Chakrabarti Averi, Bair Elizabeth F, Thirumurthy Harsha
American Institutes for Research, 201 Jones Road, Suite 100, Waltham, MA, 02451, USA.
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Blockley Hall, Philadelphia, PA, 19104-4884, USA.
SSM Popul Health. 2023 Jun;22:101383. doi: 10.1016/j.ssmph.2023.101383. Epub 2023 Mar 15.
Disruptions in health service delivery and utilization during the COVID-19 pandemic may have caused many children worldwide to not receive vital preventative health services. We investigate the pandemic's effects on routine childhood vaccinations in India, which has the world's largest child immunization program. Using data from the Government of India's health management information system and interrupted time series analyses, we estimate district-level changes in routine child vaccinations during the pandemic relative to typical monthly vaccinations in the pre-pandemic period. Our results indicate there were significant reductions in child vaccinations during the pandemic, with declines being extremely large in April 2020 when a strict national lockdown was in place. For example, district-level administration of the final required dose in the polio series declined by about 60% in April 2020 relative to the typical monthly vaccination levels observed prior to the pandemic. Vaccinations subsequently increased but largely remained below levels observed before the outbreak of COVID-19. Additional declines in vaccinations occurred in 2021 during the second wave of COVID-19 infections in India. Heterogeneity analyses suggest that vaccinations declined the most in districts with the strictest lockdowns and in districts with low health system capacity at baseline. There is a vital need for corrective actions, such as catch-up vaccination campaigns, to limit the deleterious consequences that will arise for the children who missed routine immunizations during the COVID-19 pandemic.
在新冠疫情期间，医疗服务的提供和利用受到干扰，这可能导致全球许多儿童无法获得至关重要的预防性医疗服务。我们调查了疫情对印度常规儿童疫苗接种的影响，印度拥有全球最大的儿童免疫计划。利用印度政府健康管理信息系统的数据和中断时间序列分析，我们估计了疫情期间各地区常规儿童疫苗接种相对于疫情前典型月度接种量的变化。我们的结果表明，疫情期间儿童疫苗接种显著减少，在2020年4月实施严格的全国封锁时下降幅度极大。例如，2020年4月，脊髓灰质炎系列最后一剂的地区级接种量相对于疫情前观察到的典型月度接种水平下降了约60%。疫苗接种随后有所增加，但大多仍低于新冠疫情爆发前的水平。2021年印度第二波新冠疫情感染期间，疫苗接种量进一步下降。异质性分析表明，在封锁最严格的地区以及基线时卫生系统能力较低的地区，疫苗接种下降幅度最大。迫切需要采取纠正行动，如开展补种疫苗运动，以限制新冠疫情期间错过常规免疫接种的儿童可能产生的有害后果。
