that the Ministry of Health had decided to include the Meningo ACWY vaccine in the Unified Health System (UAS). The decision was made after an increase in cases of W-type meningitis in the country, mainly in Santa Catarina, where the agent is responsible for 43% of the cases of the disease in the region. The initial proposal is to start the application in adolescents, who are more favorable to transmission and gradually increase the supply to other groups. According to the coordinator of the National Immunization Program (NIP), Carla Domingues, the legal process is already defined; only the Ministry of Health can receive proposals from the laboratories interested in selling the vaccine.
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