Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital, Zurich, Switzerland; Children's Research Centre, University Children's Hospital, Zurich, Switzerland.
Vaccine. 2013 Nov 4;31(46):5375-80. doi: 10.1016/j.vaccine.2013.09.025. Epub 2013 Sep 26.
Incomplete and delayed vaccination is a barrier to individual and population protection from vaccine-preventable diseases. We aimed to assess visit frequency and pattern in relation to vaccination status in a Swiss cohort of 2-year-old children in order to review opportunities for completion of scheduled immunizations.
A retrospective dynamic cohort study design involving children insured with a single health insurer in Switzerland was chosen. Time-to-event analysis was used to evaluate timing of defined immunizations of interest from submitted invoices. Diphtheria, tetanus, acellular pertussis (DTaP) and measles, mumps and rubella (MMR) immunizations administered to children registered with this health insurer were assessed. The specified vaccines are recommended at 2, 4, 6 and 15-24 months, and 12 and 15-24 months of age, respectively.
21,588 children born between January 1st, 2006 and June 30th, 2008 and registered with the health insurer from no later than 4 weeks of age were included. Only 40.9% of the cohort was up-to-date for both vaccines (DTaP and MMR) at 2 years of age. The average number of visits made during up to 2 years of age was 14.7 (95% CI: 15.9-16.3). Less than 5% of children made fewer than 5 visits, the minimum number required to complete all recommended immunizations by 2 years of age. Although number of visits varied by final vaccination status, more than 90% of the cohort made sufficient visits to complete the specified courses, even when contraindications were assumed to be present at up to half the visits.
Swiss children who are not fully immunized at 2 years of age make fewer visits to ambulatory health care up to that age, but they have more than sufficient opportunities to complete immunizations as scheduled. Ambulatory healthcare providers in Switzerland have ample opportunity to promote and administer vaccinations in a timely manner.
不完全和延迟接种是预防疫苗可预防疾病的个体和人群保护的障碍。我们旨在评估瑞士 2 岁儿童队列中与疫苗接种状况相关的就诊频率和模式，以审查完成计划免疫的机会。
选择了一项涉及瑞士单一健康保险公司参保儿童的回顾性动态队列研究设计。使用时间事件分析来评估从提交的发票中评估感兴趣的特定免疫接种的时间。评估在该健康保险公司注册的儿童接种的白喉、破伤风、无细胞百日咳（DTaP）和麻疹、腮腺炎和风疹（MMR）疫苗。推荐在 2、4、6 个月以及 12 和 15-24 个月龄时接种指定疫苗。
纳入了 2006 年 1 月 1 日至 2008 年 6 月 30 日期间出生且自不迟于 4 周龄起在健康保险公司注册的 21,588 名儿童。2 岁时，只有 40.9%的队列同时完成了两种疫苗（DTaP 和 MMR）的接种。在 2 岁之前，最多可达 2 年的平均就诊次数为 14.7（95%CI：15.9-16.3）。不到 5%的儿童就诊次数少于 5 次，这是在 2 岁之前完成所有推荐免疫接种所需的最少次数。尽管就诊次数因最终接种状况而异，但超过 90%的队列进行了足够的就诊，以按规定完成接种，即使在多达一半的就诊时假设存在禁忌症。
在 2 岁时未完全免疫的瑞士儿童在该年龄之前就诊次数较少，但他们有足够的机会按计划完成免疫接种。瑞士的门诊医疗服务提供者有充分的机会及时提供和管理疫苗接种。
