Wallace Aaron S, Ryman Tove K, Dietz Vance
Centers for Disease Control and Prevention, Atlanta, Georgia.
J Infect Dis. 2014 Nov 1;210 Suppl 1(0 1):S514-22. doi: 10.1093/infdis/jiu108.
Review of the historical growth in annual vaccination coverage across countries and regions can better inform decision makers' development of future goals and strategies to improve routine vaccination services.
Using the World Health Organization (WHO) and the United Nations Children's Fund estimates of annual national third dose of diphtheria-tetanus-pertussis-containing vaccine (DTP3) and third dose of polio vaccine (POL3) coverage for 1980-2009, we calculated the mean absolute annual rate of change in national DTP3 coverage among all countries (globally) and among countries within each WHO region, as well as the number of years taken by each region to reach specific regional coverage levels. Last, we assessed differences in mean absolute annual rate of change in DTP3 coverage, stratified by baseline level of DTP3 coverage.
During the 1980s, global DTP3 coverage increased a mean of 5.3 percentage points/year. Annual rate of change decreased to 0.5 percentage points/year in the 1990s and then increased to 0.9 percentage points/year during the 2000s. Mean annual rate of change in coverage across all countries was highest (9.2 percentage points) when national coverage levels were 26%-30% and lowest (-0.9 percentage points) when national coverage levels were 96%-100%. Regional differences existed as both WHO South-East Asia Region and WHO African Region countries experienced mean negative DTP3 coverage growth at lower coverage levels (81%-85%) than other regions. The regions that have achieved 95% DTP3 coverage (Americas, Western Pacific, and European) took 25-29 years to reach that level from a level of 50% DTP3 coverage. POL3 coverage change trends were similar to described DTP3 coverage change trends.
Mean national coverage growth patterns across all regions are nonlinear as coverage levels increase. Saturation points of mean 0 percentage-point growth in annual coverage varies by region and require further investigation. The achievement of >90% routine coverage is observed to take decades, which has implications for disease eradication and elimination initiatives.
回顾各国和各地区年度疫苗接种覆盖率的历史增长情况，可为决策者制定未来改善常规疫苗接种服务的目标和策略提供更充分的信息。
利用世界卫生组织（WHO）和联合国儿童基金会对1980 - 2009年各国白喉 - 破伤风 - 百日咳三联疫苗第三剂（DTP3）和脊髓灰质炎疫苗第三剂（POL3）年度覆盖率的估计数据，我们计算了全球所有国家以及WHO各区域内国家的国家DTP3覆盖率的平均绝对年变化率，以及每个区域达到特定区域覆盖率水平所需的年数。最后，我们评估了按DTP3覆盖率基线水平分层的DTP3覆盖率平均绝对年变化率的差异。
在20世纪80年代，全球DTP3覆盖率平均每年增长5.3个百分点。年变化率在20世纪90年代降至0.5个百分点/年，然后在21世纪升至0.9个百分点/年。当国家覆盖率水平为26% - 30%时，所有国家覆盖率的平均年变化率最高（9.2个百分点），而当国家覆盖率水平为96% - 100%时最低（-0.9个百分点）。存在区域差异，因为WHO东南亚区域和WHO非洲区域国家在比其他区域更低的覆盖率水平（81% - 85%）时经历了DTP3覆盖率的平均负增长。已实现95% DTP3覆盖率的区域（美洲、西太平洋和欧洲）从50% DTP3覆盖率水平达到该水平需要25 - 29年。POL3覆盖率变化趋势与上述DTP3覆盖率变化趋势相似。
随着覆盖率水平的提高，所有区域的国家平均覆盖率增长模式呈非线性。年度覆盖率平均增长0个百分点的饱和点因区域而异，需要进一步研究。实现>90%的常规覆盖率需要数十年时间，这对疾病根除和消除计划具有影响。
