Nero Alecia C, Akuete Kwei, Leasure Reeves Sarah, Dombkowski Kevin J
Departments of Internal Medicine and Pediatrics, Division of Hematology-Oncology, UT Southwestern Medical Center, Dallas, Texas (Dr Nero), Maryland Inpatient Care Specialist, Glen Burnie, Maryland (Dr Akuete); Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (Ms Reeves); and Department of Pediatrics, University of Michigan, Ann Arbor (Dr Dombkowski).
J Public Health Manag Pract. 2014 Nov-Dec;20(6):587-90. doi: 10.1097/PHH.0000000000000034.
Sickle cell disease (SCD) confers an increased risk of invasive pneumococcal disease, especially among young children. Pneumococcal vaccination decreases this risk, but the completion rate of age-appropriate vaccinations is not well defined in SCD.
The goal of this study was to assess whether pneumococcal vaccines are administered to high-risk children with SCD according to recommended vaccine schedules.
A case-control design was used to conduct this study.
Administrative data were obtained on Michigan Medicaid or Children's Special Health Care Services programs enrollees. In addition, Michigan Newborn Screening and Michigan Care Improvement Registry records were used to confirm diagnosis and vaccine administration.
This study compared pneumococcal vaccination rates in a cohort of 179 children with SCD with 537 age-matched non-SCD controls (1:3) enrolled in the Michigan Medicaid Program between 2001 and 2008. Study subjects were born in the state of Michigan between 2001 and 2005.
The main outcome measure was the proportion of children defined as up to date for pneumococcal vaccines at defined milestone ages.
Children with SCD had significantly higher vaccination rates than controls, yet these values were much lower than state and national immunization survey rates.
Barriers to completing age-appropriate recommended pneumococcal immunizations should be identified and addressed to further reduce invasive pneumococcal disease in this high-risk patient population.
镰状细胞病（SCD）会增加侵袭性肺炎球菌疾病的风险，尤其是在幼儿中。肺炎球菌疫苗接种可降低这种风险，但在SCD患者中，适龄疫苗接种的完成率尚不清楚。
本研究的目的是评估高危SCD儿童是否按照推荐的疫苗接种计划接种肺炎球菌疫苗。
采用病例对照设计进行本研究。
获取了密歇根医疗补助计划或儿童特殊医疗服务计划参保者的管理数据。此外，还利用密歇根新生儿筛查和密歇根医疗改善登记记录来确认诊断和疫苗接种情况。
本研究比较了2001年至2008年期间参加密歇根医疗补助计划的179名SCD儿童与537名年龄匹配的非SCD对照儿童（1:3）的肺炎球菌疫苗接种率。研究对象于2001年至2005年在密歇根州出生。
主要结局指标是在规定的里程碑年龄时被定义为肺炎球菌疫苗接种达标的儿童比例。
SCD儿童的疫苗接种率显著高于对照组，但这些数值远低于该州和全国免疫调查率。
应识别并解决完成适龄推荐肺炎球菌免疫接种的障碍，以进一步降低这一高危患者群体中的侵袭性肺炎球菌疾病。
