Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.
Department of Economics, FLAME University, Pune, India.
JAMA Netw Open. 2023 Feb 1;6(2):e2254919. doi: 10.1001/jamanetworkopen.2022.54919.
Children who do not receive any routine vaccinations (ie, who have 0-dose status) are at elevated risk of death, morbidity, and socioeconomic vulnerabilities that limit their development over the life course. India has the world's highest number of children with 0-dose status; analysis of national and subnational patterns is the first important step to addressing this problem.
To examine the patterns among children with 0-dose immunization status across all 36 states and union territories (UTs) in India over 29 years, from 1993 to 2021, and to elucidate the relative share of multiple geographic regions in the total geographic variation in 0-dose immunization.
DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study analyzed all 5 rounds of India's National Family Health Survey (1992-1993, 1998-1999, 2005-2006, 2015-2016, and 2019-2021) to compare the prevalence of children with 0-dose status across time-space and geographic regions. The Integrated Public Use of Microdata Series was used to construct comparable geographic boundaries for states and UTs across surveys. The study included a total of 125 619 live children aged 12 to 23 months who were born to participating women.
The outcome was a binary indicator of children's 0-dose vaccination status, coded as children aged 12 to 23 months at the time of the survey who had not received the first dose of the diphtheria-tetanus-pertussis-containing vaccine. The significance of each geographic unit was computed using the variance partition coefficient (VPC).
Among 125 619 children, the national prevalence of those with 0-dose status in India decreased from 33.4% (95% CI, 32.5%-34.2%) in 1993 to 6.6% (95% CI, 6.4%-6.8%) in 2021. A substantial reduction in the IQR of 0-dose prevalence across states from 30.1% in 1993 to 3.1% in 2021 suggested a convergence in state disparities. The prevalence in the northeastern states of Meghalaya (17.0%), Nagaland (16.1%), Mizoram (14.3%), and Arunachal Pradesh (12.6%) remained relatively high in 2021. Prevalence increased between 2016 and 2021 in 10 states, including several traditionally high-performing states and UTs, such as Telangana (1.16 percentage points) and Sikkim (0.92 percentage points). In 2021, 53.0% of children with 0-dose status resided in the populous states of Uttar Pradesh, Bihar, and Maharashtra. A multilevel analysis comparing the share of variation at the state, district, and cluster (primary sampling unit) levels revealed that clusters accounted for the highest share of the total variation in 2016 (44.7%; VPC [SE], 1.04 [0.32]) and 2021 (64.3%; VPC [SE], 0.38 [0.12]).
In this cross-sectional study, findings from approximately 3 decades of analysis suggest the need for sustained efforts to target populous states like Uttar Pradesh and Bihar and northeastern parts of India. The resurgence of 0-dose prevalence in 10 states highlights the importance of programs like Intensified Mission Indradhanush 4.0, a major national initiative to improve immunization coverage. Prioritizing small administrative units will be important to strengthening India's efforts to bring every child into the immunization regime.
未接受任何常规疫苗接种的儿童（即零剂量接种）面临更高的死亡风险、患病风险和社会经济脆弱性，这些风险会限制他们在整个生命过程中的发展。印度是全球零剂量接种儿童数量最多的国家；分析国家和次国家模式是解决这一问题的第一步。
分析 1993 年至 2021 年 29 年间印度所有 36 个邦和联邦属地（UT）中 0 剂量免疫接种状况的儿童模式，并阐明多个地理区域在总 0 剂量免疫接种地理变异中的相对份额。
设计、地点和参与者：这是一项重复的横断面研究，分析了印度国家家庭健康调查的所有 5 轮（1992-1993 年、1998-1999 年、2005-2006 年、2015-2016 年和 2019-2021 年），以比较不同时空和地理区域儿童零剂量接种状况的流行率。综合公共使用微观数据系列被用于为各州和 UT 构建可比的地理边界。研究共包括 125619 名 12 至 23 个月大的活产儿童，他们是参加调查的妇女所生。
结局是儿童零剂量疫苗接种状况的二项指标，编码为在调查时 12 至 23 个月大且未接受含白喉、破伤风、百日咳疫苗第一剂的儿童。每个地理单位的显著性使用方差分量系数（VPC）计算。
在 125619 名儿童中，印度儿童零剂量接种率从 1993 年的 33.4%（95%CI，32.5%-34.2%）下降到 2021 年的 6.6%（95%CI，6.4%-6.8%）。从 1993 年的 30.1%到 2021 年的 3.1%，各州 0 剂量接种率的 IQR 大幅降低，表明各州之间的差距正在缩小。东北部的 Meghalaya（17.0%）、Nagaland（16.1%）、Mizoram（14.3%）和 Arunachal Pradesh（12.6%）的患病率在 2021 年仍相对较高。在 2016 年至 2021 年期间，包括 Telangana（1.16 个百分点）和 Sikkim（0.92 个百分点）在内的 10 个州的患病率有所上升。2021 年，53.0%的零剂量接种儿童居住在人口众多的北方邦、比哈尔邦和马哈拉施特拉邦。在比较州、地区和聚类（初级抽样单位）水平上的份额变异的多水平分析中，发现聚类在 2016 年（44.7%；VPC[SE]，1.04[0.32]）和 2021 年（64.3%；VPC[SE]，0.38[0.12]）的总变异中占比最高。
在这项横断面研究中，大约 30 年的分析结果表明，需要持续努力针对北方邦和比哈尔邦等人口众多的邦和印度东北部地区。10 个州的零剂量接种率回升突出了像 Intensified Mission Indradhanush 4.0 这样的项目的重要性，这是一个提高免疫接种覆盖率的重大国家倡议。优先考虑小的行政单位对于加强印度将每个儿童纳入免疫计划的努力将是重要的。
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