利用记录链接估计澳大利亚原住民儿童和有医疗条件风险的儿童的肺炎球菌疫苗接种率。
Estimating pneumococcal vaccine coverage among Australian Indigenous children and children with medically at-risk conditions using record linkage.
机构信息
School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia.
School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
出版信息
Vaccine. 2021 Mar 19;39(12):1727-1735. doi: 10.1016/j.vaccine.2021.02.015. Epub 2021 Feb 20.
BACKGROUND
Risk-based recommendations are common for pneumococcal vaccines but little is known about their uptake. In Australia, pneumococcal conjugate vaccine (PCV) was funded only for Aboriginal or Torres Strait Islander (Indigenous) children and those with underlying medical conditions in 2001, and then there were different booster dose recommendations depending on risk after the introduction of universal PCV vaccination in 2005.
METHODS
We measured coverage of PCV dose 3 and additional PCV and 23-valent pneumococcal polysaccharide vaccine (PPV23) doses by risk group among children born in July 2001-December 2012 in two Australian states using linked immunisation and hospitalisation data (available until December 2013). We ascertained medical risk conditions using hospitalisation diagnosis codes and Indigenous status using an established algorithm, comparing coverage for children born pre (2001-2004) and post (2005-2012) universal PCV funding.
RESULTS
Among 1.3 million children, 63,897 (4.9%) were Indigenous and 32,934 (2.5%) had at least one medically at-risk condition identified by age 6 months. For births in 2001-2004, coverage for PCV dose 3 by 1 year of age was 37% for Indigenous, 15% for medically at-risk and 11% in other children, increasing to 83%, 91% and 92%, respectively for births in 2005-2012. In children with medically at-risk conditions, PCV dose 4 coverage by 2 years was 1% for 2001-2004 births, increasing to 9% for 2005-2012 births, with PPV23 coverage by 6 years 3% in both cohorts. Among eligible Indigenous children, PPV23 coverage by 3 years was 45% for 2001-2004 births and 51% for 2005-2012 births.
CONCLUSIONS
Coverage with additional recommended booster doses was very low among children with medical conditions, and only modest among Indigenous children. If additional PCV doses are recommended for some risk groups, especially in the context of routine schedules with reduced doses (e.g. 2 + 1 and 1 + 1), measures to improve implementation will be required.
背景
肺炎球菌疫苗的推荐通常基于风险，但对于其接种情况却知之甚少。2001 年，澳大利亚只为原住民或托雷斯海峡岛民（土著）儿童以及患有潜在疾病的儿童提供肺炎球菌结合疫苗（PCV），2005 年普及 PCV 疫苗接种后，又根据风险提出了不同的加强剂量建议。
方法
我们利用澳大利亚两个州的免疫接种和住院数据（截至 2013 年 12 月），按风险组测量了 2001 年 7 月至 2012 年 12 月期间出生的儿童的 PCV 剂量 3 和其他 PCV 及 23 价肺炎球菌多糖疫苗（PPV23）接种率。我们通过住院诊断代码确定了医疗风险条件，通过已建立的算法确定了土著身份，并比较了普及 PCV 疫苗接种前（2001-2004 年）和后（2005-2012 年）出生的儿童的接种率。
结果
在 130 万名儿童中，有 63897 名（4.9%）是土著儿童，有 32934 名（2.5%）在 6 个月大时至少有一种通过年龄确定的医疗风险状况。2001-2004 年出生的儿童中，1 岁时 PCV 剂量 3 的接种率分别为土著儿童 37%、有医疗风险儿童 15%、其他儿童 11%，而 2005-2012 年出生的儿童则分别上升至 83%、91%和 92%。在有医疗风险状况的儿童中，2 岁时 PCV 剂量 4 的接种率在 2001-2004 年出生的儿童中为 1%，在 2005-2012 年出生的儿童中则上升至 9%，而在这两组儿童中，6 岁时的 PPV23 接种率分别为 3%。在符合条件的土著儿童中，2001-2004 年出生的儿童中，3 岁时的 PPV23 接种率为 45%，2005-2012 年出生的儿童为 51%。
结论
有医疗状况的儿童中，额外推荐加强剂量的接种率非常低，土著儿童中也只是略有提高。如果为某些风险群体推荐更多的 PCV 剂量，特别是在常规接种计划中减少剂量（如 2+1 和 1+1）的情况下，需要采取措施提高实施率。
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