Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America.
Bull World Health Organ. 2024 Apr 1;102(4):276-287. doi: 10.2471/BLT.23.290129. Epub 2024 Feb 29.
To quantify the association between reduction in child mortality and routine immunization across 204 countries and territories from 1990 to 2019.
We used child mortality and vaccine coverage data from the Global Burden of Disease Study. We used a modified child survival framework and applied a mixed-effects regression model to estimate the reduction in deaths in children younger than 5 years associated with eight vaccines.
Between 1990 and 2019, the diphtheria-tetanus-pertussis (DTP), measles, rotavirus and type b vaccines were significantly associated with an estimated 86.9 (95% confidence interval, CI: 57.2 to 132.4) million fewer deaths in children younger than 5 years worldwide. This decrease represented a 24.2% (95% CI: 19.8 to 28.9) reduction in deaths relative to a scenario without vaccines. The DTP and measles vaccines averted 46.7 (95% CI: 30.0 to 72.7) million and 37.9 (95% CI: 25.4 to 56.8) million deaths, respectively. Of the total reduction in child mortality associated with vaccines, 84.2% (95% CI: 83.0 to 85.1) occurred in 73 countries supported by Gavi, the Vaccine Alliance, with an estimated 45.4 (95% CI: 29.8 to 69.2) million fewer deaths from 2000 to 2019. The largest reductions in deaths associated with these four vaccines were in India, China, Ethiopia, Pakistan and Bangladesh (in order of the size of reduction).
Vaccines continue to reduce childhood mortality significantly, especially in Gavi-supported countries, emphasizing the need for increased investment in routine immunization programmes.
量化 1990 年至 2019 年期间 204 个国家和地区儿童死亡率下降与常规免疫接种之间的关联。
我们使用全球疾病负担研究中的儿童死亡率和疫苗覆盖率数据。我们使用改良的儿童生存框架，并应用混合效应回归模型估计与八种疫苗相关的 5 岁以下儿童死亡人数减少。
1990 年至 2019 年间，白喉、破伤风、百日咳（DTP）、麻疹、轮状病毒和乙型肝炎疫苗与全球 5 岁以下儿童估计减少 8690 万死亡人数显著相关。与没有疫苗的情况下相比，这一降幅代表了死亡率下降 24.2%（95%置信区间：19.8%至 28.9%）。DTP 和麻疹疫苗分别避免了 4670 万（95%置信区间：3000 万至 7270 万）和 3790 万（95%置信区间：2540 万至 5680 万）死亡。与疫苗相关的儿童死亡率总降幅中，84.2%（95%置信区间：83.0%至 85.1%）发生在受全球疫苗免疫联盟（Gavi）支持的 73 个国家，估计 2000 年至 2019 年期间有 4540 万死亡人数减少。这些四种疫苗相关死亡人数降幅最大的国家是印度、中国、埃塞俄比亚、巴基斯坦和孟加拉国（按降幅大小排序）。
疫苗继续显著降低儿童死亡率，特别是在受 Gavi 支持的国家，这强调了增加对常规免疫规划投资的必要性。
