加泰罗尼亚老年人实施免费系统性肺炎球菌疫苗接种后的疫苗接种率演变：4年随访
Evolution of vaccination rates after the implementation of a free systematic pneumococcal vaccination in Catalonian older adults: 4-years follow-up.
作者信息
Vila-Córcoles Angel, Ochoa-Gondar Olga, Ester Francisco, Sarrá Nuria, Ansa Xabier, Saún Neus
机构信息
Primary Care Service of Tarragona-Valls, EVAN Study Group, Catalonian Health Institute, District of Tarragona, Catalonia, Spain.
出版信息
BMC Public Health. 2006 Sep 18;6:231. doi: 10.1186/1471-2458-6-231.
BACKGROUND
The systematic vaccination with 23-valent polysaccharide pneumococcal vaccine (PPV) was introduced as a strategic objective of health for all the people over 65 in Catalonia in 1999. We analysed the evolution of the pneumococcal vaccination rates from 2000 to 2003.
METHODS
We conducted a retrospective population-based study including all the individuals 65 years or older assigned to 8 Primary Care Centres (PCCs) in Tarragona (Catalonia, Spain), who figured in the administrative population databases on 31 December 2003 (n = 10,410 persons). We assessed whether every person had received PPV during the last four years (2000 to 2003) or whether they had received it before January 2000. Data sources were the computerised clinical records of the 8 participating PCCs, which included adult vaccination registries and diagnoses coded of International Classification of Diseases 9th
REVIEW RESULTS
The overall vaccination uptake increased to 38.6% at the end of 2000. Global accumulated coverages increased more slowly the following years: 44.4% in 2001, 50.9% in 2002, and 53.1% at the end of 2003. Vaccine uptake varied significantly according to age (46.7% in people 65-74 years-old, 60.9% in people 75 years or more; p < 0.001) and number of diseases or risk factors (DRFs) for pneumonia (47.1% vaccinated in people without DRFs, 56.8% in patients with one DRF, and 62.2% in patients with two or more DRFs; p < 0.001). The highest coverages were observed among those patients with: diabetes (65.9%), active neoplasia (64.8%), history of stroke (63.7%), and chronic lung disease (63.5%). The lowest uptake was observed among smokers (48.7%).
DISCUSSION
The pneumococcal vaccination coverage increased quickly after the introduction of the recommendation for free vaccination in all the elderly people (with and without risk factors), but two years after the improvement the coverage became stable and increased slowly.
背景
1999年，在加泰罗尼亚，将23价肺炎球菌多糖疫苗（PPV）的系统接种作为一项全民健康战略目标引入，针对所有65岁以上人群。我们分析了2000年至2003年肺炎球菌疫苗接种率的变化情况。
方法
我们开展了一项基于人群的回顾性研究，纳入了西班牙加泰罗尼亚塔拉戈纳8个初级保健中心（PCC）中所有65岁及以上的个体，这些个体出现在2003年12月31日的行政人口数据库中（n = 10410人）。我们评估了每个人在过去四年（2000年至2003年）是否接种了PPV，或者他们是否在2000年1月之前接种过。数据来源是8个参与研究的初级保健中心的计算机化临床记录，其中包括成人疫苗接种登记和国际疾病分类第9版编码的诊断。
回顾结果
2000年底，总体疫苗接种率升至38.6%。在随后几年中，全球累计覆盖率增长较为缓慢：2001年为44.4%，2002年为50.9%，2003年底为53.1%。疫苗接种率因年龄（65 - 74岁人群中为46.7%，75岁及以上人群中为60.9%；p < 0.001）以及肺炎的疾病或风险因素（DRF）数量而有显著差异（无DRF的人群中47.1%接种了疫苗，有一个DRF的患者中为56.8%，有两个或更多DRF的患者中为62.2%；p < 0.001）。在患有以下疾病的患者中观察到最高的覆盖率：糖尿病（65.9%）、活动性肿瘤（64.8%）、中风病史（63.7%）和慢性肺病（63.5%）。在吸烟者中观察到最低的接种率（48.7%）。
讨论
在对所有老年人（有和无风险因素）实施免费接种建议后，肺炎球菌疫苗接种覆盖率迅速上升，但在改善两年后，覆盖率趋于稳定且增长缓慢。
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