Marshall Gary S, Happe Laura E, Lunacsek Orsolya E, Szymanski Michael D, Woods Charles R, Zahn Matthew, Russell Argartha
Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, KY 40202, USA.
Pediatr Infect Dis J. 2007 Jun;26(6):496-500. doi: 10.1097/INF.0b013e31805d7f17.
The number of shots represented by the routine childhood immunization schedule poses a logistical challenge for providers and a potential deterrent for parents. By reducing the number of injections, use of combination vaccines could lead to fewer deferred doses and improved coverage rates.
To determine the effect of combination vaccines on coverage rates.
This was a retrospective study of administrative claims data from the Georgia Department of Community Health Medicaid program conducted from January through September of 2003. Coverage rates were compared between children who received at least 1 dose of HepB/Hib (COMVAX) or DTaP/HepB/IPV (PEDIARIX) (the combination cohort) and children who received no doses of either combination (the reference cohort). Infants with fewer than 4 vaccination visits were excluded from the analysis. Multivariate logistic regression was performed on the whole study population to assess the effect of combination vaccines while controlling for potential confounders. Hepatitis B and pneumococcal conjugate vaccine coverage rates were not included as outcomes.
The study population consisted of 18,821 infants, 16,007 in the combination cohort and 2814 in the reference cohort. Unadjusted coverage rates for DTaP, IPV and the 4 DTaP:3 IPV:1 MMR, 4 DTaP: 3 IPV: 1 MMR: 3 Hib: 1 varicella, and 3 DTaP:3 IPV: 3 Hib series were higher in the combination cohort. Receipt of at least 1 dose of a combination vaccine was independently associated with increased coverage for each of these vaccines and vaccine series when controlling for gender, birth quarter, race, rural versus urban residence and historical provider immunization quality.
Use of combination vaccines in this Medicaid population was associated with improved coverage rates. Additional studies are warranted, including those examining private sector populations and outcomes such as timeliness and cost.
常规儿童免疫接种计划中的注射次数给医护人员带来了后勤方面的挑战，也可能成为家长的阻碍因素。通过减少注射次数，使用联合疫苗可能会减少延迟接种剂量并提高接种覆盖率。
确定联合疫苗对接种覆盖率的影响。
这是一项对佐治亚州社区卫生医疗补助计划2003年1月至9月行政索赔数据的回顾性研究。比较了至少接种1剂乙肝/ Hib（COMVAX）或百白破/乙肝/脊髓灰质炎灭活疫苗（PEDIARIX）（联合疫苗组）的儿童与未接种任何一种联合疫苗的儿童（参照组）的接种覆盖率。分析中排除了接种次数少于4次的婴儿。对整个研究人群进行多变量逻辑回归，以评估联合疫苗的效果，同时控制潜在的混杂因素。乙肝疫苗和肺炎球菌结合疫苗接种覆盖率未作为研究结果。
研究人群包括18,821名婴儿，联合疫苗组有16,007名，参照组有2,814名。联合疫苗组中百白破疫苗（DTaP）、脊髓灰质炎灭活疫苗（IPV）以及4剂DTaP：3剂IPV：1剂麻腮风疫苗（MMR）、4剂DTaP：3剂IPV：1剂MMR：3剂Hib：1剂水痘疫苗、3剂DTaP：3剂IPV：3剂Hib系列疫苗的未调整接种覆盖率更高。在控制性别、出生季度、种族、城乡居住情况以及既往医护人员免疫接种质量等因素后，至少接种1剂联合疫苗与这些疫苗及疫苗系列中每种疫苗接种覆盖率的提高独立相关。
在这个医疗补助人群中使用联合疫苗与接种覆盖率的提高相关。有必要进行更多研究，包括针对私营部门人群以及诸如及时性和成本等结果的研究。
