Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study.
Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study.
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DOI：
10.1016/s0140-6736(21)01337-4
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发表时间：
2021-08-07
期刊：
影响因子：
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通讯作者：
Mosser JF
中科院分区：
文献类型：
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作者：
Causey K;Fullman N;Sorensen RJD;Galles NC;Zheng P;Aravkin A;Danovaro-Holliday MC;Martinez-Piedra R;Sodha SV;Velandia-González MP;Gacic-Dobo M;Castro E;He J;Schipp M;Deen A;Hay SI;Lim SS;Mosser JF
新冠肺炎大流行和减少SARS-CoV-2传播的努力对世界各地的卫生服务产生了重大影响。为了更好地了解大流行对儿童常规免疫的影响，我们估计了2020年全球和全球疾病负担(GBD)超区域与大流行相关的疫苗覆盖中断。在这项分析中，我们使用了两步分层随机样条线建模方法，使用管理数据和来自电子免疫系统的报告，以流动性数据作为模型输入，估计全球和区域对常规免疫接种的干扰。结合从GBD 2020第1版(GBD 2020 R1)疫苗覆盖模型得出的在没有新冠肺炎的情况下预计疫苗覆盖率的估计，我们估计了2020年错过第三剂白喉破伤风百日咳疫苗和第一剂麻疹疫苗(MCV1)常规接种的儿童数量。在全球范围内，2020年，与在没有新冠肺炎大流行的情况下提供的预期剂量相比，DTP3和MCV1的估计疫苗覆盖率分别为76.7%(95%不确定区间74.3-78.6)和78.9%(74.8-81.9)，与没有新冠肺炎大流行时提供的预期剂量相比，DTP3和MCV1的疫苗覆盖率分别相对减少7.7%(6.0-10.1)和7.9%(5.2-11.7)。从2020年1月到12月，我们估计有3000万(27.6-33.1%)儿童错过了DTP3剂量，2720万(23.4%-32.5%)儿童错过了MCV1剂量。与2020年合格儿童覆盖率的预期差距相比，这些估计数字意味着由于新冠肺炎大流行，额外增加了850万(6.5-11.6)未常规接种疫苗的儿童和890万(5.7-13.7)未常规接种母婴传播疫苗的儿童。在全球范围内，所有GBD超级区域的月度中断情况在2020年4月最严重，有460万(4.0-5.4%)儿童未接种DTP3,440万(3.75.2%)儿童未接种MCV1。每个GBD超级区域在3月和4月都出现了疫苗覆盖率下降的情况，北非和中东、南亚以及拉丁美洲和加勒比地区的年度影响最严重。我们估计，撒哈拉以南非洲地区的疫苗交付年减少率最低，那里全年的中断情况仍然很小。对于一些超级区域，包括DTP3和MCV1的东南亚、东亚和大洋洲、DTP3的高收入超级区域和MCV1的南亚，估计表明2020年下半年每月提供的剂量达到或高于预期水平。2020年，常规免疫服务面临严峻挑战，新冠肺炎疫情造成了近代史上范围最广、规模最大的全球混乱。尽管最新的覆盖轨迹表明一些地区正在复苏，但由于落后的免疫接种服务、SARS-CoV-2的持续传播以及大流行前疫苗覆盖率的持续缺口，到2020年底，仍有数百万儿童未接种或未接种可预防疾病的疫苗，这些缺口可能会持续到2021年。要最大限度地减少疫苗可预防疾病暴发的风险，为在大流行期间错过常规疫苗剂量的儿童接种疫苗，并加快在未来十年实现更高和更公平的疫苗接种覆盖率，加强常规免疫数据系统以及针对资源和推广工作的努力将至关重要。比尔和梅琳达·盖茨基金会。
The COVID-19 pandemic and efforts to reduce SARS-CoV-2 transmission substantially affected health services worldwide. To better understand the impact of the pandemic on childhood routine immunisation, we estimated disruptions in vaccine coverage associated with the pandemic in 2020, globally and by Global Burden of Disease (GBD) super-region. For this analysis we used a two-step hierarchical random spline modelling approach to estimate global and regional disruptions to routine immunisation using administrative data and reports from electronic immunisation systems, with mobility data as a model input. Paired with estimates of vaccine coverage expected in the absence of COVID-19, which were derived from vaccine coverage models from GBD 2020, Release 1 (GBD 2020 R1), we estimated the number of children who missed routinely delivered doses of the third-dose diphtheria-tetanus-pertussis (DTP3) vaccine and first-dose measles-containing vaccine (MCV1) in 2020. Globally, in 2020, estimated vaccine coverage was 76·7% (95% uncertainty interval 74·3–78·6) for DTP3 and 78·9% (74·8–81·9) for MCV1, representing relative reductions of 7·7% (6·0–10·1) for DTP3 and 7·9% (5·2–11·7) for MCV1, compared to expected doses delivered in the absence of the COVID-19 pandemic. From January to December, 2020, we estimated that 30·0 million (27·6–33·1) children missed doses of DTP3 and 27·2 million (23·4–32·5) children missed MCV1 doses. Compared to expected gaps in coverage for eligible children in 2020, these estimates represented an additional 8·5 million (6·5–11·6) children not routinely vaccinated with DTP3 and an additional 8·9 million (5·7–13·7) children not routinely vaccinated with MCV1 attributable to the COVID-19 pandemic. Globally, monthly disruptions were highest in April, 2020, across all GBD super-regions, with 4·6 million (4·0–5·4) children missing doses of DTP3 and 4·4 million (3·7–5·2) children missing doses of MCV1. Every GBD super-region saw reductions in vaccine coverage in March and April, with the most severe annual impacts in north Africa and the Middle East, south Asia, and Latin America and the Caribbean. We estimated the lowest annual reductions in vaccine delivery in sub-Saharan Africa, where disruptions remained minimal throughout the year. For some super-regions, including southeast Asia, east Asia, and Oceania for both DTP3 and MCV1, the high-income super-region for DTP3, and south Asia for MCV1, estimates suggest that monthly doses were delivered at or above expected levels during the second half of 2020. Routine immunisation services faced stark challenges in 2020, with the COVID-19 pandemic causing the most widespread and largest global disruption in recent history. Although the latest coverage trajectories point towards recovery in some regions, a combination of lagging catch-up immunisation services, continued SARS-CoV-2 transmission, and persistent gaps in vaccine coverage before the pandemic still left millions of children under-vaccinated or unvaccinated against preventable diseases at the end of 2020, and these gaps are likely to extend throughout 2021. Strengthening routine immunisation data systems and efforts to target resources and outreach will be essential to minimise the risk of vaccine-preventable disease outbreaks, reach children who missed routine vaccine doses during the pandemic, and accelerate progress towards higher and more equitable vaccination coverage over the next decade. Bill & Melinda Gates Foundation.