Population-level assessment of early childhood vaccination timeliness, parental vaccine hesitancy, and immunization schedule adherence in the United States, including rural-urban disparities

项目概要/摘要 按照既定时间表提供幼儿期疫苗是传染病防治的一项关键战略 控制在美国。然而，50%至75%的美国儿童经历疫苗接种不足， 被定义为在第二次接种之前， 生日麻疹、百日咳和其他疫苗可预防疾病的爆发与以下因素有关： 由于父母对疫苗犹豫不决或其他障碍， 获得免疫服务。目前还没有系统的、基于人群的方法， 跟踪美国推荐的免疫接种时间表的遵守情况，或 选择偏离推荐的时间表。此外，标准措施不足以 确定我们未能实现疫苗覆盖率目标的原因，这是一个特别的问题， 经历免疫差异的人群，包括生活在美国农村的儿童。 我们将分析11年来在全国儿童免疫调查（NIS-Child）中收集的公共使用数据， 量化四个新的衡量儿童早期免疫服务质量的指标：（1）疫苗及时性，（2） 免疫时间表依从性，（3）由于父母疫苗犹豫导致的接种不足，和（4） 疫苗接种不足是由于其他的准入障碍。在我们对这一全国代表性数据源的分析中， 我们将确定2011-2019年美国总体上与这些措施相关的趋势和因素（具体 目标1a），2011-2019年美国各州（具体目标1b），并评估COVID-19大流行如何影响 2020-2021年的趋势（具体目标1c）。我们将使用混合效应对数二项模型和零膨胀 泊松模型，以及分段回归方法，以确定如何时间，社会经济， 人口统计学和其他因素影响了美国和美国各地的这些免疫质量措施。 然后，我们将访问限制使用的NIS-Child数据，以确定 农村地区（具体目标）改变了免疫接种时间表遵守情况和具体的疫苗接种不足模式 2）。我们提出的分析，沿着我们的传播工作，将有助于实现以下长期目标： 建立对这些早期儿童免疫服务质量措施进行常规监测的方法 在国家，州，和一些地方层面。此外，本研究将建立新的数据驱动方法， 区分由于父母疫苗犹豫而导致的疫苗接种不足与其他医疗保健途径 障碍;一个重要的区别，因为从根本上解决这两类障碍的干预措施 不同。该项目的结果，特别是对农村影响的研究，将 提供有针对性的干预措施，以提高按时接种疫苗和遵守免疫接种时间表的情况， 减少疫苗可预防疾病的风险，并实现幼儿期免疫覆盖率的公平。

Project Summary/Abstract Delivery of early childhood vaccines using an established schedule is a key strategy for infectious disease control in the United States. However, between 50% and 75% of U.S. children experience undervaccination, defined as either getting some or all recommended vaccines late or not getting them at all, before their 2nd birthday. Outbreaks of measles, pertussis, and other vaccine-preventable diseases have been linked to children who were behind on or missing vaccines, either due to parental vaccine hesitancy or other barriers to accessing immunization services. There are currently no systematic, population-based approaches for tracking adherence to the U.S. recommended immunization schedule, or the prevalence of parents who choose to deviate from the recommended schedule. Furthermore, standard measures are inadequate for identifying the reasons why we fail to achieve vaccine coverage goals, which is a particular problem in populations that experience immunization disparities, including children living in the rural U.S. For this project, we will analyze 11 years of public use data collected in the National Immunization Survey-Child (NIS-Child) to quantify four novel measures of early childhood immunization services quality: (1) vaccine timeliness, (2) immunization schedule adherence, (3) undervaccination due to parental vaccine hesitancy, and (4) undervaccination due to other access barriers. In our analyses of this nationally representative data source, we will identify trends in and factors associated with these measures in the U.S. overall in 2011-2019 (Specific Aim 1a), for each U.S. state in 2011-2019 (Specific Aim 1b), and assess how the COVID-19 pandemic affected these trends in 2020-2021 (Specific Aim 1c). We will use mixed effects log-binomial models and zero-inflated Poisson models, as well as piecewise regression methods, to determine how time, socioeconomic, demographic, and other factors have affected these immunization quality measures in and across the U.S. Then, we will access restricted use NIS-Child data to determine how trends in and factors associated with immunization schedule adherence and specific undervaccination patterns are modified by rurality (Specific Aim 2). Our proposed analyses, along with our dissemination efforts, will contribute to the long-term goal of establishing methods for routine surveillance of these early childhood immunization services quality measures at national, state, and some local levels. Furthermore, this study will establish new data-driven methods for distinguishing between undervaccination due to parental vaccine hesitancy versus other healthcare access barriers; an important distinction, since interventions to address these two types of barriers fundamentally differ. The results from this project, and particularly the examinations of effect modification by rurality, will inform targeted interventions for increasing on-time vaccination and immunization schedule adherence, decreasing vaccine-preventable disease risk, and achieving immunization coverage equity in early childhood.