The need for surveillance of delay in age-appropriate immunization
The need for surveillance of delay in age-appropriate immunization
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DOI：
10.1016/s0749-3797(02)00442-7
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发表时间：
2002-07-01
影响因子：
5.5
通讯作者：
Freed, GL
中科院分区：
文献类型：
--
作者：
Dombkowski, KJ;Lantz, PM;Freed, GL
背景：疫苗接种情况是根据最新情况在全国范围内评估的，而不考虑实际接受推荐剂量的年龄。我们的研究是在2000-2001年间进行的，使用了可获得的最新的国家健康访谈调查(NHIS)公共使用文件。方法：回顾分析确定25-72个月儿童的最新和适合年龄的疫苗接种情况。五年的汇集数据(1992-1996年)来自NHIS针对25至72个月儿童的免疫补充资料，免疫数据以书面记录为基础。结果：在9223名符合条件的儿童中，80%的儿童接受了4：3：1系列疫苗的接种延迟，但48%的儿童经历了与年龄相适应的系列疫苗接种延迟的情况。对于DTP4剂量，85%是最新的，尽管只有46%的人在适当的年龄接受了这种剂量。同样，90%的儿童接受了最新的脊髓灰质炎3号疫苗，%的儿童在适当的年龄接受了这种剂量；96%的儿童接受了MMR1的最新剂量，58%的儿童在适当的年龄接受了这种剂量。从1992年到1996年，适龄儿童的DTP4疫苗接种率上升了17个百分点，而同期最新的DTP4状态仅增加了6%。结论：与适龄儿童的疫苗接种标准相比，具有最新免疫状况的儿童经常出现较大的延迟。因此，仅仅基于最新状况的疫苗接种状况衡量往往低估了人群中免疫不足的程度。有必要对适合年龄的疫苗接种进行国家监测，以确定疫苗接种延迟最普遍的亚群，并揭示通过评估最新状况可能不明显的潜在趋势。
Background: Vaccination status is assessed nationally in terms of up-to-date status without regard to the age at which recommended doses were actually received. Our study was conducted in 2000-2001 using the most current National Health Interview Survey (NHIS) public use files available.Methods: Retrospective analysis to determine up-to-date and age-appropriate vaccination status for children aged 25 to 72 months. Five years of pooled data (1992-1996) were obtained from the NHIS Immunization Supplement for children aged 25 to 72 months with immunization data based on written records. The outcome measures used were months of vaccination delay relative to age-appropriate vaccination standard as well as up-to-date vaccination status for the fourth diphtheria-tetanus-pertussis (DTP 4), Polio3, the first measles-mumps-rubella (MMR1) doses, and the 4:3:1 series.Results: Of the 9223 eligible children, 80% were up-to-date for the 4:3:1 vaccination series, but 48% had experienced delays relative to age-appropriate standards. For the DTP4 dose, 85% were up-to-date, although only 46% had received this dose at the appropriate age. Similarly, 90% of children were up-to-date with their Polio3 dose, with 64% receiving this dose at the appropriate age; 96% were up-to-date for the MMR1, and 58% received this dose at the appropriate age. Age-appropriate DTP4 vaccination increased by 17 percentage points from 1992 to 1996, whereas up-to-date DTP4 status increased by only 6% during the same period.Conclusions: Children with up-to-date vaccination status often experienced considerable delay relative to age-appropriate vaccination standards. Consequently, vaccination status measures based solely on up-to-date status tend to understate the degree of underimmunization in a population. National surveillance of age-appropriate vaccination is necessary to identify subpopulations with the greatest prevalence of vaccination delay and to reveal underlying trends that may not be evident through assessments of up-to-date status.