Atkinson S J, Cheyne J
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, England.
Bull World Health Organ. 1994;72(2):183-94.
In the past, immunization programmes have focused primarily on rural areas. However, with the recognition of the increasing numbers of urban poor, it is timely to review urban immunization activities. This update addresses two questions: Is there any need to be concerned about urban immunization and, if so, is more of the same kind of rural EPI activity needed or are there specific urban issues that need specific urban strategies? Vaccine-preventable diseases have specific urban patterns that require efficacious vaccines for younger children, higher target coverage levels, and particular focus to ensure national and global eradication of poliomyelitis. Although aggregate coverage levels are higher in urban than rural areas, gaps are masked since capital cities are better covered than other urban areas and the coverage in the poorest slum and periurban areas within cities is as bad as or worse than that in rural areas. Difficult access to immunization services in terms of distance, costs, and time can still be the main barrier in some parts of the city. Mobilization and motivation strategies in urban areas should make use of the mass media and workplace networks as well as the traditional word-of-mouth strategies. Use of community health workers has been successful in some urban settings. Management issues concern integration of the needs of the poor into a coherent city health plan, coordination of different health providers, and clear lines of responsibility for addressing the needs of new, urbanizing areas.
过去，免疫规划主要侧重于农村地区。然而，随着认识到城市贫困人口数量不断增加，对城市免疫活动进行审查恰逢其时。本次更新涉及两个问题：是否有必要关注城市免疫，如果有必要，是否需要更多与农村扩大免疫规划（EPI）相同类型的活动，还是存在需要特定城市策略来解决的特定城市问题？疫苗可预防疾病在城市有特定模式，这需要为年幼儿童提供有效的疫苗、更高的目标覆盖率，并特别注重确保在国家和全球范围内根除脊髓灰质炎。虽然城市的总体覆盖率高于农村地区，但由于首都城市的覆盖率高于其他城市地区，掩盖了差距，而且城市中最贫困的贫民窟和城市周边地区的覆盖率与农村地区一样差或更差。在距离、成本和时间方面难以获得免疫服务，在城市的一些地区仍然可能是主要障碍。城市地区的动员和激励策略应利用大众媒体、工作场所网络以及传统的口碑策略。在一些城市环境中，利用社区卫生工作者已取得成功。管理问题涉及将贫困人口的需求纳入连贯的城市卫生计划、协调不同的卫生服务提供者，以及明确应对新城市化地区需求的责任分工。
