Département de Médecine Générale, UPMC Univ Paris 06, 27 rue de Chaligny, 75571 Paris cedex 12, France.
Vaccine. 2011 Jul 18;29(32):5232-7. doi: 10.1016/j.vaccine.2011.05.020. Epub 2011 May 24.
The aim of the study was to assess factors influencing BCG vaccination among targeted children after the end of universal and mandatory BCG vaccination in France. A cross-sectional study was conducted in 2009 among general practitioners (GPs) of the French Sentinel Network. With the participation of 358 physician-investigators, 920 children were included. Of the 261 children (31%) identified to be at risk of tuberculosis, only 113 (44%) were vaccinated. The median number of French criteria for BCG vaccination correctly cited by the GPs was 3 of the existing 6. Of the 10 proposed, a median number of 5 regions in the world according to their level of tuberculosis risk were correctly classified by GPs. After adjustment using an alternating logistic model, 7 variables were found to be associated with the immunisation status of the target population. Six of these increased the probability of being vaccinated: children older than 6 months (OR=3.4 (CI 95% [1.4-8.6])), residents in central Paris or its suburbs (OR=14.7 [4.4-49.5]), children expected to travel to highly endemic regions (OR=3.5 [1.4-8.6]), those living in unfavourable conditions (OR=19.9 [6.2-63.9]), the GP's good knowledge of vaccination guidelines (OR=1.4 [1.1-1.9]) and the GP's perception of tuberculosis as a common disease (OR=2.2 [1.1-4.5]). Surprisingly, GPs with university training on infectious diseases tended to be more reluctant to follow vaccination guidelines (OR=0.14 [0.1-0.4]). Actions targeted at these factors could contribute to improving BCG immunisation coverage.
这项研究的目的是评估法国普遍和强制卡介苗（BCG）接种结束后，目标儿童接种 BCG 的影响因素。2009 年，在法国哨兵网络的全科医生（GP）中进行了一项横断面研究。在 358 名医师调查员的参与下，共纳入 920 名儿童。在 261 名（31%）被认为有结核病风险的儿童中，只有 113 名（44%）接种了疫苗。GP 正确引用的 6 项 BCG 接种标准中位数为 3 项。在 10 项提议中，GP 正确分类的全球结核病风险水平中位数为 5 个地区。使用交替逻辑模型调整后，发现 7 个变量与目标人群的免疫状况相关。其中 6 个变量增加了接种疫苗的可能性：6 个月以上的儿童（OR=3.4（95%CI[1.4-8.6]））、居住在巴黎市中心或其郊区的儿童（OR=14.7（4.4-49.5]））、预计前往高度流行地区的儿童（OR=3.5（1.4-8.6]））、生活条件差的儿童（OR=19.9（6.2-63.9]））、GP 对疫苗接种指南的良好了解（OR=1.4（1.1-1.9]）和 GP 对结核病作为常见病的认识（OR=2.2（1.1-4.5]））。令人惊讶的是，接受过传染病大学培训的 GP 更倾向于不遵循疫苗接种指南（OR=0.14（0.1-0.4]））。针对这些因素采取的行动可能有助于提高 BCG 免疫覆盖率。
