Patterns of rotavirus vaccine uptake and use in privately-insured US infants, 2006-2010.
Patterns of rotavirus vaccine uptake and use in privately-insured US infants, 2006-2010.
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DOI：
10.1371/journal.pone.0073825
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Brookhart MA
中科院分区：
文献类型：
--
作者：
Panozzo CA;Becker-Dreps S;Pate V;Jonsson Funk M;Stürmer T;Weber DJ;Brookhart MA
轮状病毒疫苗对于预防幼儿胃肠炎非常有效，目前在美国普遍推荐用于婴儿。我们研究了拥有商业保险的美国婴儿的轮状病毒疫苗使用模式。我们在 MarketScan 研究数据库中确定了 2006 年至 2010 年的一大批婴儿。该分析仅限于居住在没有国家资助的轮状病毒疫苗接种计划的州的婴儿。我们计算了汇总统计数据并使用多变量回归来评估轮状病毒疫苗接种和系列完成的患者、提供者和生态水平变量之间的关联。 2006 年至 2010 年期间，594,117 名符合条件的婴儿中约有 69% 至少接种了一剂轮状病毒疫苗。大多数婴儿在推荐年龄接种了轮状病毒疫苗，但完成单价轮状病毒疫苗系列的婴儿多于五价轮状病毒疫苗或混合疫苗的婴儿（87% vs 79% vs 73%，P<0.001）。在多变量分析中，轮状病毒疫苗系列启动和完成的最强预测因素是接受白喉、破伤风和无细胞百日咳疫苗（启动：RR = 7.91，95% CI = 7.69–8.13；完成：RR = 1.26，95% CI = 1.23–1.29），拜访儿科医生与家人 医生（起始：RR = 1.51，95% CI= 1.49–1.52；完成：RR = 1.13，95% CI = 1.11–1.14），并且生活在大城市与小都市、城市或农村地区。我们观察到轮状病毒疫苗在常规实践中的快速传播；然而，截至 2010 年，大约五分之一的婴儿尚未接种至少一剂疫苗。提高轮状病毒疫苗覆盖率的干预措施应考虑以家庭医生为目标，并鼓励完成疫苗系列。
Rotavirus vaccines are highly effective at preventing gastroenteritis in young children and are now universally recommended for infants in the US. We studied patterns of use of rotavirus vaccines among US infants with commercial insurance. We identified a large cohort of infants in the MarketScan Research Databases, 2006–2010. The analysis was restricted to infants residing in states without state-funded rotavirus vaccination programs. We computed summary statistics and used multivariable regression to assess the association between patient-, provider-, and ecologic-level variables of rotavirus vaccine receipt and series completion. Approximately 69% of 594,117 eligible infants received at least one dose of rotavirus vaccine from 2006–2010. Most infants received the rotavirus vaccines at the recommended ages, but more infants completed the series for monovalent rotavirus vaccine than pentavalent rotavirus vaccine or a mix of the vaccines (87% versus 79% versus 73%, P<0.001). In multivariable analyses, the strongest predictors of rotavirus vaccine series initiation and completion were receipt of the diphtheria, tetanus and acellular pertussis vaccine (Initiation: RR = 7.91, 95% CI = 7.69–8.13; Completion: RR = 1.26, 95% CI = 1.23–1.29), visiting a pediatrician versus family physician (Initiation: RR = 1.51, 95% CI = 1.49–1.52; Completion: RR = 1.13, 95% CI = 1.11–1.14), and living in a large metropolitan versus smaller metropolitan, urban, or rural area. We observed rapid diffusion of the rotavirus vaccine in routine practice; however, approximately one-fifth of infants did not receive at least one dose of vaccine as recently as 2010. Interventions to increase rotavirus vaccine coverage should consider targeting family physicians and encouraging completion of the vaccine series.
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