Guthmann J-P, de La Rocque F, Boucherat M, van Cauteren D, Fonteneau L, Lécuyer A, Cohen R, Lévy-Bruhl D
Unité des maladies à prévention vaccinale, département des maladies infectieuses, institut de veille sanitaire (InVS), 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
Arch Pediatr. 2009 May;16(5):489-95. doi: 10.1016/j.arcped.2009.01.006. Epub 2009 Mar 21.
In July 2007, compulsory BCG vaccination for all children was replaced by a strong recommendation to vaccinate children at high risk of tuberculosis (children who live in Ile-de-France [IDF] or Guyana regions, who were born or whose parents were born in tuberculosis endemic countries, with a family history of tuberculosis or living in conditions defined as at risk by the doctor). In the absence of tools to detect an early decrease in vaccine coverage (VC) in this specific group, we conducted a survey with the main objective of measuring BCG VC in high risk children for which BCG is now recommended and who were born after the change in BCG vaccine policy.
Cross-sectional survey performed amongst physicians registered at "Infovac-France", a network of general practitioners and paediatricians particularly aware of recent changes in the field of vaccinations. Each doctor was asked to recruit, during his medical consultation, between six and 12 children aged 2-7 months (born after the end of compulsory BCG vaccination in July 2007) and 8-23 months (born after the withdrawal from the market of the multipuncture form of BCG [Monovax] in January 2006 and before the end of compulsory BCG vaccination in July 2007). Doctors were asked to fill in a structured online questionnaire. Data were standardized and analysed with Stata 9.2.
A total of 2536 children, recruited by 279 general practitioners and paediatricians (6.5% of all contacted doctors), were included. VC in the target group of high risk children for who BCG is still recommended and who were seen by doctors working in a private medical practice was: overall 68%; 58% in children born after the end of compulsory BCG vaccination (68% in IDF, 48% outside IDF); 77% in those born after the withdrawal of Monovax from the market and before the end of compulsory BCG vaccination; 90% in children living in IDF born after the end of compulsory vaccination and considered as particularly at risk of tuberculosis (presence of vaccination criteria other than residing in IDF) and 60% in the same category of children whose sole criteria for vaccination was residing in IDF. Of doctors who worked in a private medical practice: 75% used to perform the BCG vaccination themselves and 58% had recommended or suggested vaccination to children at risk who were not yet vaccinated. Seventy-six percent of parents of children at risk of tuberculosis not yet vaccinated accepted BCG vaccination when recommended by their doctor.
Our survey showed, on the one hand, insufficient VC in children seen in a private medical practice and born after the end of compulsory vaccination for whom BCG is still recommended. This should encourage the Ministry of Health to reinforce its communication concerning this new policy. On the other hand, the survey showed encouraging results concerning both the coverage of children at particularly high risk in IDF and the adherence of doctors and families to the new vaccine policy. These results should be interpreted with caution, taking into account the methodological limitations of this survey.
2007年7月，针对所有儿童的卡介苗强制接种被一项强烈建议所取代，即建议对结核病高危儿童（居住在法兰西岛大区[IDF]或圭亚那地区、出生于结核病流行国家或父母出生于结核病流行国家、有结核病家族史或医生认定生活在高危环境中的儿童）进行接种。由于缺乏工具来检测这一特定群体中疫苗接种覆盖率（VC）的早期下降情况，我们开展了一项调查，主要目的是测量目前建议接种卡介苗的高危儿童（这些儿童在卡介苗疫苗政策变更后出生）的卡介苗接种覆盖率。
在“法国疫苗信息网”注册的医生中开展横断面调查，该网络由全科医生和儿科医生组成，他们对疫苗接种领域的近期变化尤为关注。要求每位医生在其门诊期间招募6至12名2至7个月大（2007年7月强制卡介苗接种结束后出生）以及8至23个月大（2006年1月卡介苗多针刺接种形式[单苗接种]退市后、2007年7月强制卡介苗接种结束前出生）的儿童。要求医生填写一份结构化在线问卷。数据进行标准化处理并使用Stata 9.2进行分析。
共纳入了由279名全科医生和儿科医生招募的2536名儿童（占所有联系医生的6.5%）。在私人医疗机构工作的医生所诊治的、仍建议接种卡介苗的高危儿童目标群体中的接种覆盖率为：总体68%；在强制卡介苗接种结束后出生的儿童中为58%（在IDF地区为68%，在IDF地区以外为48%）；在单苗接种退市后、强制卡介苗接种结束前出生的儿童中为77%；在强制接种结束后出生、居住在IDF地区且被认为结核病风险特别高（除居住在IDF地区外还有其他接种标准）的儿童中为90%，而在仅以居住在IDF地区为接种标准的同一类儿童中为60%。在私人医疗机构工作的医生中：75%过去自己进行卡介苗接种，58%曾向尚未接种的高危儿童推荐或建议接种。尚未接种卡介苗的结核病高危儿童的父母中，76%在医生建议时接受了卡介苗接种。
我们的调查一方面显示，在私人医疗机构就诊且在强制接种结束后出生、仍建议接种卡介苗的儿童中，接种覆盖率不足。这应促使卫生部加强关于这一新政策的宣传。另一方面，调查显示，在IDF地区结核病风险特别高的儿童的接种覆盖率以及医生和家庭对新疫苗政策的依从性方面取得了令人鼓舞的结果。考虑到本调查的方法学局限性，这些结果应谨慎解读。
