旅行者和旅行疫苗在六个医疗保健系统中的疫苗安全数据链接。
Travelers and travel vaccines at six health care systems in the Vaccine Safety Datalink.
机构信息
Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA.
Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA.
出版信息
Vaccine. 2022 Sep 29;40(41):5904-5911. doi: 10.1016/j.vaccine.2022.08.023. Epub 2022 Sep 3.
BACKGROUND
Studying the safety of travel vaccines poses challenges since recipients may be traveling during the risk window for adverse events and the identification of a suitable comparison group can also be difficult. The examination of traveler characteristics, travel vaccination patterns, and health care utilization using electronic health record (EHR) data can inform the feasibility of future travel vaccine safety studies.
METHODS
A retrospective cohort study of health plan members in the Vaccine Safety Datalink Project aged 9 months and older who had a travel-related encounter or received a travel vaccine from 2009 to 2018 was performed. Travel regions visited, travel duration, type of travel vaccine received (typhoid, yellow fever, Japanese encephalitis, rabies, and cholera), and timing of vaccination date before departure date were described. Sociodemographic information, clinical characteristics, and health care utilization were compared between travelers who received travel vaccines and travelers who did not.
RESULTS
A total of 1,026,822 unique travelers departing from the United States were identified; 612,795 travelers received 898,196 doses of travel vaccines. The most commonly administered travel vaccine was typhoid vaccine and 77% of all travel vaccines were given more than one week prior to departure. Compared with travelers without travel vaccines, travelers with travel vaccines were overall similar but as a group were slightly younger, healthier, and had lower Hispanic representation. Health care utilization dramatically decreased during travel. Outpatient visits decreased from 294.8 visits per 10,000 person-days before travel to 24.2 visits per 10,000 person-days during reported travel dates.
CONCLUSIONS
Through the EHR information from almost a million travelers, a departure date and duration of travel were successfully captured for the majority of travelers with corresponding health care utilization data. Time after vaccination and prior to departure can potentially be used in the future to compare travelers who receive travel vaccines with travelers who do not receive travel vaccines when looking at adverse events of interest after vaccination.
背景
研究旅行疫苗的安全性具有挑战性，因为接种者可能在出现不良反应的风险窗口期内旅行，且难以确定合适的对照组。利用电子健康记录 (EHR) 数据研究旅行者的特征、旅行疫苗接种模式和医疗保健利用情况，可以为未来的旅行疫苗安全性研究提供信息。
方法
本研究采用回顾性队列设计，对 2009 年至 2018 年期间参加疫苗安全数据链接项目、年龄在 9 个月及以上、有旅行相关经历或接种旅行疫苗的健康计划成员进行分析。描述了旅行目的地、旅行持续时间、接种的旅行疫苗类型（伤寒、黄热病、日本脑炎、狂犬病和霍乱）以及疫苗接种日期与出发日期的时间关系。比较了接种旅行疫苗和未接种旅行疫苗的旅行者之间的社会人口统计学信息、临床特征和医疗保健利用情况。
结果
共确定了 1,026,822 名从美国出发的独特旅行者；612,795 名旅行者接种了 898,196 剂旅行疫苗。接种最多的旅行疫苗是伤寒疫苗，77%的旅行疫苗都是在出发前一周以上接种的。与未接种旅行疫苗的旅行者相比，接种旅行疫苗的旅行者总体上相似，但作为一个群体，他们更年轻、更健康，西班牙裔的比例较低。旅行期间医疗保健利用率显著下降。门诊就诊次数从旅行前的每 10,000 人天 294.8 次减少到报告旅行日期的每 10,000 人天 24.2 次。
结论
通过近 100 万名旅行者的 EHR 信息，成功地获取了大多数旅行者的出发日期和旅行持续时间以及相应的医疗保健利用数据。接种疫苗后至出发前的时间将来可能被用于未来的研究，将接种旅行疫苗的旅行者与未接种旅行疫苗的旅行者进行比较，以观察接种疫苗后的不良反应。
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