2009年都兰县部分0～7岁流动儿童免疫状况调查

[目的]了解都兰县流动儿童免疫接种状况,以进一步加强对流动儿童的免疫规划管理。[方法]2009年7~8月,对都兰县0~7岁流动儿童的免疫接种情况进行调查。[结果]调查流动儿童231名,建卡率为85.28%,五苗全程接种率为83.55%,均低于常住儿童的98.01%和94.00%(P<0.01)。儿童建卡率,男童为83.78%、女童为86.67%(P>0.05)。五苗接种率,男童为82.88%、女童为84.17%(P>0.05);县城为84.21%、乡镇为82.00%、农村牧区为82.76%(P>0.05)。卡介苗、脊灰疫苗、百白破混合制剂、麻疹疫苗、乙肝疫苗接种率、五苗及时接种率分别为83.55%、85.28%、82.68%、83.55%、83.98%。[结论]都兰县0~7岁流动儿童免疫接种状况较差。     

2006年四川省免疫规划工作考核结果分析

目的 考核四川省2006年免疫规划工作质量.方法 查阅资料和现场检查,调查市(州)、县(市区)、乡镇的免疫规划工作保障措施的落实情况、免疫规划工作管理、疫苗管理及冷链设备管理、培训及宣传和免疫规划疫苗针对传染病等6个方面,对四川省21个市州免疫规划的工作质量进行综合考核评分.结果 四川省各种国家免疫规划疫苗(BCG、HepB、OPV、DPT、MV)的基础免疫接种率较高;各市(州)免疫规划工作考核成绩为62.2795.45分,平均成绩82.39分.结论 四川省的免疫规划工作处于中等水平,需进一步加大经费投入,规范免疫规划工作管理,保障免疫规划工作均衡发展,加快规范化门诊建设,提高工作水平和质量.     

Decentralizing EPI services and prospects for increasing coverage: the case of Tanzania

Primary health Care (PHC) strategies were adopted widely in 1978 after the Alma Ata declaration to improve accessibility to health services and the health of the people. Of the strategies of PHC was the decentralization of health services to lower levels in order to enhance participation and responsiveness of the health system to local problems. While PHC was being promoted vertical programmes such as the expanded programme on immunization (EPI) were also being promoted and achieved substantial benefits. However, almost 25 years later many countries have not been able to achieve these health goals. This study addressed the question: Can we make the process of health care decentralization more likely to support health system and EPI goals? This study analysed the experience of EPI decentralization at national, regional and district levels. Several stakeholders were identified who were supportive and others who were non‐supportive of the process. Community support to EPI measured by using willingness to pay (WTP) for kerosene (to keep vaccines cool) was low. It was significantly (p < 0.05) associated with whether providers in the nearest health facility properly attended the target population and whether the providers in the facility were available when needed. There was a substantial stakeholder support and opposition to the process of decentralization at the district level. Community support was not high possibly due to the perceived non‐availability of the service providers and their lack of awareness of the population they serve. It was proposed that reforms should give priority to the involvement of communities and peripheral health facility providers in the process. Copyright © 2005 John Wiley & Sons, Ltd.     

火车旅客免疫规划知识知晓情况调查

目的了解公众对免疫规划知识的知晓情况，为今后制定有效的传播策略提供依据。方法在北京西客站随机抽取1180名乘客，采用问卷调查方法调查公众免疫规划知识的知晓情况。结果接受调查的乘客中，87．6％的人认为打预防针／吃糖丸对小孩有好处，61．0％的人知道国家免疫规划疫苗是免费的，能够全部说出5种免疫规划疫苗的占32．1％；知道儿童出生后24小时内应接种乙肝疫苗的占44．2％。知道出生后1天内要接种卡介苗疫苗的占21．0％。39．0％的调查对象知道接种第一针疫苗后建立预防接种证。64．0％的调查对象知道“接种证需要保留到上小学；60％的对象知道入学、入托时要查验预防接种证。结论公众缺乏免疫规划的基本知识是导致免疫规划疫苗接种率低的主要原因之一。文化程度与免疫规划知识的掌握情况有一定关系。在今后的工作中，要加大对文化水平相对较低人群的宣传力度，提高该人群的疾病规划知识知晓率。     

广东省疾控机构免疫规划人力资源配置现状及公平性分析

目的从人口和地理角度评价广东省疾病预防控制机构免疫规划人力资源配置公平性。方法采用基尼系数测量广东省不同区域免疫规划人力资源的公平性。结果广东省疾控机构免疫规划人员配置总量按人口分布及按面积分布的基尼系数分别为0.353和0.279。韶关市每万名儿童拥有免疫规划人员5.78人,中山市仅为0.36人,二者相差16倍。高级职称人员50.42%集中在珠三角地区,按人口分布及按面积分布的基尼系数分别为0.475和0.580。免疫规划人员高、中、初级的比例为1:1.98:8.15。结论广东省疾控机构免疫规划人员配置总量在人口、地理分布上体现出较好的公平性,但人力资源职称结构有待优化调整,且人力资源配置存在区域性差异,优质人力资源分布不公平。     

Factors influencing acceptance of vaccination during pregnancy in The Gambia and Senegal

BackgroundVaccination during pregnancy can protect pregnant women and their babies from infectious diseases. Tetanus vaccine, also known as tetanus toxoid, is the only vaccine given to pregnant women in The Gambia and Senegal, where it is given by antenatal care providers as part of the Expanded Programme on Immunization. A qualitative study was undertaken to explore factors influencing acceptance of vaccination during pregnancy in The Gambia and Senegal.MethodsFocus group discussions and in-depth interviews were conducted across urban and rural settlements of The Gambia and Senegal. We explored the knowledge, attitudes, and perceptions of 152 women who were either pregnant or with an infant. NVivo 11 Qualitative Data Analysis Software was used for management and thematic analysis of the data.ResultsWomen had sufficient knowledge of the need for tetanus vaccine from different information sources but insufficient knowledge of tetanus causes, signs and symptoms. Tetanus vaccine was perceived to be safe and side effects such as pain and swelling at site of injection did not deter uptake of future doses. Women overall had confidence in their sources of vaccine information and the health care workers who administered maternal vaccinations. Their willingness to accept vaccination during pregnancy was particularly influenced by their husbands and trusted healthcare workers. Women across all sites mentioned they would accept new maternal vaccines if they are sensitized beforehand about any potential risks and benefits to them and their babies.ConclusionVaccine acceptance can be influenced by several factors including contextual, individual or group influences and vaccine or vaccination-specific issues. Women across The Gambia and Senegal are generally vaccine acceptors with confidence in the health care workers who vaccinate them and few concerns about maternal vaccines. Women’s acceptance of vaccination during pregnancy is based on previous vaccination experiences and individual weighing of risks and benefits.     

2004-2017年新乡市市区流行性腮腺炎发病特征分析

目的 分析不同时期流行性腮腺炎(流腮)发病特征变化,为制定流腮防控策略提供参考依据。 方法 将新乡市市区2004-2017年的流腮疫情分成扩大国家免疫规划(Expanded Program on Immunization, EPI)前期(2004-2007年)、EPI期(2008-2012年)及含流腮成分疫苗(mumps containing vaccine,MuCV)加强免疫(booster vaccination, BV)期(2013-2017年),分析三个时期流腮发病特征的变化。 结果 三个时期流腮年均报告发病率分别为6.94/10万、4.38/10万和6.01/10万,差异有统计学意义(χ²=24.531,P<0.001);三个时期均有3-6月和12月至次年1月两个发病高峰;三个时期学生的发病构成比分别为62.33%、54.25%和63.48%;男女性别发病比分别为1.56:1、1.65:1、1.52:1;3～14岁组累计发病率分别为40.98/10万、25.71/10万和33.51/10万。 结论 2004-2017年新乡市实施EPI后,市区流腮发病率开始下降,第二剂次MuCV接种率低,没有形成群体性免疫保护屏障,未能改变流腮发病周期。建议对6岁以下儿童实施二剂次MuCV常规免疫等综合防控策略。     

计划免疫疾病疫苗接种率的综合监测方法

本文提出计划免疫疾病疫苗接种率的综合监测方法,即在建立和完善疫苗接种率常规报告制度的基础上,结合进行重点抽样调查,并以工作流程图加以说明。根据批质量检验抽样方法(LQAS)的原则,提出两种可供现场选择采用的一次抽样方法,以对重点乡的接种率作出估计。     

Maternal determinants of complete child immunization among children aged 12-23 months in a southern district of Nigeria

This study was conducted to identify determinants of complete immunization status among children aged 12-23 months in a southern district of Nigeria. The World Health Organization cluster survey was used to evaluate immunization coverage of infants. Mothers of 525 children selected by the two-stage sampling method and interviewed using an adapted questionnaire responded. Completion of the immunization schedule was verified by an immunization card or by reported history indicating that the child had received full doses of four of the antigens included in the Nigeria routine immunization schedule. Multivariate logistic regression was used to identify factors associated with completion of immunization. Only 32.4% of children had completed the immunization schedule. Determinants of complete immunization status included a maternal age less than 30 years (AOR = 2.26, 95% CI:1.27-4.03), availability of an immunization card at first contact (AOR = 7.72, 95% CI:4.43-13.44), fewer than three children (AOR = 2.22, 95% CI:11.1-4.42), completion of post secondary education (AOR = 2.34, 95% CI:1.12-4.47) and maternal unemployment (AOR = 1.71, 95% CI:1.01-2.89). Identifying mothers whose children are at risk of not completing the immunization schedule and educating them is an important strategy to improve antigen coverage and prevent early childhood deaths from diseases like tuberculosis, poliomyelitis, tetanus, diphtheria, pertussis and measles.     

广西壮族自治区和甘肃省计划免疫供方计划免疫知识 态度 行为(KAP)的调查研究

于1997年7月调查了广西壮族自治区和甘肃省的县、乡、村三级计划免疫工作者（供方）637人,就计划免疫知识、态度和行为（KAP）问题进行了自填表和调查员询问填表方式的调查．结果表明：基层计划免疫工作人员对于接种禁忌症、疫苗的贮存温度及疫苗在冷藏包的存放要求知识掌握不全面;县级28％的计划免疫工作人员对脊髓灰质炎疫苗长期保存温度回答不正确;对于新生儿破伤风的预防等较新的知识更加欠缺,接种者对“新生儿预防接种可否预防新生儿破伤风”约有72％回答不正确。计划免疫工作人员对本职工作主要反映是工资待遇低,工作辛苦,工作条件差。由于知识或其它一些社会因素,对于低烧、腹泻、咳嗽等病征时,相当部分接种者对接种采取一种不积极的行为．提示我们今后要提高计划免疫队伍的素质,从行政角度要提高计划免疫工作人员的待遇,提供有利于开展计划免疫工作的政策和条件．加强对基层防保人员培训和再教育的力度和效果,对条件差、计划免疫工作薄弱地区更应加强重视．     

1998年长江洪涝灾害对湖北省计划免疫工作的影响及其对策研究

通过对６个洪涝重灾县（市，下同）计划免疫工作的调查，发现这次洪涝灾害对湖北省计划免疫工作产生了很大影响。６个县在洪涝灾害中损坏的冷链设备约占现有设备的１５％，计划免疫资料损失１０％左右，洪涝灾害大大增加了灾区流动儿童的数量，降低了灾区常规免疫的质量。同时分析了洪涝灾害对灾区计划免疫工作的远期影响，提出了恢复和重建灾区计划免疫工作的对策。     

Use of mobile phones for improving vaccination coverage among children living in rural hard-to-reach areas and urban streets of Bangladesh

In Bangladesh, full vaccination rates among children living in rural hard-to-reach areas and urban streets are low. We conducted a quasi-experimental pre-post study of a 12-month mobile phone intervention to improve vaccination among 0–11 months old children in rural hard-to-reach and urban street dweller areas. Software named “mTika” was employed within the existing public health system to electronically register each child's birth and remind mothers about upcoming vaccination dates with text messages. Android smart phones with mTika were provided to all health assistants/vaccinators and supervisors in intervention areas, while mothers used plain cell phones already owned by themselves or their families. Pre and post-intervention vaccination coverage was surveyed in intervention and control areas. Among children over 298 days old, full vaccination coverage actually decreased in control areas – rural baseline 65.9% to endline 55.2% and urban baseline 44.5% to endline 33.9% – while increasing in intervention areas from rural baseline 58.9% to endline 76*8%, difference +18.8% (95% CI 5.7–31.9) and urban baseline 40.7% to endline 57.1%, difference +16.5% (95% CI 3.9–29.0). Difference-in-difference (DID) estimates were +29.5% for rural intervention versus control areas and +27.1% for urban areas for full vaccination in children over 298 days old, and logistic regression adjusting for maternal education, mobile phone ownership, and sex of child showed intervention effect odds ratio (OR) of 3.8 (95% CI 1.5–9.2) in rural areas and 3.0 (95% CI 1.4–6.4) in urban areas. Among all age groups, intervention effects on age-appropriate vaccination coverage were positive: DIDs +13.1–30.5% and ORs 2.5–4.6 (p < 0.001 in all comparisons). Qualitative data showed the intervention was well-accepted. Our study demonstrated that a mobile phone intervention can improve vaccination coverage in rural hard-to-reach and urban street dweller communities in Bangladesh. This small-scale successful demonstration should serve as an example to other low-income countries with high mobile phone usage.     

Scaling up interventions to eliminate neonatal tetanus: Factors associated with the coverage of tetanus toxoid and clean deliveries among women in Vientiane,Lao PDR

The Lao People's Democratic Republic (PDR) is one of seven countries that have not eliminated maternal and neonatal tetanus in more than 50% of districts. We conducted a community-based household survey to assess the achievements of strategies towards maternal and neonatal tetanus elimination in the capital province. The coverage of tetanus toxoid (TT) was 79.7% by the protection-at-birth (PAB) method. The percentages of deliveries attended by skilled personnel and of deliveries at a health facility were 68.4% and 63.7%, respectively. The progress towards eliminating neonatal tetanus in Lao PDR is not sufficient despite the study sites being placed in the capital province. The lack of continuum of care for mothers and newborns is the major obstacle to scale up the tetanus toxoid coverage and PAB as well as clean deliveries.     

Vaccination coverage and factors associated with routine childhood vaccination uptake in rural Vellore,southern India, 2017

BackgroundVellore district in southern India was selected for intensified immunization efforts through India’s Mission Indradhanush campaign based on 74% coverage in the National Family Health Survey in 2015. As rural households rely almost entirely on the Universal Immunization Program (UIP), we assessed routine immunization coverage and factors associated with vaccination status of children in rural Vellore.MethodsWe conducted a cross-sectional household survey among parents or primary caretakers of children aged 12–23 months during August–September 2017 using two-stage, EPI cluster sampling. We verified vaccination histories from vaccination cards and collected data on sociodemographic and non-socio-demographic characteristics by using mobile data capture. Associations with vaccination status were examined with univariate and multivariate logistic regression models.ResultsA total of 643 children were included. Coverage of BCG, third dose pentavalent/DPT, measles/MR vaccines and full vaccination (BCG, three doses of polio and pentavalent/DPT and measles/MR vaccines) among children with vaccination cards (n = 606) was 94%, 96%, 93% and 84%, respectively. Of children with vaccination cards, 70.8% had received all recommended doses according to the UIP schedule. No socio-demographic differences were identified, but parents’ familiarity with the schedule (Adjusted Prevalence Odds Ratio (aPOR): 2.06, 95%CI = 1.26–3.38) and receiving information on recommended vaccinations during antenatal visits (aPOR: 2.16, 95% CI = 1.13–4.12) were significantly associated with full vaccination status of the children.ConclusionsWe found higher UIP antigen coverage and proportion of fully vaccinated children than previously reported from rural Vellore. However, adherence to the recommended schedule was still not optimal. Our study highlights the potential of improving parental awareness of vaccination schedule and targeting health education interventions at pregnant women during antenatal visits to sustain and improve routine immunization coverage.     

Translating vaccine policy into action: A report from the Bill & Melinda Gates Foundation Consultation on the prevention of maternal and early infant influenza in resource-limited settings

Immunization of pregnant women against influenza is a promising strategy to protect the mother, fetus, and young infant from influenza-related diseases. The burden of influenza during pregnancy, the vaccine immunogenicity during this period, and the robust influenza vaccine safety database underpin recommendations that all pregnant women receive the vaccine to decrease complications of influenza disease during their pregnancies. Recent data also support maternal immunization for the additional purpose of preventing disease in the infant during the first six months of life.     

Why school is crucial to increase vaccination coverage for children: Evaluation of school vaccination check program in South Korea 2021–2022

The School Vaccination Check Program (SVCP) is a public health measure that aims to achieve high levels of National Immunization Program (NIP) vaccination coverage for children by checking the completion of the vaccination schedule for students when they enter elementary or middle school. Due to the COVID-19 pandemic, the SVCP was stopped in 2020 and 2021, and restarted in June-August 2022. In this study, we examined and quantified the relationship with SVCP and the vaccination uptake by comparing the vaccination coverage of 2021 and 2022. Based on the standard schedule, the vaccination records of DTaP5, IPV4, MMR2 and IJEV4 were evaluated for elementary school students. The Tdap6, IJEV5 and HPV1 were evaluated for the students from middle school. Using a difference-in-difference study design and national level big data, the study compared vaccination coverage as of August 2021 and 2022. The study found that the SVCP was effective in increasing vaccination coverage for targeted vaccinations such as DTaP5, IPV4, MMR2 and IJEV4 for elementary school students, and Tdap6, IJEV5 for middle school students. However, the SVCP did not show a statistically significant effect on increasing vaccination coverage on HPV1 for middle school students. School can play an important role to improve vaccination coverage. Therefore, close collaboration with health and education authority is crucial to accomplish successful vaccination program reducing vaccine preventable disease outbreaks in schools.     

The effectiveness of maternal pertussis vaccination in protecting newborn infants in Brazil: A case-control study

IntroductionIn 2014, the Brazilian Ministry of Health (MoH) recommended Tdap to pregnant women in response to a significant increase in the incidence of pertussis among infants. The present study assessed the effectiveness of maternal immunization in preventing pertussis in infants.MethodsAn unmatched case-control study was undertaken in São Paulo State, Brazil from February 2015 to July 2016. Cases were infants aged <8 weeks at onset of pertussis reported to the Surveillance System and confirmed by real-time polymerase chain reaction or culture. Four to six healthy infants were selected as controls per case from birth certificates in the Information System on Live Births database. General characteristics and mother’s vaccination status were compared between cases and controls. The vaccine effectiveness (VE) was calculated as 1 – odds ratio (OR). For the adjusted VE, the OR was calculated using logistic regression analysis.ResultsForty-two cases and 248 controls were enrolled in the study. Mothers of 8 cases (19.1%) and 143 controls (57.4%) were vaccinated during pregnancy, resulting in an unadjusted VE of 82.6% (95% confidence interval [CI], 60.8–92.3%). The VE was unchanged after adjusting for maternal age and monthly household income.ConclusionMaternal pertussis vaccination during pregnancy was effective in protecting infants aged <8 weeks from pertussis.     

Attendance and vaccination at immunization clinics in rural Gambia before and during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic has affected the delivery of essential health services, such as routine immunization. We assessed the impact of the pandemic on the uptake of routine immunization in rural Gambia.MethodsWe collected real-time vaccine administration data in the Basse and Fuladu West Health & Demographic Surveillance Systems from September 01, 2019, to December 31, 2020. We assessed the monthly number of Expanded Program on Immunization (EPI) clinic attendances and vaccines administered, comparing data during the baseline period (September 01, 2019–March 31, 2020), COVID-19 interruption period (April 01–June 30, 2020), initial recovery period (Jul 01–September 30, 2020) and the late recovery period (October 01–December 31, 2020).ResultsCompared to the baseline period, there was an overall average monthly decline of 13.4% in EPI attendance and 38.3% reduction in average monthly immunizations during the interruption period. This decrease was particularly noticeable for Bacille Calmette-Guérin (BCG) (47.2%), birth dose hepatitis B (Hep B) (46.9%), 1st dose pentavalent (Penta1) (43.1%), 1st dose pneumococcal conjugate vaccine (PCV1) (42.4%), and measles vaccines (15.5%). Comparing the late recovery to baseline period, average monthly EPI attendance was 5.3% higher, with 1.9% increase in average monthly immunizations. Monthly immunizations for BCG were 3.0% greater, 2.5% greater for Hep B, 22.7% greater for oral polio vaccine (OPV1), 2.0% less for Penta1, 19.2% less for Penta2, and 2.6% less for PCV1.ConclusionThe reduced EPI attendance during the pandemic interruption period lasted only 3 months. Significant recovery in EPI attendance occurred during the late recovery period, while rates of monthly immunization returned to pre-pandemic levels for most antigens. EPI programmes should implement strategies to deliver missed antigens when infants do present to EPI clinics, aware that missed doses may be age dependent.