Vaccine exemptions and the kindergarten vaccination coverage gap
Vaccine exemptions and the kindergarten vaccination coverage gap
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DOI：
10.1016/j.vaccine.2017.08.036
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发表时间：
2017-09-25
期刊：
影响因子：
5.5
通讯作者：
Orenstein, Walter A.
中科院分区：
文献类型：
--
作者：
Smith, Philip J.;Shaw, Jana;Orenstein, Walter A.
背景：幼儿园入学的疫苗接种要求因州而异，但所有州都要求在幼儿园入学时接种 2 剂含麻疹疫苗 (MCV)。 目的：评估 (i) 全国上幼儿园儿童的 MCV 疫苗接种覆盖率； (ii) 入园后疫苗接种不足的情况在多大程度上是由于家长要求豁免造成的； ㈢ 在父母未请求豁免的儿童中，未接种疫苗的儿童在多大程度上错过了接种缺失剂量疫苗的机会； (iv) 就读幼儿园的儿童中“可实现的最高”MCV 覆盖率与实际 MCV 覆盖率之间的疫苗接种覆盖率差距。 方法：2013 年 10 月至 2014 年 3 月期间对 1465 名 5-7 岁儿童的家长进行了全国调查。疫苗接种覆盖率估计值基于提供者报告的疫苗接种史。如果儿童没有及时接种 MCV，或者有接种其他疫苗但不接种 MCV 的日期，则儿童将“错过接种 MCV 的机会”。 “可实现的最高”MCV 疫苗接种覆盖率是 100% 减去 (i) 父母要求豁免的疫苗接种不足儿童的百分比之和； (ii) 父母未申请豁免且其疫苗接种状况在幼儿园宽限期或临时入园期间接受评估的未接种疫苗的儿童。 结果：在所有未接种 MCV 的儿童中，2.7% 是由于父母请求豁免造成的。在 MCV 疫苗接种不足且父母未申请豁免的儿童中，41.6% 的儿童错过了 MCV 接种机会。可实现的最高 MCV 覆盖率为 98.6%，实际 MCV 覆盖率为 90.9%，幼儿园疫苗接种缺口为 7.7%。 结论：学校全面实施州幼儿园疫苗接种法，以及提供者在每次就诊时评估儿童的疫苗接种状况并管理错过的疫苗剂量，可以提高疫苗接种覆盖率。由爱思唯尔有限公司出版
Background: Vaccination requirements for kindergarten entry vary by state, but all states require 2 doses of measles containing vaccine (MCV) at kindergarten entry.Objective: To assess (i) national MCV vaccination coverage for children who had attended kindergarten; (ii) the extent to which undervaccination after kindergarten entry is attributable to parents' requests for an exemption; (iii) the extent to which undervaccinated children had missed opportunities to be administered missing vaccine doses among children whose parent did not request an exemption; and (iv) the vaccination coverage gap between the "highest achievable" MCV coverage and actual MCV coverage among children who had attended kindergarten.Methods: A national survey of 1465 parents of 5-7 year-old children was conducted during October 2013 through March 2014. Vaccination coverage estimates are based provider-reported vaccination histories. Children have a "missed opportunity" for MCV if they were not up-to-date and if there were dates on which other vaccines were administered but not MCV. The "highest achievable" MCV vaccination coverage rate is 100% minus the sum of the percentages of (i) undervaccinated children with parents who requested an exemption; and (ii) undervaccinated children with parents who did not request an exemption and whose vaccination statuses were assessed during a kindergarten grace period or period when they were provisionally enrolled in kindergarten.Results: Among all children undervaccinated for MCV, 2.7% were attributable to having a parent who requested an exemption. Among children who were undervaccinated for MCV and whose parent did not request an exemption, 41.6% had a missed opportunity for MCV. The highest achievable MCV coverage was 98.6%, actual MCV coverage was 90.9%, and the kindergarten vaccination gap was 7.7%.Conclusion: Vaccination coverage may be increased by schools fully implementing state kindergarten vaccination laws, and by providers assessing children's vaccination status at every clinic visit, and administering missed vaccine doses. Published by Elsevier Ltd.