六安市不同胎龄儿童免疫规划疫苗接种现状研究

A study on the status of immunization program vaccination of children with different gestational ages in Lu'an City

目的了解不同胎龄儿童出生24月龄内免疫规划疫苗接种情况和及时性,分析与疫苗接种延迟相关的风险因素。方法回顾性分析2016年出生儿童24月龄以内免疫规划疫苗接种情况,比较早期早产儿(<34周)、晚期早产儿(34~36+6周)和足月儿(≥37周)免疫规划疫苗接种情况,19月龄和24月龄疫苗接种覆盖率及其影响因素。结果早期早产儿乙型肝炎疫苗(简称“乙肝疫苗”)第1、3针,卡介苗,脊髓灰质炎疫苗,百白破联合疫苗第3、4针,乙型脑炎(简称“乙脑”)疫苗,甲型肝炎疫苗(简称“甲肝疫苗”)接种及时率均落后于足月儿(χ^(2)=617.598、21.381、118.555、113.345、26.853、7.853、18.659、7.285,P<0.05)。晚期早产儿乙肝疫苗第1针和第3针、卡介苗、百白破疫苗第3针和第4针、乙脑疫苗和甲肝疫苗接种及时率均低于足月儿,差异有统计学意义(χ^(2)=471.632、7.375、5.743、7.234、7.008、9.215、1.137,P<0.05)。早产儿在19月龄和24月龄疫苗接种完成率均低于足月儿。多因素分析显示,早期早产儿(OR=0.60,95%CI:0.39~0.92;OR=0.60,95%CI:0.37~0.98)、晚期早产儿(OR=0.70,95%CI:0.55~0.89;OR=0.62,95%CI:0.46~0.83)和胎次≥第2胎(OR=0.74,95%CI:0.60~0.90;OR=0.76,95%CI:0.58~0.99)是儿童完成19月龄和24月龄疫苗接种的危险因素。乙肝疫苗第1针未及时接种(OR=0.66,95%CI:0.49~0.89)和居住在城市(OR=0.80,95%CI:0.65~0.99)是19月龄儿童预防接种不足的危险因素。结论六安市早产儿疫苗接种进程不足,建议加强对早产儿、多个子女的家庭以及城市儿童的关注。

Objective To understand the status and timeliness of immunization program vaccination for children of different gestational ages up to 24 months,and to analyze the risk factors for the delay of vaccination.Methods The immunization program vaccination of children born in 2016 until 24 months old was retrospectively analyzed to compare the immunization program vaccination of early preterm infants(<34 weeks),late preterm infants(34-36+6 weeks),and full-term infants(>37 weeks).The vaccination coverage and the influencing factors by 19 and 24 months old were compared.Results The timeliness vaccination rates of early preterm infants with the 1st and 3rd doses of hepatitis B vaccine,the Bacillus Calmette-Guérin vaccine,the polio vaccine,the 3rd and 4th doses of diphtheria-pertussis-tetanus vaccine,the encephalitis vaccine,and the hepatitis A vaccine all lower than those of full-term infants,the differences were statistically significant(χ^(2)=617.598,21.381,118.555,113.345,26.853,7.853,18.659,7.285,P<0.05).The timeliness vaccination rates of late preterm infants with the 1st and 3rd doses of hepatitis B vaccine,the Bacillus Calmette-Guérin vaccine,the 3rd and 4th doses of diphtheria-pertussis-tetanus vaccine,the encephalitis vaccine,and the hepatitis A vaccine all lower than those of than full-term infants,the differences were statistically significant(χ^(2)=471.632,7.375,5.743,7.234,7.008,9.215,1.137,P<0.05).Early preterm infants had lower vaccine completion rates than full-term infants at both 19 and 24 months old.Multifactorial analysis indicated that early preterm infants(OR=0.60,95%CI:0.39-0.92;OR=0.60,95%CI:0.37-0.98),late preterm infants(OR=0.70,95%CI:0.55-0.89;OR=0.62,95%CI:0.46-0.83),and parity≥a second child(OR=0.74,95%CI:0.60-0.90;OR=0.76,95%CI:0.58-0.99)were risk factors for completion of vaccination in children at 19 and 24 months old.Untimely vaccination with the 1st dose of hepatitis B vaccine(OR=0.66,95%CI:0.49-0.89)and living in city(OR=0.80,95%CI:0.65-0.99)were risk factors for under-vaccination in children at 19 months old.Conclusion The vaccination process for preterm infants in the city of Lu'an is insufficient.We should strengthen attention of preterm infants,families with multiple children and urban children.