Seroprotection at Different Levels of the Healthcare System After Routine Vaccination With Diphtheria-Tetanus-Pertussis whole cell-Hepatitis B-Haemophilus influenzae Type B in Lao People's Democratic Republic
Seroprotection at Different Levels of the Healthcare System After Routine Vaccination With Diphtheria-Tetanus-Pertussis whole cell-Hepatitis B-Haemophilus influenzae Type B in Lao People's Democratic Republic
复制标题
DOI：
10.1093/cid/ciz143
复制
发表时间：
2019-12-15
影响因子：
11.8
通讯作者：
Black, Antony P.
中科院分区：
文献类型：
--
作者：
Hefele, Lisa;Syphan, Sengdavanh;Black, Antony P.
背景由于疫苗覆盖面不全和疫苗反应薄弱，老挝人民民主共和国继续承受着可通过疫苗预防的疾病的沉重负担。我们已经评估了五价疫苗常规接种后的血清转换，以捕捉在不同层次的医疗系统的疫苗管理的弱点。共招募了1151名儿童（8-28个月），在万象的中央医院和省医院、3家地区医院和博利坎赛省的10个保健中心接种了3剂五价疫苗。社会人口学信息收集与标准化问卷调查。分析血清样本中针对疫苗成分的抗体，并进行双变量和多变量分析以确定低疫苗应答的危险因素。省、区和卫生中心一级的血清保护率与中心医院一样高，但偏远卫生中心覆盖地区的血清保护率明显较低。保护水平也随着采样时年龄的增长而迅速下降。Bolikhamxay对不同成分的血清保护率达到70%-77%，比同一地区以前的研究高出20%; 18.8%以上的儿童接受了出生剂量的B肝炎疫苗，B肝炎病毒感染率降低了4倍。在中部省份，疫苗免疫原性显著提高，这可能是由于对冷链的培训和投资。尽管如此，仍有必要将重点放在偏远地区的“最后一英里”，即大多数儿童通过外联活动接种疫苗的地方。
Background. The Lao People's Democratic Republic continues to sustain a considerable burden of vaccine-preventable diseases because of incomplete vaccine coverage and weak vaccine responses. We have assessed seroconversion after routine vaccination with the pentavalent vaccine to capture weaknesses of vaccine management at the different levels of the healthcare system.Methods. A total of 1151 children (aged 8-28 months) with 3 documented doses of the pentavalent vaccine delivered at central hospitals in Vientiane and the provincial hospital, 3 district hospitals, and 10 health centers in Bolikhamxay province were enrolled. Sociodemographic information was collected with a standardized questionnaire. Serum samples were analyzed for antibodies against vaccine components, and bivariate and multivariable analyses were performed to identify risk factors for low vaccine responses.Results. Seroprotection rates at the provincial, district, and health center level were as high as in central hospitals, but seroprotection rates in areas covered by remote health centers were significantly lower. Protective levels also rapidly decreased with age at sampling. Seroprotection rates in Bolikhamxay against the different components reached 70%-77% and were up to 20% higher than in previous studies in the same region; 18.8% more children received the hepatitis B vaccine birth dose and the hepatitis B virus infection rate was 4 times lower.Conclusions. Vaccine immunogenicity has dramatically improved in a central province, likely due to training and investment in the cold chain. Nevertheless, there remains a need to focus on the "last mile" in remote areas were most children are vaccinated through outreach activities.