密克罗尼西亚联邦的儿童疫苗接种及时性。
Timeliness of childhood vaccination in the Federated States of Micronesia.
机构信息
Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA, United States.
Berry Technology Solutions, Atlanta, GA, United States.
出版信息
Vaccine. 2017 Nov 7;35(47):6404-6411. doi: 10.1016/j.vaccine.2017.10.001. Epub 2017 Oct 10.
BACKGROUND
Vaccination coverage is typically measured as the proportion of individuals who have received recommended vaccine doses by the date of assessment. This approach does not provide information about receipt of vaccines by the recommended age, which is critical for ensuring optimal protection from vaccine-preventable diseases (VPDs).
OBJECTIVE
To assess vaccination timeliness in the Federated States of Micronesia (FSM), and the projected impact of suboptimal vaccination in the event of an outbreak.
METHODS
Timeliness of the 4 dose of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) and 1 dose of measles, mumps, and rubella vaccine (MMR) among children 24-35 months was assessed in FSM. Both doses are defined as on time if administered from 361 through 395 days in age. Timeliness was calculated by one-way frequency analysis, and dose delays, measured in months after recommended age, were described using inverse Kaplan-Meier analysis. A time-series susceptible-exposed-infected-recovery (TSEIR) model simulated measles outbreaks in populations with on time and late vaccination.
RESULTS
Total coverage for the 4 dose of DTaP ranged from 36.6% to 98.8%, and for the 1 dose of MMR ranged from 80.9% to 100.0% across FSM states. On time coverage for the 4 dose of DTaP ranged from 3.2% to 52.3%, and for the 1 dose of MMR ranged from 21.1% to 66.9%. Maximum and median dose delays beyond the recommended age varied by state. TSEIR models predicted 10.8-13.7% increases in measles cases during an outbreak based on these delays.
CONCLUSIONS
In each of the FSM states, a substantial proportion of children received DTaP and MMR doses outside the recommended timeframe. Children who receive vaccinations later than recommended remain susceptible to VPDs during the period they remain unvaccinated, which may have a substantial impact on health systems during an outbreak. Immunization programs should consider vaccination timeliness in addition to coverage as a measure of susceptibility to VPDs in young children.
背景
疫苗接种覆盖率通常以评估日期前接受推荐疫苗剂量的个体比例来衡量。这种方法无法提供按建议年龄接种疫苗的信息，而这对于确保预防疫苗可预防疾病（VPD）的最佳保护至关重要。
目的
评估密克罗尼西亚联邦（FSM）的疫苗接种及时性，并评估在爆发情况下接种疫苗不及时的预计影响。
方法
在 FSM 中评估了 24-35 个月龄儿童的 4 剂白喉、破伤风和无细胞百日咳疫苗（DTaP）和 1 剂麻疹、腮腺炎和风疹疫苗（MMR）的及时性。如果在 361 至 395 天龄内接种，则两种剂量均定义为及时接种。通过单向频率分析计算及时性，并使用逆 Kaplan-Meier 分析描述以建议年龄后几个月计的剂量延迟。一个易感-暴露-感染-恢复（TSEIR）时间序列模型模拟了在按时和延迟接种疫苗的人群中发生的麻疹暴发。
结果
在 FSM 各州，4 剂 DTaP 的总覆盖率范围为 36.6%至 98.8%，1 剂 MMR 的覆盖率范围为 80.9%至 100.0%。4 剂 DTaP 的按时接种覆盖率范围为 3.2%至 52.3%，1 剂 MMR 的按时接种覆盖率范围为 21.1%至 66.9%。各州的最大和中位剂量延迟量各不相同。基于这些延迟，TSEIR 模型预测在暴发期间麻疹病例会增加 10.8-13.7%。
结论
在 FSM 的每个州，都有相当一部分儿童在推荐的时间框架之外接受了 DTaP 和 MMR 疫苗接种。在未接种疫苗期间，接种疫苗较晚的儿童仍然容易感染 VPD，这可能会对暴发期间的卫生系统产生重大影响。免疫规划应考虑接种及时性，作为衡量幼儿 VPD 易感性的指标，除了覆盖率之外。
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