Lin Jialing, Wood James G, Bernardo Carla, Stocks Nigel P, Liu Bette
School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, Australia.
School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, Australia.
Vaccine. 2020 Apr 29;38(20):3646-3652. doi: 10.1016/j.vaccine.2020.03.036. Epub 2020 Mar 31.
In Australia, a herpes zoster (HZ) vaccination program targeting adults aged 70 years old with catch-up for those 71-79 years began in November 2016 but there is limited information on vaccine uptake and coverage achieved since commencement.
We used a national de-identified electronic primary care dataset, MedicineInsight, and extracted records from patients turning 50-90 years old during 2016-2018. Among patients considered regular attenders, with at least one visit per year in the two years prior, we estimated the crude and adjusted average monthly HZ vaccine uptake in the target population (70-79 years old) for each year since program implementation as well as cumulative vaccine coverage until December 2018. Multivariate logistic regression was used to analyse characteristics associated with higher coverage.
Among 52,229, 55,034, and 57,316 regular attenders turning 70-79 years old in 2016, 2017 and 2018 respectively, the average monthly vaccine uptake rate was 5.5%, 3.3%, and 1.6% respectively. Up to 31st December 2018, the estimated cumulative vaccine coverage in regularly attending adults was 46.9% (25,791/55,034). It was substantially lower at 41.6% (27,040/65,010) using an alternate definition of a regular attender. Vaccine coverage differed by sex (women: 48.5% versus men: 45.1%, adjusted OR = 1.1, 95% CI: 1.1-1.2); by jurisdiction (compared to New South Wales: 43.7%, South Australia: 55.6%, aOR = 1.6, 95% CI (1.5-1.8); Northern Territory: 27.6%, aOR = 0.6, (0.5-0.7)); by remoteness status (compared to major cities: 47.6%, remote/very remote areas: 38.2%, aOR = 0.7, (0.6-0.8)); and by socioeconomic disadvantage (compared to most disadvantaged: 41.8%, most advantaged: 48.6%, aOR = 1.6 (1.2-2.1)).
Our estimates of HZ vaccine coverage are substantially higher than the only other reports based on the Australian Immunisation Register however they still suggest that uptake is suboptimal. The use of electronic medical records can complement other data for estimating vaccine coverage in Australian adults.
在澳大利亚，针对70岁成年人的带状疱疹（HZ）疫苗接种计划于2016年11月启动，71 - 79岁人群可补种，但自开始实施以来，关于疫苗接种率和覆盖率的信息有限。
我们使用了一个全国性的匿名电子初级保健数据集MedicineInsight，提取了2016 - 2018年期间年龄在50 - 90岁患者的记录。在被视为定期就诊者（即在之前两年中每年至少就诊一次）的患者中，我们估计了自项目实施以来每年目标人群（70 - 79岁）的粗月均HZ疫苗接种率以及截至2018年12月的累计疫苗覆盖率。采用多因素逻辑回归分析与更高覆盖率相关的特征。
在2016年、2017年和2018年分别达到70 - 79岁的52229名、55034名和57316名定期就诊者中，月均疫苗接种率分别为5.5%、3.3%和1.6%。截至2018年12月31日，在定期就诊的成年人中估计的累计疫苗覆盖率为46.9%（25791/55034）。使用定期就诊者的另一种定义时，该覆盖率为41.6%（27040/65010），显著更低。疫苗覆盖率因性别（女性：48.5%，男性：45.1%，调整后比值比 = 1.1，95%置信区间：1.1 - 1.2）、司法管辖区（与新南威尔士州相比：43.7%，南澳大利亚州：55.6%，调整后比值比 = 1.6，95%置信区间（1.5 - 1.8）；北领地：27.6%，调整后比值比 = 0.6，（0.5 - 0.7））、偏远程度（与大城市相比：47.6%，偏远/非常偏远地区：38.2%，调整后比值比 = 0.7，（0.6 - 0.8））以及社会经济劣势程度（与最弱势相比：41.8%，最优势：48.6%，调整后比值比 = 1.6（1.2 - 2.1））而有所不同。
我们对HZ疫苗覆盖率的估计显著高于基于澳大利亚免疫登记册的其他唯一报告，但仍表明接种情况未达最佳。电子病历的使用可以补充其他数据以估计澳大利亚成年人的疫苗覆盖率。
