Institute of Immunization and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China.
Vaccine. 2010 Feb 3;28(5):1264-74. doi: 10.1016/j.vaccine.2009.11.015. Epub 2009 Nov 24.
To properly evaluate the immunization status and determine risk factors of migrant children in 23 densely populated towns and townships in Beijing.
A household cluster sampling survey was implemented and standard face-to-face interviews were conducted with 1820 migrant children aged 12-35 months. Demographic characteristics of the child and primary caregiver, the child's migrant characteristics, the primary caregiver's knowledge and attitude toward immunization, information about immunization services provided by the local clinic, and the child's immunization history were obtained. Weighted up-to-date (UTD) and age-appropriate immunization rates for the following four vaccines were assessed: three doses of diphtheria, tetanus and pertussis combined vaccine (DTP); three doses of oral poliomyelitis vaccine (OPV); three doses of hepatitis B vaccine (HepB); and one dose of Measles-containing vaccine (MCV). Weighted UTD and age-appropriate immunization rates for the overall series of these four vaccines (the 3:3:3:1 immunization series) were also estimated. Risk factors for not being UTD, being invalid and being delayed for the 3:3:3:1 immunization series were explored using both single-level and multi-level multinomial logistic regression models.
For each antigen, the weighted UTD immunization rate was above 83%, but the age-appropriate immunization coverages for HepB, OPV, DPT, and MCV were only 45.6%, 49.6%, 50.8% and 54.7%, respectively. The 1st dose was most likely to be invalid or delayed within HepB, OPV and DPT series. For the 3:3:3:1 immunization series, the weighted UTD and age-appropriate immunization rates were 78.1% and 20.5%, respectively. Immunization status of migrant children tended to be homogenous within a village and therefore, multi-level model was more appropriate for assessing risk factors. Besides demographic characteristics, several other factors were significantly associated with age-appropriate immunization coverage. These factors included: the child's migrant characteristics; the primary caregiver's awareness of the importance of vaccination, and outreach services provided by immunization clinics including notification services and supplementary immunization activities (SIAs). The frequency and duration of clinical immunization sessions significantly influenced the UTD immunization rate but not the age-appropriate immunization rate. The degree of the primary caregiver's satisfaction with clinic services and convenience to vaccination clinic had no impact on the child's immunization status.
Alarmingly low age-appropriate immunization coverage of migrant children in densely populated areas demanded immediate intervention. Community context was an important factor to a migrant child's vaccination status and should be considered when taking measures. Strategies to strengthen outreach immunization service need to be developed to effectively improve the age-appropriate immunization coverage of migrant children.
正确评估北京市 23 个人口密集镇和乡的流动儿童的免疫状况，并确定其危险因素。
采用家庭整群抽样调查的方法，对 1820 名 12-35 月龄的流动儿童进行标准的面对面访谈。获取儿童及其主要照顾者的人口统计学特征、儿童的流动特征、主要照顾者对免疫接种的知识和态度、当地诊所提供的免疫接种服务信息以及儿童的免疫接种史。评估以下四种疫苗的加权最新（UTD）和适龄免疫率：白喉、破伤风和无细胞百日咳联合疫苗（DTaP）三剂；口服脊髓灰质炎疫苗（OPV）三剂；乙肝疫苗（HepB）三剂；麻疹疫苗（MCV）一剂。还估计了这四种疫苗的整体系列（3:3:3:1 免疫系列）的加权 UTD 和适龄免疫率。使用单级和多级多项逻辑回归模型探讨了 3:3:3:1 免疫系列未 UTD、无效和延迟的危险因素。
对于每种抗原，加权 UTD 免疫率均高于 83%，但 HepB、OPV、DTaP 和 MCV 的适龄免疫覆盖率仅分别为 45.6%、49.6%、50.8%和 54.7%。HepB、OPV 和 DTaP 系列中，第 1 剂最有可能无效或延迟。3:3:3:1 免疫系列的加权 UTD 和适龄免疫率分别为 78.1%和 20.5%。流动儿童的免疫状况在村内往往趋于一致，因此，多级模型更适合评估危险因素。除人口统计学特征外，其他几个因素与适龄免疫覆盖率显著相关。这些因素包括：儿童的流动特征；主要照顾者对疫苗接种重要性的认识，以及免疫接种诊所提供的外联服务，包括通知服务和补充免疫活动（SIAs）。临床免疫接种次数和持续时间显著影响 UTD 免疫率，但不影响适龄免疫率。主要照顾者对诊所服务的满意度和前往诊所接种的便利性对儿童的免疫状况没有影响。
人口密集地区流动儿童的适龄免疫率低得令人震惊，需要立即采取干预措施。社区背景是影响流动儿童接种状况的一个重要因素，在采取措施时应予以考虑。需要制定加强外联免疫服务的战略，以有效提高流动儿童的适龄免疫率。
Zotero 插件