Mafi Daniel, Toafa Viliami M, Grant Cameron
University of Auckland, Auckland, New Zealand.
Pac Health Dialog. 2002 Sep;9(2):203-8.
To determine the proportion of Tongan children with missed opportunities for immunisations and estimate the impact of missed opportunities on delayed immunisation.
A retrospective audit of 133 children, conducted in two Pacific primary care clinics in Auckland. Children were eligible if born in 1999 and if the clinic was their usual source of primary care. Primary care computer data files up to December 31st 2001 were reviewed. A missed opportunity was defined as a doctor visit at which an immunisation was due but not given. An immunisation was defined as given only if the date of administration was recorded. An immunisation was delayed if not received within 30 days of first being due.
Seven percent of children were delayed for the six week, 67% for the three month, 72% for the five month, and 65% for the 15 month immunisations. Thirty four percent of children had at least one missed opportunity for immunisation. Most missed opportunities occurred in acute care visits, and contraindications to immunisation were almost never present. Having a missed opportunity was associated with an increased risk of delay of the six week (OR = 48.75, 95% CI 6.82, 998.16), five month (Fisher's exact test, p = 0.03) and 15 month (Fisher's exact test, p = 0.04) immunisations but not the three month immunisation (OR = 1.00, 95% CI 0.33, 3.45).
Missed opportunities are frequent and are associated with an increased risk of delayed immunisation. They are likely to contribute to New Zealand's poor immunisation coverage and the excess burden of vaccine preventable disease experienced by Pacific children in New Zealand.
确定汤加儿童错过免疫接种机会的比例，并评估错过免疫接种机会对免疫接种延迟的影响。
在奥克兰的两家太平洋初级保健诊所对133名儿童进行回顾性审计。符合条件的儿童为1999年出生且该诊所为其常规初级保健机构。查阅了截至2001年12月31日的初级保健计算机数据文件。错过免疫接种机会定义为在应接种疫苗时就医但未接种。只有在记录了接种日期时才定义为已接种疫苗。如果在首次应接种疫苗后的30天内未接种，则定义为免疫接种延迟。
六周龄免疫接种延迟的儿童占7%，三个月龄为67%，五个月龄为72%，15个月龄为65%。34%的儿童至少有一次错过免疫接种的机会。大多数错过免疫接种机会的情况发生在急性病就诊时，几乎不存在免疫接种禁忌证。错过免疫接种机会与六周龄（比值比=48.75，95%可信区间6.82，998.16）、五个月龄（Fisher精确检验，p=0.03）和15个月龄（Fisher精确检验，p=0.04）免疫接种延迟风险增加相关，但与三个月龄免疫接种延迟无关（比值比=1.00，95%可信区间0.33，3.45）。
错过免疫接种机会的情况很常见，且与免疫接种延迟风险增加相关。它们可能导致新西兰免疫接种覆盖率低下以及新西兰太平洋儿童所面临的疫苗可预防疾病额外负担。
