PDF(Pubmed)
Abstract：
BACKGROUND: The World Health Organization approved the RTS,S/AS01 malaria vaccine for wider rollout, and Kenya participated in a phased pilot implementation from 2019 to understand its impact under routine conditions. Vaccine delivery requires coverage measures at national and sub-national levels to evaluate progress over time. This study aimed to estimate the coverage of the RTS,S/AS01 vaccine during the first 36 months of the Kenyan pilot implementation.
METHODS: Monthly dose-specific immunization data for 23 sub-counties were obtained from routine health information systems at the facility level for 2019-2022. Coverage of each RTS,S/AS01 dose was determined using reported doses as a numerator and service-based (Penta 1 and Measles) or population (projected infant populations from WorldPop) as denominators. Descriptive statistics of vaccine delivery, dropout rates and coverage estimates were computed across the 36-month implementation period.
RESULTS: Over 36 months, 818,648 RTSS/AS01 doses were administered. Facilities managed by the Ministry of Health and faith-based organizations accounted for over 88% of all vaccines delivered. Overall, service-based malaria vaccine coverage was 96%, 87%, 78%, and 39% for doses 1-4 respectively. Using a population-derived denominator for age-eligible children, vaccine coverage was 78%, 68%, 57%, and 24% for doses 1-4, respectively. Of the children that received measles dose 1 vaccines delivered at 9 months (coverage: 95%), 82% received RTSS/AS01 dose 3, only 66% of children who received measles dose 2 at 18 months (coverage: 59%) also received dose 4.
CONCLUSIONS: The implementation programme successfully maintained high levels of coverage for the first three doses of RTSS/AS01 among children defined as EPI service users up to 9 months of age but had much lower coverage within the community with up to 1 in 5 children not receiving the vaccine. Consistent with vaccines delivered over the age of 1 year, coverage of the fourth malaria dose was low. Vaccine uptake, service access and dropout rates for malaria vaccines require constant monitoring and intervention to ensure maximum protection is conferred.
METHODS: Monthly dose-specific immunization data for 23 sub-counties were obtained from routine health information systems at the facility level for 2019-2022. Coverage of each RTS,S/AS01 dose was determined using reported doses as a numerator and service-based (Penta 1 and Measles) or population (projected infant populations from WorldPop) as denominators. Descriptive statistics of vaccine delivery, dropout rates and coverage estimates were computed across the 36-month implementation period.
RESULTS: Over 36 months, 818,648 RTSS/AS01 doses were administered. Facilities managed by the Ministry of Health and faith-based organizations accounted for over 88% of all vaccines delivered. Overall, service-based malaria vaccine coverage was 96%, 87%, 78%, and 39% for doses 1-4 respectively. Using a population-derived denominator for age-eligible children, vaccine coverage was 78%, 68%, 57%, and 24% for doses 1-4, respectively. Of the children that received measles dose 1 vaccines delivered at 9 months (coverage: 95%), 82% received RTSS/AS01 dose 3, only 66% of children who received measles dose 2 at 18 months (coverage: 59%) also received dose 4.
CONCLUSIONS: The implementation programme successfully maintained high levels of coverage for the first three doses of RTSS/AS01 among children defined as EPI service users up to 9 months of age but had much lower coverage within the community with up to 1 in 5 children not receiving the vaccine. Consistent with vaccines delivered over the age of 1 year, coverage of the fourth malaria dose was low. Vaccine uptake, service access and dropout rates for malaria vaccines require constant monitoring and intervention to ensure maximum protection is conferred.
摘要：
背景：世界卫生组织批准了RTS，S/AS01疟疾疫苗的推广，肯尼亚从2019年开始参与分阶段试点实施，以了解其在常规条件下的影响。疫苗交付需要在国家和国家以下各级采取覆盖措施，以评估随着时间的推移取得的进展。这项研究旨在估计RTS的覆盖率，S/AS01疫苗在肯尼亚试点实施的前36个月。
方法：从2019-2022年设施级别的常规卫生信息系统中获得了23个县的每月剂量特异性免疫数据。每个RTS的覆盖范围，S/AS01剂量是使用报告的剂量作为分子并以服务为基础（Penta1和麻疹）或人口（WorldPop的预计婴儿人口）作为分母来确定的。疫苗交付的描述性统计，辍学率和覆盖率估计是在36个月的实施期内计算的。
结果：超过36个月，施用818,648个RTSS/AS01剂量。由卫生部和宗教组织管理的设施占交付的所有疫苗的88％以上。总的来说,以服务为基础的疟疾疫苗覆盖率为96%，87%,78%,剂量1-4分别为39%。对符合年龄的儿童使用人口派生分母，疫苗覆盖率为78%，68%,57%,剂量1-4分别为24%。在9个月时接种了1剂麻疹疫苗的儿童中（覆盖率：95％），82％的人接受了RTSS/AS01剂量3，只有66％的儿童在18个月时接受了麻疹剂量2（覆盖率：59％）也接受了剂量4。
结论：实施计划成功地将RTSS/AS01的前三剂覆盖率维持在9个月以下被定义为EPI服务使用者的儿童中，但社区内的覆盖率要低得多，多达五分之一的儿童没有接种疫苗。与1岁以上交付的疫苗一致，第四次疟疾剂量的覆盖率很低。疫苗摄取，疟疾疫苗的服务获取和辍学率需要不断监测和干预，以确保给予最大限度的保护。
方法：从2019-2022年设施级别的常规卫生信息系统中获得了23个县的每月剂量特异性免疫数据。每个RTS的覆盖范围，S/AS01剂量是使用报告的剂量作为分子并以服务为基础（Penta1和麻疹）或人口（WorldPop的预计婴儿人口）作为分母来确定的。疫苗交付的描述性统计，辍学率和覆盖率估计是在36个月的实施期内计算的。
结果：超过36个月，施用818,648个RTSS/AS01剂量。由卫生部和宗教组织管理的设施占交付的所有疫苗的88％以上。总的来说,以服务为基础的疟疾疫苗覆盖率为96%，87%,78%,剂量1-4分别为39%。对符合年龄的儿童使用人口派生分母，疫苗覆盖率为78%，68%,57%,剂量1-4分别为24%。在9个月时接种了1剂麻疹疫苗的儿童中（覆盖率：95％），82％的人接受了RTSS/AS01剂量3，只有66％的儿童在18个月时接受了麻疹剂量2（覆盖率：59％）也接受了剂量4。
结论：实施计划成功地将RTSS/AS01的前三剂覆盖率维持在9个月以下被定义为EPI服务使用者的儿童中，但社区内的覆盖率要低得多，多达五分之一的儿童没有接种疫苗。与1岁以上交付的疫苗一致，第四次疟疾剂量的覆盖率很低。疫苗摄取，疟疾疫苗的服务获取和辍学率需要不断监测和干预，以确保给予最大限度的保护。
