Dietz V J, Stevenson J, Zell E R, Cochi S, Hadler S, Eddins D
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA.
Arch Pediatr Adolesc Med. 1994 Sep;148(9):943-9. doi: 10.1001/archpedi.1994.02170090057008.
Retrospective immunization coverage surveys conducted during 1991 and 1992 demonstrated that coverage levels for the routine childhood vaccines by 24 months of age in selected urban areas of the United States ranged from 10% to 52%, far below the US Public Health Service goal of 90%. Therefore, appropriate programmatic changes must be identified and incorporated.
We analyzed coverage survey data collected from 21 sites to measure the potential impact on coverage levels of implementing selected changes in vaccination practices. In a multistaged cluster survey design, school health records of kindergarten or first-grade students were randomly selected and dates of vaccination assessed. We evaluated changes in the vaccination practices, such as eliminating missed opportunities for simultaneous administration of vaccines and ensuring that children initiated the vaccination series on time (ie, by 3 months of age). We then calculated potential increases in coverage levels for a best-case scenario.
From 77% to 96% of all children in the 21 sites had received at least one vaccination by their first birthday. Children were 2.3 to 17 times more likely to be up to date on their vaccinations by 24 months of age if they were up to date at 3 months of age. Each child had many opportunities for the simultaneous administration of diphtheria and tetanus toxoids and pertussis (DTP) vaccine, oral polio vaccine (OPV), and measles-mumps-rubella (MMR) vaccine that, if used appropriately, could have potentially raised coverage levels by 12% to 22% (median, 17%). The highest coverage levels could have been attained if all children had started the series on time and if advantage had been taken of all opportunities for simultaneous vaccination. Coverage levels for four doses of DTP vaccine, three doses of OPV, and one dose of MMR vaccine would have increased from a baseline of 10% to 52% to levels of 54% to 83%.
Although the majority of children received a vaccination by their first birthday, the coverage level at 24 months of age was low. Tracking systems are needed to ensure that children do not drop out of the system once they have begun the vaccination series. In addition, all children who are late in beginning their vaccination series are at increased risk of not completing the recommended vaccination series on time, and these children need intensive follow-up and recall efforts. Also, providers need to administer all needed vaccines simultaneously.
1991年和1992年进行的回顾性免疫接种覆盖率调查表明，在美国部分城市地区，24月龄儿童的常规儿童疫苗接种覆盖率在10%至52%之间，远低于美国公共卫生服务部门设定的90%的目标。因此，必须确定并纳入适当的计划变更。
我们分析了从21个地点收集的覆盖率调查数据，以衡量实施特定疫苗接种实践变更对覆盖率的潜在影响。在多阶段整群调查设计中，随机选择幼儿园或一年级学生的学校健康记录，并评估接种日期。我们评估了疫苗接种实践的变化，例如消除同时接种疫苗的错失机会，并确保儿童按时（即3月龄前）开始接种疫苗系列。然后，我们计算了最佳情况下覆盖率的潜在提高。
在21个地点，77%至96%的儿童在一岁生日前至少接种了一剂疫苗。如果儿童在3月龄时按时接种，那么到24月龄时按时接种疫苗的可能性要高出2.3至17倍。每个儿童都有很多机会同时接种白喉破伤风类毒素和百日咳（DTP）疫苗、口服脊髓灰质炎疫苗（OPV）以及麻疹-腮腺炎-风疹（MMR）疫苗，如果合理利用这些机会，有可能使覆盖率提高12%至22%（中位数为17%）。如果所有儿童都按时开始接种系列疫苗，并利用所有同时接种疫苗的机会，就可以达到最高的覆盖率。四剂DTP疫苗、三剂OPV疫苗和一剂MMR疫苗的覆盖率将从10%至52%的基线水平提高到54%至83%。
虽然大多数儿童在一岁生日前接种了疫苗，但24月龄时的覆盖率较低。需要跟踪系统来确保儿童一旦开始接种系列疫苗就不会退出该系统。此外，所有开始接种系列疫苗较晚的儿童不能按时完成推荐接种系列的风险都会增加，这些儿童需要加强随访和召回工作。此外，接种人员需要同时接种所有需要的疫苗。
