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

项目摘要/摘要 按照既定计划接种儿童早期疫苗是控制传染病的关键策略。 在美国的控制权。然而，50%到75%的美国儿童疫苗接种不足， 定义为延迟接种部分或全部推荐疫苗，或根本不接种，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 由于父母迟迟不接种疫苗或其他方面的障碍，未能接种或错过疫苗的儿童 获得免疫接种服务。目前还没有系统的、基于人口的方法来 跟踪对美国推荐的免疫计划的遵守情况，或父母 选择偏离建议的时间表。此外，标准措施不足以满足 找出我们未能实现疫苗覆盖率目标的原因，这是 经历免疫接种差异的人群，包括生活在美国农村的儿童。为了这个项目， 我们将分析全国免疫调查-儿童(NIS-Child)收集的11年公共使用数据，以 量化儿童早期免疫服务质量的四个新指标：(1)疫苗及时性，(2) 遵守免疫计划，(3)由于父母疫苗接种迟疑而导致接种不足，以及(4) 由于其他获取障碍，疫苗接种不足。在我们对这个具有全国代表性的数据源的分析中， 我们将在2011-2019年确定美国整体这些措施的趋势和相关因素(具体 目标1a)，针对美国各州2011-2019年(具体目标1b)，并评估新冠肺炎大流行如何影响 2020-2021年的这些趋势(具体目标1c)。我们将使用混合效应对数二项模型和零膨胀模型 泊松模型，以及分段回归方法，以确定时间，社会经济， 人口和其他因素影响了美国境内和整个美国的这些免疫质量指标。 然后，我们将访问受限使用NIS-儿童数据，以确定以下方面的趋势和相关因素 通过乡村(特定目标)修改免疫计划遵守情况和特定的接种不足模式 2)。我们建议的分析，连同我们的传播努力，将有助于实现以下长期目标 建立儿童早期免疫接种服务质量措施的常规监测方法 在国家、州和一些地方层面。此外，这项研究将建立新的数据驱动方法，以 区分由于父母疫苗接种迟缓而导致的疫苗接种不足与其他医疗保健服务 障碍；这是一个重要的区别，因为从根本上解决这两类障碍的干预措施 不同。这个项目的结果，特别是对乡村效果修改的检查，将 告知有针对性的干预措施，以增加按时接种疫苗和遵守免疫计划， 降低疫苗可预防的疾病风险，并在儿童早期实现免疫覆盖公平。

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.