Groom Amy V, Cheek James E, Bryan Ralph T
OMHD/OSI/OD, Centers for Disease Control and Prevention, c/o Indian Health Service, Division of Epidemiology and Disease Prevention, 5300 Homestead Rd NE, Albuquerque, NM 87110, USA.
Am J Public Health. 2006 Apr;96(4):697-701. doi: 10.2105/AJPH.2004.053413. Epub 2006 Feb 28.
We determined the effect of national vaccine shortages on coverage with 4 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine for American Indian/Alaska Native (AIAN) children.
Data on DTaP coverage for children aged 19 to 27 months were abstracted from Indian Health Service (IHS) immunization reports. Coverage with the fourth DTaP dose (DTaP4) was compared for different periods to determine coverage levels before, during, and after the shortage. Data were stratified geographically to determine regional variation.
AIAN children experienced a significant decline (14.8%) in DTaP4 coverage during the shortage. Considerable variation was seen among IHS regions (declines ranged from 4.5% to 26.5%).
AIAN children included in IHS immunization reports experienced a greater decline in DTaP4 coverage during the shortage than the decline reported nationally for children receiving vaccine at public clinics (14.8% vs 6%). Variations in the decline in coverage highlight possible inequities in vaccine supply and distribution and in implementation of vaccine shortage recommendations. We must identify ways to ensure more equitable vaccine distribution and consistent implementation of vaccine recommendations to protect all children from vaccine-preventable diseases.
我们确定了全国疫苗短缺对美国印第安/阿拉斯加原住民（AIAN）儿童4剂白喉破伤风类毒素和无细胞百日咳疫苗（DTaP）接种率的影响。
从印第安卫生服务局（IHS）免疫报告中提取19至27个月儿童的DTaP接种率数据。比较不同时期第四剂DTaP（DTaP4）的接种率，以确定短缺前、短缺期间和短缺后的接种率水平。数据按地理区域分层，以确定区域差异。
在短缺期间，AIAN儿童的DTaP4接种率显著下降（14.8%）。IHS各地区之间存在相当大的差异（下降幅度从4.5%到26.5%不等）。
IHS免疫报告中的AIAN儿童在短缺期间DTaP4接种率的下降幅度大于全国报告的在公共诊所接种疫苗儿童的下降幅度（14.8%对6%）。接种率下降的差异凸显了疫苗供应和分配以及疫苗短缺建议实施方面可能存在的不公平现象。我们必须找到方法，确保更公平地分配疫苗，并始终如一地实施疫苗建议，以保护所有儿童免受疫苗可预防疾病的侵害。
