Luman Elizabeth T, Ching Pamela L Y H, Jumaan Aisha O, Seward Jane F
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Pediatrics. 2006 Apr;117(4):999-1008. doi: 10.1542/peds.2005-1201.
To examine uptake of varicella vaccine, a live attenuated vaccine licensed in 1995 and recommended in 1996 for routine vaccination of US children 12 to 18 months of age.
Data were for 178,616 children (19-35 months of age) and were collected in the 1997 to 2004 National Immunization Survey. The main outcome measures were estimated varicella vaccine coverage from 1997 to 2004, coverage among susceptible children (ie, those without a history of varicella disease), racial/ethnic disparities, risk factors for nonvaccination, missed opportunities to vaccinate simultaneously with other recommended vaccines, and projected increases in coverage after elimination of missed opportunities for simultaneous vaccination.
Varicella vaccine coverage rates increased from 26% in 1997 to 87% in 2004. State-specific coverage rates increased 44 to 80 percentage points and were >80% in 42 states and >90% in 13 states by 2004. Coverage among susceptible children increased from 62% in 1999 to 88% in 2004. From 1998 onward, no statistically significant differences in coverage were found between white and black children, whereas Hispanic children had higher coverage rates than white children in 1998 to 2001 and 2004. Risk factors for undervaccination included living in the Midwest region, living in a household with >1 child, living in nonmetropolitan areas, living below the poverty level, having a mother who did not have a college degree, and having public providers. If missed opportunities for simultaneous vaccination had been eliminated, then coverage rates would have increased from 58% to 94% in 1999 and from 87% to 96% in 2004.
Uptake of varicella vaccine has been steady and is an example of successful elimination of racial and ethnic disparities. Additional focus should be placed on reducing missed opportunities for simultaneous vaccination, improving coverage in rural areas and the Midwest region, and closing remaining gaps related to maternal education, provider type, and multiple-children households.
研究水痘疫苗的接种情况。水痘疫苗是一种减毒活疫苗，于1995年获得许可，并于1996年被推荐用于美国12至18个月龄儿童的常规接种。
数据来自178,616名19至35个月龄儿童，这些数据是在1997年至2004年全国免疫调查中收集的。主要结局指标包括1997年至2004年估计的水痘疫苗接种覆盖率、易感儿童（即无水痘病史的儿童）的接种覆盖率、种族/民族差异、未接种疫苗的风险因素、与其他推荐疫苗同时接种时错过的机会，以及消除同时接种错过的机会后预计的接种覆盖率增加情况。
水痘疫苗接种率从1997年的26%增至2004年的87%。到2004年，各州的接种率提高了44至80个百分点，42个州的接种率超过80%，13个州的接种率超过90%。易感儿童的接种率从1999年的62%增至2004年的88%。从1998年起，白人和黑人儿童在接种率上未发现统计学上的显著差异，而在1998年至2001年及2004年期间，西班牙裔儿童的接种率高于白人儿童。疫苗接种不足的风险因素包括生活在中西部地区、生活在有多个孩子的家庭、生活在非都市地区、生活在贫困线以下、母亲没有大学学历以及由公共医疗机构提供服务。如果消除了同时接种错过的机会，那么接种率在1999年将从58%增至94%，在2004年将从87%增至96%。
水痘疫苗的接种情况一直很稳定，是成功消除种族和民族差异的一个范例。应进一步关注减少同时接种错过的机会，提高农村地区和中西部地区的接种率，并消除与母亲教育程度、医疗机构类型和多子女家庭相关的剩余差距。
