Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data
Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data
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DOI：
10.1016/j.vaccine.2020.08.019
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发表时间：
2020-10-21
期刊：
影响因子：
5.5
通讯作者：
Khan, Aamir Javed
中科院分区：
文献类型：
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作者：
Chandir, Subhash;Siddiqi, Danya Arif;Khan, Aamir Javed
背景：COVID-19大流行影响了全球的常规免疫接种。在医疗资源有限和卫生系统脆弱的低收入和中等收入国家，影响可能会更大。我们量化了巴基斯坦信德省4800万受影响人口的儿童免疫接种的影响、空间异质性和决定因素。方法：我们从2019年9月23日至2020年7月11日的实时省级电子免疫登记处提取了个人免疫记录。通过比较基线（封锁前6个月）和COVID-19封锁期，我们分析了地理区域对每种抗原每日免疫接种率的影响。我们使用多变量logistic回归，探讨与免疫接种在封锁。结果：有一个52.5%的下降，在封锁期间接种疫苗的日均总数相比，基线。下降幅度最大的是卡介苗（BCG）（40.6%（958/2360））固定接种。在封锁期间，每天约有8438名儿童错过了免疫接种。在农村地区、有大量贫民窟的城市分区和小儿麻痹症流行的超高风险分区，入学率下降最多。在医院出生的婴儿（RR：1.09; 95%CI：1.04-1.15）和母亲受过高等教育的婴儿（RR：1.19-1.50; 95%CI：1.13-1.65）五价-3（penta-3）免疫率较高。每延迟一周，五种疫苗接种的可能性就会降低5%。结论：信德省每两名儿童中就有一名在该省COVID-19封锁期间错过了常规疫苗接种。在封锁期间，未接种疫苗的儿童人数正在扩大，使他们容易感染疫苗可预防的疾病。有必要采取有针对性的干预措施，以促进免疫接种和安全服务的提供。更高的孕产妇教育，设施为基础的分娩，并提前登记进入免疫接种计划继续显示出积极的关联与免疫接种的吸收，即使在一个具有挑战性的封锁。(C)2020爱思唯尔有限公司保留所有权利。
Background: COVID-19 pandemic has affected routine immunization globally. Impact will likely be higher in low and middle-income countries with limited healthcare resources and fragile health systems. We quantified the impact, spatial heterogeneity, and determinants for childhood immunizations of 48 million population affected in the Sindh province of Pakistan.Methods: We extracted individual immunization records from real-time provincial Electronic Immunization Registry from September 23, 2019, to July 11, 2020. Comparing baseline (6 months preceding the lockdown) and the COVID-19 lockdown period, we analyzed the impact on daily immunization coverage rate for each antigen by geographical area. We used multivariable logistic regression to explore the predictors associated with immunizations during the lockdown.Results: There was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Calmette Guerin (BCG) (40.6% (958/2360) immunization at fixed sites. Around 8438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. Pentavalent-3 (penta-3) immunization rates were higher in infants born in hospitals (RR: 1.09; 95% CI: 1.04-1.15) and those with mothers having higher education (RR: 1.19-1.50; 95% CI: 1.13-1.65). Likelihood of penta-3 immunization was reduced by 5% for each week of delayed enrollment into the immunization program.Conclusion: One out of every two children in Sindh province has missed their routine vaccinations during the provincial COVID-19 lockdown. The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. There is a need for tailored interventions to promote immunization visits and safe service delivery. Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown. (C) 2020 Elsevier Ltd. All rights reserved.