Department of Global Health Studies, Northwestern University, Evanston, IL 60201, United States.
Department of Anthropology, Northwestern University, Evanston, IL 60201, United States.
Vaccine. 2020 Apr 16;38(18):3429-3435. doi: 10.1016/j.vaccine.2020.03.011. Epub 2020 Mar 14.
The timely receipt of the recommended vaccination regimen, i.e. vaccination maintenance, is an underexplored, but important, indicator of public health. There is currently no standardized method for quantifying cumulative vaccination maintenance, however, and no simple way to explore predictors of adherence to vaccination schedules. We therefore sought to (1) develop a Vaccination Maintenance Score (VMS) and (2) apply this score to determine the predictors of vaccination behavior among infants in western Kenya (n = 245).
Women in western Kenya were enrolled during pregnancy and surveyed repeatedly through one year postpartum. Data were collected on a range of sociodemographic and health indicators and vaccinations. For each infant, we analyzed receipt of 11 vaccines recommended by the Kenyan Ministry of Health. We operationalized VMS as the total number of vaccines received on schedule. Vaccines that were not received or received off schedule were scored 0. VMS was modeled using multivariable tobit regression models.
We found that 85.7% of infants were fully immunized, but only 42.4% had optimal VMS, i.e. scored 11. The median (IQR) VMS was 10 (3). In multivariable regression, each one-point increase in maternal quality of life score (range: 0-32) was associated with a 0.22-point increase in VMS; each additional child in the household was associated with a 0.34-point increase in VMS; and initiating breastfeeding at birth was associated a 2.01-point increase in VMS.
Coverage of the recommended vaccinations (85.7%) was nearly twice as high as cumulative timely receipt (42.4%). The VMS satisfies a need for a location-specific but easily adaptable metric of vaccination adherence behavior. It can be used to complement traditional methods of vaccination coverage and timeliness to better understand underlying behaviors that influence vaccination events, and thereby inform interventions to improve vaccination rates and decrease the burden of vaccine-preventable disease.
NCT02974972 and NCT02979418.
及时接种推荐的疫苗方案（即疫苗维持）是公共卫生领域一个尚未得到充分探索但很重要的指标。然而，目前还没有标准化的方法来量化累计疫苗维持，也没有简单的方法来探索疫苗接种计划的依从性预测因素。因此，我们试图（1）开发疫苗维持评分（VMS），并（2）应用该评分来确定肯尼亚西部婴儿的疫苗接种行为的预测因素（n=245）。
在肯尼亚西部招募孕妇，并在产后一年内多次进行调查。收集了一系列社会人口统计学和健康指标以及疫苗接种数据。对于每个婴儿，我们分析了肯尼亚卫生部推荐的 11 种疫苗的接种情况。我们将 VMS 定义为按时接种的疫苗总数。未接种或未按时接种的疫苗得分为 0。使用多变量 Tobit 回归模型对 VMS 进行建模。
我们发现 85.7%的婴儿完全接种了疫苗，但只有 42.4%的婴儿获得了最佳 VMS，即得分为 11。VMS 的中位数（IQR）为 10（3）。在多变量回归中，母亲生活质量评分每增加 1 分（范围：0-32），VMS 就会增加 0.22 分；家庭中每增加一个孩子，VMS 就会增加 0.34 分；出生时开始母乳喂养，VMS 就会增加 2.01 分。
推荐疫苗的覆盖率（85.7%）几乎是累计及时接种率（42.4%）的两倍。VMS 满足了一种特定于地点但易于适应的疫苗接种依从性行为衡量标准的需求。它可以与传统的疫苗接种覆盖率和及时性方法结合使用，以更好地了解影响疫苗接种事件的潜在行为，并为改善疫苗接种率和减少疫苗可预防疾病负担的干预措施提供信息。
NCT02974972 和 NCT02979418。
