Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1.
Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1.
复制标题
DOI：
10.1016/s0140-6736(21)00984-3
复制
发表时间：
2021-08-07
期刊：
影响因子：
--
通讯作者：
GBD 2020, Release 1, Vaccine Coverage Collaborators
中科院分区：
文献类型：
--
作者：
GBD 2020, Release 1, Vaccine Coverage Collaborators
衡量常规儿童疫苗接种对于为全球疫苗政策和计划实施提供信息以及跟踪全球疫苗行动计划 (GVAP) 和 2030 年免疫议程设定的目标的进展至关重要。需要对常规疫苗覆盖率进行稳健估计，以确定过去的成功和持续存在的漏洞。根据 2020 年全球疾病、伤害和风险因素负担研究 (GBD) 第 1 版，我们使用统计框架按疫苗和时间段对全球、区域和国家疫苗覆盖率趋势进行了系统分析。在这项分析中，我们整理了 1980 年至 2019 年间常规儿童疫苗接种覆盖率的 55~326 个国家特定、队列特定、年份特定、疫苗特定和剂量特定观察结果。利用时空高斯过程回归，我们对 1980 年至 2019 年 204 个国家和地区的 11 个常规儿童疫苗覆盖率指标进行了特定地点和特定年份的估计，并调整了国家报告的偏差数据并反映报告的缺货和供应中断情况。我们分析了零剂量儿童（定义为从未接种过白喉-破伤风-百日咳 [DTP] 疫苗剂量的儿童）覆盖率和数量的全球和区域趋势、GVAP 目标的进展以及疫苗覆盖率与社会人口发展之间的关系。到 2019 年，第三剂 DTP（DTP3；81·6% [95% 不确定性区间 80·4–82·7]）的全球覆盖率比 1980 年估计的水平（39·9% [37·5–42·1]）增加了一倍多，第一剂麻疹疫苗（MCV1；2019 年的 38·5% [35·4–41·3]）的全球覆盖率也是如此。 1980 年至 2019 年的 83·6% [82·3–84·8]）。第三剂脊髓灰质炎疫苗（Pol3）覆盖率也有所增加，从1980年的42·6%（41·4–44·1）增加到2019年的79·8%（78·4–81·1），新疫苗的全球覆盖率在2000年至2019年间迅速增加。1980年至2019年间，全球零剂量儿童数量下降了近75%，从 56·8 百万 (52·6–60·9) 到 14·5 百万 (13·4–15·9)。然而，在过去十年中，全球疫苗覆盖率基本趋于稳定；自 2010 年以来，有 94 个国家和地区的 DTP3 覆盖率出现下降。据估计，只有 11 个国家和地区达到了 2019 年所有评估疫苗覆盖率至少 90% 的国家 GVAP 目标。在全球儿童疫苗覆盖率大幅提高后，世界大部分地区的这一进展在 2010 年至 2019 年期间陷入停滞或逆转。这些发现强调了重新审视常规免疫策略和规划方法的重要性，最近围绕公平和服务不足的人群提供服务。从现在到 2030 年，加强疫苗数据和监测系统对于这些目标至关重要，以确保所有儿童都能获得救命疫苗并从中受益。比尔及梅琳达·盖茨基金会。
Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. By 2019, global coverage of third-dose DTP (DTP3; 81·6% [95% uncertainty interval 80·4–82·7]) more than doubled from levels estimated in 1980 (39·9% [37·5–42·1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38·5% [35·4–41·3] in 1980 to 83·6% [82·3–84·8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42·6% (41·4–44·1) in 1980 to 79·8% (78·4–81·1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56·8 million (52·6–60·9) to 14·5 million (13·4–15·9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Bill & Melinda Gates Foundation.