Davis Matthew M, Gaglia Michael A
Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, and Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Vaccine. 2005 Apr 27;23(23):3053-60. doi: 10.1016/j.vaccine.2004.10.047.
School and daycare entry requirements have been credited with increasing immunization rates among school-age children, but no prior study has assessed the nationwide effects of entry requirements while controlling for individual, family, and household characteristics. The 2002 National Immunization Survey (NIS) is a nationally representative annual survey that includes provider record-verified immunization dates for 20,546 children aged 19-35 months without prior history of varicella. In weighted bivariate and multivariate logistic regression models, we examined the association of state entry mandate implementation with children's up-to-date (UTD) status for varicella vaccine, adjusted for sociodemographic characteristics of children, mothers, and household income and for children's UTD status for other recommended vaccines. In this national sample representative of 5.6 million children, 83.2% (95% CI: 82.3%-84.1%) were UTD for varicella vaccine. Between 1997 and 2002 inclusive, 33 states and the District of Columbia had implemented school and/or daycare entry immunization mandates for varicella. In bivariate analyses, 84.9% (83.9%-85.9%) of children in states with varicella entry mandates were UTD, compared to 76.8% (75.3%-78.4%) of children in states without such mandates. In multivariate analyses controlling for child and family characteristics, children living in states with varicella entry mandates remained significantly more likely to be UTD for varicella than children in states without mandates. These findings indicate that immunization entry requirements are associated with higher immunization rates among preschool-age children, and suggest that the effects of entry requirements are independent of other individual and household factors associated with childhood immunization.
学校和日托机构的入学要求被认为提高了学龄儿童的免疫接种率，但此前没有研究在控制个体、家庭和家庭特征的同时评估入学要求对全国范围的影响。2002年全国免疫调查（NIS）是一项具有全国代表性的年度调查，其中包括20546名19 - 35个月大且无水痘病史儿童的经医疗服务提供者记录核实的免疫接种日期。在加权双变量和多变量逻辑回归模型中，我们研究了各州入学强制规定的实施与儿童水痘疫苗最新接种状态之间的关联，并根据儿童、母亲的社会人口特征、家庭收入以及儿童其他推荐疫苗的最新接种状态进行了调整。在这个代表560万儿童的全国样本中，83.2%（95%置信区间：82.3% - 84.1%）的儿童完成了水痘疫苗接种。在1997年至2002年（含）期间，33个州和哥伦比亚特区实施了针对水痘的学校和/或日托机构入学免疫强制规定。在双变量分析中，有水痘入学强制规定的州中84.9%（83.9% - 85.9%）的儿童完成了接种，而没有此类规定的州中这一比例为76.8%（75.3% - 78.4%）。在控制儿童和家庭特征的多变量分析中，与没有强制规定的州的儿童相比，生活在有水痘入学强制规定州的儿童完成水痘疫苗接种的可能性仍然显著更高。这些发现表明，免疫接种入学要求与学龄前儿童更高的免疫接种率相关，并表明入学要求的影响独立于与儿童免疫接种相关的其他个体和家庭因素。
