Blose Ntombifuthi, Amponsah-Dacosta Edina, Kagina Benjamin M, Muloiwa Rudzani
Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Western Cape, South Africa.
Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Western Cape, South Africa.
Vaccine X. 2021 Dec 13;10:100130. doi: 10.1016/j.jvacx.2021.100130. eCollection 2022 Apr.
Adherence to recommended age-specific immunisation schedules is critical in ensuring vaccine effectiveness against vaccine preventable diseases (VPDs). There is limited data on immunisation timeliness in sub-Saharan Africa. Therefore, this study assessed the timeliness of age-specific routine childhood immunisation within the Western Cape Province of South Africa. Participant records (N = 709) from a prospective health-facility based study conducted in Cape Town, SA in 2012-2016 were analysed. The outcome measure was receiving age-specific immunisations ≥4 weeks of that recommended for age as per the South African Expanded Programme on Immunisation (EPI-SA) schedule. Proportions, medians, inter-quartile ranges (IQR) and regression were used to obtain the prevalence, time-at-risk, and risk factors for delayed immunisation. A total of 652 /709 (91.9%) participants were eligible. Immunisation coverage declined with age from 94.9% (95% CI 92.9-96.4) at birth to 72.0% (95% CI 65.7-77.6) at 18 months. The highest delay in the uptake of vaccine doses was observed among the 3 rd dose of the DTP vaccine [163 (34.6% (95% CI 30.3-39.1)], while the lowest was seen among BCG [40 (6.5% (95% CI 4.7-8.8)]. The longest median time-at-risk of VPDs was among the 2 nd dose of the measles vaccine [12.9 (IQR 6.7-38.6) weeks] and the lowest was OPV birth dose [IQR 6.3 (5.3-9.1) weeks]. Low and upper-middle socio-economic quartiles were associated with delayed uptake of vaccine doses. Delayed vaccination increases the time of susceptibility to VPDs during infancy and childhood. There is a need to develop strategies aimed at mitigating factors associated with delay in uptake of routine childhood vaccines in the Western Cape. Mitigation strategies should provide vaccine education and mobile reminder systems. Education about timely vaccine uptake will aid in the provision of informed council from healthcare providers to caregivers. Multiple reminder systems could cater for low network coverage areas and caregivers with busy schedules.
坚持推荐的特定年龄免疫接种计划对于确保疫苗预防疫苗可预防疾病（VPD）的有效性至关重要。撒哈拉以南非洲地区关于免疫及时性的数据有限。因此，本研究评估了南非西开普省特定年龄儿童常规免疫接种的及时性。分析了2012 - 2016年在南非开普敦进行的一项基于前瞻性医疗机构研究的参与者记录（N = 709）。结果指标是按照南非扩大免疫规划（EPI - SA）时间表，在推荐年龄≥4周时接受特定年龄的免疫接种。采用比例、中位数、四分位数间距（IQR）和回归分析来获取延迟免疫接种的患病率、风险时间和风险因素。共有652 / 709（91.9%）名参与者符合条件。免疫接种覆盖率随年龄下降，从出生时的94.9%（95%CI 92.9 - 96.4）降至18个月时的72.0%（95%CI 65.7 - 77.6）。在白喉、破伤风、百日咳疫苗（DTP）第三剂中观察到疫苗接种延迟最高[163例（34.6%（95%CI 30.3 - 39.1）]，而卡介苗（BCG）延迟最低[40例（6.5%（95%CI 4.7 - 8.8）]。VPD风险时间中位数最长的是麻疹疫苗第二剂[12.9（IQR 6.7 - 38.6）周]，最低的是口服脊髓灰质炎疫苗出生剂量[IQR 6.3（5.3 - 9.1）周]。社会经济四分位数中的低和中高阶层与疫苗接种延迟有关。延迟接种疫苗会增加婴儿期和儿童期对VPD易感的时间。有必要制定旨在减轻与西开普省儿童常规疫苗接种延迟相关因素的策略。缓解策略应提供疫苗教育和移动提醒系统。关于及时接种疫苗的教育将有助于医疗保健提供者向护理人员提供明智的建议。多种提醒系统可以满足网络覆盖低的地区以及日程繁忙的护理人员的需求。
