新冠疫情期间的疫苗接种情况及国家以下层面的不平等：对12个低收入和中等收入国家行政数据的中断时间序列分析
Vaccination Utilization and Subnational Inequities during the COVID-19 Pandemic: An Interrupted Time-Series Analysis of Administrative Data across 12 Low- and Middle-Income Countries.
作者信息
Mwinnyaa George, Peters Michael A, Shapira Gil, Neill Rachel, Sadat Husnia, Yuma Sylvain, Akilimali Pierre, Hossain Shahadat, Wendrad Naod, Atiwoto Wisdom K, Ofosu Anthony Adofo, Alfred Jean Patrick, Kiarie Helen, Wesseh Chea Sanford, Isokpunwu Chris, Kangbai Desmond Maada, Mohamed Abdifatah Ahmed, Sidibe Kadidja, Drouard Salome', Fernandez Pablo Amor, Azais Viviane, Hashemi Tawab, Hansen Peter M, Ahmed Tashrik
机构信息
The Global Financing Facility for Women, Children, and Adolescents, Washington, DC 1818, USA.
The World Bank, Washington, DC 20433, USA.
出版信息
Vaccines (Basel). 2023 Aug 24;11(9):1415. doi: 10.3390/vaccines11091415.
BACKGROUND
During and after the SARS-CoV-2 (COVID-19) pandemic, many countries experienced declines in immunization that have not fully recovered to pre-pandemic levels. This study uses routine health facility immunization data to estimate variability between and within countries in post-pandemic immunization service recovery for BCG, DPT1, and DPT3.
METHODS
After adjusting for data reporting completeness and outliers, interrupted time series regression was used to estimate the expected immunization service volume for each subnational unit, using an interruption point of March 2020. We assessed and compared the percent deviation of observed immunizations from the expected service volume for March 2020 between and within countries.
RESULTS
Six countries experienced significant service volume declines for at least one vaccine as of October 2022. The shortfall in BCG service volume was ~6% (95% CI -1.2%, -9.8%) in Guinea and ~19% (95% CI -16%, 22%) in Liberia. Significant cumulative shortfalls in DPT1 service volume are observed in Afghanistan (-4%, 95% CI -1%, -7%), Ghana (-3%, 95% CI -1%, -5%), Haiti (-7%, 95% CI -1%, -12%), and Kenya (-3%, 95% CI -1%, -4%). Afghanistan has the highest percentage of subnational units reporting a shortfall of 5% or higher in DPT1 service volume (85% in 2021 Q1 and 79% in 2020 Q4), followed by Bangladesh (2020 Q1, 83%), Haiti (80% in 2020 Q2), and Ghana (2022 Q2, 75%). All subnational units in Bangladesh experienced a 5% or higher shortfall in DPT3 service volume in the second quarter of 2020. In Haiti, 80% of the subnational units experienced a 5% or higher reduction in DPT3 service volume in the second quarter of 2020 and the third quarter of 2022.
CONCLUSIONS
At least one region in every country has a significantly lower-than-expected post-pandemic cumulative volume for at least one of the three vaccines. Subnational monitoring of immunization service volumes using disaggregated routine health facility information data should be conducted routinely to target the limited vaccination resources to subnational units with the highest inequities.
背景
在严重急性呼吸综合征冠状病毒2（SARS-CoV-2，即新冠病毒）大流行期间及之后，许多国家的免疫接种率出现下降，且尚未完全恢复到大流行前的水平。本研究利用常规卫生机构免疫接种数据，估计各国之间以及各国内部在大流行后卡介苗、百白破疫苗第一剂（DPT1）和百白破疫苗第三剂（DPT3）免疫服务恢复情况的差异。
方法
在对数据报告完整性和异常值进行调整后，采用中断时间序列回归法，以2020年3月为中断点，估计每个次国家级单位的预期免疫服务量。我们评估并比较了各国之间以及各国内部2020年3月观察到的免疫接种量与预期服务量的偏差百分比。
结果
截至2022年10月，六个国家至少有一种疫苗的服务量出现显著下降。几内亚卡介苗服务量短缺约6%（95%置信区间为-1.2%，-9.8%），利比里亚约为19%（95%置信区间为-16%，-22%）。在阿富汗（-4%，95%置信区间为-1%，-7%）、加纳（-3%，95%置信区间为-1%，-5%）、海地（-7%，95%置信区间为-1%，-12%）和肯尼亚（-3%，95%置信区间为-1%，-4%）观察到百白破疫苗第一剂服务量存在显著的累计短缺。在报告百白破疫苗第一剂服务量短缺5%或更高的次国家级单位中，阿富汗的占比最高（2021年第一季度为85%，2020年第四季度为79%），其次是孟加拉国（2020年第一季度，83%）、海地（2020年第二季度，80%）和加纳（2022年第二季度，75%）。2020年第二季度，孟加拉国所有次国家级单位的百白破疫苗第三剂服务量短缺均达到5%或更高。在海地，80%的次国家级单位在2020年第二季度和2022年第三季度百白破疫苗第三剂服务量减少了5%或更多。
结论
每个国家至少有一个地区的三种疫苗中至少有一种在大流行后的累计接种量显著低于预期。应定期利用常规卫生机构信息数据的细分数据对次国家级单位的免疫服务量进行监测，以便将有限的疫苗接种资源投向不公平程度最高的次国家级单位。
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