Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

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• 作者：Christel Hoest^a ; ^{christel.host@nih.gov} ; Jessica C. Seidman^a ; Gwenyth Lee^b ; James A Platts-Mills^c ; Asad Ali^d ; Maribel Paredes Olortegui^e ; Pascal Bessong^f ; Ram Chandyo^g ; ^h ; Sudhir Babjiⁱ ; Venkata Raghava Mohanⁱ ; Dinesh Mondal^j ; Mustafa Mahfuz^j ; Estomih R Mduma^k ; Emanuel Nyathi^f ; Claudia Abreu^l ; Mark A. Miller^a ; William Pan^m ; Carl J. Masonⁿ ; Stacey L. Knobler^a ; the MAL-ED Network Investigators¹
• 关键词：MAL-ED ; The Etiology ; Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development ; EPI ; Expanded Program on Immunization ; BGD ; Dhaka ; Bangladesh ; BRF ; Fortaleza ; Brazil ; INV ; Vellore ; India ; NEB ; Bhaktapur ; Nepal ; PEL ; Loreto ; Peru ; PKN ; Naushero Feroze ; Pakistan ; SAV ; Venda ; South Africa ; TZH ; Haydom ; Tanzania ; BCG ; Bacillus Calmette-Gu&eacute ; rin ; DPT ; Diphtheria ; Pertussis ; and Tetanus ; OPV ; Oral Polio Vaccine ; IPV ; Inactivated Po
• 刊名：Vaccine
• 出版年：2017
• 出版时间：11 January 2017
• 年：2017
• 卷：35
• 期：3
• 页码：443-451
• 全文大小：453 K
• 卷排序：35

文摘

Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings.MethodsThe Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered.ResultsCoverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87–100%, whereas measles vaccination rates ranged widely, 73–100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific.ConclusionsOur findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission.