Luman Elizabeth T, Ryman Tove K, Sablan Mariana
Global Immunization Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, USA.
Vaccine. 2009 Apr 28;27(19):2534-9. doi: 10.1016/j.vaccine.2008.10.002. Epub 2008 Oct 21.
Public health programs rely on household-survey estimates of vaccination coverage as a basis of programmatic and policy decisions; however, the validity of estimates derived from household-retained vaccination cards and parental recall has not been thoroughly evaluated. Using data from a vaccination coverage survey conducted in the Western Pacific's Northern Mariana Islands, we compared results from household data sources to medical record sources for the same children. We calculated the percentage of children aged 1, 2, and 6 years who received all vaccines recommended by age 12 months, 24 months, and for school entry, respectively. Coverage estimates based on vaccination cards ranged from 14% to 30% in the three age groups compared to 78-91% for the same children based on medical records. When cards were supplemented by parental recall, estimates were 51-53%. Concordance, sensitivity, specificity, positive and negative predictive values, and kappa statistics generally indicated poor agreement between household and medical record sources. Household-retained vaccination cards and parental recall were insufficient sources of information for estimating vaccination coverage in this population. This study emphasizes the importance of identifying reliable sources of vaccination history information and reinforces the need for awareness of the potential limitations of vaccination coverage estimated from surveys that rely on household-retained cards and/or parental recall.
公共卫生项目依赖于通过家庭调查对疫苗接种覆盖率进行估算，以此作为项目规划和政策决策的依据；然而，源自家庭留存的疫苗接种卡及家长回忆的估算结果的有效性尚未得到全面评估。利用在西太平洋北马里亚纳群岛开展的一项疫苗接种覆盖率调查的数据，我们将同一批儿童的家庭数据来源结果与医疗记录来源结果进行了比较。我们分别计算了1岁、2岁和6岁儿童中，在12月龄、24月龄及入学时接种了所有推荐疫苗的儿童的百分比。在这三个年龄组中，基于疫苗接种卡的覆盖率估算值为14%至30%，而基于医疗记录的同一批儿童的覆盖率为78%至91%。当用家长回忆补充卡片信息时，估算值为51%至53%。一致性、敏感性、特异性、阳性和阴性预测值以及kappa统计量总体表明家庭与医疗记录来源之间的一致性较差。家庭留存的疫苗接种卡和家长回忆作为估算该人群疫苗接种覆盖率的信息来源是不充分的。本研究强调了识别可靠的疫苗接种史信息来源的重要性，并强化了对依赖家庭留存卡片和/或家长回忆的调查所估算的疫苗接种覆盖率潜在局限性的认识。
