Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA; Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA.
Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA; NoviSci, Durham, North, Carolina, USA.
Vaccine. 2024 Aug 30;42(21):126179. doi: 10.1016/j.vaccine.2024.126179. Epub 2024 Aug 7.
The Advisory Committee on Immunization Practices (ACIP) recommends early childhood vaccinations, but knowledge is limited about the magnitude and timing of vaccine delay for each recommended dose on a population level. We sought to characterize longitudinal patient-level patterns of early childhood vaccination schedule adherence.
Using the Merative MarketScan Commercial Database (2009-2019), we identified commercially-insured infants who received at least one timely dose of a 2-month recommended vaccine. We categorized the number of recommended vaccines administered on the same date at 2, 4, 6, and 12-15 months of age (grace period: -7, +21 days). A Sankey diagram illustrated the number of vaccines received concomitantly during each age window and depicted transitions to different states over time (e.g., no vaccine delay to vaccine delay). For each vaccine dose, we estimated the cumulative incidence of receipt.
Among 1,239,364 eligible children, 28% of infants aged 4 months and 38% of infants aged 6 months did not receive timely, concomitant administration of all recommended vaccines. The number of timely vaccines received concomitantly and age at receipt varied most for doses recommended during the second year of life. Children with a previously delayed (versus timely) dose consistently experienced longer time to subsequent dose.
National coverage improved over time for all recommended vaccine doses under study, most notably for measles, mumps, and rubella. However, many children do not receive vaccines on schedule. Interventions to maintain adherence to the recommended schedule are needed early in life.
免疫实践咨询委员会（ACIP）建议进行儿童期疫苗接种，但关于在人群水平上每剂推荐疫苗的延迟程度和时间，人们的了解有限。我们试图描述儿童早期疫苗接种计划依从性的纵向患者水平模式。
使用 Merative MarketScan 商业数据库（2009-2019 年），我们确定了至少接受一剂推荐的 2 个月疫苗的商业保险婴儿。我们将在 2、4、6 和 12-15 个月（宽限期：-7、+21 天）龄同日接种的推荐疫苗数量分类。桑基图说明了每个年龄窗口同时接种的疫苗数量，并描绘了随时间推移向不同状态的转变（例如，从无疫苗延迟到疫苗延迟）。对于每种疫苗剂量，我们估计了接种的累积发生率。
在 1,239,364 名合格儿童中，4 月龄婴儿中有 28%，6 月龄婴儿中有 38%未及时同时接种所有推荐疫苗。同时接种的及时疫苗数量和接种年龄因第二年推荐的疫苗剂量而异最大。先前延迟（而非及时）剂量的儿童始终会经历更长的时间才能接受后续剂量。
随着时间的推移，所有研究推荐疫苗剂量的国家覆盖率都有所提高，麻疹、腮腺炎和风疹疫苗的覆盖率提高最为显著。然而，许多儿童未能按时接种疫苗。需要在生命早期采取措施来维持对推荐时间表的遵守。
