Effects of the introduction of new vaccines in Guinea-Bissau on vaccine coverage, vaccine timeliness, and child survival: an observational study
Effects of the introduction of new vaccines in Guinea-Bissau on vaccine coverage, vaccine timeliness, and child survival: an observational study
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DOI：
10.1016/s2214-109x(14)70274-8
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发表时间：
2014-08-01
影响因子：
34.3
通讯作者：
Aaby, Peter
中科院分区：
文献类型：
--
作者：
Fisker, Ane B.;Hornshoj, Linda;Aaby, Peter
背景2008年，全球疫苗和免疫联盟资助在几内亚比绍引进新疫苗（包括五价白喉-百日咳[DTP]加B型肝炎和流感嗜血杆菌B型抗原）。在引进疫苗的同时，还增加了疫苗接种外展服务，并采取了更严格的浪费政策，包括只为12个月以下的儿童接种疫苗。我们评估了所有疫苗在扩大免疫接种计划的覆盖面之前和之后的新疫苗的引进，和对儿童survival.Methods的影响，这观察性队列研究使用的数据从Bandim健康项目，监测疫苗接种状态和死亡率随机选择的村庄集群在几内亚比绍自1990年以来。我们使用2007年和2009年出生的儿童的队列数据评估了疫苗接种覆盖率的变化;使用1999-2006年的数据分析了12个月后接种麻疹疫苗的儿童比例;使用1999年至2006年的数据，比较了接种麻疹疫苗和未接种麻疹疫苗的儿童12个月后的死亡率。在2007年队列中，12月龄时完全接种疫苗的儿童比例为53%（468/878），在2009年队列中为53%（467/879）（相对风险[RR] 1.00，95%CI 0.89-1.11）。DTP-3和五价-3的覆盖率从73%（878人中的644人），2007年增至81% 2009年（共879件）（RR 1 10，95%CI 1.04 - 1.17）;相比之下，麻疹疫苗接种覆盖率从71%（620/878）下降到66%（577/879; RR 0.93，0.85-1.01）。DTP-3疫苗接种率与麻疹疫苗接种率相比，变化的影响有显著性差异（p= 0.002）。在12个月大之后，调整死亡率比为0.71（95% CI 0.56-0.90），与未接种麻疹疫苗的儿童相比（女孩0.59 [0.43-0.80]，男孩0.87 [0.62-1.23]）2008年实施的新疫苗接种计划增加了白喉、破伤风和百日咳疫苗的覆盖率，但减少了麻疹疫苗的覆盖率。1999-2006年，未接种麻疹疫苗的儿童死亡率高于接种疫苗的儿童。
Background In 2008, the GAVI Alliance funded the introduction of new vaccines (including pentavalent diphtheriatetanus- pertussis [DTP] plus hepatitis B and Haemophilus infl uenzae type b antigens) in Guinea-Bissau. The introduction was accompanied by increased vaccination outreach services and a more restrictive wastage policy, including only vaccinating children younger than 12 months. We assessed coverage of all vaccines in the Expanded Program on Immunizations before and after the new vaccines' introduction, and the implications on child survival.Methods This observational cohort study used data from the Bandim Health Project, which has monitored vaccination status and mortality in randomly selected village clusters in Guinea-Bissau since 1990. We assessed the change in vaccination coverage using cohort data from children born in 2007 and 2009; analysed the proportion of children who received measles vaccine after 12 months of age using data from 1999-2006; and compared child mortality after age 12 months in children who had received measles vaccine and those who had not using data from 1999 to 2006.Findings The proportion of children who were fully vaccinated by 12 months of age was 53% (468 of 878) in the 2007 cohort and 53% (467 of 879) in the 2009 cohort (relative risk [RR] 1.00, 95% CI 0.89-1.11). Coverage of DTP-3 and pentavalent-3 increased from 73% (644 of 878) in 2007 to 81% (712 of 879) in 2009 (RR 1 10, 95% CI 1.04 -1.17); by contrast, the coverage of measles vaccination declined from 71% (620 of 878) to 66% (577 of 879; RR 0.93, 0.85-1.01). The eff ect of the changes was signifi cantly diff erent for DTP-3 coverage compared with measles vaccine coverage (p=0 002). After 12 months of age, the adjusted mortality rate ratio was 0.71 (95% CI 0.56-0.90) for children who had received measles vaccine compared with those who had not (0.59 [0.43-0.80] for girls and 0.87 [0.62-1.23] for boys).Interpretation The introduction of the new vaccination programme in 2008 was associated with increased coverage of DTP, but decreased coverage of measles vaccine. In 1999-2006, child mortality was higher in children who had not received measles vaccine than in those who had.