Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Immunization Division, Ministry of Health, Phnom Penh, Cambodia.
Vaccine. 2018 Jul 16;36(30):4517-4524. doi: 10.1016/j.vaccine.2018.06.009. Epub 2018 Jun 19.
Missed opportunities for vaccination (MOV) can result in inadequate protection against disease. Although healthcare provider reluctance to open multi-dose, lyophilized vaccine vials (particularly the measles-containing vaccine [MCV]) for every eligible child due to concerns about wasting vaccine is a known reason for MOV, little is known about providers' related attitudes and practices.
In 100 randomly selected health facilities and 24 districts of Cambodia, we surveyed healthcare providers and their district supervisors regarding routine vaccine administration and wastage knowledge and practices, and child caregivers (five per facility) regarding MOV. Vaccine stock management data covering six months were reviewed to calculate facility and district level wastage rates and vaccine usage patterns for six vaccines, including a recently introduced second dose of MCV (MCV2).
Response rates were 100/100 (100%) among facility staff, 48/48 (100%) among district staff, and 436/500 (87%) among caregivers. Mean facility-level wastage rates varied from 4% for single-dose diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b vaccine to 60% for 10-dose MCV; district-level wastage rates for all vaccines were 0%. Some vaccines had lower wastage rates in large facilities compared to small facilities. The mean MCV wastage rate was the same before and immediately after MCV2 introduction. Providers reported waiting for a mean of two children prior to opening an MCV vial, and 71% of providers reported offering MCV vaccination less frequently during scheduled vaccination sessions than other vaccines. Less than 5% of caregivers reported that their child had been turned away for vaccination, most frequently (65%) for MCV.
Although the MCV wastage rate in our study was in line with national targets, providers reported waiting for more than one child before opening an MCV vial, contrary to vaccine management guidelines. Future research should explore the causal links between provider practices related to vaccine wastage and their impact on vaccination coverage.
错过接种机会（MOV）可能导致疾病预防不足。尽管由于担心浪费疫苗，医护人员不愿为每一个符合条件的儿童打开多剂量冻干疫苗瓶（特别是含麻疹疫苗[MCV]），这是 MOV 的已知原因，但对于提供者的相关态度和做法知之甚少。
在柬埔寨 100 个随机选定的卫生机构和 24 个地区，我们调查了医疗保健提供者及其地区主管关于常规疫苗接种和浪费知识和实践的情况，以及每个机构的五名儿童看护人关于 MOV 的情况。审查了六个月的疫苗库存管理数据，以计算设施和地区级别的浪费率以及六种疫苗（包括最近推出的第二剂 MCV[MCV2]）的疫苗使用模式。
设施工作人员的回复率为 100/100（100%），地区工作人员的回复率为 48/48（100%），看护人的回复率为 436/500（87%）。平均设施级别的浪费率从单剂量白喉、破伤风、百日咳、乙型肝炎、流感嗜血杆菌 b 疫苗的 4%到 10 剂量 MCV 的 60%不等；所有疫苗的地区级浪费率均为 0%。与小设施相比，一些疫苗在大设施中的浪费率较低。在 MCV2 推出前后，MCV 的平均浪费率相同。提供者报告说，在打开 MCV 小瓶之前，平均要等待两个孩子，71%的提供者报告说，在计划的接种会议期间，他们提供的 MCV 接种频率低于其他疫苗。不到 5%的看护人报告说他们的孩子因接种疫苗而被拒之门外，最常见的原因是（65%）MCV。
尽管我们的研究中的 MCV 浪费率符合国家目标，但提供者报告说，在打开 MCV 小瓶之前，他们要等待不止一个孩子，这与疫苗管理指南背道而驰。未来的研究应探讨与疫苗浪费相关的提供者实践之间的因果关系及其对疫苗接种覆盖率的影响。
