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英国儿童接种疫苗的及时性:基于人口的队列研究
Anne M Suffel1, Jemma L Walker2, Elizabeth Williamson3
1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom; Health Protection Research Unit in Vaccines and Immunisation at the London School of Hygiene and Tropical Medicine, United Kingdom.
在英格兰,延迟儿童接种疫苗是很常见的,特别是百日咳和麻疹疫苗. 初级保健数据可以识别患有延迟免疫接种风险较高的儿童,使及时干预成为可能.
科学领域:
- 儿科健康 儿科健康
- 疫苗学 疫苗学 疫苗学
- 公共卫生监督 公共卫生监督
背景情况:
- 在英格兰,儿童疫苗监测传统上侧重于特定年龄 (1,2,5岁) 的覆盖.
- 之前关于疫苗及时性的研究使用了对"迟到"或"及时"疫苗接种的不一致的定义.
- 需要对整个儿童免疫计划中接种疫苗的时间进行详细,全面的分析.
研究的目的:
- 提供有关英格兰儿童免疫计划中接种疫苗的时间和模式的详细和整体信息.
- 用初级保健电子健康记录分析疫苗的及时性.
- 为了确定与疫苗接种延迟相关的因素.
主要方法:
- 利用临床实践研究数据链接 (CPRD) Aurum初级保健电子健康记录在英格兰出生的儿童 (2006-2014).
- 描述了针对百日咳,肺炎球菌和麻疹抗原的疫苗接种量,按年龄分为几天,按种族,地区和出生队列分层.
- 采用流图来可视化疫苗接种途径和生存分析 (加速失效时间模型),根据先前的剂量时间来预测接种疫苗的年龄.
主要成果:
- 追踪了573,015名儿童直到他们的第五个生日,在两剂麻疹,疹,红疹 (MMR) 方面达到90.16%的覆盖率,在四剂角膜炎,结,百日咳 (DTP) 方面达到88.78%.
- 观察到较晚的预产日期与疫苗接种延迟的增加相关;黑人种族的儿童和伦敦的儿童表现出不同的接种模式.
- 第三次DTP剂量的显著延迟 (超过一年的延迟) 导致接下来的剂量比及时接种疫苗延迟2.7倍;对于延迟的MMR第一剂量,观察到较小的延迟.
结论:
- 疫苗接种延迟的风险随着孩子的年龄和先前疫苗剂量的延迟而升级.
- 初级保健数据提供了一种有价值的工具,可以迅速识别患有延迟疫苗接种风险较高的儿童.
- 这项研究强调了详细的及时性分析的重要性,超出了简单的覆盖范围指标,以实现有效的公共卫生干预.
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