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标题：Differential Effects of the DTaP and MMR Vaccine Shortages on Timeliness of Childhood Vaccination Coverage
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作者：Tammy A. Santibanez ; Jeanne M. Santoli ; Lawrence E. Barker 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2006
卷号：96
期号：4
页码：691-696
DOI：10.2105/AJPH.2004.053306
语种：English
出版社：American Public Health Association
摘要：Objectives. We determined the effect of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) and measles, mumps, rubella (MMR) vaccine shortages on timeliness of the third dose of DTaP (DTaP3), the fourth dose of DTaP (DTaP4), and the first dose of MMR (MMR1) among subgroups of preschool children. Methods. Data from the 2001 and 2002 National Immunization Surveys were analyzed. Children age-eligible to receive DTaP3, DTaP4, or MMR1 during the shortages were considered subject to the shortage, and those not age-eligible were not subject to the shortage; timeliness of vaccinations was compared. Results. Among children vaccinated only at public clinics, children residing outside metropolitan statistical areas, and children in the Southern Census Region, those age-eligible to receive DTaP4 during the shortage were less likely to be vaccinated by 19 months of age than children not subject to the shortage. Conclusions. There was notable disparity in the effects of the recent vaccine shortages; children vaccinated only in public clinics, in rural areas, or in the Southern United States were differentially affected by the shortages. Between 2000 and mid-2003, the United States experienced shortages of a number of routinely recommended vaccines. The affected vaccines were diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), measles, mumps, and rubella vaccine (MMR), varicella and pneumococcal conjugate vaccines, and tetanus and diphtheria toxoids. The shortages were of sufficient magnitude and duration that recommendations for these vaccines had to be temporarily modified, and certain doses were suspended. 1 ^– 4 Specifically, if a provider had insufficient quantities of vaccine, the Advisory Committee on Immunization Practices recommended the deferral of the fourth and fifth doses of DTaP and the second dose of MMR. 1 ^– 2 ^, 4 Although this strategy allowed scarce vaccine to be targeted to those in greatest need, it delayed the provision of a preventive health benefit, and in some cases an entitlement, for many children, adolescents, and adults. Little is known about the impact of the shortages on childhood immunization coverage. An analysis of the 2002 Puerto Rico Immunization Survey, which measures vaccination coverage among children aged 24 months, showed that receipt of the third dose of DTaP was similar in 2002 to that in 2001, whereas there was a substantial drop in coverage with the fourth dose of DTaP from 95.8% in 2001 to 31.8% in 2002. 5 Because substantial efforts were made by the Puerto Rico Department of Health to encourage implementation of their recommendation to suspend the fourth dose of DTaP, it is difficult to determine how much of this drop in coverage was due to actual shortage and how much to compliance with recommendations. Earlier reports of data from the National Immunization Survey (NIS), which monitors immunization coverage in preschool children on an annual basis, showed no evidence of a national decrease in immunization coverage in 2001 and 2002 compared with previous years; however, timeliness of vaccinations and subgroup analyses were not examined. 6 ^, 7 Did the vaccine shortages affect US pre-school immunization in a way not reflected in standard NIS coverage estimates? We investigated the magnitude and distribution of effects of 2 vaccine shortages on the timeliness of receipt of the third dose of DTaP (DTaP3), the fourth dose of DTaP (DTaP4), and the first dose of MMR (MMR1) among subgroups of children aged 19 to 35 months in the United States. Because vaccination with varicella and pneumococcal vaccines, also in short supply during this time, had not yet reached full implementation, coverage levels for both vaccines continued to increase. This made assessing changes in timely vaccination with these vaccines difficult. Thus, we focused on only the DTaP and MMR vaccine shortages.