Evaluation of invalid vaccine doses
Evaluation of invalid vaccine doses
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DOI：
10.1016/j.amepre.2003.09.002
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发表时间：
2004-01-01
影响因子：
5.5
通讯作者：
Klevens, RM
中科院分区：
文献类型：
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作者：
Stokley, S;Maurice, E;Klevens, RM
背景：2002年推荐的儿童免疫接种时间表澄清了无效剂量疫苗的定义，即在最低年龄或间隔过去之前5天或之前接种的任何剂量。目的：确定美国儿童接种无效疫苗的比例，评估无效剂量不计入对疫苗接种率的影响，如果至少重复一次无效剂量，则确定疫苗购买成本。方法：对2000年全国免疫调查抽样调查的19~35个月儿童的疫苗接种史进行评估。分析是在2002年免疫做法咨询委员会(ACIP)建议的免疫时间表公布后进行的。接种的任何疫苗剂量：在建议的最低年龄或间隔前5天被归类为无效。疫苗接种覆盖率的变化是通过从估计的最新覆盖率(基于无论年龄或间距接受的剂量数)减去估计的有效剂量覆盖率(基于接收的有效剂量)来确定的。结果：总体而言，10.5%(+/-0.6%)的儿童至少接种过一次无效疫苗。无效剂量中，乙肝占51%，第三针占100%；白喉/破伤风百日咳(DTP/DTaP)占19%，占第四针的92%；麻疹疫苗(MCV)占12%；水痘疫苗占15%；脊髓灰质炎疫苗占4%，占96%。剔除无效剂量后，接种覆盖率略有变化：DTP/DTaP为2.2%，脊髓灰质炎为0.7%，乙肝为6.5%，MCV为1.4%，水痘为1.7%。重复接种至少一剂无效疫苗的成本从大约1000万美元(公共购买)到大约1800万美元(私人购买)不等。结论：在全国范围内，在1997年2月至1999年5月期间出生的19至35个月儿童中，约有595,000人接种了至少一剂无效疫苗。为这些儿童重新接种疫苗的费用是巨大的，可能会对父母、医生和疫苗购买者产生负面影响。应对免疫提供者进行有关适当免疫时间的教育，以减少无效剂量疫苗的管理。
Background: The 2002 Recommended Childhood Immunization Schedule clarified the definition of an invalid dose of vaccine as any dose administered greater than or equal to5 days before the minimum age or interval had elapsed. Any invalid dose of vaccine should be repeated.Objective: Determine the proportion of U.S. children who received an invalid dose of vaccine, evaluate the impact on vaccination coverage levels if invalid doses were not counted, and determine the vaccine purchase cost if at least one invalid dose is repeated.Methods: Provider-reported vaccination histories of children aged 19 to 35 months sampled by the 2000 National Immunization Survey were evaluated. Analyses were performed in 2002 after the 2002 Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule was released. Any vaccine dose administered :5 days before the recommended minimum age or interval was classified as invalid. Change in vaccination coverage was determined by subtracting estimated valid-dose coverage (based on number of valid doses received) from the estimated up-to-date coverage (based on number of doses received regardless of age or spacing).Results: Overall, 10.5% (+/-0.6%) of children had received at least one invalid dose of vaccine. Of the invalid doses, 51% were hepatitis B, 100% of which were the third dose; 19% were diphtheria-tetanus-pertussis (DTP/DTaP), 92% of which were the fourth dose; 12% were measles-containing vaccine (MCV); 15% were varicella vaccine; and 4% were polio vaccine, 96% of which were the first dose. Excluding invalid doses resulted in a small change in vaccination coverage: 2.2% for DTP/DTaP, 0.7% for polio, 6.5% for hepatitis B, 1.4% for MCV, and 1.7% for varicella. The vaccine purchase cost to repeat at least one invalid dose ranged from approximately $10 million (public-purchased) to approximately $18 million (private-purchased).Conclusions: Nationally about 595,000 of children aged 19 to 35 months, born between February 1997 and May 1999, received at least one invalid dose of vaccine. The cost of revaccinating these children is substantial and may have a negative impact on parents, physicians, and vaccine purchasers. Educating immunization providers regarding proper immunization timing should be conducted to reduce the administration of invalid doses of vaccines.