Manthiram Kalpana, Blood Emily A, Kuppuswamy Vasanthan, Martins Yolanda, Narayan Athi, Burmeister Kelly, Parvathy K, Hassan Areej
Division of Pediatric Infectious Disease, Vanderbilt University Medical Center, Nashville, TN, United States.
Division of Adolescent Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Clinical Research Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
Vaccine. 2014 Jun 5;32(27):3417-23. doi: 10.1016/j.vaccine.2014.04.012. Epub 2014 Apr 13.
In Tamil Nadu, India, bacille Calmette-Guérin, diphtheria-tetanus-pertussis, oral poliomyelitis, hepatitis B, and measles vaccines are part of the routine immunization schedule and are available free from government health centers. All other vaccines are optional and available in the private sector at a cost to families. This study assesses immunization rates of routine and optional vaccines and examines parental attitudes toward vaccines in Pallavapuram, Tamil Nadu.
The cluster sampling method was used to estimate immunization coverage. Seven children 18 to 36 months old were selected from 30 clusters for a total sample of 210 children. Demographics and vaccination data were collected from interviews and immunization records. Predictors of vaccination status were identified with logistic regression models. In addition, 21 parents participated in semi-structured interviews regarding their attitudes toward vaccination. Interviews were analyzed qualitatively for themes.
Eighty one percent of children were fully immunized with routine vaccines. However, only 21% received all "major" optional vaccines, defined as 3 doses of Haemophilus influenzae type b vaccine, one dose of measles, mumps, rubella vaccine, and one dose of varicella zoster virus vaccine. Birth in a private hospital (OR 5.6, 95% CI 1.3 to 22.9, P<0.01), higher income (P=0.03), and maternal completion of high school (OR 6.4, 95% CI 1.5 to 27.6, P<0.01) were significant predictors of receiving all major optional vaccines. Elucidated themes from interviews included (1) strong parental support for immunizations, (2) low concern for side effects, and (3) low uptake of optional vaccines due to high cost and lack of awareness.
Coverage of optional vaccines is low despite positive attitudes toward immunizations. Efforts to reduce cost and increase awareness of these vaccines particularly among low-income families or to include these vaccines in the routine schedule may increase uptake and reduce morbidity and mortality from vaccine-preventable diseases.
在印度泰米尔纳德邦，卡介苗、白喉-破伤风-百日咳疫苗、口服脊髓灰质炎疫苗、乙型肝炎疫苗和麻疹疫苗是常规免疫计划的一部分，可从政府卫生中心免费获得。所有其他疫苗为非强制性疫苗，在私营部门提供，家庭需付费。本研究评估了泰米尔纳德邦帕拉瓦普拉姆常规和非强制性疫苗的接种率，并调查了家长对疫苗的态度。
采用整群抽样方法估计免疫接种覆盖率。从30个群组中选取7名18至36个月大的儿童，共210名儿童作为样本。通过访谈和免疫记录收集人口统计学和疫苗接种数据。使用逻辑回归模型确定疫苗接种状况的预测因素。此外，21名家长参与了关于他们对疫苗接种态度的半结构化访谈。对访谈进行定性分析以找出主题。
81%的儿童完成了常规疫苗的全程接种。然而，只有21%的儿童接种了所有“主要”非强制性疫苗，即3剂b型流感嗜血杆菌疫苗、1剂麻疹、腮腺炎、风疹疫苗和1剂水痘带状疱疹病毒疫苗。在私立医院出生（比值比5.6，95%置信区间1.3至22.9，P<0.01）、收入较高（P=0.03）以及母亲完成高中学业（比值比6.4，95%置信区间1.5至27.6，P<0.01）是接种所有主要非强制性疫苗的显著预测因素。访谈中阐明的主题包括：（1）家长对免疫接种的大力支持；（2）对副作用的低关注度；（3）由于成本高和缺乏认识，非强制性疫苗的接种率低。
尽管对免疫接种态度积极，但非强制性疫苗的接种覆盖率较低。努力降低成本并提高对这些疫苗的认识，特别是在低收入家庭中，或者将这些疫苗纳入常规免疫计划，可能会提高接种率并降低疫苗可预防疾病的发病率和死亡率。
