利用LQAS方法开展疫苗接种率调查的分析

目的：比较厦门市儿童调查疫苗接种率与常规免疫报告接种率的差异,评价调查抽样方法LQAS的优点与缺点。方法采用批质量保证抽样方法（ LQAS）抽取厦门3个乡镇适龄儿童各42名,调查统计儿童疫苗接种情况,并将调查疫苗接种率与中国国家常规免疫监测系统中报告疫苗接种率进行比较。结果3个街道/乡镇调查疫苗接种率均在97.62%以上,报告疫苗接种率均在97.84%以上。思明区鼓浪屿街道与湖里区金山街道调查疫苗接种率与报告疫苗接种率相比无显著性差异,而同安区西柯镇调查疫苗接种率低于报告疫苗接种率。结论 LAQS方法具有快速及便捷优点,适用于大规模接种率调查,并可评价报告接种率质量;但其不能精确估计接种率高低,在解决实际问题的调查中要慎用。在应用时要做好抽样的随机性及调查的质量控制。     

黄冈市国家免疫规划疫苗接种率调查

目的分析黄冈市国家免疫规划疫苗接种率调查情况,评价实施效果。方法全市10个县(市、区)全部参与调查,采用批质量保证抽样方法 (LQAS),每个乡(镇、街道)入户调查42名2~3岁儿童的国家免疫规划疫苗接种情况,采用描述流行病学方法进行分析。结果全市适龄儿童基础免疫疫苗接种率乡镇达标率较高(84.92%以上),加强免疫疫苗接种率乡镇达标率偏低(40.48%以下),特别是新增扩大国家免疫规划疫苗的A群流脑疫苗、乙脑疫苗和甲肝疫苗接种率乡镇达标率较低(76.98%以下),乙肝首针及时接种率乡镇达标率偏低(34.92%),通过疫苗接种率乡镇达标率可以间接反映出疫苗接种率情况。结论黄冈市加强免疫疫苗接种率、新增扩大免疫规划疫苗接种率和乙肝首针及时接种率有待进一步提高。     

上海老年人肺炎疫苗接种情况及影响因素分析

目的:探讨上海老年人肺炎疫苗接种情况及影响因素。方法:通过整群随机抽样方式,将年龄≥60岁且在上海市居住一年以上的老年人作为本次调查对象,采取自制调查问卷方式,调查上海老年人肺炎疫苗接种情况并分析其影响因素。结果:肺炎疫苗接种与受访者自身经济状况和学历有直接关系。结论:卫生行政部门要加强对老年人肺炎防治知识的宣传,提高医学知识普及率。同时对医务人员进行培训,提高疫苗接种率。建议减轻老年人接种疫苗的经济负担,从而令更多老年人接受疫苗接种。     

中山市2019年国家免疫规划疫苗接种率及其影响因素调查

目的 调查中山市儿童国家免疫规划(national immunization program,NIP)疫苗接种率及其影响因素. 方法 采用批质量保证抽样方法在全市24个乡镇各抽取60名1～8岁儿童开展NIP疫苗接种率调查,采用病例对照研究探讨接种率的影响因素. 结果 共调查1 440名儿童.除A群脑膜炎球菌多糖疫苗第2...     

北京市丰台区中小学生流感疫苗接种状况及影响因素

目的分析2015-2016年北京市丰台区部分中小学生流感疫苗接种现状,探讨流感疫苗接种影响因素。方法通过分层整群抽样方法抽取丰台区2 106名中小学生,进行问卷调查,建立多因素Logistic回归模型,分析流感疫苗接种现况及影响因素。结果被调查的中小学生流感疫苗接种率是42.16%;Logistic回归分析显示,家人吸烟及接种流感疫苗是学生接种流感疫苗的影响因素。结论加强宣传,提高家长对流感疫苗的认知度,能够提高中小学生流感疫苗接种率。     

崇左市边境地区儿童免疫规划疫苗预防接种现况调查

目的了解崇左市边境地区儿童免疫规划疫苗预防接种的现况,为进一步完善免疫规划工作策略提供依据。方法采用批质量保证抽样方法,随机抽取崇左市4个边境县(市)43个乡镇215个村的1 806名儿童,入户调查儿童的基本信息、免疫规划疫苗接种率、监护人的预防接种相关知识的知晓等情况。结果调查儿童各种免疫规划疫苗接种率均达95%以上,4个边境县(市)儿童免疫规划疫苗接种率差异均无统计学意义(P0.05),常住儿童和流动儿童的卡介苗、乙肝疫苗全程、脊灰疫苗全程接种率差异无统计学意义(P0.05),流动儿童其余疫苗接种率均低于常住儿童,差异有统计学意义(P0.05),城镇和农村儿童监护人对大部分免疫规划预防接种知晓率存在较大差异(P0.05)。结论崇左市4个边境县(市)儿童免疫规划疫苗接种率保持在较高水平,但边境地区流动儿童预防接种仍是今后工作的重点和难点,需要加强预防接种服务管理和健康教育,才能提高儿童的健康水平。     

医疗卫生人员2019年度流感疫苗接种率和2020年度流感疫苗接种意愿及其影响因素调查

目的了解医疗卫生人员2019年度流感疫苗接种率、2020年度流感疫苗接种意愿及其影响因素。方法采用分层整群抽样方法于2020年11月选取5个省份92所医疗卫生机构的工作人员,开展网络问卷调查,分析2019年度流感疫苗接种率和2020年度流感疫苗接种意愿及其影响因素。结果在8 975名调查对象中,2019年度流感疫苗接种率、2020年度流感疫苗接种意愿率分别为24.97%、70.23%。Logistic回归分析显示,地区、年龄、文化程度、工作单位、职称、收入是影响调查对象2019年度流感疫苗接种的因素;地区、文化程度、工作单位、职称、收入、基础疾病、新型冠状病毒肺炎认知、2019年度流感疫苗接种史是影响调查对象2020年度流感疫苗接种意愿的因素。结论医疗卫生人员2019年度流感疫苗接种率低,但因新型冠状病毒肺炎疫情,2020年度流感疫苗接种意愿较高;需加强医疗卫生人员流感相关知识培训和疫苗接种工作。     

2013年广西免疫规划疫苗接种率调查分析

目的了解广西实施扩大国家免疫规划后免疫规划疫苗接种现状。方法采用批质量保证抽样方法(LQAS),随机抽取广西34个乡镇、170个村的1 428名2~3岁目标儿童,入户调查儿童免疫规划疫苗接种情况。结果广西各种免疫规划疫苗的接种率均95%。不同年龄组及不同性别儿童的免疫规划疫苗接种率无差别。17.65%的乡镇有≥1剂次的免疫规划疫苗接种率90%。儿童未接种免疫规划疫苗的主要原因是"不知道需要接种(或监护人忘记接种疫苗)"、"孩子生病"和"父母太忙,家中无人带孩子去接种"。结论广西免疫规划疫苗接种率总体保持较高水平,但局部地区接种率未达到国家要求。     

Excel在免疫规划疫苗接种率抽样调查中的应用

目的探讨Excel在免疫规划疫苗接种率抽样调查与数据统计中的应用。方法以组群抽样法为例,使用Excel建立工作表,应用Excel函数进行组群抽样和接种率调查数据的统计与分析。结果用Excel进行随机抽样确定调查单位,方法简捷直观。应用Excel可以提高调查数据录入质量和统计结果准确性,进行疫苗接种情况判定、调查数据统计、不合格与未接种原因分析、接种率相关因素分析等,提高调查信息的利用价值。结论 Excel可以快速完成免疫规划疫苗接种率的随机抽样和调查数据统计与分析。     

重庆市进城务工者乙肝疫苗接种情况及影响因素分析

目的 了解重庆市进城务工者乙肝疫苗接种情况及其影响因素。方法 采用目的性抽样的方法,调查重庆市主城区不同行业、18岁及以上的进城务工者1188名。结果 重庆市进城务工者乙肝疫苗接种率为51.09%,其中男性、女性疫苗接种率分别为50.21%和51.66%。随着研究对象年龄的增高,疫苗接种水平相对下降（OR=0.97,95%CI:0.95～0.98）;文化程度为高中（OR=1.42,95%CI:1.07～1.89）和大专及以上者（OR=1.80,95%CI:1.21～2.67）疫苗接种水平高于初中及以下者;未婚有恋人/已婚者（OR=2.00,95%CI:1.47～2.74）乙肝疫苗接种水平高于单身者。结论 重庆市进城务工者乙肝疫苗接种水平尚可。应加强对进城务工者的乙肝知识宣教和接种疫苗的动员,重点关注年龄较大、文化程度较低、单身的进城务工者。     

Immunization coverage in Italy

In Italy information on immunization coverage against pertussis, measles, and rubella is absent or incomplete. In 1985 the Istituto Superiore di Sanità (ISS) organized a series of immunization coverage surveys for these diseases in several local health units (Unità Sanitaria Locale) (USL). The surveys were conducted simultaneously in 80 USLs in 1985 with modified EPI cluster sampling techniques, using schools attended by children aged 3 to 10 years as the clusters. Information on previously performed immunizations was collected for each child sampled. The total immunization coverage and proportion of immunized children in eight birth cohorts were calculated.     

Accelerating measles elimination and strengthening routine immunization services in Guizhou Province,China, 2003–2009

BackgroundTo develop a successful model for accelerating measles elimination in poor areas of China, we initiated a seven-year project in Guizhou, one of the poorest provinces, with reported highest measles incidence of 360 per million population in 2002.MethodsProject strategies consisted of strengthening routine immunization services, enforcement of school entry immunization requirements at kindergarten and school, conducting supplemental measles immunization activities (SIAs), and enhancing measles surveillance. We measured coverage of measles containing vaccines (MCV) by administrative reporting and population-based sample surveys, systematic random sampling surveys, and convenience sampling surveys for routine immunization services, school entry immunization, and SIAs respectively. We measured impact using surveillance based measles incidence.ResultsRoutine immunization coverage of the 1st dose of MCV (MCV1) increased from 82% to 93%, while 2nd dose of MCV (MCV2) coverage increased from 78% to 91%. Enforcement of school entry immunization requirements led to an increase in MCV2 coverage from 36% on primary school entry in 2004 to 93% in 2009. Province-wide SIAs achieved coverage greater than 90%. The reported annual incidence of measles dropped from 200 to 300 per million in 2003 to 6 per million in 2009, and sustained at 0.9–2.2 per million in 2010–2013.ConclusionsThis project found that a package of strategies including periodic SIAs, strengthened routine immunization, and enforcing school entry immunization requirements, was an effective approach toward achieving and sustaining measles elimination in less-developed area of China.     

Cluster sampling for immunization coverage

The WHO/EPI cluster sampling method for immunization coverage surveys is part of the course for management training in EPI programmes. The application of this method, based on a framework of villages, is impractical in dispersed populations common in many countries in Africa. To make the method work under those circumstances leads to unacceptable bias, which tends to overestimate the real coverage rate. A modified random cluster sampling method for dispersed populations is presented.     

Knowledge, attitude and practice survey on immunization service delivery in Guangxi and Gansu, China.

BACKGROUND: a knowledge, attitude and practice (KAP) survey on immunization service delivery among providers and parents was conducted in Guangxi and Gansu, Provinces in China. PURPOSE: provide baseline information for a health education program. METHODS: KAP surveys were conducted in 12 randomly selected counties from high and low quality immunization service delivery area in Guangxi and Gansu Provinces. Caretakers of 2520 children born in 1995 and 637 immunization providers were selected by probability proportional to size sampling. RESULTS: the level of immunization knowledge among parents was positively associated with attitude and practices of immunization. Immunization coverage was 89.3% in the high and 63.8% in the low service areas. Low coverage was associated (p < 0.01) with the number of immunization service sessions per year, fee for immunization services and health insurance schemes for immunization services. CONCLUSIONS: immunization coverage can be improved by ensuring sufficient immunization service sessions per year, reducing the cost of immunization services and increasing the participation in health insurance schemes for immunization services.     

Vaccination coverage in India: A small area estimation approach

Information on population health indicators in India come from a number of surveys that vary in periodicity, scope and detail. In the case of immunization, the most recent coverage indicators are derived from the first round of Annual Health Survey (AHS-1, 2010-11), but these were conducted only in 9 of 35 states and union territories. The most recent national surveys of immunization coverage were conducted in 2009 (Coverage Evaluation Survey) by UNICEF. Therefore, reliable immunization coverage data for the entire country since 2009 is lacking. We used an established approach of small area estimation to predict coverage rates of several vaccinations for the remaining 26 states (not covered by AHS-1) in 2011. In our method, we considered a linear mixed model that combines data from five cross sectional surveys representing five different time points. Our model encompasses sampling error of the survey estimates, area specific random effects, autocorrelated area by time random effects and hence, borrows strength across areas and time points both. Model-based estimates for 2011 are almost identical to the AHS-1 estimates for the nine states, suggesting that our model provides reliable prediction of vaccination coverage as AHS-1 estimates are highly precise because of their large sample size. Results indicate that coverage inequality between rural and urban areas has been reduced significantly for most states in India. The National Rural Health Mission has had both supply side and demand side effects on the immunization programme in rural India. In combination, these effects may have contributed to the reduction of vaccination coverage gaps between urban and rural areas.     

Lot quality assurance sampling: methods and applications in public health

Lot Quality Assurance Sampling (LQAS), developed to meet industrial quality control needs, has been applied to health surveys. The WHO used this method to assess immunization coverage. The sampling strategy was developed to classify lots as acceptable or unacceptable. Lot sampling is an efficient, simple and time-efficient procedure for quality assurance. Under certain conditions, efficiency can be improved with double sampling. We describe the method and its theoretical basis and illustrate applications of LQAS in epidemiological surveillance and quality control of medical records. The advantages and disadvantages of this method are presented.     

Surveys of measles vaccination coverage in eastern and southern Africa: a review of quality and methods used

ObjectiveTo assess the methods used in the evaluation of measles vaccination coverage, identify quality concerns and provide recommendations for improvement.MethodsWe reviewed surveys that were conducted to evaluate supplementary measles immunization activities in eastern and southern Africa during 2012 and 2013. We investigated the organization(s) undertaking each survey, survey design, sample size, the numbers of study clusters and children per study cluster, recording of immunizations and methods of analysis. We documented sampling methods at the level of clusters, households and individual children. We also assessed the length of training for field teams at national and regional levels, the composition of teams and the supervision provided.FindingsThe surveys were conducted in Comoros, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Uganda, Zambia and Zimbabwe. Of the 13 reports we reviewed, there were weaknesses in 10 of them for ethical clearance, 9 for sample size calculation, 6 for sampling methods, 12 for training structures, 13 for supervision structures and 11 for data analysis.ConclusionWe recommend improvements in the documentation of routine and supplementary immunization, via home-based vaccination cards or other records. For surveys conducted after supplementary immunization, a standard protocol is required. Finally, we recommend that standards be developed for report templates and for the technical review of protocols and reports. This would ensure that the results of vaccination coverage surveys are accurate, comparable, reliable and valuable for programme improvement.     

Combining cluster surveys to estimate vaccination coverage: Experiences from Nigeria’s multiple indicator cluster survey / national immunization coverage survey (MICS/NICS), 2016–17

In 2015 immunization stakeholders in Nigeria were proceeding with plans that would have fielded two nationally representative surveys to estimate vaccination coverage at the same time. Rather than duplicate efforts and generate either conflicting or redundant results, the stakeholders collaborated to conduct a combined Multiple Indicator Cluster Survey (MICS) / National Immunization Coverage Survey (NICS) with MICS focusing on core sampling clusters and NICS adding supplementary clusters in 20 states, to improve precision of outcomes there. This paper describes the organizational and technical aspects of that collaboration, including details on design of the sample supplement and analysis of the pooled dataset. While complicated, the collaboration was successful; it yielded a unified set of relevant coverage estimates and fostered some novel sub-national results dissemination work.     

Issues and considerations in the use of serologic biomarkers for classifying vaccination history in household surveys

Accurate estimates of vaccination coverage are crucial for assessing routine immunization program performance. Community based household surveys are frequently used to assess coverage within a country. In household surveys to assess routine immunization coverage, a child's vaccination history is classified on the basis of observation of the immunization card, parental recall of receipt of vaccination, or both; each of these methods has been shown to commonly be inaccurate. The use of serologic data as a biomarker of vaccination history is a potential additional approach to improve accuracy in classifying vaccination history. However, potential challenges, including the accuracy of serologic methods in classifying vaccination history, varying vaccine types and dosing schedules, and logistical and financial implications must be considered. We provide historic and scientific context for the potential use of serologic data to assess vaccination history and discuss in detail key areas of importance for consideration in the context of using serologic data for classifying vaccination history in household surveys. Further studies are needed to directly evaluate the performance of serologic data compared with use of immunization cards or parental recall for classification of vaccination history in household surveys, as well assess the impact of age at the time of sample collection on serologic titers, the predictive value of serology to identify a fully vaccinated child for multi-dose vaccines, and the cost impact and logistical issues on outcomes associated with different types of biological samples for serologic testing.