In 2012, 48,277 cases of pertussis were diagnosed in the United States. Pertussis, otherwise known as whooping cough, is a highly contagious, often debilitating, sometimes deadly, vaccine-preventable disease with an increasing incidence and death rate in the U.S, which may be due to vaccine exemptions. The purpose of this project was to determine if a relationship exists between immunization policies and immunization exemption rates, immunization exemption rates and pertussis rates, and immunization policies and pertussis rates in each state. Bronfenbrenner's bio-ecological framework was used to guide the project. Publically available data from the Centers for Disease Control and Prevention (CDC), schools of public health, state health departments, and public health officials were retrieved for this cross-sectional, ecological comparison study. Spearman's r product-moment correlation coefficient was used to investigate the relationship between the variables. States with lenient vaccine laws had higher exemption rates (r = .359, p < .01), and states with higher exemption rates had higher pertussis rates (r = .470, p < .01). Finally, states with lenient vaccine laws had higher pertussis rates (r = .111, p = 0.439). This project should be added to the literature used to inform and educate the public as well as influence policy makers. As a result of this study, arguments for eliminating non-medical vaccine exemptions should be strengthened. As policies are changed, social change should follow in the form of decreased immunization exemption rates and decreased pertussis rates.

Measles immunization coverage in Namibia has not yet reached the WHO target of 90% in all provinces and districts, particularly in Luderitz district. The study aimed to determine the factors associated with the uptake of measles immunization among children in Luderitz district. A quantitative cross-sectional study was conducted among 150 parents/caregivers and their children who visited Luderitz clinic during July 2019 to August 2019. A developed questionnaire collected data on the several factors including child-related ,health service related and the perception of parents/caregivers. Data was analysed using STATA 14. Measles immunization uptake was 61% and significantly associated with child’s age (p=0.001) and gender (p=0.003), parents/caregivers age (p≤0.0001), gender (p=0.021), marital status (p≤0.0001) and employment status (p=0.009). Barriers to measles immunization were mainly inconvenient vaccination time (44%) and forgetfulness (25%) while suggested cues to action, were sending the reminders (30%), providing immunization the whole day (40%) and health education and promotion. / Health Studies / M.A. (Nursing Science)

Submitted in fulfilment of the requirements for the Degree of Master of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015 / Brief background: The Expanded Programme on Immunisation (EPI) is one of the most powerful and cost-effective public health programmes to improve child survival. In South Africa the programme remained fragmented because of the system of apartheid until 1995 when the national EPI was formed through the unification of all immunisation services in the country. Since then there have been significant advances in immunisation service delivery in South Africa. Amongst the revisions that were made in 2009 was the change of the EPI schedule. Aim of the study The aim of the study was to investigate the factors that influence the uptake of the revised EPI for children between the ages of 6 to 12 years at Umlazi Township, KwaZulu-Natal in order to improve immunisation coverage. Methodology A descriptive quantitative design was used to conduct the study. A total of ten primary health care clinics were included in the study. Data was collected from child caregivers and health care workers using self-directed questionnaires. Results: It was worth noting that although the results of the study revealed that the EPI coverage for children between the ages 6 to 12 years remained low in Umlazi Township, however, the programme was well-implemented. Several factors that influenced the uptake of the immunisations were identified and these factors could be used to strengthen the EPI programme in Umlazi. Factors that had a negative influence on the uptake of immunisations were also identified and these factors could be used to develop strategies address the challenges.

Objetivos: Estimar a cobertura vacinal contra a influenza em idosos; identificar os motivos de não adesão da vacina e analisar os fatores associados à adesão à vacinação. Metodologia: Estudo transversal de base populacional, desenvolvido com dados do Projeto Saúde, Bem-Estar e Envelhecimento (SABE). Foram incluídas pessoas de 60 anos e mais, residentes no Município de São Paulo/SP, Brasil. A amostra final foi constituída de 1.399 idosos, de ambos os sexos, selecionados a partir de amostragem probabilística por conglomerados. A análise de dados levou em consideração os pesos de amostragem, propiciando a inferência de representatividade das conclusões. A variável dependente foi o relato de vacinação contra a influenza no ano de 2006. As variáveis independentes incluíram características demográficas, socioeconômicas, comportamentais, condições de saúde autorreferidas e uso e acesso de serviços de saúde. Como medida de efeito e associação entre variáveis, utilizou-se a razão de prevalências e intervalos de confiança de 95 por cento, conforme estimadas diretamente e com ajuste multivariado por meio da regressão de Poisson. Resultados: Registrou-se cobertura vacinal autorreferida de 73,8 por cento. O principal motivo relatado para a não adesão à vacinação foi não acreditar na vacina. Observou-se menor percentual de vacinados entre os idosos na faixa etária de 60 a 69 anos. As variáveis que se mostraram associadas à vacinação e permaneceram no modelo final foram: idade, 70-79 anos (RP = 1,13; IC 95 por cento: 1,06-1,21), 80 anos e mais (RP = 1,11; IC 95 por cento: 1,02-1,21); número de doenças crônicas, uma (RP = 1,13; IC 95 por cento: 1,01-1,27), duas ou mais (RP = 1,18; IC 95 por cento: 1,06-1,32) e atendimento à saúde no último ano (RP = 1,40; IC 95 por cento: 1,08-1,80). Associação negativa foi encontrada para os idosos que sofreram internação no último ano (RP = 0,84; IC 95 por cento: 0,75-0,96). Conclusão: Os fatores associados à vacinação contra a influenza em idosos apresentaram estrutura multidimensional, incluindo características demográficas, condições de saúde e uso e acesso de serviços de saúde. No entanto, as variáveis socioeconômicas não associaram com a adesão à medida, indicando que o acesso à vacinação não diferiu entre os estratos sociais. Evidenciou-se a necessidade de incentivar a vacinação de idosos com menos de 70 anos, assim como orientar os profissionais de saúde no sentido de propiciar a ampliação de cobertura nos grupos com menor participação nas campanhas / Objectives: To estimate the coverage of influenza vaccination among the elderly; to identify the reasons for the non-adherence to the vaccine and to analyze factors associated with vaccination. Methods: Cross-sectional population-based study assessing data gathered for the Health, Wellbeing and Aging Study (SABE). The sample comprised individuals aged 60 or more years old who lived in São Paulo/SP, Brazil. The final sample included 1,399 elderly men and women in a random clustered sampling. Data analysis was weighted, thus allowing probabilistic inference of conclusions. The dependent variable was the self-report of having been vaccinated against influenza in 2006. Independent variables included demographic, socioeconomic and behavioral characteristics, as well as variables related to health status and self-reported use of and access to health services. Poisson regression with and without multivariate adjustment were used to assess prevalence ratios and 95 per cent confidence intervals, to assess factors associating with the outcome. Results: The coverage of self-reported vaccination ranked 73.8 per cent. The main reason for having not been vaccinated was disbelief in vaccination. Coverage ranked lower among the elderly aged 60 to 69 years. Variables that were associated with vaccination in the final model were: age 70-79 years (PR = 1.13, 95 per cent CI: 1.06 to 1.21), 80 years and older (PR = 1, 11, 95 per cent CI: 1.02 to 1.21), number of chronic diseases, one (PR = 1.13, 95 per cent CI: 1.01 to 1.27), two or more (PR = 1.18 95 per cent CI: 1.06 to 1.32) and having received health care during the previous year (PR = 1.40, 95 per cent CI: 1.08 to 1.80). Negative association was observed for elderly subjected to hospitalization during the previous year (PR = 0.84, 95 per cent CI: 0.75 to 0.96). Conclusion: Factors associating with influenza vaccination in the elderly have a multidimensional structure, which includes demographic characteristics, health status and use and access to health services. However, covariates assessing socioeconomic status have not associated with vaccination, which suggests that the access to vaccination does not differ among social strata. Results highlighted the need of implementing vaccination among the elders aged than 70 years old, as well as to instruct professionals to expand vaccination coverage in groups with lower adherence to the campaigns

Objetivos: Estimar a cobertura vacinal contra a influenza em idosos; identificar os motivos de não adesão da vacina e analisar os fatores associados à adesão à vacinação. Metodologia: Estudo transversal de base populacional, desenvolvido com dados do Projeto Saúde, Bem-Estar e Envelhecimento (SABE). Foram incluídas pessoas de 60 anos e mais, residentes no Município de São Paulo/SP, Brasil. A amostra final foi constituída de 1.399 idosos, de ambos os sexos, selecionados a partir de amostragem probabilística por conglomerados. A análise de dados levou em consideração os pesos de amostragem, propiciando a inferência de representatividade das conclusões. A variável dependente foi o relato de vacinação contra a influenza no ano de 2006. As variáveis independentes incluíram características demográficas, socioeconômicas, comportamentais, condições de saúde autorreferidas e uso e acesso de serviços de saúde. Como medida de efeito e associação entre variáveis, utilizou-se a razão de prevalências e intervalos de confiança de 95 por cento, conforme estimadas diretamente e com ajuste multivariado por meio da regressão de Poisson. Resultados: Registrou-se cobertura vacinal autorreferida de 73,8 por cento. O principal motivo relatado para a não adesão à vacinação foi não acreditar na vacina. Observou-se menor percentual de vacinados entre os idosos na faixa etária de 60 a 69 anos. As variáveis que se mostraram associadas à vacinação e permaneceram no modelo final foram: idade, 70-79 anos (RP = 1,13; IC 95 por cento: 1,06-1,21), 80 anos e mais (RP = 1,11; IC 95 por cento: 1,02-1,21); número de doenças crônicas, uma (RP = 1,13; IC 95 por cento: 1,01-1,27), duas ou mais (RP = 1,18; IC 95 por cento: 1,06-1,32) e atendimento à saúde no último ano (RP = 1,40; IC 95 por cento: 1,08-1,80). Associação negativa foi encontrada para os idosos que sofreram internação no último ano (RP = 0,84; IC 95 por cento: 0,75-0,96). Conclusão: Os fatores associados à vacinação contra a influenza em idosos apresentaram estrutura multidimensional, incluindo características demográficas, condições de saúde e uso e acesso de serviços de saúde. No entanto, as variáveis socioeconômicas não associaram com a adesão à medida, indicando que o acesso à vacinação não diferiu entre os estratos sociais. Evidenciou-se a necessidade de incentivar a vacinação de idosos com menos de 70 anos, assim como orientar os profissionais de saúde no sentido de propiciar a ampliação de cobertura nos grupos com menor participação nas campanhas / Objectives: To estimate the coverage of influenza vaccination among the elderly; to identify the reasons for the non-adherence to the vaccine and to analyze factors associated with vaccination. Methods: Cross-sectional population-based study assessing data gathered for the Health, Wellbeing and Aging Study (SABE). The sample comprised individuals aged 60 or more years old who lived in São Paulo/SP, Brazil. The final sample included 1,399 elderly men and women in a random clustered sampling. Data analysis was weighted, thus allowing probabilistic inference of conclusions. The dependent variable was the self-report of having been vaccinated against influenza in 2006. Independent variables included demographic, socioeconomic and behavioral characteristics, as well as variables related to health status and self-reported use of and access to health services. Poisson regression with and without multivariate adjustment were used to assess prevalence ratios and 95 per cent confidence intervals, to assess factors associating with the outcome. Results: The coverage of self-reported vaccination ranked 73.8 per cent. The main reason for having not been vaccinated was disbelief in vaccination. Coverage ranked lower among the elderly aged 60 to 69 years. Variables that were associated with vaccination in the final model were: age 70-79 years (PR = 1.13, 95 per cent CI: 1.06 to 1.21), 80 years and older (PR = 1, 11, 95 per cent CI: 1.02 to 1.21), number of chronic diseases, one (PR = 1.13, 95 per cent CI: 1.01 to 1.27), two or more (PR = 1.18 95 per cent CI: 1.06 to 1.32) and having received health care during the previous year (PR = 1.40, 95 per cent CI: 1.08 to 1.80). Negative association was observed for elderly subjected to hospitalization during the previous year (PR = 0.84, 95 per cent CI: 0.75 to 0.96). Conclusion: Factors associating with influenza vaccination in the elderly have a multidimensional structure, which includes demographic characteristics, health status and use and access to health services. However, covariates assessing socioeconomic status have not associated with vaccination, which suggests that the access to vaccination does not differ among social strata. Results highlighted the need of implementing vaccination among the elders aged than 70 years old, as well as to instruct professionals to expand vaccination coverage in groups with lower adherence to the campaigns

Background: Infant immunization pain is not currently well managed despite effective strategies. Objective: To determine the effectiveness of tactile stimulation when added to a combination of pain-reducing interventions in infants undergoing immunization. Methods: Healthy infants aged 4-6 months undergoing immunization in primary care were randomized to tactile stimulation or usual care. All infants also received pain-relieving interventions. A validated measure of acute pain in infants, the Modified Behavioral Pain Scale (MBPS), was the primary outcome. Results: Altogether, 120 infants participated. Characteristics did not differ (p > 0.05) between those allocated to tactile stimulation and usual care groups. Mean MBPS pain scores did not differ between groups: 8.2 (1.1) vs. 8.0 (1.3); p = 0.57, respectively. Conclusions: Parent-led tactile stimulation did not improve pain relief in infants when added to other interventions. Parental attention could have been focused on tactile stimulation, preventing parents from performing appropriate soothing activities. Additional investigation of the effectiveness of clinician-led tactile stimulation is recommended.

Background: Infant immunization pain is not currently well managed despite effective strategies. Objective: To determine the effectiveness of tactile stimulation when added to a combination of pain-reducing interventions in infants undergoing immunization. Methods: Healthy infants aged 4-6 months undergoing immunization in primary care were randomized to tactile stimulation or usual care. All infants also received pain-relieving interventions. A validated measure of acute pain in infants, the Modified Behavioral Pain Scale (MBPS), was the primary outcome. Results: Altogether, 120 infants participated. Characteristics did not differ (p > 0.05) between those allocated to tactile stimulation and usual care groups. Mean MBPS pain scores did not differ between groups: 8.2 (1.1) vs. 8.0 (1.3); p = 0.57, respectively. Conclusions: Parent-led tactile stimulation did not improve pain relief in infants when added to other interventions. Parental attention could have been focused on tactile stimulation, preventing parents from performing appropriate soothing activities. Additional investigation of the effectiveness of clinician-led tactile stimulation is recommended.

Orientador: Maria Marluce dos Santos Vilela / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T14:05:39Z (GMT). No. of bitstreams: 1 Carniel_EmiliadeFaria_D.pdf: 3924865 bytes, checksum: 69afc983570e4078c9b9af49ed7e4fb9 (MD5) Previous issue date: 2009 / Resumo: Introdução: A possibilidade de combinar vacinas sem causar interferência com a segurança e a eficácia contribui para reduzir os custos, melhorar as dificuldades logísticas e para a adesão da população aos esquemas de imunização propostos. Com isso, o controle de doenças imunopreveníveis, objetivo do Programa Nacional de Imunizações, poderá ser facilitado. Objetivos: Avaliar a imunogenicidade e a segurança da vacina recombinante contra a hepatite B (Butang®) combinada com a vacina BCG, produzidas pelo Instituto Butantan (SP-Brasil). Métodos: Realizou-se um ensaio clínico aberto e randomizado comparando a vacina Butang® (HbsAg recombinante 10 µg; hidróxido de alumínio 0,625 mg; timerosal 0,05 mg; qsp 0,5ml) administrada separada ou combinada com a BCG (BCG em suspensão - cepa Moreau - Rio de Janeiro - 0,1mg; glutamato de sódio 1,1mg; NaCl 0,85%; qsp 0,1ml). Foram selecionados 552 recém-nascidos saudáveis, cujas mães eram HbsAg, HIV e sífilis negativas, que foram alocados aleatoriamente em dois grupos: Grupo I: Butang® combinada com a BCG por via intradérmica (ID) nas primeiras 24 horas de nascimento e Butang® por via intramuscular (IM) com um e seis meses de vida e Grupo II: uma dose de BCG ID e uma dose de Butang® IM nas primeiras 24 horas, após o nascimento, e Butang® IM com um e seis meses de vida. Foram colhidas amostras de sangue imediatamente antes da terceira dose de Butang® e aproximadamente 30 dias após, e realizadas análises quantitativas de anti-HBs (mIU/ml) usando Axsym Ausab® ABBOTT GmbH Diagnostika (Laboratories, Park IL, USA). Os dados foram analisados utilizando-se o programa SPSS v.11, Chicago IL, USA. Resultados: Das 552 crianças selecionadas, 498 cumpriram o protocolo do estudo. Dessas, 245 (116 do sexo masculino e 129 do sexo feminino) pertenciam ao Grupo I e 253 (146 do sexo masculino e 107 do sexo feminino) ao Grupo II. A estratégia de campo, adotada nesse ensaio, garantiu pouca interferência na rotina de vida das famílias, no seguimento pediátrico e na vacinação da criança e permitiu uma adesão de 90,2% dos participantes. Não foram observados eventos adversos. Foram encontrados títulos de anti-HBs > 10 mUI/mL em 99,6% dos vacinados do Grupo I e 99,2% do Grupo II após a terceira dose da Butang®. O intervalo de confiança da diferença entre as proporções de soroproteção mostrou que a vacina combinada não foi inferior às vacinas aplicadas separadamente. Conclusão: A vacina combinada mostrou adequada imunogenicidade e segurança, respaldando o seu uso em recém-nascidos / Resumo: Introdução: A possibilidade de combinar vacinas sem causar interferência com a segurança e a eficácia contribui para reduzir os custos, melhorar as dificuldades logísticas e para a adesão da população aos esquemas de imunização propostos. Com isso, o controle de doenças imunopreveníveis, objetivo do Programa Nacional de Imunizações, poderá ser facilitado. Objetivos: Avaliar a imunogenicidade e a segurança da vacina recombinante contra a hepatite B (Butang®) combinada com a vacina BCG, produzidas pelo Instituto Butantan (SP-Brasil). Métodos: Realizou-se um ensaio clínico aberto e randomizado comparando a vacina Butang® (HbsAg recombinante 10 µg; hidróxido de alumínio 0,625 mg; timerosal 0,05 mg; qsp 0,5ml) administrada separada ou combinada com a BCG (BCG em suspensão - cepa Moreau - Rio de Janeiro - 0,1mg; glutamato de sódio 1,1mg; NaCl 0,85%; qsp 0,1ml). Foram selecionados 552 recém-nascidos saudáveis, cujas mães eram HbsAg, HIV e sífilis negativas, que foram alocados aleatoriamente em dois grupos: Grupo I: Butang® combinada com a BCG por via intradérmica (ID) nas primeiras 24 horas de nascimento e Butang® por via intramuscular (IM) com um e seis meses de vida e Grupo II: uma dose de BCG ID e uma dose de Butang® IM nas primeiras 24 horas, após o nascimento, e Butang® IM com um e seis meses de vida. Foram colhidas amostras de sangue imediatamente antes da terceira dose de Butang® e aproximadamente 30 dias após, e realizadas análises quantitativas de anti-HBs (mIU/ml) usando Axsym Ausab® ABBOTT GmbH Diagnostika (Laboratories, Park IL, USA). Os dados foram analisados utilizando-se o programa SPSS v.11, Chicago IL, USA. Resultados: Das 552 crianças selecionadas, 498 cumpriram o protocolo do estudo. Dessas, 245 (116 do sexo masculino e 129 do sexo feminino) pertenciam ao Grupo I e 253 (146 do sexo masculino e 107 do sexo feminino) ao Grupo II. A estratégia de campo, adotada nesse ensaio, garantiu pouca interferência na rotina de vida das famílias, no seguimento pediátrico e na vacinação da criança e permitiu uma adesão de 90,2% dos participantes. Não foram observados eventos adversos. Foram encontrados títulos de anti-HBs > 10 mUI/mL em 99,6% dos vacinados do Grupo I e 99,2% do Grupo II após a terceira dose da Butang®. O intervalo de confiança da diferença entre as proporções de soroproteção mostrou que a vacina combinada não foi inferior às vacinas aplicadas separadamente. Conclusão: A vacina combinada mostrou adequada imunogenicidade e segurança, respaldando o seu uso em recém-nascidos / Abstract: Background: the possibility of combining vaccines without affecting their safety and efficacy might reduce costs, overcome logistic difficulties and increase population acceptation to immunization schedules. As a consequence, preventable-vaccine diseases might be controlled. Objectives: to evaluate immunogenicity and safety of recombinant Hepatitis B vaccine (Butang®) combined with BCG vaccine, both produced by Instituto Butantan (Brazil). Methods: a randomized non-inferiority study was conducted to compare immunogenicity and safety of the Butang® (recombinant HbsAg 10 µg; aluminium hydroxide 0.625 mg; thimerosal 0.05 mg; qsp 0.5 mL) administered alone or combined with BCG (BCG suspension Moreau - Rio de Janeiro strain 0.1 mg; sodium glutamate 1.1 mg; NaCL 0.85%; qsp 0.1 mL). Five hundred and fifty two healthy newborn children from negative HbsAg, HIV and sifilis mothers were split in two groups, according to the following treatments applied up to 24 h after birth: Group I: Butang® combined with BCG administered intradermaly and Group II: Butang® administered intramuscularly and BCG intradermaly. Both groups received subsequent doses of Butang® at one and six months of age. Blood samples were collected immediately before applying the third dose of Butang® and 30 days after, in order to perform anti-HBs (mIU/mL) quantitative analysis using Axsym Ausab® ABBOTT GmbH Diagnostika (Laboratories, Park IL, USA). Data were analyzed by computer software named SPSS v.11, Chicago IL, USA. The subsequent Butang® applications and blood samples were taken in participants' home. Results: No adverse events occurred during experimental period. The field strategy used in this clinical trial allowed adoption by 90.2% of the participants and caused little interference in families' daily routine, pediatrics appointments and children's vaccine. Out of 552 randomized children, 498 completed the study protocol, in which 245 (116 males and 129 females) were allocated in Group I and 253 (146 males and 107 females) in Group II. Anti-HBs titers > 10 mUI/mL were found in 99% of both groups. The confidence interval of proportion difference in seroprotection was within the range to define equivalence between combined and alone vaccine application. Conclusion: Combined Butang® with BCG vaccine administration showed similar safety and efficacy, as compared to alone vaccine application in newborns / Doutorado / Saude da Criança e do Adolescente / Doutor em Saude da Criança e do Adolescente

Submitted by Geyciane Santos (geyciane_thamires@hotmail.com) on 2015-08-07T13:40:57Z No. of bitstreams: 1 Dissertação - Aldalice Pinto de Aguiar.pdf: 937145 bytes, checksum: 3ed69e4a4131efa3b36a4bb3e6c831b6 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2015-08-11T19:30:11Z (GMT) No. of bitstreams: 1 Dissertação - Aldalice Pinto de Aguiar.pdf: 937145 bytes, checksum: 3ed69e4a4131efa3b36a4bb3e6c831b6 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2015-08-11T19:42:59Z (GMT) No. of bitstreams: 1 Dissertação - Aldalice Pinto de Aguiar.pdf: 937145 bytes, checksum: 3ed69e4a4131efa3b36a4bb3e6c831b6 (MD5) / Made available in DSpace on 2015-08-11T19:42:59Z (GMT). No. of bitstreams: 1 Dissertação - Aldalice Pinto de Aguiar.pdf: 937145 bytes, checksum: 3ed69e4a4131efa3b36a4bb3e6c831b6 (MD5) Previous issue date: 2011-08-24 / Não informada / Vaccination represents an important health action in preventing morbidity and mortality from vaccine-preventable diseases, immunization coverage and the analysis is essential to assess the adequacy of the provision of services in this field and provide information that assists in planning of vaccination in the city. The objective of this study, which was developed through qualitative and quantitative research, was to analyze the immunization coverage of children under 5 years old of rural and urban areas in the municipality of São Gabriel da Cachoeira - AM from 2004 to 2009. The quantitative data collection was done from secondary sources of registration of vaccines doses, classified by age group of children vaccinated, obtained from the Sistema de Informação do Programa Estadual de Imunização and the municipality and vaccine census of Distrito Sanitário Especial Indígena do Alto Rio Negro. The collection of qualitative data concerning the role of multidisciplinary teams of health was conducted through semi-structured interviews, dealing with topics of planning and scheduling of vaccination activities. The universe of this study included all doses of vaccines administered during the research and interviews with 26 professionals who work in immunization activities in the municipality. The results show that vaccination coverage in rural areas are more trustful than the urban area. The job of healthcare professionals has shown a mix of management, administration and support and in Indian areas demanded by complex technical-operational actions given through a tremendous amount of logistics, more flattening in the relationship between members of the multidisciplinary team of health Indian and flexibility in the direct performance, rigidity and hierarchy of roles and tasks among many professional levels. The professional roles in the urban area, the actions were simpler, not by promoting dialogue and cross-cutting interactions among team members. After all, there is a great disparity of sources to calculate the population vaccine coverage, especially in urban areas; these factors have committed the accuracy of qualitative data. The low coverage reflects the limitations found in the operationalization of immunization activities in the municipality of São Gabriel da Cachoeira. / A vacinação representa uma importante ação de saúde na prevenção da morbimortalidade por doenças imunopreveníveis, e a análise da cobertura vacinal é fundamental para avaliar a adequação da provisão de serviços nesse campo e disponibilizar informações que auxiliem no planejamento das ações de vacinação do município. O objetivo deste estudo, desenvolvido mediante pesquisa quali-quantitativa, foi analisar a cobertura vacinal das crianças menores de 5 anos da área rural e urbana no município de São Gabriel da Cachoeira - AM no período compreendido entre 2004 a 2009. A coleta de dados quantitativos foi realizada a partir de fontes secundárias de registro das doses aplicadas de vacinas, classificadas segundo a faixa etária das crianças vacinadas, obtidos no Sistema de Informação do Programa Estadual de Imunização e do município e nos censos vacinais do Distrito Sanitário Especial Indígena do Alto Rio Negro. A coleta de dados qualitativos foi efetuada por meio de entrevistas semi-estruturadas referente à atuação das equipes multiprofissionais de saúde, versando sobre tópicos de planejamento e programação das atividades de vacinação. O universo deste estudo compreendeu todas as doses de vacinas aplicadas no período da pesquisa e entrevistas com os 26 profissionais atuantes nas ações de vacinação no município. Os resultados mostraram que as coberturas vacinais da área rural são mais fidedígnas do que as da área urbana. O processo de trabalho dos profissionais de saúde revelou-se misto, de gestão, administração e assistência, na área indígena demandado por ações técnicas-operacionais complexas, veiculadas por meio de uma grande carga de logística, maior horizontalização no relacionamento entre os membros da equipe multiprofissional e flexibilidade no desempenho dos papéis profissionais. Na área urbana, as ações se mostraram mais simples e rotineiras, maior rigidez e hierarquização de papeis e tarefas entre os diversos níveis profissionais. Conclui-se que há uma grande disparidade das fontes populacionais para o cálculo das coberturas vacinais, principalmente para a área urbana, tais fatores comprometeram a precisão dos dados qualitativos. As baixas coberturas encontradas refletem as limitações da operacionalização das ações de vacinação no município de São Gabriel da Cachoeira.

Résumé : Malgré le fait que la vaccination soit reconnue comme l’une des mesures de santé publique les plus efficaces, elle est perçue comme non sécuritaire et non nécessaire par un nombre grandissant de parents. Dans ce contexte, la compréhension du processus décisionnel des parents par rapport à la vaccination de leur enfant serait aidante. Le but de cette étude est d’explorer le processus décisionnel des parents concernant la vaccination de leur nourrisson, selon leur génération d’appartenance, soit la génération X ou Y. Une étude de cas descriptive et comparative a été réalisée avec des entrevues semi-structurées ainsi qu’une analyse des sources d’informations consultées par les participantes. Les mères ont été sélectionnées selon leur intention de vaccination pour leur enfant. Les données ont été codifiées et analysées de façon systématique et rigoureuse au niveau intra-cas et inter-cas, co-analysées et ensuite validées avec les participantes. Quatre mères dans chaque génération ont été interviewées, dont trois participantes par génération à deux reprises. Le processus décisionnel est similaire d’une génération à l’autre. Les composantes du processus sont l’attitude initiale envers la vaccination, le processus cognitif, la recherche d’information, la décision, l’acte et l’évaluation rétrospective de l’expérience vécue. Toutes ces composantes sont influencées par des facteurs intrinsèques et extrinsèques. Certaines trouvailles de cette étude ont peu été documentées dans la littérature telles que la perception positive envers la vaccination, l’inconscience du processus, l’importance du déclencheur et le fait de saisir le moment opportun. Malgré la rigueur de cette étude, la principale limite est la saturation des données qui n’a possiblement pas été atteinte pour tous les aspects du processus décisionnel. Même si la norme sociale est favorable à la vaccination, aucune participante n’avait consciemment réfléchi à l’immunisation de son enfant jusqu’à ce qu’un déclencheur soit introduit. Ceci soulève l’enjeu et l’impact de la transmission de l’information adéquate, au moment opportun, et du soutien donné aux parents qui naviguent dans ce processus. / Abstract : Even though vaccination is known as one of the most efficient public health interventions, it is often perceived as unsafe and unnecessary by parents. In this context, understanding the decisional process of parents towards their child’s vaccination would be helpful. The objective of this study is to explore the decisional process of parents towards their child’s vaccination in regards to parent’s generation of belonging, either generation X or Y. A multiple descriptive and comparative case study was done using semi-structured interviews as well as an analysis of sources consulted by participants. Mothers were selected based on their vaccination intention for their child. Data was codified and analysed systematically as well as rigorously at the intra-case level as well as at the inter-case level, co-analysed and then validated with participants. Four mothers in each generation were interviewed: three were interviewed twice. The decisional process was similar for all participants of both generations. The process components were the initial attitude towards vaccination, the cognitive process, the information research, the decision, the action of vaccinating and the retrospective evaluation of the experience. All these components were influenced by intrinsic as well extrinsic factors. Some of these findings were not well documented in the literature such as the initial positive perception towards vaccination, the unconsciousness of the process, the importance of a trigger and the importance of seizing the moment. Even though this study was rigorous, the main limit is data saturation that might not have been achieved for all aspects of the process. Even if social norm is favorable to vaccination, no participant had consciously thought about their child’s immunization until a trigger had been introduced. This introduces the question of the impact of adequate and timely information giving as well as the support offered to parents that navigate through this process.