Surveillance of Vaccination Coverage Among Adult Populations -United States, 2018.
Surveillance of Vaccination Coverage Among Adult Populations -United States, 2018.
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DOI：
10.15585/mmwr.ss7003a1
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发表时间：
2021-05-14
期刊：
影响因子：
--
通讯作者：
Williams WW
中科院分区：
文献类型：
--
作者：
Lu PJ;Hung MC;Srivastav A;Grohskopf LA;Kobayashi M;Harris AM;Dooling KL;Markowitz LE;Rodriguez-Lainz A;Williams WW
成年人面临着因疫苗可预防的疾病，特别是流感和肺炎球菌疾病而患病、住院、残疾和在某些情况下死亡的风险。疾病预防控制中心根据年龄、健康状况、先前接种疫苗和其他考虑因素建议成年人接种疫苗。CDC的最新疫苗接种建议每年在美国成人免疫计划中公布。尽管长期以来建议使用许多疫苗，但美国成年人的疫苗接种覆盖率仍然很低。2017年8月至2018年6月（流感疫苗）和2018年1月至12月（肺炎球菌、带状疱疹、破伤风和白喉[Td]/破伤风类毒素、减少白喉类毒素、无细胞百日咳[Tdap]、甲型肝炎、乙型肝炎和人乳头瘤病毒[HPV]疫苗）。全国健康访谈调查（NHIS）是一个连续的，横断面的美国非机构平民人口的全国家庭调查。全年在家庭概率样本中进行面对面访谈，并每年汇编和发布NHIS数据。NHIS的目标是监测美国人口的健康状况，并提供健康指标、医疗保健使用和获取以及健康相关行为的估计。评估了成人接受流感、肺炎球菌、带状疱疹、Td/Tdap、甲型肝炎、乙型肝炎和至少1剂HPV疫苗的情况。根据一项新的成人疫苗接种质量综合衡量标准和选定的人口统计学和获得保健的特征（例如，年龄、种族/民族、疫苗接种指征、旅行史[前往肝炎感染流行的国家旅行]、健康保险状况、与医生接触、出生和公民身份）得出估计数。评估了2010 - 2018年期间成人疫苗接种的趋势。在所有年龄组中，成人适龄综合测量的覆盖率都很低。所有疫苗接种的覆盖率存在种族和民族差异，与非西班牙裔白人成年人相比，非白人的大多数疫苗接种覆盖率较低。线性趋势测试表明，本报告中大多数疫苗的覆盖率从2010年到2018年有所增加。很少有年龄≥19岁的成年人接种了所有适龄疫苗，包括流感疫苗，无论是否接种了百白破疫苗（13.5%）或破伤风类毒素疫苗（20.2%）。2017 - 18流感季成人疫苗接种率（46.1%）与2016 - 17流感季的估计接种率（45.4%）相似，肺炎球菌（成人≥65岁[69.0%]）、带状疱疹（成人≥50岁和≥60岁[分别为24.1%和34.5%]）、破伤风（成人≥19岁[62.9%]）、Tdap（成人≥19岁[31.2%]）、甲型肝炎（成人≥19岁[11.9%]）、2018年HPV（19-26岁女性[52.8%]）疫苗接种率与2017年的估计相似。与2017年相比，年龄≥19岁的成年人和年龄≥19岁的卫生保健人员（HCP）的乙肝疫苗接种覆盖率分别提高了4.2和6.7个百分点，达到30.0%和67.2%。19-26岁男性的HPV疫苗接种覆盖率比2017年的估计数增加了5.2个百分点，达到26.3%。总体而言，19-26岁女性的HPV疫苗接种覆盖率没有增加，但19-26岁西班牙裔女性的覆盖率比2017年的估计增加了10.8个百分点，达到49.6%。与有健康保险的成年人相比，没有健康保险的成年人接种以下疫苗的比例较低：流感疫苗（年龄≥19岁、19 - 49岁和50-64岁的成年人）、肺炎球菌疫苗（19 - 64岁风险增加的成年人）、Td疫苗（所有年龄组）、Tdap疫苗（年龄≥19岁和19 - 64岁的成年人）、甲型肝炎疫苗（年龄≥19岁的成年人和年龄≥19岁的旅行者）、乙型肝炎疫苗（年龄≥19岁和19 - 49岁的成年人和年龄≥19岁的旅行者）、带状疱疹疫苗（年龄≥60岁的成年人）、HPV疫苗（19-26岁的男性和女性）。无论是否有健康保险，报告有常规医疗场所的成年人通常比没有此类场所的成年人更常报告接受推荐的疫苗接种。与那些在前一年没有看过医生的人相比，报告在前一年有过≥1次医生接触的成年人的疫苗接种覆盖率更高，无论他们是否有健康保险。即使是那些在前一年有医疗保险并接触过10次以上医生的成年人（视疫苗而定），也有20.1%-87.5%的人报告说，他们没有接种推荐给所有人或有特定适应症的人接种的疫苗。总体而言，美国出生的成年人的疫苗接种覆盖率显著高于外国出生的成年人，包括流感疫苗接种（年龄≥19岁）、肺炎球菌疫苗接种（所有年龄）、破伤风疫苗接种（所有年龄）、百日咳疫苗接种（所有年龄）、乙型肝炎疫苗接种（年龄≥19岁、19 - 49岁和年龄≥19岁的旅行者）、带状疱疹疫苗接种（所有年龄）和19 - 26岁女性的HPV疫苗接种。疫苗接种覆盖率也因公民身份和在美国居住的年限而异。国家卫生保健系统的数据表明，许多成年人仍然无法预防疫苗可预防的疾病。在所有年龄组中，成人适龄综合测量的覆盖率都很低。成人个体疫苗接种覆盖率仍然很低，但乙型肝炎（≥19岁的成年人和HCP≥19岁的成年人）和HPV（19 - 26岁的男性和19 - 26岁的西班牙裔女性）的疫苗接种覆盖率略有增加。自2017年以来，免疫实践咨询委员会疫苗接种指征的其他疫苗和群体的覆盖率没有改善。尽管19-26岁男性和19-26岁西班牙裔女性的HPV疫苗接种覆盖率有所增加，但约50%的19-26岁女性和70%的19-26岁男性仍未接种疫苗。对于常规推荐的成人疫苗，种族/民族的疫苗接种差异仍然存在。拥有健康保险、有通常的医疗保健场所、在过去12个月内与医生接触≥1次与较高的疫苗接种率相关；然而，这些因素本身与最佳成人疫苗接种覆盖率无关，研究结果表明，仍然存在错过接种疫苗的机会。为了减轻疫苗可预防疾病的负担，需要大幅度提高成人疫苗接种的接种率。根据成人免疫实践标准（https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html），所有提供者应在每次临床接触时例行评估成人的疫苗接种状况，强烈推荐适当的疫苗，提供所需的疫苗或将患者转介给能够管理所需疫苗的其他提供者，并在免疫信息系统中记录患者接受的疫苗接种。
Adults are at risk for illness, hospitalization, disability and, in some cases, death from vaccine-preventable diseases, particularly influenza and pneumococcal disease. CDC recommends vaccinations for adults on the basis of age, health conditions, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults remains low. August 2017–June 2018 (for influenza vaccination) and January–December 2018 (for pneumococcal, herpes zoster, tetanus and diphtheria [Td]/tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap], hepatitis A, hepatitis B, and human papillomavirus [HPV] vaccination). The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. NHIS’s objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Adult receipt of influenza, pneumococcal, herpes zoster, Td/Tdap, hepatitis A, hepatitis B, and at least 1 dose of HPV vaccines was assessed. Estimates were derived for a new composite adult vaccination quality measure and by selected demographic and access-to-care characteristics (e.g., age, race/ethnicity, indication for vaccination, travel history [travel to countries where hepatitis infections are endemic], health insurance status, contacts with physicians, nativity, and citizenship). Trends in adult vaccination were assessed during 2010−2018. Coverage for the adult age-appropriate composite measure was low in all age groups. Racial and ethnic differences in coverage persisted for all vaccinations, with lower coverage for most vaccinations among non-White compared with non-Hispanic White adults. Linear trend tests indicated coverage increased from 2010 to 2018 for most vaccines in this report. Few adults aged ≥19 years had received all age-appropriate vaccines, including influenza vaccination, regardless of whether inclusion of Tdap (13.5%) or inclusion of any tetanus toxoid–containing vaccine (20.2%) receipt was measured. Coverage among adults for influenza vaccination during the 2017−18 season (46.1%) was similar to the estimate for the 2016−17 season (45.4%), and coverage for pneumococcal (adults aged ≥65 years [69.0%]), herpes zoster (adults aged ≥50 years and aged ≥60 years [24.1% and 34.5%, respectively]), tetanus (adults aged ≥19 years [62.9%]), Tdap (adults aged ≥19 years [31.2%]), hepatitis A (adults aged ≥19 years [11.9%]), and HPV (females aged 19–26 years [52.8%]) vaccination in 2018 were similar to the estimates for 2017. Hepatitis B vaccination coverage among adults aged ≥19 years and health care personnel (HCP) aged ≥19 years increased 4.2 and 6.7 percentage points to 30.0% and 67.2%, respectively, from 2017. HPV vaccination coverage among males aged 19–26 years increased 5.2 percentage points to 26.3% from the 2017 estimate. Overall, HPV vaccination coverage among females aged 19–26 years did not increase, but coverage among Hispanic females aged 19–26 years increased 10.8 percentage points to 49.6% from the 2017 estimate. Coverage for the following vaccines was lower among adults without health insurance compared with those with health insurance: influenza vaccine (among adults aged ≥19 years, 19–49 years, and 50–64 years), pneumococcal vaccine (among adults aged 19–64 years at increased risk), Td vaccine (among all age groups), Tdap vaccine (among adults aged ≥19 years and 19–64 years), hepatitis A vaccine (among adults aged ≥19 years overall and among travelers aged ≥19 years), hepatitis B vaccine (among adults aged ≥19 years and 19–49 years and among travelers aged ≥19 years), herpes zoster vaccine (among adults aged ≥60 years), and HPV vaccine (among males and females aged 19–26 years). Adults who reported having a usual place for health care generally reported receipt of recommended vaccinations more often than those who did not have such a place, regardless of whether they had health insurance. Vaccination coverage was higher among adults reporting ≥1 physician contact during the preceding year compared with those who had not visited a physician during the preceding year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts during the preceding year, depending on the vaccine, 20.1%–87.5% reported not having received vaccinations that were recommended either for all persons or for those with specific indications. Overall, vaccination coverage among U.S.-born adults was significantly higher than that of foreign-born adults, including influenza vaccination (aged ≥19 years), pneumococcal vaccination (all ages), tetanus vaccination (all ages), Tdap vaccination (all ages), hepatitis B vaccination (aged ≥19 years and 19–49 years and travelers aged ≥19 years), herpes zoster vaccination (all ages), and HPV vaccination among females aged 19–26 years. Vaccination coverage also varied by citizenship status and years living in the United States. NHIS data indicate that many adults remain unprotected against vaccine-preventable diseases. Coverage for the adult age-appropriate composite measures was low in all age groups. Individual adult vaccination coverage remained low as well, but modest gains occurred in vaccination coverage for hepatitis B (among adults aged ≥19 years and HCP aged ≥19 years), and HPV (among males aged 19–26 years and Hispanic females aged 19–26 years). Coverage for other vaccines and groups with Advisory Committee on Immunization Practices vaccination indications did not improve from 2017. Although HPV vaccination coverage among males aged 19–26 years and Hispanic females aged 19–26 years increased, approximately 50% of females aged 19–26 years and 70% of males aged 19–26 years remained unvaccinated. Racial/ethnic vaccination differences persisted for routinely recommended adult vaccines. Having health insurance coverage, having a usual place for health care, and having ≥1 physician contacts during the preceding 12 months were associated with higher vaccination coverage; however, these factors alone were not associated with optimal adult vaccination coverage, and findings indicate missed opportunities to vaccinate remained. Substantial improvement in adult vaccination uptake is needed to reduce the burden of vaccine-preventable diseases. Following the Standards for Adult Immunization Practice (https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html), all providers should routinely assess adults’ vaccination status at every clinical encounter, strongly recommend appropriate vaccines, either offer needed vaccines or refer their patients to another provider who can administer the needed vaccines, and document vaccinations received by their patients in an immunization information system.
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影响因子：
1.9
作者：
Buelow, Victoria H.;Van Hook, Jennifer
通讯作者：
Van Hook, Jennifer
DOI：
10.15585/mmwr.mm6738a2
发表时间：
2018-09-28
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Black CL;Yue X;Ball SW;Fink RV;de Perio MA;Laney AS;Williams WW;Graitcer SB;Fiebelkorn AP;Lu PJ;Devlin R
通讯作者：
Devlin R
影响因子：
3.3
作者：
Byrd, Kathy K.;Lu, Peng-Jun;Murphy, Trudy V.
通讯作者：
Murphy, Trudy V.
影响因子：
4.4
作者：
Campos-Outcalt, Doug;Jeffcott-Pera, Michelle;Young, Herbert F.
通讯作者：
Young, Herbert F.
影响因子：
5.5
作者：
Bridges, Carolyn B.;Hurley, Laura P.;Groom, Amy V.
通讯作者：
Groom, Amy V.