Vacinao

Ocupacional
Heloisa Ihle Garcia
Giamberardino
Conflitos de Interesse
Responsvel Tcnica Centro de Vacinas
Pequeno Prncipe
Responsvel Tcnica Imunobiolgicos
Hospital do Trabalhador
Pesquisadora : Ministrio Sade, Sanofi-
Pasteur, Pfizer
Presidente da Asociao Brasileira de
Imunizaes Regional Paran (SBImPR)
Agenda
Cenrio
Caractersticasdo grupo
Objetivos da vacinao de
trabalhadores
Indicaes e estratgias
Calendrios/Novas vacinas
Vacinao nas gestantes
 Preveno das Doenas Infecciosas
uma das principais metas na
manuteno da sade do trabalhador
Imunobiolgicos ferramenta extrema
relevncia e imprescindvel, mbito da
sade ocupacional
Indicaes e
estratgias
Estabelecer prioridades

Fatores individuais

Estratgias de vacinao
Fatores individuais
Histrico vacinal do funcionrio
Presena de comorbidades e/ou outras condies
que aumentam o risco de infeces como :
Diabetes, Doenas Pulmonares, Doenas
Cardiovasculares, Imunossupresso , Faixa Etria

Avaliao dos riscos no e para o ambiente de

trabalho
Tipo de contato com humanos
Contato com animais e/ou vetores
Manuseio de materias biolgicos
Ambientes com potencial risco biolgico a
funcionrios,clientes, usurios,consumidores
Tipo de trabalho
Categoria Profissional
Sade (NR 32 + PCMSO)
Vacinas recomendadas
Hepatite B, HepatiteA
Trplice viral,dTpa,
Meningoccica(C, ACWY)
Varicela
Influenza

Alimentos/Bebidas HepatiteA
Trplice viral,dTpa,Influenza

Escolas /creches Trplice viral,Hepatite A,

Influenza, dTpa
Dejetos/guas contaminadas Hepatite B, HepatiteA
Trplice viral, dT,Influenza,
Febre tifide
Calendrio Vacinal Ocupacional SBIM 2013/2014www.sbim.org.br
 CALENDRIO OCUPACIONAL SBIm 2013/2014
Vacinas especialmente Esquemas
indicadas
Trplice Viral Considerado protegido 2 doses >
1ano (intervalo mnimo 30 dias)
Hepatite A,B ou A e B B (3 doses) ; A (2 doses); A e B(2
doses)
Trplice bacteriana acelular Bsico : 3 doses, 10 anos
do tipo adulto (dTpa)
Influenza 1 dose anual
Varicela 2 doses (intervalo de 1 a 3 meses)
Meningoccica conjugada 1 dose p/ aqueles vacinados na
infncia ou h mais de 5 anos
Febre Amarela 1 dose p/ residentes ou viajantes
Raiva Pr-exposio 3 doses(0,7,14 a 21
dias)
Febre Tifide Dose nica > 2 anos IM/SC
HPV Homens e Mulheres (0,2, 6 meses) IM
 CALENDRIO OCUPACIONAL SBIm 2013/2014
Indicaes especiais conforme rea de atuao
Sade
Alimentos e Bebidas
Militares Policiais E Bombeiros
Dejetos e Aguas Contaminadas
Escolas/Creches (Crianas)
Animais
Profissionais de Sade
Profissionais Aviao
Profissionais Viajantes
Receptivos de Estrangeiros
Aquavirios
Manicures e Podlogos
Coletores de Lixo
Profissionais do Sexo
Calendrio do Homem
Calendrio Mulher - SBIm
Calendrio Adultos ACIP/2014
Calendrio Adulto com
comorbidades
Estratgias de vacinao
Considerar
nmero func.,tipo vacina e
nmero doses, definir:
Momento da vacinao
Admisso
Exames peridicos
Campanhas na empresa
Mudana de funo
Local vacinao
Empresa, rede pblica, rede privada
credenciada pela ANVISA
Programa Imunizao de sucesso: qualidade
vacina + rede de frio + tcnica de aplicao +
comunicao adequada ao pblico alvo
Distribudo questionrio:

185 unidades bsicas de

sade
5639Profissionais de Sade
(PF)
2055 PF responderam (36%)
Questionrio annimo
Caractersticas Conhecimento
Atitudes comparativas
Reviso obrigatria de carteira
vacinal

Alemanha University
Erlangen-Nuremberg
242 estudantes
121 com reviso carteira
vacinal
121 sem reviso
 www.elsevierhealt h.com/ j ournals/ j hin

Obligat or y occupat ional healt h check increases

vaccinat ion rat es among medical st udent s*
K. Schmid*, K. Merkl, K. Hiddemann-Koca, H. Drexler

Inst i t ut e and Out pat ient Clinic of Occupat ional, Social and Environment al Medicine,
Universit y of Erlangen-Nuremberg, Erlangen, Germany

Received 19 February 2008; accept ed 16 May 2008

Available online 14 July 2008

KEYWORDS Summary In Oct ober 2002 an obligat ory occupat ional healt h check for all
Medical st udent s; preclinical st udent s at t he Universit y of Erlangen-Nuremberg was int ro-
Vaccinat ion; duced. Over t he period 2005 t o 2007, medical st udent s st art ed t heir clinical
Vaccinat ion coverage;
year eit her wit h or wit hout a healt h check during t heir preclinical years. The
Hepat it is B;
aim of t he st udy was t o evaluat e t he efcacy of healt h checks for preclinical
Occupat ional healt h
check; Efcacy st udent s wit h respect t o vaccinat ion rat es. At t he beginning of t he clinical
year we examined 242 consecut ive st udent s, 121 wit h and 121 wit hout a pre-
ceding preclinical occupat ional healt h check. The immunisat ion rat e against
hepat it isBincreased during medical educat ion from 50%t o 96%in women and
from 58%t o 96%in men. In medical st udent s wit hout an init ial occupat ional
healt h check, vaccinat ion rat es were signicant ly lower (85%in women and
81%in men). A signicant benet f rom t he preclinical check was seen in
men regarding immunisat ion st at us for hepat it is B, t et anus, dipht heria, po-
lio, rubella and mumps and in women for hepat it is B and rubella. This st udy
demonst rat es t hat it is possible t o signicant ly increase vaccinat ion rat es,
part icularly for men. Even in medical st udent s st art ing t heir clinical t raining,
an individual occupat ional healt h check is necessary t o opt imise immunisa-
t ion against inf ect ious diseases. Rout ine occupat ional healt h checks could
make an import ant cont ribut ion t o closing gaps in vaccinat ion coverage.
2008 The Hospit al Inf ect ion Societ y. Published by Elsevier Lt d. All right s
reserved.
Concluso
Dados de literatura indicam que escapes
na cobertura de algumas vacinas em
adultos so frequentes;
Reviso de rotina do calendrio vacinal
pode trazer uma importante contribuio
para corrigir escapes (gaps) na
cobertura vacinal deste grupo.
 Vaccine Safety 1802
The Cow Pock or the Wonderful
Effects of the New Inoculation

Influenza
PA AAP 32
 Transmisso das Infeces Respiratrias
Virais
Transmisso por gotculas extremamente eficiente

Outras vias:
fomites (2-8h ambiente influenza)
Conjuntivas/mos
Mos
auto-inoculao
Influenza 2014
Vacina trivalente
Contm protenas purificadas e
inativadas(partculas virais)
A/California/7/2009 (H1N1)pdm09,
A/Texas/50/2012 (H3N2)
B/Massachusetts/2/2012.
Dose 0,5 ml, IM
Produtores: Sanofi, GSK e Abbot
 1983 - vacina
polissacardica 23
Vacinas valente (PPV23)
Pneumocccicas Dose : 0,5 ml ,IM
Sanofi/Merck
> 2 anos

2010 vacina
conjugada 13
valente (PVC13)
Dose : 0,5 ml IM
Pfizer
Crianas e >50 anos
 Vacinas Pneumoccicas e
coberturas de Sorotipos
PVS 23
1 2 3 4 5 6B 7F 8 9N 9V 10 11 1 1 15 17 18 19 19 2 22 23 33
A A 2 4 B F C A F 0 F F F
F

4 6B 9V 14 18 19 23F 1 5 7F 6A 19 3
C F A

PCV 13 (90%)

N=257 Berezin PIDJ 2007

 Incremento da Coqueluche
Tanto a infeco natural quanto a imunizao no
produzem, uma imunidade duradoura
Ausncia de booster naturais e reduo da
imunidade na infncia/adolescncia/adulto
Endmica mesmo em pases com altas
coberturas vacinais
Epidmica (3 a 5 anos)
Casos com manifestaes atpicas e/ou casos no
reconhecidos como coqueluche em adolescentes e
adultos
Alta transmissibilidade: 80% dos contatos domiciliares
adquirem a infeco

Red Book 29th 2012

 | 31

Mas ser
mesmo que os
adultos so
susceptveis??
 | 32

E quem pode ter coqueluche?

Caso de coqueluche em time
australiano atrapalha programao de
rival de Cielo

James Magnussen, principal rival de Cielo

nos 100 m livres nos Jogos Olmpicos de
Londres, teve sua preparao afetada
pela coqueluche

O nadador e seus companheiros de

seleo australiana tiveram de alterar
suas programaes por conta de trs
casos de coqueluche que afetaram
duas atletas e um treinador da seleo
feminina de plo aqutico.
 Homem de 64 anos
admitido com suspeita
de exacerbao de
asma.

Piora da evoluo nas 3

semanas anteriores
internao mesmo com
tratamento com
corticides

Aps internao, os
mdicos ouviram som
sugestivo de guincho e
foi feita azitromicina +
feita coleta de material,
que foi positiva para
pertussis
Melhora clnica em 5 dias
 Vacinas dTpa Adolescentes e
Adultos
Tipo de Vacina Fabricante Antgenos Recomenda
Pertussis e o de uso
outros
dTpa GSK Toxode pertussis A partir 4
(Refortrix) Hemaglutinina anos,IM
Pertactina

dTpa IPV GSK Toxode pertussis A partir de 4

(Refortrix IPV) Hemaglutinina anos,IM
Pertactina
Polio inativada

dTpa IPV Sanofi Pasteur Toxode pertussis A partir 3

(Adacel) Hemaglutinina anos,IM
Pertactina
Fmbrias tipo 2 e 3
Polio inativada
Hepatite A
A atual soroprevalncia para Hepatite A no
Brasil demonstra situao epidemiolgica
heterognea e intermediria
Estima-se que 30 a 40% dos adultos brasileiros
sejam suscetveis a Hepatite A
Em Curitiba recente estudo do perfil de
soroprevalncia em cas entre 1-15 anos
demosntrou presena do AC VHA em
19,8%.Portanto 80% suscetveis.

Imunizaes Amato Neto, Vicente,2011.

Vacina Hepatite A
Vacina inativada
Eficcia de 94 a 100%
Baixa reatogenicidade
2 doses com intervalo de 6 meses
Aprox. 90% dos vacinados apresentam
soroconverso 15 dias aps a 1 dose
Vacinas Hepatite A so intercambiveis
Vacinas Hepatite A

Avaxim Sanofi Pasteur

Havrix GSK

Vaqta Merck
Vacinao na
gestante Tabu?
 theoretic risks of vaccination must be weighed against the risks of the disease to
mother and fetus. Inadvertent administration of any of these vaccinations, however,
is not considered an indication for termination of the pregnancy. (Am Fam Physician
Cenrio da Vacinao das
2003;68:E299-309. Copyright 2003 American Academy of Family Physicians.)
This article
Gestantes
exemplifies the AAFP
2003 Annual Clinical
Focus on prevention
and health promotion.
Ainda existem conceitos
equivocados sobre segurana e
benefcios das vacinas atuais
disponveis para os adultos
O auge deste equvoco
durante a gestao
Indicaes mdicas hesitantes
Algumas posturas mdicas e de
outros profissionais de sade so
relutantes This
electronic (E) ver- usually outweigh the potential risks.
sion supplements the
print version of this
article and addresses
vaccinations typically
not administered on
a routine basis.
JULY 15, 2003 / VOLUME 68, NUMBER 2
T
he administration of vaccines Vaccines commonly administered by family
during pregnancy poses a num- physicians, and their indication for use during
ber of concerns to physicians and pregnancy, are summarized in Table 1.1
patients about the risk of trans- Women of childbearing age often are con-
mitting a virus to a developing cerned about whether breastfeeding is safe
fetus. This risk is primarily theoretic. Live- during immunization. Physicians should reas-
virus vaccines are therefore generally con- sure their patients that no vaccines are con-
traindicated in pregnant women.According to traindicated during breastfeeding.1
the Centers for Disease Control and Preven-
tion (CDC),1 if a live-virus vaccine is inadver- Tetanus and Diphtheria
tently given to a pregnant woman, or if a The tetanus and diphtheria toxoids vaccine
woman becomes pregnant within four weeks (Td) is effective in preventing tetanus and
Vaccinations in Pregnancy
after vaccination, she should be
about potential effects on the fetus.
counseled
DENISE Inadver-
K. SUR, M.D., and
diphtheria,
conditions.
DAVID H. WALLIS, M.D.,
University of CaliforniaLos Angeles, California
two potentially life-threatening
Diphtheria
David Geffen Schoolis of an infection of the
Medicine,
tent administration of these vaccines, how- nasal, pharyngeal, laryngeal, orHills, other mucous
THEODORE X. OCONNELL, M.D., Kaiser PermanenteWoodland Hills, Woodland California
ever,isnot considered an indicationAdultforimmunization
termi- ratesmembranes
have fallen short ofthat nationalcan
goals cause neuritis,
partly because of mis- myo-
nation of the pregnancy. conceptions about the safety and benefits of current vaccines. The danger of these
carditis, thrombocytopenia, and ascending
misconceptions is magnified during pregnancy, when concerned physicians are hesi-
No evidence shows an increased tant risk fromvaccinesparalysis.
to administer and patients are2 reluctant to accept them. Routine vaccines
Tetanus infection can cause pro-
that generally are safe to administer during pregnancy include diphtheria, tetanus,
vaccinating pregnant women withinfluenza,
inactivated
and hepatitis B.duction ofsucha asneurotoxin, leading tobe tetanic
Other vaccines, meningococcal and rabies, may
considered. Vaccines that are contraindicated, because of the theoretic risk of fetal
virus or bacterial vaccines or toxoids. 1
There- muscle contractions.
transmission, include measles, mumps, and rubella; varicella; and bacille Calmette-
Gurin. A number of other vaccines have not yet been adequately studied; therefore,
fore, if a patient is at high risk of being Td toxoid is routinely recommended for
theoretic risks of vaccination must be weighed against the risks of the disease to
exposed to a particular disease, mother
would pose a risk to the mother or
if infection
fetus, andCopyright
2003;68:E299-309.
susceptible
and fetus. Inadvertent
dence
administration pregnant
of any of these
exists Academy
2003 American to prove
women.
vaccinations,
is not considered an indication for termination of the pregnancy. (Am Fam Physician
thatPhysicians.)
of Family
While
however,no evi-
tetanus and diph-
if the vaccine is unlikely to cause harm, the theria toxoids are teratogenic,1 waiting until
T
This article he administration of vaccines Vaccines commonly administered by family
benefits of vaccinating a pregnant woman the second duringtrimester of apregnancy to adminis-
exemplifies the AAFP pregnancy poses num- physicians, and their indication for use during
2003 Annual Clinical
Focus on prevention ter Td is
ber a
of reasonable precaution,
concerns to physicians and minimizing
pregnancy, are summarized in Table 1. 1
patients about the risk of trans- Women of childbearing age often are con-
Physicians should consider and health promotion.
vaccinating any concern about the theoretic
mitting a virus to a developing possibility
cerned about whether of breastfeeding is safe
pregnant women on the basis of the risks of fetus. This risk is primarily 1 theoretic. Live- during immunization. Physicians should reas-
such reactions. Previously vaccinated
virus vaccines are therefore generally con-
preg-
sure their patients that no vaccines are con-
vaccination versus the benefits of protection traindicated nant women in pregnant who have nottoreceived
women.According a Td
traindicated vac-
during breastfeeding.1
in each particular situation, regardless of the tion
Centers for Disease Control and Preven-
cination
(CDC), if awithin theispast
live-virus vaccine
1
inadver- 10 Tetanusyearsand should
Diphtheria
whether live or inactivated vaccines are used. receive
tently given toa booster
a pregnant dose.
woman, Pregnant
or if a women
The who
tetanus and diphtheria toxoids vaccine
woman becomes pregnant within four weeks (Td) is effective in preventing tetanus and
after vaccination, she should be counseled diphtheria, two potentially life-threatening
about potential effects on the fetus. Inadver- conditions. Diphtheria is an infection of the
tent administration of these vaccines, how- nasal, pharyngeal, laryngeal, or other mucous
www.aafp.org/afp A MERICAN F AMILY
ever, is not considered an indication for termi- PHYS ICIAN that
membranes 299
E can cause neuritis, myo-
nation of the pregnancy. carditis, thrombocytopenia, and ascending
No evidence shows an increased risk from paralysis.2 Tetanus infection can cause pro-
vaccinating pregnant women with inactivated duction of a neurotoxin, leading to tetanic
virus or bacterial vaccines or toxoids.1 There- muscle contractions.
fore, if a patient is at high risk of being Td toxoid is routinely recommended for
exposed to a particular disease, if infection susceptible pregnant women. While no evi-
 Cobertura Vacinal Gestantes
EUA
Estimated Influenza Vaccination (trivalent)
Coverage, Pregnant Women*
BRFSSPregnant BRFSSNot Pregnant PRAMS(10 states)
NHFS Internet Panel
80
HP 2020 target is 80 percent
70
60
% Vaccinated

49 47
50
35 38 40
40 43
27 27 27 32
30
31 30 31
20 28
23 25
10 18

0
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12
Influenza Season
* Behavioral Risk Factor Surveillance (BRFSS) data from December-February interviews only, for women 18-44 years pregnant or not pregnant when
interviewed. Differences in influenza vaccination coverage between pregnant and not pregnant women were statistically significant (p<0.05) only for the
2009-10, 2010-11, and 2011-12 seasons. Other estimates for pregnant women from PRAMS (MMWR December 3, 2010 / 59(47);1541-1545); NHFS (Ding et
al. Am. J. Obstetrics & Gynecology, June 2011 Supplement); and internet panel survey (MMWR August 19, 2011 / 60(32);1078-1082, MMWR September 28,
2012 / 61(8 ); 758 - 763 )
Cobertura vacinal influenza
MS 2013
Racional

Vrias vacinas de rotina so seguras e recomendadas

durante a gestao

Algumas vacinas no so recomendadas , mas podem ser

consideradas conforme exposio e riscos

Risco terico de transmisso de infeces a gestante ou

ao feto, das vacinas de vrus vivos no deve restringir a
indicao de vacinas inativadas de vrus ou de toxodes

Administrao inadvertida de qualquer vacina no deve

ser considerada, como uma indicao para suspender-se
a gestao
Vacinas Rotina Gestantes
Td ou dTpa

Influenza

Hepatite B
 CALENDRIO
CDC
VACINAS
INDICADAS
HEPATITE A
HEPATITE B
INFLUENZA
dTpa (27-36S)

VACINAS A SEREM
CONSIDERADAS
MENINGOCCCICA
PNEUMOCCCICA

VACINAS NO
RECOMENDADAS
INFLUENZA ATENUADA
TRIPLICE VIRAL
VARICELA
HPV
Calendrio
SBIM MULHER

VACINAS
INDICADAS
HEPATITE B
INFLUENZA
dTpa

VACINAS A
SEREM
CONSIDERADA
S
HEPATITE A
FEBRE AMARELA
MENINGOCCCIC
A

VACINAS NO
RECOMENDADAS
TRIPLICE VIRAL
VARICELA
HPV
Vacinao na Gestante
Apesar das barreiras para a vacinao das
gestantes, o perodo gestacional representa
um momento privilegiado para reforar os
cuidados com a imunizao: a gestao
motiva a mulher a se engajar no seu auto-
cuidado com a sade
Atitude pr-ativa da equipe de sade em
informar sobre a segurana das vacinas para
as gestantes, tem impacto extremamente
positivo nesta adeso, reduz o tabu
Obrigada,
heloisa.ihle@hpp.org.br
www.sbim.org.br
sbimpr@gmail.com