Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 1 - Jan/Mar - 2018

Original Article Imprimir 

Páginas 34 a 41


Adolescent's knowledge and practice regarding the vaccine calendar: evaluation in a Federal Education Institution

Conocimiento de los adolescentes y prácticas relacionadas al calendario de vacunas: evaluación en una Institución Federal de Enseñanza

Conhecimento dos adolescentes e práticas relacionadas ao calendário vacinal: avaliação em uma Instituição Federal de Ensino

Autores: Doralice Limeira da Silva1; Dalva Muniz Pereira2; José Hermínio Roch Magalhães Santos3; Cecília Teresa Muniz Pereira4; Darlisson Limeira da Silva5; Dilma Maria Limeira da Silva6

1. Specialist in Public Health and Family Health at Don Bosco College. Nurse of the Nucleus of Assistance to Educating (NAE), Federal Institute of Education, Science and Technology of Maranhão (IFMA) - Caxias Campus. Caxias, MA, Brazil
2. Master in Biomedical Sciences by the Federal University of Piauí (UFPI) Nutritionist of the Nucleus of Assistance to Educating (NAE) of the Federal Institute of Education, Science and Technology of Maranhão (IFMA) - Caxias Campus. Caxias, MA, Brazil
3. Specialist in Family Health by the Federal University of Maranhão (UFMA). São Luís, MA, Brazil. Doctor of the Nucleus of Assistance to Educating (NAE), Federal Institute of Education, Science and Technology of Maranhão (IFMA) - Caxias Campus. Caxias, MA, Brazil
4. Doctor in Food and Nutrition from the State University of Campinas (UNICAMP). Campinas, SP, Brazil. Master's Degree in Food and Nutrition from the Federal University of Piauí (UFPI). Teresina, PI, Brazil. Professor of the Department of Education (DE), Federal Institute of Education, Science and Technology of Maranhão (IFMA) - Campus Codó. Codó, MA, Brazil
5. Graduating in Analysis and Development of Systems by the Faculty of Sciences and Technology of Maranhão (FACEMA). Caxias, MA, Brazil
6. Graduating in Biological Sciences from the State University of Maranhão (UEMA). Caxias, MA, Brazil

Correspondência:
Doralice Limeira da Silva
Rua 9, Qd. D17, Casa 09, Eugênio Coutinho
Caxias, MA, Brasil. CEP: 65604-554
(doralima255@gmail.com)

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How to cite this article

Keywords: Adolescent, immunization, public health.
Palabra Clave: Adolescente, inmunización, salud pública.
Descritores: Adolescente, imunização, saúde pública.

Abstract:
OBJECTIVE: Assess the vaccination status of adolescents enrolled in a Federal Institution of Education.
METHODS: A crosssectional quantitative study of 304 adolescents of both sexes, aged between 13 to 19 years, enrolled in the secondary year of the Federal Institute of Education, Science and Technology of Maranhão, located in the city of Caxias. Adolescents were asked to respond a semi-structured and self-administered questionnaire. Lectures were given in the classroom and vaccination portfolios were analyzed.
RESULTS: Regarding the situation of the vaccination schedule, 88.8% (270) adolescents said they were not updated. Another 9.6% (29) said they had the vaccines up to date and 1.6% (05) did not respond. Regarding the reasons for lack of vaccination, 52.3% (159) do not know the vaccines adolescents should take, 10.5% (32) reported lack of time, 25.7% (78) gave other reasons such as: fear, find unnecessary, lack of interest, do not want to take, do not have the card, the lack of the vaccine in health centers and 11.5% (35) did not answer. It was verified that, of the 102 adolescents who delivered the vaccination card, only 04 (3.9%) had the complete scheme, 81 (79.4%) were incomplete and / or late and 17 (16.7%) needed to follow the recommendations of the Ministry of Health.
CONCLUSION: The stimulation of the search for Primary Care services, as well as the development of health actions within the school environment, are strategies that contribute positively to self-care and prevention of aggravation for adolescent clients.

Resumen:
OBJETIVO: Evaluar la situación de vacunas de los adolescentes matriculados en una Institución Federal de Enseñanza.
MÉTODOS: Estudio cuantitativo, transversal, cuya población fue compuesta por 304 adolescentes, de ambos sexos, con franja etaria entre 13 19 años, matriculados en la enseñanza media del Instituto Federal de Educación, Ciencia y Tecnología de Maranhão, localizado en la ciudad de Caxias. Fue pedido a los adolescentes que contestaran a un cuestionario semiestructurado y autoaplicado. Fueron realizadas exposiciones en sala y analizadas las libretas de vacunación.
RESULTADOS: Con relación a la situación del calendario de vacunas, 88,8% (270) adolescentes dijeron que no estaba actualizado. Otros 9,6% (29) dijeron estar con las vacunas al día y 1,6% (05) no contestaron. En relación a los motivos para la falta de vacunación, 52,3% (159) desconocen las vacunas a ser tomadas durante la adolescencia, 10,5% (32) relataron falta de tiempo, 25,7% (78) colocaron otros motivos como: miedo, lo creen innecesario, falta de interés, no querer tomarla, no tener la libreta, la falta de la vacuna en los servicios de salud y 11,5% (35) no contestaron. Se verificó que de los 102 adolescentes que entregaron las libretas, apenas 04 (3,9%) estaban con el informe completo, 81 (79,4%) estaban incompletas y/o en atraso y 17 (16,7%) necesitaban seguir las recomendaciones conforme Ministerio de Salud.
CONCLUSIÓN: El estímulo a la búsqueda por servicios de Atención Básica, así como el desarrollo de acciones de salud dentro del ambiente escolar son estrategias que aportan positivamente para el autocuidado y prevención de agravantes para la clientela adolescente.

Resumo:
OBJETIVO: Avaliar a situação vacinal dos adolescentes matriculados em uma Instituição Federal de Ensino.
MÉTODOS: Estudo quantitativo, transversal, cuja população foi composta por 304 adolescentes, de ambos os sexos, com faixa etária entre 13 e 19 anos, matriculados no ensino médio do Instituto Federal de Educação, Ciência e Tecnologia do Maranhão, localizado na cidade de Caxias. Foi solicitado aos adolescentes que respondessem a um questionário semi-estruturado e autoaplicado. Foram realizadas palestras em sala e analisadas as carteiras de vacinação.
RESULTADOS: Em relação à situação do calendário vacinal, 88,8% (270) adolescentes disseram que não estava atualizado. Outros 9,6% (29) disseram estar com as vacinas em dia e 1,6% (05) não responderam. Quanto às razões para a falta de vacinação, 52,3% (159) desconhecem as vacinas a serem tomadas durante a adolescência, 10,5% (32) relataram falta de tempo, 25,7% (78) colocaram outros motivos como: medo, achar desnecessário, falta de interesse, não querer tomar, não ter o cartão, a falta da vacina nos postos de saúde e 11,5% (35) não responderam. Verificou-se que, dos 102 adolescentes que entregaram as carteiras, apenas 04 (3,9%) estavam com o esquema completo, 81 (79,4%) estavam incompletas e/ou em atraso e 17 (16,7%) precisavam seguir as recomendações conforme Ministério da Saúde.
CONCLUSÃO: O estímulo à procura pelos serviços da Atenção Básica, bem como o desenvolvimento de ações de saúde dentro do ambiente escolar são estratégias que contribuem positivamente para o autocuidado e prevenção de agravos para a clientela adolescente.

INTRODUCTION

In recent years we have seen a major international mobilization around vaccines and vaccinations, with the introduction of new vaccines in national vaccination programs, increased access to vaccination of needy populations, increased vaccination coverage, and the elimination and prevention of immunopreventable diseases in levels never reached1. Brazil, which has the National Immunization Program (PNI) as a strategy to prevent and/or control the incidence of infectious diseases, is among the countries that offer the most free vaccines and immunobiological products (pharmacological products containing microorganisms - viruses , bacteria and others) to the population2.

In 2004, ordinance No. 597 / GM was published that establishes the basic calendars for vaccination by life cycles: children, adolescents, adults and the elderly. The recommended vaccines for adolescents aged 11 to 19 years are: hepatitis B vaccines (made in three doses) depending on the vaccination situation, dT - double adult vaccine (one dose every ten years), yellow fever (one dose every ten years) and the viral triple (two doses) depending on the vaccination situation3. And, more recently, the HPV vaccine that is available to girls in the age group of 9 to 13 years of age and done in 2 doses.

Considering vaccines as instruments of a collective practice, it is understood that the act of vaccination, in its individual dimension, results in protection not only of the individual vaccinated against certain diseases, but also in the protection of the community in which this subject is inserted4. Thus, there is a need to take advantage of the spaces and educational moments to publicize the update of the adolescents' immunization schedule, informing them that immunization protects them from some potentially serious diseases5.

The health service must start from actions that value the context of adolescents, having in school an ideal partnership in health promotion, ensuring the right to health and education in adolescence, so that immunization may also have an increasing space in this promotion health and disease prevention among adolescents6.

This study aimed to evaluate the vaccination status of adolescents enrolled in a Federal Education Institution.


METHOD

This is a cross-sectional quantitative study whose population was composed of adolescents of both sexes, aged between 13 and 19 years, enrolled in the secondary education of the Federal Institute of Education, Science and Technology of Maranhão, located in the city of Caxias-MA.

At the first moment, 304 students participated in the research after signing the Term of Assent and Free and Informed Consent Term - TCLE (under 18 years old). They were asked to respond to a semi-structured and self-administered questionnaire, with five open and closed questions related to the knowledge of the adolescent's vaccination schedule, health services, and possession of the vaccination card. After the application of the data collection instrument, lectures were given in the classroom, with the doctor and the nurse of the Campus, to provide clarifications and information about autoimmunizable diseases, vaccines recommended for adolescents and the importance of the updated vaccination schedule. Informational folders were distributed and students were asked to bring their vaccination portfolios, which was done by 102 students. After analysis, the portfolios were returned with guidelines regarding the situation of each: "Congratulations, you have your vaccination card up to date"; "Attention, you need to follow the scheme recommended by the Ministry of Health" or "Attention, you need to update your vaccination card".

The immunization occurred after the collection of the state of the vaccine, on September 21, 2016, totaling 65 immunized students, with the support of the Basic Attention Coordination of the city of Caxias-MA, which provided the immunobiological and professionals for application. Of the four immunobiologicals that were requested by trade (Hepatitis B, Viral Triple, Yellow Fever and diphtheria / tetanus-dT) only two were feasible (Yellow Fever and diphtheria / tetanus-dT) due to the low amount of doses available in the municipality.

The analysis process was performed by tabulation and interpretation, in which the data obtained were organized into an Excel 2013 data sheet, thus generating the graphs and tables presented in the results.

The present study was submitted to the Ethics in Research and Teaching Committee of the Center for Higher Studies of Caxias - CESC / State University of Maranhão - UEMA, respecting the requirements set forth in Resolution no. 466/12 of the National Health Council resulting from the opinion approval number 1,485,383.


RESULTS

The survey was conducted in the period from August 2015 to September 2016 with 304 students. The results of the present research are composed by the analysis and interpretation of the answers of the applied questionnaire, as well as of the evaluation of the vaccination passbooks of adolescents. The characteristics of the research participants are described in Table 1.




Of the total number of students analyzed, 90.1% (274) said they were not aware of the vaccines in the adolescents' calendar, only 8.6% (26) reported knowing the vaccines that are part of the adolescent's immunization schedule, and others 1.3% (04) didn´t respond.

When questioning whether the participants had the vaccine card of the adolescent, 66.4% (201) said they didn´t have this document, 33.3% (102) said yes and 0.3% (01) didn´t respond. Regarding the timing of the vaccination schedule, 88.8% (270) adolescents said they were not current, 9.6% (29) said they had the vaccines up to date and 1.6% (05) didn´t respond. Vaccinations were requested to assess the protective status and/or vaccine vulnerability of adolescents. The verification of the vaccination cards was done by a nursing professional, since it requires knowledge of the vaccines, doses and recommended intervals.

Regarding the reasons for lack of vaccination, 52.3% (159) don´t know the vaccines to be taken during adolescence, 10.5% (32) reported lack of time, 25.7% (78) put other reasons such as: fear of being unnecessary, lack of interest, not wanting to take, not having the card, the lack of vaccination at the health posts, and 11.5% (35) didn´t respond.

The existence of disease is the main reason for seeking health services for 51.3% (156) of the research participants; 25.7% (78) never seek health services; 16.1% (49) seek at times; 4.6% (14) sought frequently and 2.3% (07) didn´t respond.

In the evaluation phase of the vaccination situation, carried out by analyzing the SUS card and the child and adolescent vaccination cards, 102 students presented a document for analysis (Table 2). Of these, 77 (75.5%) were female and 25 (24.5%) were male. The rest of the students reported not having and/or having lost those documents. In this case, adolescents who didn´t have proof of previous vaccine were instructed to follow the whole scheme recommended by the Ministry of Health.




Only 9 (3.9%) of the adolescents who delivered the portfolios were fully vaccinated, 81 (79.4%) were incomplete and/or late, and 17 (16.7% ) needed to follow the recommendations of the Ministry of Health, that is, take the three doses against hepatitis B, one dose of the dT vaccine (every 10 years), one dose of the yellow fever vaccine (every 10 years) and two doses of the triple viral vaccine. The vaccine coverage analysis of 102 adolescents reported that 18 were vaccinated against Yellow Fever, 79 were vaccinated against Hepatitis B, 16 were vaccinated against Diphtheria and Tetanus, and 57 were vaccinated against Measles, Mumps and Rubella as shown in figure 1.


Figure 1. Vaccination coverage of adolescents analyzed according to vaccine type.



In the present study, 65 students were immunized. Of these, 53 (81.5%) received vaccines against yellow fever and dT; 09 (13.9%) students received only the dT vaccine and 03 (4.6%) students received only the vaccine against yellow fever. Due to the scarce amount of hepatitis B and triple viral vaccines in the city, it was not possible to make them available. Still, the students who needed to take these vaccines were instructed to look for the health center closest to their home.


DISCUSSION

Immunization was assumed as an instrument of preventive medicine in the late eighteenth century. It is undoubtedly the medical procedure that has the greatest impact in reducing morbidity and mortality7. Regarding the vaccination coverage of adolescents, it is noticed that there is still a need for continued actions to intensify it, such as information and awareness among young people and their caregivers regarding the vaccines available in the national calendar, and their respective diseases. There is a marked lack of knowledge about the diseases that can be prevented through vaccines8.

Our results showed that only 8.6% (26) of adolescents said they knew which vaccines are parts of the vaccine schedule for their age group. Similar data were found by Lemos et al.9 in which only 7.47% (05) reported having knowledge about the vaccine schedule for the adolescent. In the study carried out by Carvalho and Araújo4, 60.2% of the adolescents evaluated reported not knowing the adolescent vaccine schedule.

There is a great deficiency in the fulfillment of the vaccination schedule in adolescence, contrasting with the reality of childhood vaccination coverage9. Vaccination coverage of the 102 adolescents who delivered the vaccine card was low compared to yellow fever and diphtheria / tetanus vaccines, where 18 were vaccinated against yellow fever and 16 were vaccinated against diphtheria and tetanus. In the study by Adamcheski et al.5, yellow fever vaccines were the most absent in the portfolios, a result that corroborates with those described by Lemos et al.9, in which 88.1% of the 67 adolescents participating in the research had to receive vaccine against yellow fever. Carvalho and Araújo4 found, in turn, 35.2% of adolescents vaccinated against yellow fever.

In the social context in which these adolescents are inserted, parents, health professionals and educators are also responsible for informing them about preventive factors and health promoters, which are guaranteed by specific law as fundamental rights of adolescents10. Most adolescents have partial knowledge about the availability of vaccines in the public network, but it is up to health professionals to find ways to guide and clarify the importance of vaccines, as well as the right of adolescents to these immunobiologicals and their age correct to receive reinforcements5.

The use of adolescent educational practices allows the professionals to know their singularities and to enter the demands from the health needs of this population. However, it is necessary to have joint actions to favor the access of this group in health spaces11.

It is noticed that the search for health services occurs only when the adolescents are sick or with physical symptoms, which was verified in 51.3% (156) of the adolescents analyzed in the present study. The same was observed by Melo et al.6, in which adolescents interviewed don´t consider health services as disease prevention strategies, but rather as a curative service, since the culture of routine consultation isn´t common. Thus, the service is only sought when it is already sick.

Thus, adolescents tend not to value symptoms that are not very serious and adhere less to preventive actions in relation to treatment12. In the study conducted by Ruzany et al.13, the conditions of care of the Adolescent Health Program were evaluated in a city of Rio de Janeiro, where it was verified that it is necessary to improve the professional qualification to give full attention to this age group. Although they recognized the importance of this / moment for educational actions, the interviewees pointed out the lack of training and time as limiting factors for care. These restrictions impede the proper orientation of young people, generating what are known as missed opportunities for health promotion.

In relation to adolescents, there are many vaccines offered by SUS, but their use depends on the personal decision of the adolescent and/or family. The promotion of education with the resources of the space community and the reorganization of health practices in vaccination rooms, as well as co-responsibility for protection, are steps towards a more comprehensive action in terms of solving health problems, especially the improvement of coverage and possession of the vaccine card14.

We found that 52.3% (159) didn´t know the vaccines to be taken during adolescence, 10.5% (32) reported lack of time, 25.7% (78) indicated other reasons such as: fear, finding unnecessary, lack of interest, not wanting to take, not having the card, or own lack of vaccine at health posts. Similar results were found by Adamcheski et al.5, in which the adolescents who were incomplete showed that they lacked knowledge about which vaccines they were entitled to (n = 37, 48.7%), fear of vaccination (n = 16, 21.1%), lack of interest (n = 13, 17.1%) and lack of time (n = 8, 10.5%).

The school, as a space for learning and for influencing adolescent behavior, becomes a privileged space to develop health promotion and education strategies and other actions that seek to improve the health conditions of the school community6. Vaccination in the school environment is a strategy that extends the possibilities of administering the complete vaccine scheme15 with the potential to increase the vaccination rates of adolescents16.

Interventions directed at adolescents may be effective, but they may also encounter barriers to implementation. Thus, continuous work is needed to improve vaccination coverage in this age group17. Despite the importance of effective implementation of the vaccination calendar, especially for adolescents, it is necessary to create continuity strategies for these actions, as they show a marked resistance to approaching health institutions, and these, in turn, have difficulty accommodating these adolescents who looking for them18.


CONCLUSION

The adolescents of this research have insufficient knowledge about the vaccines recommended in the calendar and their importance, being found vulnerable to the development of immunoprevalible diseases. It was also verified that vaccination coverage was low, but that the provision of information by health professionals about the benefits of vaccines, diseases prevented and the age of return to the health units to receive the reinforcements presented positive results for the immunization within the school environment.

Adolescents and parents and/or caregivers should be continuously informed about the benefits and appropriate use of vaccines available in the public and private network. Thus, the development of health education actions, with a stimulus for the search for Primary Care services, as well as the development of health actions within the school environment are also strategies that contribute positively to self-care and prevention of diseases, importance that health professionals are able to receive the adolescent clientele and attentive to the constant updates of the vaccination schemes.


ACKNOWLEDGMENTS

We thank all those who contributed during the development of the research, including those who agreed to participate.


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