Department of Social Medicine, National Research Institute for Child Health and Development , Tokyo , Japan.
Front Pediatr. 2016 Mar 15;4:19. doi: 10.3389/fped.2016.00019. eCollection 2016.
Although the control of varicella outbreaks is an important health issue, cost could present a major barrier for vaccination. The aim of this study is to investigate the association of vaccine subsidies and caregivers' socioeconomic status with varicella vaccine coverage of their children in Greater Tokyo, Japan, before the period that varicella vaccination was included in routine immunization program.
Participants were recruited from two different cities. In Chiba city, parents of 18-month-old infants (N = 378) undergoing a medical examination in July 2013 were recruited at a clinic where no subsidy for varicella immunization was provided. In Nishitokyo city, parents of 24- to 30-month-old children (N = 315) undergoing a health checkup in July and August 2013 were recruited at a clinic where a partial subsidy was provided. The association between household income and varicella immunization was investigated by multivariate logistic regression stratified by city.
Vaccine coverage was 61.0% in Chiba city and 73.3% in Nishitokyo city. In Chiba city, odds ratios of middle and high household income for varicella immunization were 4.22 [95% confidence interval (CI): 1.65-10.7] and 5.94 (95% CI: 1.89-18.6), respectively, compared to low household income. However, household income was not associated with varicella vaccination in Nishitokyo city. Neither working status nor education was associated with vaccination in both cities.
While household income was associated with high vaccine coverage in the city with no vaccine subsidy, this association was not observed in the city where the subsidy was given, which suggests that cost is a barrier for varicella immunization. Thus, in countries where varicella vaccination is not included in routine immunization programs, introducing subsidies nationwide or routine immunization programs for varicella vaccination would be an important approach to eliminate inequality in vaccine coverage.
尽管控制水痘疫情是一个重要的健康问题，但费用可能是疫苗接种的主要障碍。本研究旨在调查疫苗补贴和照顾者的社会经济地位与日本大东京地区儿童水痘疫苗接种率之间的关系，该地区在水痘疫苗纳入常规免疫规划之前。
参与者分别从两个不同的城市招募。在千叶市，2013 年 7 月在一家诊所对 18 个月大的婴儿（N=378）进行体检的父母参加了研究，该诊所不提供水痘免疫补贴。在西东京市，2013 年 7 月和 8 月在一家诊所对 24 至 30 个月大的儿童（N=315）进行健康检查的父母参加了研究，该诊所提供部分补贴。通过按城市分层的多变量逻辑回归调查家庭收入与水痘免疫之间的关联。
在千叶市，水痘疫苗接种率为 61.0%，在西东京市为 73.3%。在千叶市，中高收入家庭的水痘免疫比值比（OR）分别为低收入家庭的 4.22（95%可信区间[CI]：1.65-10.7）和 5.94（95% CI：1.89-18.6）。然而，家庭收入与西东京市的水痘疫苗接种无关。在这两个城市，工作状况和教育程度都与疫苗接种无关。
虽然在没有疫苗补贴的城市，家庭收入与高疫苗覆盖率相关，但在提供补贴的城市，这种关联并不存在，这表明费用是水痘免疫的一个障碍。因此，在水痘疫苗未纳入常规免疫规划的国家，在全国范围内引入补贴或常规免疫规划接种水痘疫苗将是消除疫苗接种覆盖率不平等的重要途径。
