Gindler J S, Cutts F T, Barnett-Antinori M E, Zell E R, Swint E B, Hadler S C, Rullán J V
Division of Immunization, National Center for Prevention Services, Centers for Disease Control, Atlanta, GA 30333.
Pediatrics. 1993 Feb;91(2):315-20.
The objective of this study was to evaluate immunization delivery and determine reasons for low coverage among preschool-age public clinic attendees in Puerto Rico. In 25 randomly selected clinics, coverage and missed immunization opportunities were assessed in 273 children aged 2 to 59 months, exist interviews were conducted with parents, and providers were interviewed. Two neighborhoods close to the clinics were surveyed to determine parental knowledge about immunizations, and the vaccination status of children in these neighborhoods was assessed. Two hundred seventy-three clinic attendees were interviewed. Among 229 (84%) with vaccination cards, only 126 (55%) had received all indicated vaccines by completion of the clinic visit. Forty-five percent of children with cards in the household survey were not up-to-date. Of 171 (75%) clinic attendees eligible for vaccination at the visit, 118 (69%) missed one or more immunizations at the visit. In addition, half of all children had previously missed one or more immunizations when they had received another vaccine. Missed opportunities occurred because of nonavailability of vaccines, lack of integration of services, provider misconceptions about contraindications, and failure to administer vaccines simultaneously. Other problems included barriers to immunization services and lack of information and education activities. It is concluded that deficiencies in immunization delivery substantially delay immunization and reduce coverage.
本研究的目的是评估波多黎各公立诊所学龄前就诊儿童的免疫接种情况，并确定接种率低的原因。在随机选取的25家诊所中，对273名年龄在2至59个月的儿童的接种情况和错过的免疫接种机会进行了评估，与家长进行了现场访谈，并对医护人员进行了访谈。对诊所附近的两个社区进行了调查，以确定家长对免疫接种的了解情况，并评估这些社区儿童的疫苗接种状况。对273名诊所就诊儿童进行了访谈。在229名（84%）有疫苗接种卡的儿童中，只有126名（55%）在完成诊所就诊时接种了所有指定疫苗。在家庭调查中有接种卡的儿童中，45%未按时接种疫苗。在171名（75%）就诊时符合接种条件的诊所就诊儿童中，118名（69%）在就诊时错过一次或多次免疫接种。此外，所有儿童中有一半在接种其他疫苗时曾错过一次或多次免疫接种。错过免疫接种机会的原因包括疫苗供应不足、服务整合不足、医护人员对禁忌证的误解以及未能同时接种多种疫苗。其他问题包括免疫接种服务的障碍以及缺乏信息和教育活动。研究得出结论，免疫接种服务的不足严重延迟了免疫接种并降低了接种率。
