School of Industrial and Systems Engineering, Georgia Institute of Technology, 755 Ferst Drive, NW, Atlanta, GA 30332-0205, USA.
School of Industrial and Systems Engineering, Georgia Institute of Technology and School of Public Policy (by Courtesy), Georgia Institute of Technology, 755 Ferst Drive, NW, Atlanta, GA 30332-0205, USA.
Vaccine. 2014 Jan 3;32(2):246-51. doi: 10.1016/j.vaccine.2013.11.018. Epub 2013 Nov 25.
During the 2009-2010 H1N1 pandemic, children and high-risk adults had priority for vaccination. Vaccine in short supply was allocated to states pro-rata by population, but vaccination rates as of January 2010 varied among states from 21.3% to 84.7% for children and 10.4% to 47.2% for high-risk adults. States had different campaign processes and decisions.
To determine program and system factors associated with higher state pandemic vaccination coverage for children and high-risk adults during an emergency response with short supply of vaccine.
Regression analysis of factors predicting state-specific H1N1 vaccination coverage in children and high-risk adults, including state campaign information, demographics, preventive or health-seeking behavior, preparedness funding, providers, state characteristics, and surveillance data.
Our modeling explained variation in state-specific vaccination coverage with an adjusted R-squared of 0.82 for children and 0.78 for high-risk adults. We found that coverage of children was positively associated with programs focusing on school clinics and with a larger proportion of doses administered in public sites; negatively with the proportion of children in the population, and the proportion not visiting a doctor because of cost. The coverage for high-risk adults was positively associated with shipments of vaccine to "general access" locations, including pharmacy and retail, with the percentage of women with a Pap smear within the past 3 years and with past seasonal influenza vaccination. It was negatively associated with the expansion of vaccination to the general public by December 4, 2009. For children and high-risk adults, coverage was positively associated with the maximum number of ship-to-sites and negatively associated with the proportion of medically underserved population.
Findings suggest that distribution and system decisions such as vaccination venues and providers targeted can positively impact vaccination rates for children and high-risk adults. Additionally, existing health infrastructure, health-seeking behaviors, and access affected coverage.
在 2009-2010 年 H1N1 大流行期间，儿童和高危成年人优先接种疫苗。由于疫苗供应短缺，按照人口比例将疫苗分配给各州，但截至 2010 年 1 月，各州儿童疫苗接种率从 21.3%到 84.7%不等，高危成年人疫苗接种率从 10.4%到 47.2%不等。各州的疫苗接种运动过程和决策有所不同。
确定与疫苗供应短缺情况下紧急应对期间，儿童和高危成年人的大流行疫苗接种覆盖率较高相关的计划和系统因素。
对儿童和高危成年人的特定州 H1N1 疫苗接种覆盖率进行回归分析，包括州疫苗接种运动信息、人口统计学、预防或就医行为、准备资金、提供者、州特征和监测数据。
我们的模型解释了特定州疫苗接种覆盖率的变化，儿童的调整 R 平方为 0.82，高危成年人的调整 R 平方为 0.78。我们发现，儿童疫苗接种覆盖率与专注于学校诊所的计划以及在公共场所接种的疫苗比例较大呈正相关，与儿童人口比例以及因费用而不去看医生的儿童比例呈负相关。高危成年人的疫苗接种覆盖率与向包括药店和零售店在内的“一般准入”地点运送疫苗、过去 3 年内接受巴氏涂片检查的女性百分比以及过去季节性流感疫苗接种呈正相关。它与 2009 年 12 月 4 日之前向公众扩大疫苗接种范围呈负相关。对于儿童和高危成年人，疫苗接种覆盖率与最大船舶数量呈正相关，与医疗服务不足人群的比例呈负相关。
研究结果表明，分配和系统决策，如接种地点和提供者的选择，可以对儿童和高危成年人的疫苗接种率产生积极影响。此外，现有的卫生基础设施、就医行为和可及性也会影响疫苗接种覆盖率。
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