Green H K, Andrews N, Letley L, Sunderland A, White J, Pebody R
Public Health England, United Kingdom.
Public Health England, United Kingdom.
Vaccine. 2015 May 21;33(22):2620-8. doi: 10.1016/j.vaccine.2015.03.049. Epub 2015 Mar 30.
Through a phased rollout, the UK is implementing annual influenza vaccination for all healthy children aged 2-16 years old. In the first year of the programme in England in 2013/14, all 2-3 year olds were offered influenza vaccine through primary care and a primary school age programme was piloted, mainly through schools, in geographically distinct areas. Equitable delivery is a key aim of the programme; it is unclear if concerns by some religious groups over influenza vaccine content have impacted on uptake.
At the end of the 2013/14 season, variations in uptake for 2-3 year olds and 4-11 year olds were assessed and stratified by population-level predictors: deprivation, ethnicity, religious beliefs and rurality. GP practice or school level uptake was linearly regressed against these variables to determine potential predictors and changes in uptake, adjusting for significant factors.
Uptake varied considerably by geographic locality for both 2-3 year olds and 4-11 year olds. Lower uptake was seen in increasingly deprived areas, with an adjusted uptake in the most deprived quintile 12% and 8% lower than the least deprived areas by age-group respectively. By ethnicity, the highest non-white population quartile had an adjusted uptake 9% and 14% lower than the lowest non-white quartile by age-group respectively. Uptake also varied according to religious beliefs, with adjusted uptake in 4-11 year olds in the highest Muslim population tertile 8% lower than the lowest Muslim population tertile.
In the first season of the childhood influenza vaccination programme, uptake was not uniform across the country, with deprivation and ethnicity both predictors of low uptake in pre-school and primary school age children, and religious beliefs also an important factor, particularly the latter group. With the continued rollout of the programme, these population-level factors should be addressed to achieve sustained successful uptake, along with assessment of contribution of individual and household-level factors.
英国正在分阶段推行针对所有2至16岁健康儿童的年度流感疫苗接种计划。在2013/14年度该计划于英格兰实施的第一年，所有2至3岁儿童通过初级医疗保健机构接种流感疫苗，同时在不同地理区域试点了一项主要针对小学生的计划，主要通过学校开展。公平接种是该计划的一个关键目标；目前尚不清楚一些宗教团体对流感疫苗成分的担忧是否影响了接种率。
在2013/14年度流感季节结束时，评估了2至3岁和4至11岁儿童的接种率差异，并按人口层面的预测因素进行分层：贫困程度、种族、宗教信仰和农村地区情况。将全科医生诊所或学校层面的接种率与这些变量进行线性回归，以确定潜在的预测因素和接种率的变化，并对显著因素进行调整。
2至3岁和4至11岁儿童的接种率在不同地理位置差异很大。在贫困程度不断增加的地区，接种率较低，按年龄组划分，最贫困五分之一地区的调整后接种率分别比最不贫困地区低12%和8%。按种族划分，非白人人口比例最高的四分位数地区的调整后接种率分别比非白人人口比例最低的四分位数地区低9%和14%。接种率也因宗教信仰而异，在穆斯林人口比例最高的三分位数地区，4至11岁儿童的调整后接种率比穆斯林人口比例最低的三分位数地区低8%。
在儿童流感疫苗接种计划的第一个季节，全国范围内的接种情况并不统一，贫困程度和种族都是学前和小学年龄段儿童接种率低的预测因素，宗教信仰也是一个重要因素，尤其是对后一组人群而言。随着该计划的持续推行，应解决这些人口层面的因素，以实现持续成功的接种，同时评估个人和家庭层面因素的影响。
