Hepatitis B vaccination timing: results from demographic health surveys in 47 countries
Hepatitis B vaccination timing: results from demographic health surveys in 47 countries
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DOI：
10.2471/blt.16.178822
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发表时间：
2017-03-01
影响因子：
11.1
通讯作者：
Krause, Gerard
中科院分区：
文献类型：
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作者：
Schweitzer, Aparna;Akmatov, Manas K.;Krause, Gerard
目的探讨乙肝疫苗接种时间表和疫苗种类对乙肝疫苗接种时机的影响。方法采用来自47个中低收入国家(2012年研究中位数)的211 643名儿童的人口与健康调查数据。数据来自疫苗接种卡和产妇访谈。我们根据疫苗接种计划和使用的疫苗类型(单价或混合疫苗)对国家进行了分组。对于每个国家，我们计算了乙肝疫苗接种覆盖率和及时收到疫苗剂量。我们使用多变量Logistic回归模型来研究疫苗接种计划和类型对疫苗接种延迟的影响。结果发现，即使在所有疫苗覆盖率相当高的国家，疫苗接种也出现了显著的延迟。第一针(108626例)和第三针(101 542例)的中位延迟时间分别为1.0周(四分位数范围：0.3~3.6)和3.7周(IQR：1.4~9.3)。我们观察到从6周龄和9周龄开始的疫苗接种计划延迟的几率较低的趋势。对于第一次接种，我们记录了联合疫苗比单价疫苗延迟接种的几率更低(调整后的优势比，AOR：0.76，95%可信区间，CI：0.71至0.81)。结论各国在乙肝疫苗接种覆盖率和对疫苗接种时间表的遵守程度上存在很大差异，强调了继续加强国家免疫系统的必要性。及时启动疫苗接种进程可能会导致及时接受连续接种，并提高总体覆盖率。我们建议将疫苗接种时间作为疫苗接种方案的绩效指标，以补充覆盖率指标。
Objective To examine the impact of hepatitis B vaccination schedules and types of vaccines on hepatitis B vaccination timing.Methods We used data for 211 643 children from demographic and health surveys in 47 low- and middle-income countries (median study year 2012). Data were from vaccination cards and maternal interviews. We grouped countries according to the vaccination schedule and type of vaccine used (monovalent or combination). For each country, we calculated hepatitis B vaccination coverage and timely receipt of vaccine doses. We used multivariable logistic regression models to study the effect of vaccination schedules and types on vaccination delay.Findings Substantial delays in vaccination were observed even in countries with fairly high coverage of all doses. Median delay was 1.0 week (interquartile range, IQR: 0.3 to 3.6) for the first dose (n = 108 626 children) and 3.7 weeks (IQR: 1.4 to 9.3) for the third dose (n = 101 542). We observed a tendency of lower odds of delays in vaccination schedules starting at 6 and at 9 weeks of age. For the first vaccine dose, we recorded lower odds of delays for combination vaccines than for monovalent vaccines (adjusted odds ratio, aOR: 0.76, 95% confidence interval, CI: 0.71 to 0.81).Conclusion Wide variations in hepatitis B vaccination coverage and adherence to vaccination schedules across countries underscore the continued need to strengthen national immunization systems. Timely initiation of the vaccination process might lead to timely receipt of successive doses and improved overall coverage. We suggest incorporating vaccination timing as a performance indicator of vaccination programmes to complement coverage metrics.