Smith Philip J, Shaw Jana, Seither Ranee, Lopez Adriana, Hill Holly A, Underwood Mike, Knighton Cynthia, Zhao Zhen, Ravanam Megha Shah, Greby Stacie, Orenstein Walter A
Centers for Disease Control and Prevention, Atlanta, GA, United States.
Upstate Medical University, Syracuse, NY, United States.
Vaccine. 2017 Sep 25;35(40):5346-5351. doi: 10.1016/j.vaccine.2017.08.036. Epub 2017 Aug 24.
Vaccination requirements for kindergarten entry vary by state, but all states require 2 doses of measles containing vaccine (MCV) at kindergarten entry.
To assess (i) national MCV vaccination coverage for children who had attended kindergarten; (ii) the extent to which undervaccination after kindergarten entry is attributable to parents' requests for an exemption; (iii) the extent to which undervaccinated children had missed opportunities to be administered missing vaccine doses among children whose parent did not request an exemption; and (iv) the vaccination coverage gap between the "highest achievable" MCV coverage and actual MCV coverage among children who had attended kindergarten.
A national survey of 1465 parents of 5-7year-old children was conducted during October 2013 through March 2014. Vaccination coverage estimates are based provider-reported vaccination histories. Children have a "missed opportunity" for MCV if they were not up-to-date and if there were dates on which other vaccines were administered but not MCV. The "highest achievable" MCV vaccination coverage rate is 100% minus the sum of the percentages of (i) undervaccinated children with parents who requested an exemption; and (ii) undervaccinated children with parents who did not request an exemption and whose vaccination statuses were assessed during a kindergarten grace period or period when they were provisionally enrolled in kindergarten.
Among all children undervaccinated for MCV, 2.7% were attributable to having a parent who requested an exemption. Among children who were undervaccinated for MCV and whose parent did not request an exemption, 41.6% had a missed opportunity for MCV. The highest achievable MCV coverage was 98.6%, actual MCV coverage was 90.9%, and the kindergarten vaccination gap was 7.7%.
Vaccination coverage may be increased by schools fully implementing state kindergarten vaccination laws, and by providers assessing children's vaccination status at every clinic visit, and administering missed vaccine doses.
各州幼儿园入学的疫苗接种要求各不相同，但所有州都要求儿童在进入幼儿园时接种两剂含麻疹疫苗（MCV）。
评估（i）已上幼儿园儿童的全国MCV疫苗接种覆盖率；（ii）入园后疫苗接种不足在多大程度上可归因于家长要求豁免；（iii）在家长未要求豁免的儿童中，未充分接种疫苗的儿童错过接种缺失剂量疫苗机会的程度；以及（iv）已上幼儿园儿童中“可实现的最高”MCV覆盖率与实际MCV覆盖率之间的疫苗接种覆盖率差距。
2013年10月至2014年3月期间对1465名5至7岁儿童的家长进行了全国性调查。疫苗接种覆盖率估计基于提供者报告的疫苗接种史。如果儿童未按时接种且在其他疫苗接种日期却未接种MCV，则该儿童有MCV“错过机会”。“可实现的最高”MCV疫苗接种覆盖率为100%减去以下两者百分比之和：（i）家长要求豁免的未充分接种疫苗儿童的百分比；以及（ii）家长未要求豁免且在幼儿园宽限期或临时入园期间评估其疫苗接种状况的未充分接种疫苗儿童的百分比。
在所有MCV疫苗接种不足的儿童中，2.7%可归因于有家长要求豁免。在MCV疫苗接种不足且家长未要求豁免的儿童中，41.6%有MCV错过机会。可实现的最高MCV覆盖率为98.6%，实际MCV覆盖率为90.9%，幼儿园疫苗接种差距为7.7%。
学校全面实施州幼儿园疫苗接种法律，以及提供者在每次门诊就诊时评估儿童的疫苗接种状况并接种错过的疫苗剂量，可能会提高疫苗接种覆盖率。
