Semba Richard D, de Pee Saskia, Berger Sarah G, Martini Elviyanti, Ricks Michelle O, Bloem Martin W
Hopkins School of Medicine, 550 N. Broadway, Suite 700, Baltimore, MD 21205, USA.
Southeast Asian J Trop Med Public Health. 2007 Jan;38(1):120-9.
Although it has been thought that child immunization programs may miss the children who are in greatest need, there are little published quantitative data to support this idea. We sought to characterize malnutrition and morbidity among children who are missed by the childhood immunization program in Indonesia. Vaccination and morbidity histories, anthropometry, and other data were collected for 286,500 children, aged 12-59 months, in rural Indonesia. Seventy-three point nine percent of children received complete immunizations (3 doses of diphtheria-pertussis-tetanus, 3 doses of oral poliovirus, and measles), 16.8% had partial coverage (1-6 of 7 vaccine doses), and 9.3% received no vaccines. Of children with complete, partial, and no immunization coverage, respectively, the prevalence of severe underweight (weight-for-age Z score < -3) was 5.4, 9.9, and 12.6%, severe stunting (height-for-age Z score < -3) was 10.2, 16.2, and 21.5%, and current diarrhea was 3.8, 7.3, and 8.6% (all p < 0.0001), respectively. In families where the child had complete, partial, and no immunizations, the history of infant mortality was 6.4, 11.4, and 16.5%, and under-five child mortality was 7.3, 13.4, and 19.2% (both p < 0.0001). Expanded programmatic coverage is needed to reach children who are missed by childhood immunizations in rural Indonesia, as missed children are at higher risk of morbidity and mortality.
尽管有人认为儿童免疫计划可能遗漏了最需要接种疫苗的儿童，但几乎没有公开的定量数据支持这一观点。我们试图描述印度尼西亚儿童免疫计划遗漏的儿童中的营养不良和发病情况。我们收集了印度尼西亚农村地区286,500名12至59个月大儿童的疫苗接种和发病史、人体测量数据及其他数据。73.9%的儿童接受了全程免疫（3剂白喉-百日咳-破伤风疫苗、3剂口服脊髓灰质炎病毒疫苗和麻疹疫苗），16.8%的儿童部分接种（7剂疫苗中的1 - 6剂），9.3%的儿童未接种任何疫苗。在全程接种、部分接种和未接种疫苗的儿童中，重度体重不足（年龄别体重Z评分 < -3）的患病率分别为5.4%、9.9%和12.6%，重度发育迟缓（年龄别身高Z评分 < -3）的患病率分别为10.2%、16.2%和21.5%，当前腹泻的患病率分别为3.8%、7.3%和8.6%（所有p < 0.0001）。在孩子全程接种、部分接种和未接种疫苗的家庭中，婴儿死亡率分别为6.4%、11.4%和16.5%，五岁以下儿童死亡率分别为7.3%、13.4%和19.2%（两者p < 0.0001）。需要扩大计划免疫覆盖范围，以覆盖印度尼西亚农村地区被儿童免疫计划遗漏的儿童，因为这些被遗漏的儿童发病和死亡风险更高。
