Usher Institute of Population Health Sciences and Informatics, Old Medical School, Teviot Place, University of Edinburgh, Scotland EH8 9AG, UK.
NHS Lothian, Directorate of Public Health and Health Policy, National Health Service Scotland, 2-4 Waterloo Place, Edinburgh EH1 3EG, UK.
Vaccine. 2019 Sep 3;37(37):5614-5624. doi: 10.1016/j.vaccine.2019.07.080. Epub 2019 Aug 8.
In 2018, there was a record incidence of measles and other vaccine-preventable diseases across developed countries. Declining childhood immunisation uptake in southeast Scotland-an area with a large, highly mobile, and socioeconomically diverse population-threatens regional herd immunity and warrants investigation of suboptimal coverage. As deprivation of social and material resources increases risk of non-vaccination, we examined here the relationship between deprivation, uptake, and timeliness for four routine childhood vaccines and identified trends over the past decade.
This retrospective cohort study analysed immunisation data from the Scottish Immunisation Recall System (SIRS) for four routine childhood vaccines in the UK: the third dose of the primary vaccine (TPV), both doses of measles, mumps, rubella (MMR 1 and MMR 2), and the preschool booster (PSB). Immunisations (N = 329,897) were administered between 2008 and 2018. Deprivation was measured via the Scottish Index of Multiple Deprivation (SIMD), ranking postcodes by deprivation decile. Chi-squared tests and cox proportional hazards models assessed the relationship between uptake, timeliness, and deprivation.
There is strong evidence for an association between deprivation, uptake, and timeliness. Uptake for all childhood immunisations are very high, especially for TPV and MMR 1 (>98.0%), though certain deprivation deciles exhibit increased risks of non-vaccination for all vaccines. Delay was pronounced for the 40% most deprived population and for immunisations scheduled at later ages. Absolute PSB and MMR 2 uptake has improved since 2008; however, disparities in uptake have increased for all vaccines since the 2006 birth cohort.
Both timeliness and uptake are strongly associated with deprivation. While absolute uptake was high for all vaccines, relative uptake and timeliness has been worsening for most groups; the reason for this decline is unclear. Here we identified subgroups that may require targeted interventions to facilitate uptake and timeliness for essential childhood vaccines.
2018 年，发达国家出现了麻疹和其他可通过疫苗预防的疾病的创纪录发病率。苏格兰东南部地区儿童免疫接种率下降，该地区人口众多、流动性大、社会经济多样化，这威胁到了区域群体免疫，需要调查疫苗接种率不理想的原因。由于社会和物质资源的匮乏增加了未接种疫苗的风险，因此我们在这里研究了贫困与四种常规儿童疫苗的接种率和及时性之间的关系，并确定了过去十年的趋势。
这项回顾性队列研究分析了英国苏格兰免疫回忆系统（SIRS）的四种常规儿童疫苗的免疫接种数据：基础疫苗的第三针（TPV）、麻疹、腮腺炎、风疹（MMR1 和 MMR2）的两针和学前加强针（PSB）。免疫接种（N=329897）于 2008 年至 2018 年期间进行。贫困程度通过苏格兰多重贫困指数（SIMD）进行衡量，按贫困程度的十分位数对邮政编码进行排名。卡方检验和 Cox 比例风险模型评估了接种率、及时性和贫困程度之间的关系。
贫困程度、接种率和及时性之间存在很强的关联。所有儿童疫苗的接种率都非常高，尤其是 TPV 和 MMR1（>98.0%），但某些贫困程度较高的群体所有疫苗的非接种风险都较高。对于 40%最贫困的人群和安排在较晚年龄的免疫接种，延迟情况更为明显。自 2008 年以来，PSB 和 MMR2 的绝对接种率有所提高；然而，自 2006 年出生的群体以来，所有疫苗的相对接种率和及时性都有所恶化。
及时性和接种率都与贫困程度密切相关。虽然所有疫苗的绝对接种率都很高，但大多数群体的相对接种率和及时性都在下降；下降的原因尚不清楚。在这里，我们确定了需要有针对性干预措施的亚组，以促进重要儿童疫苗的接种率和及时性。
