Implementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort.
Implementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort.
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DOI：
10.1136/bmjopen-2020-041198
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发表时间：
2020-12-31
期刊：
影响因子：
2.9
通讯作者：
Gill CJ
中科院分区：
文献类型：
--
作者：
Gunning CE;Mwananyanda L;MacLeod WB;Mwale M;Thea DM;Pieciak RC;Rohani P;Gill CJ
关于最新覆盖率和及时进行常规儿童免疫接种的可靠信息对于指导全世界的公共卫生工作至关重要，但对个别社区内疫苗接种规划的前瞻性观察很少。在这里，我们提供了一项纵向分析，直接观察到在赞比亚卢萨卡一个资源匮乏的社区对婴儿接种三剂初级疫苗系列。在整个2015年，我们从赞比亚卢萨卡Chawama大院的城市周边非正式定居点招募了一组纵向出生队列的母亲/婴儿（初始登记，1981对；随访，1497对）。我们前瞻性地监测了出生后14-18周的白喉-破伤风-百日咳（DTP）疫苗接种情况。我们分析了总体和按年龄组分层的研究出勤率和疫苗覆盖率。我们采用Kaplan-Meier分析来估计与年龄相适应的疫苗接种延迟。我们还评估了计划时间违规，包括早期和压缩剂量给药。在研究完成时，第一剂（DTP1）完成率很高（92.9%），而第三剂（DTP3）完成率要低得多（61.9%）。错过疫苗接种和退出研究都导致了低百白破疫苗完成率。61名婴儿（4.1%）很晚（10周或10周后）接受DTP1治疗。64名婴儿（4.3%）过早接种DTP1疫苗，77名婴儿（5.1%）连续接种剂量低于最低推荐间隔28天。我们观察到在儿童早期接种百白破疫苗的时间有很大的个体差异，尽管遵循这一出生队列证明是具有挑战性的。我们的研究结果表明，及时给药DTP1和DTP3在这个社区仍然是一个挑战。这些直接观察到的、基于个人的结果与更粗略的、基于调查的国家和省最新疫苗覆盖率估计提供了重要的对比。这项研究还强调了在资源匮乏的城市环境中，疫苗犹豫和（免费）卫生保健服务的次优利用的挑战。
Reliable information on rates of up-to-date coverage and timely administration of routine childhood immunisations are critical for guiding public health efforts worldwide, yet prospective observation of vaccination programmes within individual communities is rare. Here, we provide a longitudinal analysis of the directly observed administration of a three-dose primary vaccination series to infants in a low-resource community in Lusaka, Zambia. Throughout 2015, we recruited a longitudinal birth cohort of mother/infant pairs (initial enrolment, 1981 pairs; attending, 1497 pairs) from the periurban informal settlement of Chawama compound, located in Lusaka, Zambia. We prospectively monitored the administration of scheduled diphtheria–tetanus–pertussis (DTP) vaccinations across the first 14–18 weeks of life. We analysed study attendance and vaccine coverage, both overall and stratified by age group. We employed Kaplan-Meier analyses to estimate delays in age-appropriate administration of vaccine doses. We also assessed schedule timing violations, including early and compressed dose administration. At study completion, first dose (DTP1) rates were high (92.9% of attending), whereas third dose completion (DTP3) rates were far lower (61.9%). Missed vaccinations and study dropout both contributed to the low DTP3 completion rates. DTP1 was administered very late (at or after 10 weeks) to 61 infants (4.1%). DTP1 was administered too early to 64 infants (4.3%), and 77 (5.1%) received consecutive doses below the minimum recommended spacing of 28 days. We observe substantial individual variation in the timing of early childhood DTP doses, though following this birth cohort proved challenging. Our results indicate that timely administration of both DTP1 and DTP3 remains a challenge in this community. These directly-observed, individual-based results provide an important counterpoint to more course-grained, survey-based national and province estimates of up-to-date vaccine coverage. This study also highlights the challenges of vaccine hesitancy and suboptimal utilisation of (no-cost) healthcare services in a low-resource urban setting.
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