IRD Global, 15 Beach Road #02-01, Singapore 189677, Singapore; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA.
IRD Global, 15 Beach Road #02-01, Singapore 189677, Singapore.
Vaccine. 2020 Oct 21;38(45):7146-7155. doi: 10.1016/j.vaccine.2020.08.019. Epub 2020 Aug 15.
COVID-19 pandemic has affected routine immunization globally. Impact will likely be higher in low and middle-income countries with limited healthcare resources and fragile health systems. We quantified the impact, spatial heterogeneity, and determinants for childhood immunizations of 48 million population affected in the Sindh province of Pakistan.
We extracted individual immunization records from real-time provincial Electronic Immunization Registry from September 23, 2019, to July 11, 2020. Comparing baseline (6 months preceding the lockdown) and the COVID-19 lockdown period, we analyzed the impact on daily immunization coverage rate for each antigen by geographical area. We used multivariable logistic regression to explore the predictors associated with immunizations during the lockdown.
There was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Cal-mette Guérin (BCG) (40.6% (958/2360) immunization at fixed sites. Around 8438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. Pentavalent-3 (penta-3) immunization rates were higher in infants born in hospitals (RR: 1.09; 95% CI: 1.04-1.15) and those with mothers having higher education (RR: 1.19-1.50; 95% CI: 1.13-1.65). Likelihood of penta-3 immunization was reduced by 5% for each week of delayed enrollment into the immunization program.
One out of every two children in Sindh province has missed their routine vaccinations during the provincial COVID-19 lockdown. The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. There is a need for tailored interventions to promote immunization visits and safe service delivery. Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown.
COVID-19 大流行已在全球范围内影响常规免疫接种。医疗资源有限且卫生系统脆弱的中低收入国家受到的影响可能更大。我们量化了 COVID-19 封锁对巴基斯坦信德省 4800 万受影响人群儿童免疫接种的影响、空间异质性及其决定因素。
我们从 2019 年 9 月 23 日至 2020 年 7 月 11 日从实时省级电子免疫登记册中提取个体免疫记录。通过比较基线（封锁前 6 个月）和 COVID-19 封锁期间，我们按地理区域分析了每种抗原的日常免疫覆盖率的影响。我们使用多变量逻辑回归来探讨与封锁期间免疫接种相关的预测因素。
与基线相比，封锁期间每日平均接种总数下降了 52.5%。在固定地点接种卡介苗（BCG）的免疫接种下降了 40.6%（958/2360）。在封锁期间，每天约有 8438 名儿童错过免疫接种。农村地区、贫民窟较多的城市分区和脊髓灰质炎高风险超级分区的登记人数下降幅度最大。五联疫苗-3（penta-3）免疫接种率在医院出生的婴儿中更高（RR：1.09；95%CI：1.04-1.15）和母亲受教育程度较高的婴儿中更高（RR：1.19-1.50；95%CI：1.13-1.65）。入组免疫规划每延迟一周，penta-3 免疫接种的可能性降低 5%。
信德省每两个儿童中就有一个在省级 COVID-19 封锁期间错过了常规疫苗接种。在封锁期间，未免疫儿童的人数不断增加，使他们容易感染疫苗可预防的疾病。需要采取有针对性的干预措施，以促进免疫接种和安全服务的提供。较高的母亲教育程度、在医疗机构出生和尽早入组免疫规划继续与免疫接种率呈正相关，即使在具有挑战性的封锁期间也是如此。
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