PDF(Pubmed)
Abstract：
Yearly national immunization coverage reporting does not measure performance at the subnational level throughout the year and conceals inequalities within countries. We analyzed subnational immunization coverage from seven high-priority countries in our region. We analyzed subnational, monthly immunization data from seven high-priority countries. Five were Gavi eligible (i.e., Afghanistan, Pakistan, Somalia, Syria, and Yemen); these are countries that according to their low income are eligible for support from the Global Alliance on Vaccine and Immunization, while Iraq and Jordan were included because of a recent decrease in immunization coverage and contribution to the regional number of under and unimmunized children. DTP3 coverage, which is considered as the main indicator for the routine immunization coverage as the essential component of the immunization program performance, varied monthly in 2019-2021 before reaching pre-pandemic coverage in the last two months of 2021. Somalia and Yemen had a net gain in DTP3 coverage at the end of 2021, as improvement in 2021 exceeded the regression in 2020. In Pakistan and Iraq, DTP3 improvement in 2021 equaled the 2020 regression. In Afghanistan, Syria and Jordan, the regression in DTP3 coverage continued in 2020 and 2021. The number of districts with at least 6000 zero-dose children improved moderately in Afghanistan and substantially in Somalia throughout the follow-up period. In Pakistan, the geographical distribution differed between 2020 and 2021.Of the three countries with the highest number of zero-dose children, DTP1 coverage reached 109% in Q4 of 2020 after a sharp drop to 69% in Q2 of 2020. However, in Pakistan, the number of zero-dose children decreased to 1/10 of its burden in Q4 of 2021. In Afghanistan, the number of zero-dose children more than a doubled. Among the even countries, adaptation of immunization service to the pandemic varied, depending on the agility of the health system and the performance of the components of the expanded program on immunization. We recommended monitoring administrative monthly immunization coverage data at the subnational level to detect low-performing districts, plan catchup, identify bottlenecks towards reaching unvaccinated children and customize strategies to improve the coverage in districts with zero-dose children throughout the year and monitor progress.
摘要：
每年的国家免疫覆盖率报告没有衡量全年国家以下一级的业绩，掩盖了国家内部的不平等。我们分析了我们地区七个高度优先国家的次国家免疫覆盖率。我们分析了国家以下，七个高度优先国家的每月免疫数据。五人符合Gavi资格(即，阿富汗,巴基斯坦,索马里,叙利亚,和也门）；这些国家根据其低收入有资格获得全球疫苗和免疫联盟的支持，而伊拉克和约旦被包括在内，因为最近免疫覆盖率下降，对区域未接种和未接种儿童人数的贡献。DTP3覆盖率,被认为是常规免疫覆盖率的主要指标，是免疫规划绩效的重要组成部分，2019-2021年每月变化一次，然后在2021年的最后两个月达到大流行前的覆盖率。到2021年底，索马里和也门的DTP3覆盖率净增长，因为2021年的改善超过了2020年的回归。在巴基斯坦和伊拉克,2021年DTP3的改善等于2020年的回归。在阿富汗,叙利亚和约旦,DTP3覆盖率的回归在2020年和2021年继续。在整个后续期间，阿富汗和索马里至少有6000名零剂量儿童的地区数量略有改善。在巴基斯坦,地理分布在2020年至2021年之间有所不同。在零剂量儿童最多的三个国家中，DTP1覆盖率在2020年第四季度达到109%，而2020年第二季度则大幅下降至69%。然而,在巴基斯坦,在2021年第四季度，零剂量儿童的数量减少到其负担的1/10。在阿富汗,零剂量儿童的数量增加了一倍多。在偶数国家中，免疫服务对大流行的适应各不相同，取决于卫生系统的敏捷性和扩大免疫计划各组成部分的性能。我们建议在国家以下一级监测行政每月免疫覆盖率数据，以发现表现不佳的地区，计划追赶,确定接触未接种疫苗的儿童的瓶颈，制定策略，以提高全年零剂量儿童地区的覆盖率，并监测进展情况。
