Bisset Kate, Chisnall Georgia, Campbell Colin N J, Saliba Vanessa, Mounier-Jack Sandra, Chantler Tracey
London School of Hygiene and Tropical Medicine, London, UK.
UK Health Security Agency, London, UK.
BMC Public Health. 2025 Aug 18;25(1):2821. doi: 10.1186/s12889-025-23859-x.
The neonatal Bacillus Calmette-Guérin (BCG) selective vaccination pathway in England was revised in September 2021 due to the introduction of a national evaluation of newborn screening for Severe Combined Immunodeficiency (SCID). BCG is a live attenuated vaccine that is contraindicated in infants with SCID, hence BCG vaccination was moved from soon after birth to after SCID results were available, typically at 14-17 days. The transition also shifted vaccination delivery from maternity units to community clinics, raising concerns about potential barriers to access and lower vaccine uptake. This study explored parents' experiences of navigating the new neonatal BCG vaccination pathway and identified access barriers and enablers.
A qualitative study was conducted involving semi-structured interviews with 30 parents of infants eligible (or invited) for BCG vaccination in two urban areas where SCID screening was implemented. Participants were recruited through vaccine providers and community centres. Thematic analysis of interview transcripts was conducted using the 'Framework Method', incorporating an inductive approach.
Parents were unaware of SCID screening and the changes to the neonatal BCG vaccination schedule and encountered diverse challenges in accessing the vaccine. Assessment errors led to eligibility confusion, with some ineligible infants receiving vaccine invitations. Many parents first learned about BCG vaccination on the postnatal ward, describing it as a "surprise vaccine," with limited antenatal discussion diminishing informed decision-making. Appointment notification systems were inconsistent, with some parents receiving short-notice invitations or no notification at all. Physical access barriers included unfamiliar and distant clinic locations, transport, and the physical challenges of traveling soon after birth with a newborn. Parents with limited social support or financial constraints faced additional difficulties.
Parents were generally accepting of the need to amend the BCG timeline on account of SCID screening; however, we identified distinct accessibility concerns that varied from those associated with the routine immunisation programme. These barriers, and the separateness of the BCG programme from routine services, impacted parental experiences and vaccine uptake. Addressing these challenges is important to meet neonatal BCG uptake targets and support tuberculosis prevention efforts in England.
由于英国引入了对严重联合免疫缺陷（SCID）新生儿筛查的全国性评估，2021年9月对新生儿卡介苗（BCG）选择性接种途径进行了修订。卡介苗是一种减毒活疫苗，SCID婴儿禁忌接种，因此卡介苗接种从出生后不久推迟到SCID检测结果出来之后，通常是在14至17天。这一转变还将接种地点从产科病房转移到了社区诊所，引发了对潜在获取障碍和疫苗接种率降低的担忧。本研究探讨了父母在新的新生儿卡介苗接种途径中的经历，并确定了获取障碍和促进因素。
在实施SCID筛查的两个城市地区，对30名符合（或受邀）接种卡介苗的婴儿的父母进行了半结构化访谈，开展了一项定性研究。参与者通过疫苗供应商和社区中心招募。使用“框架法”对访谈记录进行主题分析，采用归纳法。
父母对SCID筛查以及新生儿卡介苗接种时间表的变化并不知晓，在获取疫苗方面遇到了各种挑战。评估错误导致资格认定混乱，一些不符合条件的婴儿收到了疫苗接种邀请。许多父母是在产后病房首次得知卡介苗接种的，将其描述为“意外疫苗”，产前讨论有限，削弱了知情决策。预约通知系统不一致，一些父母收到的是短时间通知邀请，或者根本没有收到通知。实际获取障碍包括诊所地点不熟悉且距离远、交通问题，以及产后不久带着新生儿出行的身体困难。社会支持有限或经济拮据的父母面临更多困难。
父母普遍认可因SCID筛查而修改卡介苗接种时间线的必要性；然而，我们发现了与常规免疫计划相关的不同的明显获取问题。这些障碍以及卡介苗计划与常规服务的分离，影响了父母的体验和疫苗接种率。应对这些挑战对于实现英国新生儿卡介苗接种目标和支持结核病预防工作至关重要。
