小柯机器人

GBD 2020疫苗覆盖协作组分析了1980-2019年204个国家和地区儿童常规疫苗接种的覆盖率。这一研究成果于2021年7月14日发表在《柳叶刀》杂志上。

衡量儿童常规疫苗接种对于为全球疫苗政策和规划实施提供信息，以及跟踪实现《全球疫苗行动计划》（GVAP）和《2030年免疫接种议程》所确定目标的进展至关重要。需要对常规疫苗覆盖率进行可靠估计，以确定过去的成功经验和持续实施的不足。根据《2020年全球疾病、伤害和危险因素负担研究》（GBD）第1版，研究组使用统计框架，按疫苗和持续时间对全球、区域和国家的疫苗覆盖趋势进行了系统分析。

研究组整理了1980至2019年间55326项针对特定国家、特定队列、特定年份、特定疫苗和特定剂量的儿童常规疫苗接种覆盖率的观察结果。利用时空高斯过程回归，研究组对204个国家和地区1980至2019年间的11项常规儿童疫苗覆盖指标进行了特定地点和特定年份的估计，并对国家报告数据中的偏差进行了校正，反映了报告的缺货和供应中断。研究组分析了零剂量儿童（定义为从未接受过白喉-破伤风-百日咳（DTP）疫苗的儿童）的覆盖率和数量的全球和区域趋势、实现GVAP目标的进展以及疫苗覆盖率与社会人口发展之间的关系。

到2019年，第三剂量DTP（DTP3；81.6%） 的覆盖率比1980年估计的水平（39.9%）增加了一倍多，首剂含麻疹疫苗（MCV1）的覆盖率从1980年的38.5%增加至2019年的83.6%。第三剂脊髓灰质炎疫苗（Pol3）的覆盖率也有所增加，从1980年的42.6%增加到2019年的79.8%，新疫苗的全球覆盖率从2000年至2019年迅速增加。

1980年至2019年，全球零剂量儿童数量下降了近75%，从5600万下降到1450万。然而，在过去十年中，全球疫苗覆盖率大致趋于稳定；自2010年以来，有94个国家和地区的DTP3覆盖率出现下降。据估计，2019年只有11个国家和地区达到了GVAP的国家目标，即所有评估疫苗的覆盖率至少达到90%。

研究结果表明，在全世界儿童疫苗覆盖率取得巨大进展后，世界大部分地区从2010至2019年，这一进展停滞或逆转。该发现强调了重新审视常规免疫策略和方案方法的重要性，重新将服务提供集中于缺乏公平和服务的人群。

附：英文原文

Title: Measuring routine childhood vaccination coverage in 204 countries and territories, 1980–2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Author: Natalie C Galles, Patrick Y Liu, Rachel L Updike, Nancy Fullman, Jason Nguyen, Sam Rolfe, Alyssa N Sbarra, Megan F Schipp, Ashley Marks, Gdiom Gebreheat Abady, Kaja M Abbas, Sumra Wajid Abbasi, Hedayat Abbastabar, Foad Abd-Allah, Amir Abdoli, Hassan Abolhassani, Akine Eshete Abosetugn, Maryam Adabi, Abdu A Adamu, Olatunji O Adetokunboh, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Saira Afzal, Seyed Mohammad Kazem Aghamir, Bright Opoku Ahinkorah, Sohail Ahmad, Tauseef Ahmad, Sepideh Ahmadi, Haroon Ahmed, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Yusra Ahmed Salih, Yonas Akalu, Addis Aklilu, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Fares Alahdab, Luciana Albano, Yosef Alemayehu, Kefyalew Addis Alene, Ayman Al-Eyadhy, Robert Kaba Alhassan, Liaqat Ali, Syed Mohamed Aljunid, Sami Almustanyir, Khalid A Altirkawi, Nelson Alvis-Guzman, Hubert Amu, Catalina Liliana Andrei, Tudorel Andrei, Adnan Ansar, Alireza Ansari-Moghaddam, Ippazio Cosimo Antonazzo, Benny Antony, Jalal Arabloo, Morteza Arab-Zozani, Kurnia Dwi Artanti, Judie Arulappan, Asma Tahir Awan, Mamaru Ayenew Awoke, Muluken Altaye Ayza, Ghasem Azarian, Ahmed Y Azzam, Darshan B B, Zaheer-Ud-Din Babar, Senthilkumar Balakrishnan, Maciej Banach, Simachew Animen Bante, Till Winfried Brnighausen, Hiba Jawdat Barqawi, Amadou Barrow, Quique Bassat, Narantuya Bayarmagnai, Diana Fernanda Bejarano Ramirez, Tariku Tesfaye Bekuma, Habtamu Gebrehana Belay, Uzma Iqbal Belgaumi, Akshaya Srikanth Bhagavathula, Dinesh Bhandari, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Krittika Bhattacharyya, Sadia Bibi, Ali Bijani, Antonio Biondi, Archith Boloor, Dejana Braithwaite, Danilo Buonsenso, Zahid A Butt, Paulo Camargos, Giulia Carreras, Felix Carvalho, Carlos A Castaeda-Orjuela, Raja Chandra Chakinala, Jaykaran Charan, Souranshu Chatterjee, Soosanna Kumary Chattu, Vijay Kumar Chattu, Fazle Rabbi Chowdhury, Devasahayam J Christopher, Dinh-Toi Chu, Sheng-Chia Chung, Paolo Angelo Cortesi, Vera Marisa Costa, Rosa A S Couto, Omid Dadras, Amare Belachew Dagnew, Baye Dagnew, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Jan-Walter De Neve, Meseret Derbew Molla, Behailu Tariku Derseh, Rupak Desai, Abebaw Alemayehu Desta, Deepak Dhamnetiya, Mandira Lamichhane Dhimal, Meghnath Dhimal, Mostafa Dianatinasab, Daniel Diaz, Shirin Djalalinia, Fariba Dorostkar, Bassey Edem, Hisham Atan Edinur, Sahar Eftekharzadeh, Iman El Sayed, Maysaa El Sayed Zaki, Muhammed Elhadi, Shaimaa I El-Jaafary, Aisha Elsharkawy, Shymaa Enany, Ryenchindorj Erkhembayar, Christopher Imokhuede Esezobor, Sharareh Eskandarieh, Ifeanyi Jude Ezeonwumelu, Sayeh Ezzikouri, Jawad Fares, Pawan Sirwan Faris, Berhanu Elfu Feleke, Tomas Y Ferede, Eduarda Fernandes, Joo C Fernandes, Pietro Ferrara, Irina Filip, Florian Fischer, Mark Rohit Francis, Takeshi Fukumoto, Mohamed M Gad

Issue&Volume: 2021-07-14

Abstract:

Background

Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time.

Methods

For this analysis we collated 55326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development.

Findings

By 2019, global coverage of third-dose DTP (DTP3; 81·6% [95% uncertainty interval 80·4–82·7]) more than doubled from levels estimated in 1980 (39·9% [37·5–42·1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38·5% [35·4–41·3] in 1980 to 83·6% [82·3–84·8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42·6% (41·4–44·1) in 1980 to 79·8% (78·4–81·1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56·8 million (52·6–60·9) to 14·5 million (13·4–15·9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019.

Interpretation

After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines.

DOI: 10.1016/S0140-6736(21)00984-3

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00984-3/fulltext

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