Underimmunization among children: Effects of vaccine safety concerns on immunization status
Underimmunization among children: Effects of vaccine safety concerns on immunization status
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DOI：
10.1542/peds.114.1.e16
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发表时间：
2004-07-01
期刊：
影响因子：
8
通讯作者：
Schwartz, B
中科院分区：
文献类型：
--
作者：
Gust, DA;Strine, TW;Schwartz, B
Objective.为了检查父母的态度，信念，和行为的儿童免疫不足的关于大于或等于2种疫苗，最近受到负面关注，与父母的孩子完全免疫的建议疫苗。设计。病例对照研究。设置. 2001年，对参加全国免疫调查的抽样家庭进行了重新联系。评估疫苗接种状态。病例组受试者对3种疫苗（白喉-破伤风-百日咳或白喉-破伤风-无细胞百日咳、B肝炎或含麻疹疫苗）中的2种以上免疫接种不足，对照组受试者完全免疫接种。应答率为52.1%（4440名受试者中的2315名）。与对照家庭相比，病例家庭更有可能赚取0至3万美元（调整后的比值比[OR]：2.7; 95%置信区间[CI]：1.5 - 4.6）至少超过75000美元，有大于或等于2个供应商（OR：2.0; 95% CI：1.3 - 3.1）大于1，且有大于或等于4个子女（OR：3.1; 95% CI：1.5 - 6.3）大于1个子女。在控制人口统计学和医疗保健因素的情况下，病例受试者比对照受试者更不希望新生儿接受所有注射（OR：3.8; 95% CI：1.5 - 9.8），将疫苗评分为不安全或较安全（OR：2.0; 95%CI：1.2 - 3.4），并要求医生或护士不要给孩子接种疫苗，因为疾病以外的原因（OR：2.7; 95%CI：1.2 - 6.1）。在病例中，14.8%的免疫接种不足是由于父母的态度，信仰和行为。在美国，疫苗安全性问题的态度、信念和行为是导致免疫不足的主要原因。尽管在免疫不足儿童的父母中，这种担忧更为普遍，但许多完全免疫儿童的父母表现出类似的态度、信念和行为，这表明目前高疫苗接种水平存在风险。保持和提高免疫覆盖率的努力需要针对那些有态度/信仰/行为表明疫苗安全问题的人，以及那些有社会经济和卫生保健问题的人。
Objective. To examine the attitudes, beliefs, and behaviors of parents whose children were underimmunized with respect to greater than or equal to 2 vaccines that have recently received negative attention, compared with parents whose children were fully immunized with respect to the recommended vaccines.Design. Case-control study. Setting. A sample of households that participated in the National Immunization Survey were recontacted in 2001.Main Outcome Measure. Vaccination status was assessed. Case subjects were underimmunized with respect to greater than or equal to 2 of 3 vaccines (diphtheria-tetanus-pertussis or diphtheria-tetanus-acellular pertussis, hepatitis B, or measles-containing vaccines), and control subjects were fully immunized.Results. The response rate was 52.1% ( 2315 of 4440 subjects). Compared with control households, case households were more likely to make $0 to $30 000 ( adjusted odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.5 - 4.6) than at least $ 75 000, to have greater than or equal to2 providers ( OR: 2.0; 95% CI: 1.3 - 3.1) than 1, and to have greater than or equal to4 children (OR: 3.1; 95% CI: 1.5 - 6.3) than 1 child. With control for demographic and medical care factors, case subjects were more likely than control subjects to not want a new infant to receive all shots (OR: 3.8; 95% CI: 1.5 - 9.8), to score vaccines as unsafe or somewhat safe (OR: 2.0; 95% CI: 1.2 3.4), and to ask the doctor or nurse not to give the child a vaccine for reasons other than illness ( OR: 2.7; 95% CI: 1.2 - 6.1). Among case subjects, 14.8% of underimmunization was attributable to parental attitudes, beliefs, and behaviors.Conclusions. Attitudes, beliefs, and behaviors indicative of vaccine safety concerns contribute substantially to underimmunization in the United States. Although concerns were significantly more common among parents of underimmunized children, many parents of fully immunized children demonstrated similar attitudes, beliefs, and behaviors, suggesting a risk to the currently high vaccination levels. Efforts to maintain and improve immunization coverage need to target those with attitudes/ beliefs/behaviors indicative of vaccine safety concerns, as well as those with socioeconomic and health care access problems.