Kodėl suaugusių pacientų vakcinavimas Lietuvoje yra vienas mažiausių Europos Sąjungoje?

Kodėl suaugusių pacientų vakcinavimas Lietuvoje yra vienas mažiausių Europos Sąjungoje?

Arvydas AmbrozaitisŠiandien mažiau vaikų, palyginti su suaugusiais pacientais, miršta nuo vakcinomis valdomų ligų. Tai labai geras pastarųjų kelerių dešimtmečių kūdikių imunizacijos programų rezultatas. Norint pasiekti panašių suaugusių pacientų rezultatų, būtina dėti daugiau pastangų.

65-oji pasaulinė sveikatos asamblėja 2012 metais patvirtino vakcinacijos veiksmų planą. Pagal jį galima įdiegti viso gyvenimo skiepijimo programas, norint užtikrinti vakcinų teikiamos naudos prieinamumą kiekvienam bet kurios amžiaus grupės rizikos pacientui. Taigi skiepų planas nėra skirtas tik kūdikiams – jis tik pradedamas kūdikystėje ir tęsiamas visą gyvenimą.

Siekdama, kad suaugusių pacientų vakcinacija taptų Lietuvos gydytojų kasdienio darbo dalimi, Lietuvos infektologų draugija kartu su kitų terapinių sričių specialistais rengia Senyvo amžiaus žmonių skiepijimo Lietuvoje rekomendacijas ir Suaugusiųjų rizikos grupių skiepijimo Lietuvoje rekomendacijas (šiemet išleistas jau antrasis atnaujintas leidimas). Teigiami Lietuvos Respublikos sveikatos apsaugos ministerijos sprendimai ir didėjantis mūsų valstybės finansavimas suaugusiems pacientams vakcinuoti tapo sektinu pavyzdžiu mūsų kaimynėms Latvijai ir Estijai. Nepaisant bendrų imunoprofilaktikos ekspertų ir valstybės pastangų, palyginti su Europos Sąjunga, suaugusių pacientų Lietuvoje paskiepijama mažiausiai. Kodėl?

Kviečiu kartu aptarti galimus suaugusių pacientų skiepijimo barjerus iš gydytojo perspektyvos. Lietuvos gydytojai turi rekomenduojamą kiekvienos lėtinių ligų grupės skiepijimo planą ir tikslius nurodymus dėl skiepijimo schemų, terminų net tokioms sudėtingoms dėl pačios ligos ir skirto gydymo grupėms kaip pacientai, sergantys imunosupresinėmis ligomis. Kodėl gydytojai dar jaučiasi nedrąsiai, ypač priimdami sprendimą dėl imunosupresinių pacientų skiepijimo? Keturios vakcinos, kurios Lietuvoje yra rekomenduojamos suaugusiems pacientams, nepriklausomai nuo to, kokia liga jie serga, yra sezoninė gripo, pneumokokinė, difterijos stabligės ir erkinio encefalito. Dvi jų – sezoninio gripo ir pneumokokinę – valstybė kompensuoja sergantiems tam tikromis ligomis pacientams. Vakcinų kaina šiuo atveju nėra kliūtis, tad kodėl dauguma rizikos grupių pacientų lieka neskiepyti? Europoje atliktas tyrimas PneuVUE parodė, kad 92 proc. vyresnių nei 50 metų asmenų sutiktų pasiskiepyti pneumokokine vakcina, jeigu gydytojas ją rekomenduotų. Kodėl gydytojai dažnai pacientams nė neužsimena apie jiems gresiančią riziką ir apie galimybę jos išvengti skiepijantis? Ar galimas atsakymas į visus šiuos klausimus nėra tai, kad gydytojai vis dar mato suaugusių pacientų vakcinaciją kaip papildomą neprioritetinį darbą, o ne kaip privalomąjį paciento sveikatos priežiūros komponentą? Dažnai tenka girdėti, kad gydytojas neturi laiko aptarti su pacientu dar ir skiepų. Skiepai yra ne mažiau svarbi prevencinė priemonė kaip ir sveika mityba bei fizinis aktyvumas. Todėl, be kitų darbų, tokių kaip paciento būklės įvertinimas, tyrimų ir gydymo paskyrimas, gydytojas turėtų skirti laiko įvertinti, ar pacientui yra atlikti visi reikalingi skiepai.

Ne mažiau svarbūs yra ir administraciniai barjerai. Iki šiol nėra jokio dokumento, nei popierinio, nei elektroninio, kuriame būtų užfiksuota, kokios ir kada vakcinos buvo įskiepytos suaugusiam asmeniui, numatytos kitų vakcinų dozių datos, jeigu skiepijama pagal schemą, arba revakcinacijos datos, jeigu tokių reikia. Kodėl gydytojams specialistams, pavyzdžiui, onkologams, reumatologams, endokrinologams, sunku įvertinti, ar šeimos gydytojas pacientą jau paskiepijo, tarkime, pneumokokine vakcina, ir, jeigu ne, atkreipti šeimos gydytojo dėmesį į tai, jog riziką turintį pacientą paskiepyti būtina. Jeigu neklystu, nėra kitos tokios šalies Europos Sąjungoje kaip Lietuva, kurioje gydytojai specialistai neturėtų teisės patys paskirti skiepų pagal savo sritį prižiūrimiems pacientams. Juk būtent gydytojas specialistas geriausiai gali įvertinti paciento riziką, gydymo ypatumus ir numatyti tinkamiausią laiką pasiskiepyti. Suaugusių pacientų  vakcinacija, išskyrus rizikos grupių valstybės finansuojama sezoninio gripo vakcina, šiandien mūsų šalyje nėra skatinamoji paslauga. Tai irgi prisideda prie gydytojų požiūrio, kad suaugusių pacientų vakcinacija nėra prioritetas.

Dėl visų šių barjerų Lietuvoje ir nutinka taip, kai didelę riziką susirgti vakcinomis kontroliuojamomis ligomis turintį pacientą gydytojai mato po kelis kartus per mėnesį, bet jis taip ir lieka nepaskiepytas. Tai viena priežasčių, kodėl kasmet pasitaiko mirčių nuo gripo ir pneumokokinės infekcijos atvejų, nors, spėju, jiems buvo skirtos valstybės finansuojamos vakcinos.

Norėčiau priminti, kad šiandien Lietuvoje suaugusiems pacientams valstybės lėšomis finansuojamos šios vakcinos: difterijos, stabligės, pradedant nuo 26 metų kas 10 metų, ir sezoninio gripo ir pneumokokinė Lietuvos Respublikos sveikatos apsaugos ministerijos įsakymais numatytiems rizikos grupių pacientams. Nuo 2018 metų sausio 1 dienos valstybės lėšomis nemokamai pradedami skiepyti pacientai, sergantys lėtine obstrukcine plaučių liga ir cukriniu diabetu. Vakcinacija nuo gripo ir pneumokokinės infekcijos priklauso kategorijai efektyviausių sveikatos prevencinių programų, tokių kaip rūkymo metimas ir vėžio patikra. Vakcinos gali apsaugoti tik tada, jeigu yra skiepijamos. Kitaip jos yra bevertės.

Pasitinkant naujuosius 2018 metus, norėčiau palinkėti suaugusių pacientų vakcinacijos barjerus po truputį pradėti šalinti. Gydytojams – integruoti skiepus į bendrą paciento sveikatos priežiūros planą, specialistų profesinėms draugijoms – siekti gydytojų specialistų kompetencijų papildymo medicinos normose, įtraukiant vakcinaciją, sveikatos politikams – numatyti priemonę, kuri informuotų apie pacientui atliktus skiepus, ir biudžetą suaugusių pacientų vakcinacijos paskatinti.
Internistas Nr.10, 2017 m.

Prof. Arvydas Ambrozaitis

Vilniaus universiteto ligoninės Santaros klinikų filialo Infekcinių ligų centras

 


136 mintys apie “Kodėl suaugusių pacientų vakcinavimas Lietuvoje yra vienas mažiausių Europos Sąjungoje?

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