Eurich Dean T, Weaver Olivia, McDermott Cathleen, Soprovich Allison, Wozniak Lisa A, Woytas Beth, Sarin Chris, Bilinsky Lauren, Thiara Parminder, O'Brien Celine, Bill Lea, Crowshoe Lynden, Senthilselvan Ambikaipakan, Samanani Salim
School of Public Health, University of Alberta, Edmonton, Alberta 26E 2G1, Canada.
School of Public Health, University of Alberta, Edmonton, Alberta 26E 2G1, Canada.
Vaccine. 2025 Jan 25;45:126614. doi: 10.1016/j.vaccine.2024.126614. Epub 2024 Dec 18.
COVID-19 profoundly impacted First Nation peoples. Historically, records of on- and off-reserve vaccine delivery have been fragmented. For the first time in Canada, we aimed to describe complete immunization rates, on- and off-reserve vaccine delivery, for COVID-19 in Alberta, Canada among First Nations on-reserve.
Fifteen First Nations in Alberta, Canada participated in this prospective, descriptive cohort study whereby real-time integration (RTI) was deployed to reconcile COVID-19 vaccine delivery records on-reserve (local database) to those reported off-reserve (provincial database) between January 3, 2021-December 1, 2022. Immunization data (individuals ≥ 6 months) were aggregated into 100 one-week intervals. Weekly immunization rates were assessed by age, sex, community size, and location of vaccine administration (on- or off-reserve) using multiple linear regressions and chi2 tests.
50,758 First Nation people were included, approximately 50% of whom were female. RTI data showed that 64% received at least one dose of vaccine with higher rates in older First Nation adults. No sex differences were observed. Nearly half received their first dose off-reserve and would have been missed by local public health on-reserve (local database) without the implementation of RTI. First dose immunization rates rapidly increased with graduated First Nation-specific eligibility and provincial incentives promoting uptake (p < 0.001).
We accurately assessed complete immunization rates among First Nation people receiving services on-reserve irrespective of delivery of immunizations on- or off-reserve through deployment of an innovative RTI approach. Without these RTI advances, immunization rates would have been substantially under-reported and may have misdirected public health initiatives around vaccine uptake. RTI should be a priority for all provinces in Canada to ensure accurate coverage rates for First Nation people.
新冠疫情对原住民产生了深远影响。从历史上看，保留地内外疫苗接种记录一直零散不全。在加拿大，我们首次旨在描述加拿大艾伯塔省原住民保留地内新冠疫苗的全程免疫接种率、保留地内外的疫苗接种情况。
加拿大艾伯塔省的15个原住民部落参与了这项前瞻性描述性队列研究，通过实时整合（RTI）将2021年1月3日至2022年12月1日期间保留地内（本地数据库）的新冠疫苗接种记录与保留地外报告的记录（省级数据库）进行核对。免疫数据（年龄≥6个月的个体）按100个一周间隔进行汇总。使用多元线性回归和卡方检验，按年龄、性别、社区规模和疫苗接种地点（保留地内或外）评估每周的免疫接种率。
纳入了50,758名原住民，其中约50%为女性。实时整合数据显示，64%的人至少接种了一剂疫苗，年长的原住民成年人接种率更高。未观察到性别差异。近一半的人在保留地外接种了第一剂疫苗，如果没有实施实时整合，这些人在保留地内的当地公共卫生记录（本地数据库）中就会被遗漏。随着原住民特定资格的逐步放宽和省级鼓励接种措施的实施，第一剂疫苗接种率迅速上升（p<0.001）。
通过采用创新的实时整合方法，我们准确评估了在保留地接受服务的原住民的全程免疫接种率，无论疫苗接种是在保留地内还是外进行。如果没有这些实时整合方面的进展，免疫接种率可能会被大幅低估，并且可能会误导围绕疫苗接种的公共卫生举措。实时整合应成为加拿大所有省份的优先事项，以确保原住民的准确覆盖率。
