Hoest Christel, Seidman Jessica C, Lee Gwenyth, Platts-Mills James A, Ali Asad, Olortegui Maribel Paredes, Bessong Pascal, Chandyo Ram, Babji Sudhir, Mohan Venkata Raghava, Mondal Dinesh, Mahfuz Mustafa, Mduma Estomih R, Nyathi Emanuel, Abreu Claudia, Miller Mark A, Pan William, Mason Carl J, Knobler Stacey L
Division of International Epidemiology and Population Studies of Fogarty International Center, National Institutes of Health, 16 Center Drive, Bethesda, MD 20892, USA.
Division of International Epidemiology and Population Studies of Fogarty International Center, National Institutes of Health, 16 Center Drive, Bethesda, MD 20892, USA.
Vaccine. 2017 Jan 11;35(3):443-451. doi: 10.1016/j.vaccine.2016.11.075. Epub 2016 Dec 18.
Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings.
The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered.
Coverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87-100%, whereas measles vaccination rates ranged widely, 73-100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific.
Our findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission.
扩大免疫规划（EPI）于1974年启动，据估计每年可预防两到三百万人死于脊髓灰质炎、白喉、结核病、百日咳、麻疹和破伤风。通过更好地了解在特定环境中影响EPI免疫程序依从性的因素，可以挽救更多生命。
肠道感染与营养不良的病因、危险因素及相互作用及其对儿童健康与发育的影响（MAL-ED）研究在南亚、非洲和南美洲的八个地点跟踪队列，并对参与研究的儿童在出生后的头两年内的疫苗接种情况进行监测。每月从疫苗接种卡、当地诊所记录和/或照顾者报告中获取疫苗接种史。将疫苗接种史与每个国家规定的EPI免疫程序进行比较，并根据疫苗接种时间检查覆盖率。还考虑了社会经济因素对疫苗接种时间和覆盖率的影响。
EPI疫苗的覆盖率因地点和疫苗类型而异；总体而言，尼泊尔和孟加拉国地点的覆盖率最高，坦桑尼亚和巴西地点的覆盖率最低。卡介苗在所有地点的覆盖率都很高，为87%-100%，而麻疹疫苗接种率差异很大，为73%-100%。所有地点都存在预定接种年龄与实际接种日期之间的显著延迟，尤其是麻疹疫苗，按时接种的不到40%。一系列社会经济因素与研究儿童的疫苗接种状况显著相关，但这些结果在很大程度上因地点而异。
我们的研究结果强调，需要提高麻疹疫苗接种率并减少延迟接种，以实现与建立群体免疫和减少疾病传播相关的EPI目标。
