Casillas Shannon M, Bednarczyk Robert A
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; Emory Vaccine Center, Emory University, Atlanta, GA.
J Pediatr. 2017 Aug;187:265-271.e1. doi: 10.1016/j.jpeds.2017.04.001. Epub 2017 May 5.
To quantify the number of missed opportunities for vaccination with hepatitis A vaccine in children and assess the association of missed opportunities for hepatitis A vaccination with covariates of interest.
Weighted data from the 2013 National Immunization Survey of US children aged 19-35 months were used. Analysis was restricted to children with provider-verified vaccination history (n = 13 460). Missed opportunities for vaccination were quantified by determining the number of medical visits a child made when another vaccine was administered during eligibility for hepatitis A vaccine, but hepatitis A vaccine was not administered. Cross-sectional bivariate and multivariate polytomous logistic regression were used to assess the association of missed opportunities for vaccination with child and maternal demographic, socioeconomic, and geographic covariates.
In 2013, 85% of children in our study population had initiated the hepatitis A vaccine series, and 60% received 2 or more doses. Children who received zero doses of hepatitis A vaccine had an average of 1.77 missed opportunities for vaccination compared with 0.43 missed opportunities for vaccination in those receiving 2 doses. Children with 2 or more missed opportunities for vaccination initiated the vaccine series 6 months later than children without missed opportunities. In the fully adjusted multivariate model, children who were younger, had ever received WIC benefits, or lived in a state with childcare entry mandates were at a reduced odds for 2 or more missed opportunities for vaccination; children living in the Northeast census region were at an increased odds.
Missed opportunities for vaccination likely contribute to the poor coverage for hepatitis A vaccination in children; it is important to understand why children are not receiving the vaccine when eligible.
量化儿童甲型肝炎疫苗接种错失机会的数量，并评估甲型肝炎疫苗接种错失机会与相关协变量之间的关联。
使用了2013年美国19 - 35个月龄儿童国家免疫调查的加权数据。分析仅限于有经提供者核实的疫苗接种史的儿童（n = 13460）。通过确定儿童在符合甲型肝炎疫苗接种条件且接种其他疫苗时未接种甲型肝炎疫苗的就诊次数，来量化接种错失机会。采用横断面双变量和多变量多分类逻辑回归来评估接种错失机会与儿童及母亲的人口统计学、社会经济和地理协变量之间的关联。
2013年，我们研究人群中85%的儿童开始接种甲型肝炎疫苗系列，60%的儿童接种了2剂或更多剂。未接种甲型肝炎疫苗剂量的儿童平均有1.77次接种错失机会，而接种2剂的儿童平均有0.43次接种错失机会。有2次或更多次接种错失机会的儿童比没有接种错失机会的儿童晚6个月开始接种该疫苗系列。在完全调整的多变量模型中，年龄较小、曾接受妇女、婴儿和儿童营养补充计划（WIC）福利或生活在有儿童保育入学规定州的儿童，出现2次或更多次接种错失机会的几率降低；生活在东北人口普查区的儿童几率增加。
接种错失机会可能导致儿童甲型肝炎疫苗接种覆盖率低；了解儿童在符合条件时未接种疫苗的原因很重要。
