Perguntas e Respostas sobre a Vacina Profilática contra o HPV

Como funciona a vacinação contra o HPV no SUS?
Em 2014, o Ministério da Saúde incluiu a vacina contra o HPV no Calendário Nacional de Vacinação. Ela é fornecida gratuitamente, pelo Sistema Único de Saúde (SUS), a meninas de 11 a 13 anos. A vacina está disponível nas 36 mil salas de vacina da rede pública de saúde durante, todo o ano. Assim como no início da vacinação no SUS, o Ministério da Saúde recomendou aos municípios que organizem a aplicação da segunda dose nas escolas públicas e privadas que aderiram à estratégia a partir de 10 de março.

Quem deve tomar a vacinar?
Em 2014, a população-alvo da vacina contra o HPV é composto por meninas de 11 a 13 anos. Em 2015, serão vacinadas as adolescentes de 9 a 11 anos e, a partir de 2016, serão vacinadas as meninas que completam 9 anos de idade. Com isso, o Brasil, em apenas dois anos, protegerá as meninas de 9 a 13 anos – faixa etária que melhor se beneficia da proteção da vacina. No caso da população indígena, serão vacinadas meninas de 9 a 13 anos em 2014 e de 9 anos de idade a partir de 2015.

Por que o Ministério da Saúde incluiu a vacina contra o HPV no Calendário Nacional de Vacinação?

O vírus HPV é a principal causa do câncer do colo de útero, o terceiro tipo mais frequente entre as mulheres, atrás apenas do câncer de mama e de cólon e reto. Por isso, a incorporação da vacina no calendário nacional tem o objetivo de prevenir o câncer do colo do útero. Com a introdução da vacina no SUS, espera-se a redução da incidência e da mortalidade por esta doença. Estima-se que 270 mil mulheres, no mundo, morrem devido ao câncer de colo do útero. No Brasil, o Instituto Nacional do Câncer (INCA) estima o surgimento de 15 mil novos casos e cerca de 4,8 mil óbitos em 2014. Com a vacinação, também será possível a prevenção de verrugas genitais e outros tipos de câncer induzidos pelo HPV.

Qual é a meta de vacinação para 2014?
A meta é vacinar pelo menos 80% do grupo-alvo. Em 2014, esse público é formado por 4,9 milhões de meninas na faixa-etária de 11 a 13 anos em 2014. Com uma alta cobertura vacinal ocorre uma “imunidade coletiva ou de rebanho”. Ou seja, há a possibilidade de redução da transmissão mesmo entre as pessoas não vacinadas.

Por que o Ministério da Saúde estabeleceu a faixa etária de 9 a 13 anos?
A vacina adotada no SUS – chamada de quadrivalente – é altamente eficaz contra os tipos de HPV 6, 11, 16 e 18, sendo que os tipos 16 e 18 são responsáveis por cerca de 70% dos casos de câncer de colo do útero em todo mundo. A idade mais favorável à vacinação é a faixa etária entre 9 a 13 anos porque é neste período que a vacina garante maior proteção, já que as adolescentes não iniciaram a vida sexual, e, por isso, não estiveram expostas ao vírus.

Por que o Ministério da Saúde não incluiu os meninos na estratégia de vacinação?
Como o objetivo desta estratégia de vacinação é reduzir casos e mortes ocasionados pelo câncer de colo do útero, a vacinação será restrita ao sexo feminino. Estudos comprovam que os meninos passam a ser protegidos indiretamente com a vacinação no grupo feminino (imunidade coletiva), havendo drástica redução na transmissão de verrugas genitais entre homens após a implantação da vacina contra o HPV como estratégia de saúde pública.

Como o Ministério da Saúde irá sensibilizar os pais sobre a importância de vacinar suas filhas contra o HPV?

Os pais serão informados a partir de materiais informativos distribuídos pelo Ministério da Saúde, assim como as adolescentes e profissionais de saúde e educação. Esses materiais esclarecem os objetivos da vacinação e a sua relevância como medida de saúde pública para a redução da incidência e mortalidade pelo câncer do colo do útero. Campanhas publicitárias na televisão, cartazes, mídia em geral, redes sociais e grupos de jovens serão, ainda, estratégias utilizadas para sensibilização.

Como funcionará a vacinação nas escolas?
Os pais devem checar se o município onde reside realizará vacinação nas escolas. As secretarias municipais de Saúde foram orientadas a programar a vacinação nas escolas públicas e privadas que aderiram à estratégia. As instituições de ensino devem informar, com antecedência, aos pais ou responsáveis a data de vacinação. Na escola, a vacina será aplicada em ambientes seguro e adequado e por profissionais de saúde.

Para ser vacinada nas escolas, a adolescente precisa de autorização dos pais? E nos postos de saúde?

A vacinação contra o HPV é uma importante ação de saúde pública para a prevenção do câncer de colo do útero. Os pais que não quiserem que seus filhos sejam vacinados nas escolas deverão preencher o Termo de Recusa de vacinação contra HPV entregue pela própria escola e enviar para a instituição de ensino durante o período em que o ocorrer a vacinação nestas localidades. Nas unidades de saúde, a adolescente que queira se vacinar deve apresentar a caderneta de vacinação ou documento de identidade, sem a necessidade de autorização dos pais ou responsáveis.

Se a adolescente não puder comparecer no período de vacinação na escola, ela poderá vacinar em outro momento?

Sim. A vacina integra o Calendário de Imunização do SUS e está disponível nas unidades de saúde, durante todo o ano.

Adolescentes que já tomaram outros tipos de vacina contra o HPV, como devem proceder?
O Ministério da Saúde recomenda que a adolescente continue o esquema com a mesma vacina nos próprios serviços onde se iniciou a vacinação contra o HPV.

Se a adolescente tiver feito a primeira dose na rede privada antes da campanha e quiser completar o esquema na rede pública?

Sim, a adolescente poderá tomar até duas doses seguintes na rede pública.

Se a adolescente de 11 a 13 anos ainda não tomou a primeira dose ela ainda pode tomar?
Sim. A vacina está disponível para as meninas que fazem parte do público-alvo nas 36 mil salas de vacinação da rede pública de saúde, durante todo o ano.

Se a adolescente tomou a primeira dose com 13 anos e já completou 14 anos pode tomar a 2a dose?

Sim. Todas as meninas que começaram a vacinação deverão seguir o esquema vacinal, composto por três doses.

VACINA E SUA PROTEÇÃO

Que vacina contra o HPV é oferecida no SUS?
O Ministério da Saúde adquiriu a vacina quadrivalente, que confere proteção contra quatro tipos (6, 11, 16 e 18) do HPV. O esquema de vacinação adotado pelo Ministério da Saúde é chamado de “estendido” e composto por três doses, sendo que a 2a dose deve ser aplicada seis meses após a 1a e a 3a dose, cinco anos depois da 1a. O esquema “estendido” é recomendado pela Organização Pan-Americana de Saúde (OPAS/OMS) e utilizado em países como Canadá, México, Colômbia e Suíça e garante maior duração da proteção fornecida pela vacina.

A vacina é administrada por via oral ou é injeção?
É por via intramuscular – injeção de apenas 0,5 ml em cada dose.

A vacina contra HPV provoca algum efeito colateral? O que fazer caso sinta alguns desses sintomas?

A vacina é muito segura. Pode ocorrer eventos adversos leves como dor no local da aplicação, inchaço e coloração avermelhada. Em casos raros, pode ocasionar dor de cabeça, febre maior que 38o C e desmaios. É importante ressaltar que a ocorrência de desmaios durante a vacinação contra HPV não está relacionada à vacina especificamente, mas sim ao processo de vacinação, que pode acontecer com a aplicação de qualquer produto injetável. Em caso de algum desses sintomas, o Ministério da Saúde recomenda que a adolescente procure uma unidade de saúde mais próxima relatando o que sentiu ou está sentindo.

Em quais situações a vacina contra o HPV não deve ser administrada?
A vacina é contraindicada a gestantes, meninas com hipersensibilidade ao princípio ativo da vacina (sulfato de hidroxifosfato de alumínio amorfo) e que apresentarem alguma reação alérgica grave após receberem a primeira dose.

Como foi adquirida a vacina pelo SUS?
Para a aquisição da vacina contra o HPV, o Ministério da Saúde firmou Parceria para o Desenvolvimento Produtivo (PDP) com o laboratório público Instituto Butantan e o laboratório privado MerckSharpDohme (MSD). Será investido R$ 1,1 bilhão na compra de 41 milhões de doses da vacina durante cinco anos – período necessário para a total transferência de tecnologia ao laboratório brasileiro. Somente para 2014, foram adquiridas 15 milhões de doses. A PDP possibilitou uma economia estimada de R$ 83,5 milhões na compra da vacina em 2014. O Ministério da Saúde pagará R$ 31,02 por dose, o menor preço já praticado no mercado.

PREVENÇÃO

Meninas que já tiveram diagnóstico de HPV podem se vacinar?
Sim. Existem estudos com evidências de que a vacina previne a reinfecção ou a reativação da doença relacionada ao vírus nela contido.

A vacinação contra HPV substituirá o exame de Papanicolau?
Não. É importante lembrar que a vacinação é uma ferramenta de prevenção e não substitui o rastreamento do câncer do colo do útero em mulheres na faixa etária entre 25 e 64 anos. Assim, as meninas vacinadas, só terão recomendação para o rastreamento quando atingirem a faixa etária preconizada para o exame Papanicolau e já tiverem vida sexual ativa.

Mesmo vacinada será necessário utilizar preservativo durante a relação sexual?
Sim, quando iniciarem a vida sexual, é imprescindível manter a prevenção por meio do uso de preservativo na relação. O preservativo protege, além do HPV, outras doenças transmitidas por via sexual, como HIV, sífilis, hepatite B, etc.

SOBRE O HPV E O CÂNCER DO COLO DO ÚTERO

O que é HPV?
Sigla em inglês para Papilomavírus Humano (Human Papiloma Virus – HPV). Os HPV são vírus capazes de infectar a pele ou as mucosas. Existem mais de 150 tipos diferentes de HPV.

O HPV de tipos 16 e 18 causam a maioria dos casos de câncer de colo do útero em todo mundo (cerca de 70%). Já os de tipo 6 e 11, estão relacionados ao surgimento de verrugas genitais e papilomas laríngeos.

Como o HPV é transmitido?
O HPV é altamente contagioso, sendo possível contaminar-se com uma única exposição, e a sua transmissão se dá por contato direto com a pele ou mucosa infectada. A principal forma é pela via sexual, que inclui contato oral-genital, genital-genital ou mesmo manual-genital. Portanto, o contágio com o HPV pode ocorrer mesmo na ausência de penetração vaginal ou anal. Também pode haver transmissão durante o parto. Embora seja raro, o vírus pode propagar-se também por meio de contato com mão.

O que é câncer do colo do útero?
É uma doença grave, caracterizada pelo crescimento anormal de células do colo do útero. Cerca de metade de todas as mulheres diagnosticadas com câncer de colo do útero tem entre 35 e 55 anos de idade. Muitas provavelmente foram expostas ao HPV na adolescência ou na faixa dos 20 anos de idade. Estima-se que 270 mil mulheres, no mundo, morrem devido ao câncer de colo do útero. No Brasil, o Instituto Nacional do Câncer (INCA) estima o surgimento de 15 mil novos casos e cerca de 4,8 mil óbitos em 2014.

Como se prevenir da transmissão do HPV e do câncer do colo do útero?
As medidas de prevenção mais importantes são uso do preservativo nas relações sexuais, evitar ter muitos parceiros sexuais, realizar higiene pessoal, vacinar-se contra o HPV e realizar o exame Papanicolau. É importante lembrar que só a vacina contra o HPV não protege contra o vírus.

Fonte: Agência Saúde

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