Bouhamam N, Laporte R, Boutin A, Uters M, Bremond V, Noel G, Rodier P, Minodier P
Service d'urgences des enfants, CHU Nord, AP-HM, chemin des Bourrely, 13915 Marseille cedex 20, France.
Arch Pediatr. 2012 Mar;19(3):242-7. doi: 10.1016/j.arcped.2011.12.001. Epub 2012 Jan 4.
Poor children are more susceptible to infectious diseases. Routine medical follow-up is infrequent in these patients, sometimes resulting in immunization delays. The aim of this study was to correlate a number of socioeconomic factors related to poverty with vaccination coverage in children visiting a pediatric emergency ward.
Previous routine vaccinations and various socioeconomic features were prospectively recorded for children aged 9 months to 7 years visiting two public pediatric emergency departments in Marseilles (southern France) from 2009 to 2010.
Three hundred and seventy-five children were included. Vaccination coverage was 87% for diphtheria, tetanus, poliomyelitis, Haemophilus influenzae type b infections and pertussis, 69% for tuberculosis (Bacillus Calmette-Guérin), 77% for measles, mumps and rubella, 74% for pneumococcal infections (conjugate vaccine), and 55% for hepatitis B. Socioeconomic factors related to poverty were significantly associated with delays in immunizations. Children not attending school (OR=2.5), having parents who were not fluent in French (OR=5.7), living in caravans or squatting (OR=11.5), or being recipients of the national medical assistance for foreigners (OR=12.8) had significant delays with diphtheria, tetanus, and poliomyelitis vaccines. The measles-mumps-rubella vaccine was also delayed in homeless children (OR=3.4). Children who were recipients of the national medical assistance for citizens were better vaccinated against tuberculosis and hepatitis B.
Poor children living in southern France had significant delays in their routine immunizations, resulting in gaps in their protection. Every medical visit, even those conducted in an emergency ward, should identify children with immunization delays and offer a catch-up schedule if necessary.
贫困儿童更容易感染传染病。这些患者很少进行常规医疗随访，有时会导致免疫接种延迟。本研究的目的是将一些与贫困相关的社会经济因素与到儿科急诊病房就诊的儿童的疫苗接种覆盖率相关联。
前瞻性记录了2009年至2010年到法国南部马赛的两个公共儿科急诊科就诊的9个月至7岁儿童以前的常规疫苗接种情况和各种社会经济特征。
共纳入375名儿童。白喉、破伤风、脊髓灰质炎、b型流感嗜血杆菌感染和百日咳的疫苗接种覆盖率为87%，结核病（卡介苗）为69%，麻疹、腮腺炎和风疹为77%，肺炎球菌感染（结合疫苗）为74%，乙型肝炎为55%。与贫困相关的社会经济因素与免疫接种延迟显著相关。未上学的儿童（比值比=2.5）、父母法语不流利的儿童（比值比=5.7）、居住在大篷车或 squatting（原文可能有误，推测为临时住所之类）的儿童（比值比=11.5）或接受国家外国医疗援助的儿童（比值比=12.8）在白喉、破伤风和脊髓灰质炎疫苗接种方面有显著延迟。无家可归儿童的麻疹-腮腺炎-风疹疫苗接种也有延迟（比值比=3.4）。接受国家公民医疗援助的儿童在结核病和乙型肝炎疫苗接种方面情况较好。
生活在法国南部的贫困儿童在常规免疫接种方面有显著延迟，导致其防护存在缺口。每次就诊，即使是在急诊病房进行的就诊，都应识别出免疫接种延迟的儿童，并在必要时提供补种计划。
