Holt E, Guyer B, Hughart N, Keane V, Vivier P, Ross A, Strobino D
Department of International Health, Maternal and Child Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Pediatrics. 1996 Apr;97(4):474-80.
To determine the community-wide incidence of missed opportunities to vaccinate, to describe the clinical settings in which they occur, and to estimate the impact of missed opportunities on immunization coverage.
We abstracted outpatient medical records from a random, community-based sample of 2-year-old children whose residence was inner-city Baltimore. The date of each vaccine and the date, diagnoses, and temperature at each visit were collected for 502 children at 98 different provider sites.
Missed opportunities to vaccinate and up-to-date vaccination status.
By 24 months of age, 75% of the children had at least one missed opportunity and only 55% were up-to-date for the 4:3:1 series. Missed opportunities occurred at more than one third of eligible visits for each vaccine, including > 20% of preventative care visits. Diagnoses commonly associated with missed opportunities were "well child," otitis media, upper respiratory infection, gastroenteritis, skin infection, and resolving illness. If no missed opportunities had occurred, 73% of the children would have been up-to-date by 24 months.
Missed opportunities occurred commonly at providers serving inner-city children in Baltimore and represent a major factor in underimmunization. Reduction of missed opportunities by accurate screening at all visits and adherence to the contraindication guidelines is a provider-based, low-cost method to increase immunization coverage.
确定社区范围内疫苗接种错失机会的发生率，描述错失机会发生的临床场景，并评估错失机会对免疫接种覆盖率的影响。
我们从居住在巴尔的摩市中心的2岁儿童的随机社区样本中提取门诊病历。收集了98个不同医疗机构中502名儿童每次疫苗接种的日期以及每次就诊的日期、诊断结果和体温。
疫苗接种错失机会和及时接种状态。
到24个月龄时，75%的儿童至少有一次错失机会，对于4:3:1系列疫苗，只有55%的儿童及时接种。每种疫苗在超过三分之一的符合条件的就诊中出现错失机会，包括超过20%的预防性保健就诊。与错失机会通常相关的诊断为“健康儿童”、中耳炎、上呼吸道感染、肠胃炎、皮肤感染和疾病缓解期。如果没有发生错失机会，73%的儿童到24个月时会及时接种。
在为巴尔的摩市中心儿童提供服务的医疗机构中，错失机会普遍存在，是免疫接种不足的一个主要因素。通过在每次就诊时进行准确筛查并遵守禁忌证指南来减少错失机会，是一种基于医疗机构的低成本提高免疫接种覆盖率的方法。
