利用 2 岁龄加强免疫平台来弥补免疫空白：巴基斯坦、菲律宾和南非的 DHS 二次分析。
Use of catch-up vaccinations in the second year of life (2YL) platform to close immunity gaps: A secondary DHS analysis in Pakistan, Philippines, and South Africa.
机构信息
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Biostatistics & Medical Informatics, University of Wisconsin - Madison, WI, USA.
出版信息
Vaccine. 2023 Jan 4;41(1):61-67. doi: 10.1016/j.vaccine.2022.10.040. Epub 2022 Nov 14.
BACKGROUND
Immunity gaps caused by COVID-19-related disruptions highlight the importance of catch-up vaccination. Number of countries offering vaccines in second year of life (2YL) has increased, but use of 2YL for catch-up vaccination has been variable. We assessed pre-pandemic use of 2YL for catch-up vaccination in three countries (Pakistan, the Philippines, and South Africa), based on existence of a 2YL platform (demonstrated by offering second dose of measles-containing vaccine (MCV2) in 2YL), proportion of card availability, and geographical variety.
METHODS
We conducted a secondary data analysis of immunization data from Demographic and Health Surveys (DHS) in Pakistan (2017-2018), the Philippines (2017), and South Africa (2016). We conducted time-to-event analyses for pentavalent vaccine (diphtheria-tetanus-pertussis-Hepatitis B-Haemophilus influenzae type b [Hib]) and MCV and calculated use of 2YL and MCV visits for catch-up vaccination.
RESULTS
Among 24-35-month-olds with documented dates, coverage of third dose of pentavalent vaccine increased in 2YL by 2%, 3%, and 1% in Pakistan, Philippines, and South Africa, respectively. MCV1 coverage increased in 2YL by 5% in Pakistan, 10% in the Philippines, and 3% in South Africa. In Pakistan, among 124 children eligible for catch-up vaccination of pentavalent vaccine at time of a documented MCV visit, 45% received a catch-up dose. In the Philippines, among 381 eligible children, 38% received a pentavalent dose during an MCV visit. In South Africa, 50 children were eligible for a pentavalent vaccine dose before their MCV1 visit, but only 20% received it; none with MCV2.
CONCLUSION
Small to modest vaccine coverage improvements occurred in all three countries through catch-up vaccination in 2YL but many missed opportunities for vaccination continue to occur. Using the 2YL platform can increase coverage and close immunity gaps, but immunization programmes need to change policies, practices, and monitor catch-up vaccination to maximize the potential.
背景
与新冠相关的干扰导致免疫空白凸显了补种疫苗的重要性。提供 2 岁以下儿童疫苗的国家数量有所增加，但补种疫苗的 2 岁以下儿童使用情况存在差异。我们评估了三个国家（巴基斯坦、菲律宾和南非）在大流行前使用 2 岁以下儿童进行补种疫苗的情况，依据是存在 2 岁以下儿童平台（表现为在 2 岁以下儿童提供第二剂麻疹疫苗）、卡片的可获得性比例以及地域多样性。
方法
我们对巴基斯坦（2017-2018 年）、菲律宾（2017 年）和南非（2016 年）的人口与健康调查（DHS）中的免疫数据进行了二次数据分析。我们对五联疫苗（白喉-破伤风-百日咳-乙型肝炎-Hib）和麻疹疫苗进行了生存时间分析，并计算了 2 岁以下儿童和麻疹疫苗就诊的补种疫苗使用情况。
结果
在有记录日期的 24-35 月龄儿童中，巴基斯坦、菲律宾和南非的五联疫苗第三剂覆盖率分别在 2 岁以下儿童中增加了 2%、3%和 1%。巴基斯坦的麻疹疫苗 1 剂覆盖率在 2 岁以下儿童中增加了 5%，菲律宾增加了 10%，南非增加了 3%。在巴基斯坦，在有记录的麻疹疫苗就诊时，124 名符合五联疫苗补种条件的儿童中，有 45%接受了一剂补种。在菲律宾，381 名符合条件的儿童中，有 38%在麻疹疫苗就诊时接种了五联疫苗。在南非，在 MCV1 就诊前，有 50 名儿童有资格接种五联疫苗，但只有 20%的儿童接种了该疫苗；没有一人接种了 MCV2。
结论
所有三个国家都通过在 2 岁以下儿童中进行补种疫苗，实现了小到中等程度的疫苗覆盖率提高，但仍有许多错过的接种机会。利用 2 岁以下儿童平台可以提高覆盖率并缩小免疫空白，但免疫规划需要改变政策、实践，并监测补种疫苗，以充分发挥潜力。
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