Geographic Clusters in Underimmunization and Vaccine Refusal
Geographic Clusters in Underimmunization and Vaccine Refusal
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DOI：
10.1542/peds.2014-2715
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发表时间：
2015-02-01
期刊：
影响因子：
8
通讯作者：
Kulldorff, Martin
中科院分区：
文献类型：
--
作者：
Lieu, Tracy A.;Ray, G. Thomas;Kulldorff, Martin
背景与目的：近年来，父母拒绝和拖延儿童疫苗接种的情况有所增加，据信在一些社区集中出现。这些集群可能对实现免疫质量基准构成公共卫生风险和障碍。我们的目的是（1）描述地理集群的免疫接种不足和疫苗拒绝，（2）比较集群的免疫接种不足与不同的疫苗，（3）评估是否疫苗拒绝集群可能会构成障碍，以实现高免疫rates.METHODS：我们分析了2000年和2011年之间出生的儿童的电子健康记录，在凯撒永久北方加州的成员。研究人群包括来自13个县的154424名儿童，这些儿童从出生到36个月大都是连续成员。我们使用空间扫描统计，以确定集群的免疫接种不足（错过了一个或多个疫苗的36个月的年龄）和疫苗拒绝（根据国际疾病分类，第九次修订版，临床修改代码）。结果：我们确定了5个统计学显着集群的免疫接种不足的儿童谁变成36个月大的2010年至2012年。免疫接种不足率在集群内为18%~ 23%，集群外为11%。在统计学上最显著的群体中，儿童的免疫不足率是其他群体的1.58倍（P <0.001）。麻疹、腮腺炎、风疹和水痘疫苗的免疫不足集中在相似的地理区域。疫苗拒绝也聚集，集群内的5.5%至13.5%，与2.6%以外themes.CONCLUSIONS：免疫接种不足和疫苗拒绝集群地理。空间扫描统计可能是一个有用的工具，以确定在实现高免疫率方面存在挑战的地点，这些地点需要采取重点干预措施。
BACKGROUND AND OBJECTIVE: Parental refusal and delay of childhood vaccines has increased in recent years and is believed to cluster in some communities. Such clusters could pose public health risks and barriers to achieving immunization quality benchmarks. Our aims were to (1) describe geographic clusters of underimmunization and vaccine refusal, (2) compare clusters of underimmunization with different vaccines, and (3) evaluate whether vaccine refusal clusters may pose barriers to achieving high immunization rates.METHODS: We analyzed electronic health records among children born between 2000 and 2011 with membership in Kaiser Permanente Northern California. The study population included 154 424 children in 13 counties with continuous membership from birth to 36 months of age. We used spatial scan statistics to identify clusters of underimmunization (having missed 1 or more vaccines by 36 months of age) and vaccine refusal (based on International Classification of Diseases, Ninth Revision, Clinical Modification codes).RESULTS: We identified 5 statistically significant clusters of underimmunization among children who turned 36 months old during 2010-2012. The underimmunization rate within clusters ranged from 18% to 23%, and the rate outside them was 11%. Children in the most statistically significant cluster had 1.58 (P < .001) times the rate of underimmunization as others. Underimmunization with measles, mumps, rubella vaccine and varicella vaccines clustered in similar geographic areas. Vaccine refusal also clustered, with rates of 5.5% to 13.5% within clusters, compared with 2.6% outside them.CONCLUSIONS: Underimmunization and vaccine refusal cluster geographically. Spatial scan statistics may be a useful tool to identify locations with challenges to achieving high immunization rates, which deserve focused intervention.