Desafios Não Atendidos na Prevenção da COVID-19 em Indivíduos Imunocomprometidos: Uma Análise de Consenso em Portugal
DOI:
https://doi.org/10.20344/amp.9949Palavras-chave:
COVID-19/prevenção e controlo, Hospedeiro Imunocomprometido, Portugal, SARS-CoV-2, Técnica DelphiResumo
Introdução: A pandemia de COVID-19, causada pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), resultou numa carga significativa de doenças e mortalidade. Apesar dos sucessos das vacinas, novas variantes do vírus persistem, afetando gravemente indivíduos não vacinados e imunocomprometidos (IIC). Estes grupos de alto risco enfrentam taxas elevadas de mortalidade e hospitalização. A vigilância e as medidas de saúde direcionadas permanecem cruciais após a pandemia. Este estudo teve como objetivo desenvolver um consenso sobre as necessidades não atendidas na prevenção da COVID-19 entre IIC.
Métodos: Realizámos um Delphi envolvendo 45 especialistas, incluindo médicos, gestores de saúde, decisores políticos, especialistas em saúde pública, membros de sociedades médicas e organizações de doentes. O consenso foi alcançado em 65% para cada estratégia identificada, utilizando uma escala que varia de “concordo totalmente” a “discordo totalmente”. Foram realizadas três rondas Delphi para abordar quatro questões principais: identificar necessidades não atendidas na prevenção da COVID-19 para IIC; identificar as características que distinguem os IIC como um grupo suscetível; determinar os principais resultados da COVID-19 em IIC; e indicar planos de ação para proteger os IIC. A primeira ronda envolveu a votação de indicadores pré-identificados. As segunda e terceira rondas envolveram a análise das informações recolhidas e a votação de cada indicador para alcançar consenso.
Resultados: Foi alcançada uma taxa de retenção de 80%. Dos 89 indicadores válidos analisados, 23 alcançaram consenso. Estes incluíram: oito indicadores que destacaram a importância de aumentar a conscientização sobre a COVID-19 e os resultados da vacinação, garantindo segurança e compreensão, e desenvolvendo estratégias de vacinação direcionadas para IIC; cinco indicadores que identificaram grupos suscetíveis dentro dos IIC, como indivíduos em quimioterapia ou radioterapia, aqueles com imunodeficiências primárias, recetores de transplantes de órgãos sólidos, pacientes com doença renal crónica e recetores de transplantes de medula óssea; dois indicadores que mostraram melhorias nos resultados clínicos e redução das hospitalizações; e oito indicadores que recomendaram o desenvolvimento de terapias eficazes, vacinas mais imunogénicas e tratamentos para infeções virais em IIC.
Conclusão: O estudo enfatizou a importância de estratégias de vacinação direcionadas, monitorização e educação personalizada para abordar as diversas necessidades dos IIC. Estes resultados fornecem uma base para o desenvolvimento de políticas futuras que visem gerir e proteger eficazmente os IIC durante e após a pandemia de COVID-19.
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