Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA.
Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., UG2AB-30, 351 N. Sumneytown Pike, North Wales, PA, 19454, USA.
BMC Public Health. 2019 Apr 15;19(1):404. doi: 10.1186/s12889-019-6693-5.
Timely and complete vaccination with multi-dose schedules is of public health importance, because an incomplete vaccination series may yield suboptimal disease protection. However, data on adherence of adults to multi-dose vaccines are limited. We sought to estimate adherence to multi-dose hepatitis vaccination schedules among adults in the United Kingdom (UK).
This retrospective cohort study was conducted using anonymized electronic health record (EHR) data from the Clinical Practice Research Datalink (CPRD). Individuals aged 19 years and older at their first identified dose of hepatitis vaccine (2009-2016) were included if they had continuous EHR data for 12 months before the first identified hepatitis A dose or for 6 months before the first identified hepatitis B or combination hepatitis A/B dose. We estimated dose and series completion for each vaccine and adherence to recommended vaccination schedules, as well as adherence within additional prespecified time periods after the first vaccine dose, with sensitivity analyses restricted to adults who had available data for up to 24 months after the first dose. Median time to series completion was estimated using Kaplan-Meier methods.
Mean (SD) age at initiation was 42 (16) years for hepatitis A (n = 374,881), 40 (16) years for hepatitis B (n = 71,634), and 38 (15) years for hepatitis A/B (n = 10,335). Women comprised 52 to 55% of each vaccine cohort. Overall, 42,294 adults (11%) completed the two-dose hepatitis A vaccine series within the recommended 12 months; and 15,564 (22%) and 1076 (10%) completed the three-dose hepatitis B and hepatitis A/B series, respectively, within the recommended 6 months. These percentages rose to only 23, 35, and 33%, respectively, when the follow-up periods were extended to 36 months for hepatitis A and to 30 months for hepatitis B and A/B vaccines. Median times to series completion within recommended schedules were not reached in any cohort. Sensitivity analyses supported the primary findings for the full cohorts.
Adherence and series completion rates for hepatitis A and B vaccines in the UK are low. Identifying, understanding, and addressing barriers to series completion for multi-dose vaccines for adults in real-world settings are needed.
多剂量方案的及时和完全接种对公共卫生具有重要意义，因为不完全的疫苗接种系列可能会导致疾病保护效果不理想。然而，关于成年人对多剂量疫苗的接种依从性的数据有限。我们旨在估计英国（英国）成年人对多剂量肝炎疫苗接种计划的接种依从性。
这项回顾性队列研究使用来自临床实践研究数据链接（CPRD）的匿名电子健康记录（EHR）数据进行。如果他们在首次确定的甲型肝炎疫苗剂量前 12 个月或首次确定的乙型肝炎或联合甲型肝炎/乙型肝炎剂量前 6 个月有连续的 EHR 数据，则年龄在 19 岁及以上的个体在其首次识别的剂量时包括在内肝炎疫苗。我们估计了每种疫苗的剂量和系列完成情况以及对推荐疫苗接种时间表的依从性，以及在首次疫苗接种后额外指定的时间段内的依从性，敏感性分析仅限于首次接种后最多 24 个月内有可用数据的成年人。使用 Kaplan-Meier 方法估计系列完成的中位时间。
启动时的平均（SD）年龄为甲型肝炎（n=374881）为 42（16）岁，乙型肝炎（n=71634）为 40（16）岁，甲型肝炎/乙型肝炎（n=10335）为 38（15）岁。每个疫苗队列的女性占 52%至 55%。总体而言，42294 名成年人（11%）在推荐的 12 个月内完成了两剂甲型肝炎疫苗系列；15564 名（22%）和 1076 名（10%）分别在推荐的 6 个月内完成了三剂乙型肝炎和甲型肝炎/乙型肝炎系列。当将甲型肝炎的随访期延长至 36 个月，乙型肝炎和 A/B 疫苗的随访期延长至 30 个月时，这些百分比分别仅上升至 23%、35%和 33%。任何队列中都未达到推荐方案内的系列完成中位时间。敏感性分析支持全队列的主要发现。
英国甲型肝炎和乙型肝炎疫苗的接种依从性和系列完成率较低。需要在现实环境中确定、了解和解决成年人多剂量疫苗系列完成的障碍。
