1999年广东省不同经济水平地区儿童计划免疫与乙型肝炎免疫接种率调查

目的　分析评价广东省不同经济水平地区儿童计划免疫和乙型肝炎 (乙肝 )疫苗接种率现状。方法　采用分层多阶段随机抽样方法 ,调查了广东省 89个市 (县、区 )的 1 2 0个村 (居委会 )的 84 4名 1 997年出生儿童的免疫状况。结果　广东省儿童计划免疫建卡率 98.5%、建证率94 8%。卡证相符率 89 7%、保偿率 56.2 %、卡介苗疤痕 (卡疤 )阳性率 88.2 % ;四苗合格接种率分别为卡介苗 (BCG) 98.5%、脊髓灰质炎疫苗 (OPV) 97.8%、白百破混合制剂 (DPT) 97.4 %、麻疹疫苗(MV) 96.8% ,“四苗”全程接种率 94 3 % ;乙肝疫苗合格接种率为 73 .6%。除“四苗”接种率经济发达地区与经济欠发达地区之间差异无显著性外 ,乙肝疫苗接种率、计免保偿率、建证率、卡证相符率、卡疤阳性率均前者高于后者。结论　经济水平的高低影响乙肝疫苗接种和保偿制开展的好坏 ,而对“四苗”接种率影响不大。     

Building on the success of the Expanded Programme on Immunization: enhancing the focus on disease prevention and control

The Expanded Programme on Immunization (EPI) has succeeded in establishing a vaccine delivery system in all low and middle income (LMI) countries. Because EPI has focused on immunization delivery, its major outcome is measured in many countries only as vaccine coverage, not as disease reduction, the real goal of EPI. Monitoring disease reduction requires real-time case-based disease surveillance and appropriate interventions, for which a functional public health infrastructure is needed. If the highest priority for assessing impact of EPI shifts to disease prevention and control from vaccine coverage, the programme may be transformed to one of control of childhood communicable diseases (CCCD), with the potential of expanding the range of diseases of children and adults for control and of integrating all other current vertical (single disease) control efforts with it. EPI provides the essential platform on which CCCD can be built to create a public health infrastructure.     

佛山市计划免疫消除白喉的效果及评价

目的　评价佛山市白喉免疫接种效果。方法　对佛山市 1 950～ 1 999年白喉免疫接种资料、1 986～ 1 999年采用锡克氏试验检测白喉免疫成功率及健康人群免疫保护率的免疫资料进行了分析 ,并使用DALY指标对白喉的预防接种进行成本—效益分析。结果　佛山市七十年代、八十年代、九十年代白喉类毒素年均接种率分别为 76.9%、92 .8%、99.2 % ;1 986～ 1 999年 ,白喉免疫成功率年均 98.9% ;各年龄组健康人群白喉免疫保护率在 91 .2 %～ 98.2 % ;白喉发病相应大幅度下降 ,白喉年均发病率由五、六十年代的 1 3 .3 /十万下降至七十年代的 1 .1 /十万 ,八十年代后发病率均在 0 .5/十万以下 ,1 993年后无白喉病例发生。 1 979～ 1 999年佛山市白喉预防接种成本效益比为 1∶4 .2。结论　佛山市实施计划免疫控制白喉效果显著 ,显示计划免疫是消除白喉的根本措施。提出在控制、消除以致消灭白喉的不同阶段制订相应的免疫策略。     

Endemic diphtheria in Ho Chi Minh City; Viet Nam: a matched case-control study to identify risk factors of incidence

From 1999 to 2004, Ho Chi Minh City (HCMC), Vie Nam reported 401 clinically suspected and 90 laboratory-confirmed diphtheria. To identify risk factors, a matched case-control study was conducted during 2005 and 2006. In total, 88 cases that occurred in 2003 and 2004 and 352 age- and sex-matched controls were studied. No DPT/DT immunisation (odds ratio, 9.9 [95% CI, 1.9-52.3]) and bathing only once a day or less (OR 1.7 [95% CI, 1.0-2.9]) were associated with diphtheria incidence. Estimated vaccine efficacy of three or more DPT/DT doses was 88%. Immunising children with zero-dose status of diphtheria toxoid inoculation, rather than the introduction of booster doses, and the promotion of skin hygiene were considered to be the priority interventions in controlling the endemic diphtheria in HCMC.     

The origins of the vaccine cold chain and a glimpse of the future

International efforts to eradicate smallpox in the 1960s and 1970s provided the foundation for efforts to expand immunization programmes, including work to develop immunization supply chains. The need to create a reliable system to keep vaccines cold during the lengthy journey from the manufacturer to the point of use, even in remote areas, was a crucial concern during the early days of the Expanded Programme on Immunization. The vaccine cold chain was deliberately separated from other medical distribution systems to assure timely access to and control of vaccines and injection materials. The story of the early development of the vaccine cold chain shows how a number of challenges were overcome with technological and human resource solutions. For example, the lack of methods to monitor exposure of vaccines to heat during transport and storage led to many innovations, including temperature-sensitive vaccine vial monitors and better methods to record and communicate temperatures in vaccine stores. The need for appropriate equipment to store and transport vaccines in tropical developing countries led to innovations in refrigeration equipment as well as the introduction and widespread adoption of novel high performance vaccine cold-boxes and carriers. New technologies also helped to make injection safer. Underlying this work on technologies and equipment was a major effort to develop the human resources required to manage and implement the immunization supply chain. This included creating foundational policies and a management infrastructure; providing training for managers, health workers, technicians, and others. The vaccine cold chain has contributed to one of the world’s public health success stories and provides three priority lessons for future: the vaccine supply chain needs to be integrated with other public health supplies, re-designed for efficiency and effectiveness and work is needed in the longer term to eliminate the need for refrigeration in the supply chain.     

Vaccination coverage among young homeless children compared to US national immunization survey data

IntroductionComprehensive vaccination coverage among homeless children in the United States (US) is largely unknown although a few studies suggest low coverage with single vaccinations. This study compared vaccination coverage with a combined 7-vaccines series among homeless children in the District of Columbia (DC) to coverage among other US children.Materials and methodsA cross-sectional survey of homeless children in DC was conducted from 2018 to 2019. Recruitment occurred at housing shelters, social services centers, and a diaper dispensary, and through limited chain referral. English-speaking parents of a child aged 19 to 35 months who spent the majority of the last 30 nights homeless were recruited. Participants consented for their child’s healthcare providers to submit vaccination records. The vaccination coverage estimate of this sample was compared with estimates of three populations in the 2018 National Immunization Survey (NIS): children in DC (NIS DC), children in the US (NIS US), and children in the US below the federal poverty level (NIS poor).ResultsMost of the 135 children had experienced at least two lifetime episodes (63.7%) and 12 months (57%) of homelessness. The estimated percent up to date was 52.6% (95% CI: 43.8%, 61.3%). This estimate was 20.4 (95% CI: 11.9, 28.8, p < .0001), 20 (95% CI: 11.5, 28.4, p < .0001), and 11.5 (95% CI: 3.1, 20, p < .01) percentage points lower than estimates for the NIS DC, NIS US and NIS poor populations, respectively. After adjusting for child’s age and race/ethnicity, vaccination coverage of the NIS DC sample was below that of NIS US (p < .01) and NIS poor samples (p < .05).ConclusionChildren experiencing homelessness may be at risk of under-vaccination, even when compared to a general population of children in poverty. Awareness of this heightened risk may allow for more precise targeting of vaccination delivery support specifically to children experiencing homelessness.     

疫苗免费后对基层免疫规划工作的影响

目的探讨基层免疫规划工作在疫苗免费后的影响因素，为卫生行政部门决策提供依据。方法对漯河市召陵区疫苗免费后区、乡、村三级免疫规划工作进行调查，比较免费前后工作成效，提出今后工作努力方向。结果召陵区疫苗免费后区、乡、村三级免疫规划工作经费投入来源、工作模式发生了变化，工作成效有明显提升。结论疫苗免费后给基层免疫规划工作带来丁机遇和挑战，建立长效的经费投入机制及有效的工作管理机制是基层免疫规划工作健康发展的关健。     

Seasonal influenza vaccine uptake in Germany 2007/2008 and 2008/2009: results from a national health update survey

In 2008/2009 a nationwide cross-sectional telephone survey was conducted to assess, among other health-relevant parameters, seasonal influenza vaccination coverage. Data from 21,262 household-interviews representative of the adult population in Germany were collected and analyzed. In seasons 2007/2008 and 2008/2009, vaccine uptake in individuals aged ≥60 years was 57% and 55% and in individuals with underlying chronic diseases 44% and 42%. Living in the eastern part of Germany, higher age, and medium household income level were independently associated with higher vaccine uptake in both target groups. Healthcare workers were significantly less frequently (21.9% in 2007/2008; 20.4% in 2008/2009) vaccinated than the general population (30.8% and 28.1%). Special effort must be undertaken to develop immunization strategies for improved vaccine uptake in target groups, especially in healthcare workers.     

Vaccination coverage of health care personnel working in health care facilities in France: results of a national survey, 2009

We conducted a national cross-sectional survey to investigate vaccination coverage (VC) in health care personnel (HCP) working in clinics and hospitals in France. We used a two-stage stratified random sampling design to select 1127 persons from 35 health care settings. Data were collected by face-to-face interviews and completed using information gathered from the occupational health doctor. A total of 183 physicians, 110 nurses, 58 nurse-assistants and 101 midwives were included. VC for compulsory vaccinations was 91.7% for hepatitis B, 95.5% for the booster dose of diphtheria-tetanus-polio (DTP), 94.9% for BCG. For non-compulsory vaccinations, coverage was 11.4% for the 10 year booster of the DTP pertussis containing vaccine, 49.7% for at least one dose of measles, 29.9% for varicella and 25.6% for influenza. Hepatitis B VC did not differ neither between HCP working in surgery and HCP in other sectors, nor in surgeons and anaesthesiologists compared to physicians working in medicine. Young HCP were better vaccinated for pertussis and measles (p<0.01), and those working in an obstetric or a paediatric ward were better vaccinated for influenza and pertussis (p<0.01). HCP are overall well covered by compulsory vaccinations, whereas VC for non-compulsory vaccinations is very insufficient. The vaccination policy regarding these latter vaccinations should be reinforced in France.     

潜江市扩大国家免疫规划工作现状调查

目的了解潜江市扩大国家免疫规划进展情况,及时发现工作中存在的问题和薄弱环节,为解决问题提供科学依据,促进免疫规划工作健康发展。方法采取查阅资料、入户调查和问卷访谈等方式在全市范围内进行调查。结果潜江市建立了比较完善的管理体系和专业队伍,儿童基础免疫各疫苗上报接种率均达到99％以上,“老五苗”入户调查接种率均高于90％,但部分流动儿童管理不到位。结论潜江市扩大国家免疫规划总体上运行良好,但也存在一些问题。     

Routine immunization coverage in Pakistan: a survey of children under 1 year of age in community-based vaccination areas

Pakistan is one of two countries in which poliovirus remains endemic. Considering the high number of children born every year, reaching and vaccinating new birth cohorts by improving routine immunization coverage in children <1 year of age is crucial to halting virus transmission. In 2015, a community-based vaccination (CBV) strategy, using local community members to enhance vaccine acceptance and improve routine immunization service delivery, was introduced in areas of Pakistan that have never interrupted poliovirus transmission. In order to assess progress towards improving routine immunization, we performed house-to-house immunization surveys across ten CBV areas in 2017 and 2018. In each household, we determined age-appropriate routine antigen coverage for children <1 year of age based on vaccination card and caregiver recall. We surveyed 5,499 and 5,264 children in 2017 and 2018, respectively. Overall, coverage of inactivated poliovirus vaccine (IPV) at 14 weeks of age was 32% in 2017 and 39% in 2018 based on vaccination card and recall. Across the surveyed areas, coverage ranged from 7% in Killa Abdullah to 61% in Peshawar in 2018. Oral poliovirus vaccination coverage decreased with successive vaccination visits, ranging from 66% for the birth dose to 42% for the 14-week dose in 2018. No area reached the target of 80% coverage for any routine antigen. Our findings highlight the need for concerted efforts to improve routine immunization coverage in these critical areas of wild poliovirus transmission.     

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。     

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.     

Immunization costs,from evidence to policy: Findings from a nationally representative costing study and policy translation effort in Tanzania

IntroductionInformation on the costs of routine immunization programs is needed for budgeting, planning, and domestic resource mobilization. This information is particularly important for countries such as Tanzania that are preparing to transition out of support from Gavi, the Vaccine Alliance. This study aimed to estimate the total and unit costs for of child immunization in Tanzania from July 2016 to June 2017 and make this evidence available to key stakeholders.MethodsWe used an ingredients-based approach to collect routine immunization cost data from the facility, district, regional, and national levels. We collected data on the cost of vaccines as well as non-vaccine delivery costs. We estimated total and unit costs from a provider perspective for each level and overall, and examined how costs varied by delivery strategy, geographic area, and facility-level service delivery volume. An evidence-to-policy plan identified key opportunities and stakeholders to target to facilitate the use of results.ResultsThe total annual economic cost of the immunization program, inclusive of vaccines, was estimated to be US$138 million (95% CI: 133, 144), or $4.32 ($3.72, $4.98) per dose. The delivery costs made up $45 million (38, 52), or $1.38 (1.06, 1.70) per dose. The costs of facility-based delivery were similar in urban and rural areas, but the costs of outreach delivery were higher in rural areas than in urban areas. The facility-level delivery cost per dose decreased with the facility service delivery volume.DiscussionWe estimated the costs of the routine immunization program in Tanzania, where no immunization costing study had been conducted for five years. These estimates can inform the program’s budgeting and planning as Tanzania prepares to transition out of Gavi support. Next steps for evidence-to-policy translation have been identified, including technical support requirements for policy advocacy and planning.     

南通市流动儿童免疫规划相关疾病免疫水平监测结果分析

目的评价南通市外来从事规模种植业农民、砖窑厂工人及渔船民0～7岁子女免疫规划相关疾病免疫水平,为制订流动儿童预防接种管理措施提供依据。方法采用分层整群抽样调查法,对南通市9个县(市、区)外来人口集聚地流动儿童抗体水平进行检测并作统计学分析。结果乙肝抗-HbsAg阳性率76.17%;脊髓灰质炎Ⅰ、Ⅱ、Ⅲ型抗体阳性率和抗体几何平均滴度(GMT)分别为96.11%、97.28%、94.94%和1∶439.43、1∶295.34、1∶93.613;白喉抗体阳性率和抗体GMT分别为76.71%、1∶10.836;百日咳抗体阳性率和抗体水平分别为22.41%、15.976IU/ml;破伤风抗体阳性率和抗体GMT分别为67.87%、1∶33.644;麻疹抗体阳性率和抗体水平分别为94.74%、1 105.1mIU/ml;A群流脑抗体阳性率和抗体GMT分别为64.78%、1∶11.522;乙脑抗体阳性率和抗体GMT分别为62.89%、1∶11.704。结论脊灰、麻疹阳性率和抗体水平均较高,对这部分人群的保护较好。而乙肝、白喉、百日咳、破伤风、A群流脑、乙脑阳性率偏低,显示本市上述行业流动儿童免疫覆盖水平不足,易受到相关传染病的侵袭,预防接种工作有待于进一步加强。     

The impact of the COVID-19 pandemic on vaccine coverage in Kilifi,Kenya: A retrospective cohort study

The COVID-19 pandemic caused unprecedented disruption in health service delivery, globally. This study sought to provide evidence on the impact of the pandemic on vaccine coverage in Kilifi County, Kenya. We conducted a vaccine coverage survey between April and June 2021 within the Kilifi Health and Demographic Surveillance System (KHDSS). Simple random sampling was used to identify 1500 children aged 6 weeks–59 months. Participants were grouped into three retrospective cohorts based on when they became age-eligible for vaccination: before the pandemic, during the first year, or during the second year of the pandemic. Survival analysis with Cox regression was used to evaluate the association between the time-period at which participants became age-eligible for vaccination and the rate of vaccination within a month of age-eligibility for the third dose of pentavalent vaccine (Pentavalent-3) and within three months of age-eligibility for the first dose of Measles vaccine (MCV-1). A total of 1,341 participants were included in the survey. Compared to the pre-COVID-19 baseline period, the rate of vaccination within a month of age-eligibility for Pentavalent-3 was not significantly different in the first year of the pandemic (adjusted hazard ratio [aHR] 1.03, 95 % confidence interval [CI] 0.90–1.18) and was significantly higher during the second year of the pandemic (aHR 1.33, 95 % CI 1.07–1.65). The rate of vaccination with MCV-1 within three months of age-eligibility was not significantly different among those age-eligible for vaccination during the first year of the pandemic (aHR 1.04, 95 % CI 0.88–1.21) and was 35 % higher during the second year of the pandemic (95 % CI 1.11–1.64), compared to those age-eligible pre-COVID-19. After adjusting for known determinants of vaccination, the COVID-19 pandemic did not adversely affect the rate of vaccination within the KHDSS.     

中国城乡112个疾病监测点乙型肝炎疫苗接种率、免疫策略及费用调查

为了解我国乙型肝炎(乙肝 )疫苗接种率、免疫策略以及接种费用的现况,采用二阶段固定样本随机抽样入户调查方法,于 1996年对全国 2 5个省、市、自治区 112个疾病监测点进行调查。结果表明,1993年至 1994年城市监测点新生儿接种率为 96.9%,显著高于农村监测点的 50.8% ;1994年城市点 7～ 9岁学龄儿童接种率为 85.8%,显著高于农村点的 31.5%。至1994年,97.5%和 73.9%的城乡区县卫生防疫站已将新生儿乙肝疫苗接种纳入计划免疫管理 ;92.5%和 4 3.5%的城乡点产前对全部或部分孕妇筛查HBeAg和HBsAg。母亲双阳性新生儿免疫方案多种多样,约半数加用高价免疫球蛋白实施联合免疫,双阴性及不做筛查的地区主要以 10 μg×3方案进行免疫。部分农村点新生儿接种率较低,主要原因可能与疫苗分配不当有关,接种费用过高及疫苗订购量不足也有一定关系。孕妇乙肝感染标记筛查质量有必要进行评价。上述表明,我国乙肝疫苗免疫已取得显著的阶段性成果。     

Increasing Burden of Acute Hepatitis A among Ethiopian Children,Adolescents, and Young adults: A Change in Epidemiological Pattern and Need for Hepatitis A Vaccine

BackgroundHepatitis A is a vaccine-preventable, feco-oral infection due to poor sanitary conditions. It is predominantly acquired during early childhood and results in lasting acquired protective immunity. However, it results in severe disease which can end up in acute fulminant hepatitis and hepatic failure when acquired during adolescence and adulthood. The prevalence of acute hepatitis A is increasing among children, adolescents, and young adults from higher-income households. They acquire this infection at a later age when they are exposed for the first time to contaminated food and drinks after being brought up in a relatively clean environment. This calls for the introduction of the Hepatitis A vaccine in Ethiopia; possibly as part of the Expanded Program on Immunization (EPI).MethodsSocio-demographic and clinical data were collected from patients who were diagnosed to have hepatitis A infection at Adera Medical Center in 2020.ResultsThis study showed that clinical acute hepatitis A is becoming common among children, adolescents, and young adults from relatively high-income families. Among patients with acute hepatitis, 89% were from middle and high-income families.ConclusionsThere is a need for the incorporation of hepatitis A vaccine in the Ethiopian EPI program.     

Vaccination against 2008/2009 and 2009/2010 seasonal influenza in Spain: coverage among high risk subjects, HCWs, immigrants and time trends from the 2005/2006 campaign

Influenza continues to be a very important cause of morbidity, mortality and a large number of hospitalizations each year, however the compliance with vaccine uptake is low and has barely varied over time among health care workers (HCWs) and people under 65 years of age suffering a chronic condition. Based on data from two nation-wide representative health surveys namely the 2006 Spanish National Health Survey and the 2009 European Health Interview Survey for Spain the aim of this study is to describe influenza vaccination coverage and time trends for the Spanish population as a whole and in recommended populations in four vaccination campaigns: 2005/2006, 2006/2007, 2008/2009 and 2009/2010.Our results show an increasing trend (OR 1.03) in seasonal influenza vaccine coverage for the total population from 2005/2006 to 2009/2010, especially in HCWs (21.8% in 2005/2006; 31.1% in 2009/2010). Coverage in people under 60 with a chronic disease remains low and did not vary significantly during the analyzed period. Immigrants presented a significantly lower probability of having received the influenza vaccine than indigenous people in the 2008/2009 campaign.Different strategies need to be implemented in order to achieve higher coverage levels in these at-risk populations.     

中国城乡112个疾病监测点乙型肝炎疫苗接种率、免疫策略及费用调查

为了解我国乙型肝炎 (乙肝 )疫苗接种率、免疫策略以及接种费用的现况 ,采用二阶段固定样本随机抽样入户调查方法 ,于 1996年对全国 2 5个省、市、自治区 112个疾病监测点进行调查。结果表明 ,1993年至 1994年城市监测点新生儿接种率为 96.9% ,显著高于农村监测点的 50 .8% ;1994年城市点 7～ 9岁学龄儿童接种率为 85.8% ,显著高于农村点的 31.5%。至 1994年 ,97.5%和 73.9%的城乡区县卫生防疫站已将新生儿乙肝疫苗接种纳入计划免疫管理 ;92 .5%和 4 3.5%的城乡点产前对全部或部分孕妇筛查HBeAg和HBsAg。母亲双阳性新生儿免疫方案多种多样 ,约半数加用高价免疫球蛋白实施联合免疫 ,双阴性及不做筛查的地区主要以 10 μg× 3方案进行免疫。部分农村点新生儿接种率较低 ,主要原因可能与疫苗分配不当有关 ,接种费用过高及疫苗订购量不足也有一定关系。孕妇乙肝感染标记筛查质量有必要进行评价。上述表明 ,我国乙肝疫苗免疫已取得显著的阶段性成果。