北京市常住儿童与流动儿童9种免疫规划疫苗接种率的比较分析

Comparative Study on Immunization Coverage Rates of Nine Vaccines Between Local and Floating Children

目的了解北京市9种免疫规划疫苗的接种状况，比较常住儿童与流动儿童的接种率水平。方法采用分层随机抽样方法，在北京市18个区（县）中，每个区（县）抽取2个普通乡、1个流动人口聚集乡和1个集贸市场，调查对象为1999-2002年出生的儿童。结果常住儿童预防接种建卡率、建证率均〉99％，卡证符合率、五种疫苗[卡介苗、乙型肝炎疫苗（HepB）、口服脊髓灰质炎减毒活疫苗（OPV）、百白破联合疫苗（DPT）、麻疹减毒活疫苗（MV）]基础免疫（初种）合格接种率与OPV、DPT、MV加强免疫（复种）合格接种率均〉95％，除HepB基础免疫及时接种率为87％外，其它四种疫苗基础免疫及时接种率〉90％；风疹疫苗、流行性腮腺炎疫苗、脑膜炎球菌多糖疫苗（MPV）、流行性乙型脑炎疫苗（JEV）基础免疫合格接种率分别达78％、75％、93％、93％，MPV、JEV加强免疫合格接种率分别为87％、76％。与常住儿童相比，流动儿童的建卡率与卡证符合率各平均低15个百分点，而建证率相近；五种疫苗各针次合格接种率、五种疫苗基础免疫针次及时接种率与其它疫苗针次合格接种率平均分别低19、28、35个百分点。除建证率外，其它各项指标常住儿童与流动儿童之间差异有非常显著的统计学意义（P〈0．01）。另外，五种疫苗针次中以超期接种多，而其它疫苗针次中以未种多。结论北京市常住儿童五种疫苗各针次接种率维持在较高水平，流动儿童的接种率水平显著低于常住儿童。需摸清影响儿童（特别是流动儿童）接种率的因素，有针对性地采取措施，减少免疫空白，提高接种质量。

Objective To clarify the vaccination status of 9 kinds of vaccines related to Expanded Program on Immunization （EPI） and to compare the immunization coverage between local and floating children residing in Beijing. Methods Through stratified sampling, 2 general townships, 1 floating-population township and 1 agricultural market were randomly selected as investigation settings. Children born from 1999 to 2002 were subjects in the study. Results Among local children,the immunization card rate and the immunization certificate rate were all ≥99%, and the compatible card-certificate rate,the qualified coverage for the primary doses of 5 vaccines （BCG, HepB, OPV, DPT, MV）, and the qualified coverage for the booster of OPV, DPT and MV all reached ≥95%. The timely coverage for 4 of 5 vaccines targeted ≥90% ,but 87% for HepB. For the primary dose of rubella,mumps, meningitis, and encephalitis type B vaccines, the qualified coverage was 78% ,75% ,93% and 93% ,respectively,and 87% for the booster of meningitis vaccine and 76% for the booster of Japanese encephalitis vaccine. Comparatively, the card rate and the compatible card-certificate rate among floating children were lower than among local children with 15% difference, whereas the certificate rate was similar. The qualified coverage for all doses of the 5 vaccines, the timely coverage for primary doses of the 5 vaccines, and the qualified coverage for all doses of other vaccines were also lower, with 19 %, 28 and 35% difference on average,respectively. All indicators but the certificate rate between the local and floating were significantly different （Chi square test, P 〈0.01）. The non-qualified or nontimely immunization was mainly attributed to overdue vaccination for the 5 vaccines and to absent vaccination for the other. Conclusions The immunization coverage rates of the 5 vaccines in Beijing local children maintained high level. But all vaccine coverage rates in floating children were significantly lower than in local children. Suggestion It is essential to identify the risk factors of affecting vaccine coverage, especially in the floating children, and to take adequate measures to reduce vaccination blank and improve vaccination quality.