PDF(Pubmed)
Abstract：
BACKGROUND: Routine vaccination coverage in Latin America and the Caribbean declined prior to and during the coronavirus pandemic. We assessed the pandemic\'s impact on national coverage levels and analyzed whether financial and inequality indicators, immunization policies, and pandemic policies were associated with changes in national and regional coverage levels.
METHODS: We compared first- and third-dose coverage of diphtheria-pertussis-tetanus-containing vaccine (DTPcv) with predicted coverages using time series forecast modeling for 39 LAC countries and territories. Data were from the PAHO/WHO/UNICEF Joint Reporting Form. A secondary analysis of factors hypothesized to affect coverages during the pandemic was also performed.
RESULTS: In total, 31 of 39 countries and territories (79%) had greater-than-predicted declines in DTPcv1 and DTPcv3 coverage during the pandemic, with 9 and 12 of these, respectively, falling outside the 95% confidence interval. Within-country income inequality (i.e., Gini coefficient) was associated with significant declines in DTPcv1 coverage, and cross-country income inequality was associated with declines in DTPcv1 and DTPcv3 coverages. Observed absolute and relative inequality gaps in DTPcv1 and DTPcv3 coverage between extreme country quintiles of income inequality (i.e., Q1 vs. Q5) were accentuated in 2021, as compared with the 2019 observed and 2021 predicted values. We also observed a trend between school closures and greater-than-predicted declines in DTPcv3 coverage that approached statistical significance (p = 0.06).
CONCLUSIONS: The pandemic exposed vaccination inequities in LAC and significantly impacted coverage levels in many countries. New strategies are needed to reattain high coverage levels.
METHODS: We compared first- and third-dose coverage of diphtheria-pertussis-tetanus-containing vaccine (DTPcv) with predicted coverages using time series forecast modeling for 39 LAC countries and territories. Data were from the PAHO/WHO/UNICEF Joint Reporting Form. A secondary analysis of factors hypothesized to affect coverages during the pandemic was also performed.
RESULTS: In total, 31 of 39 countries and territories (79%) had greater-than-predicted declines in DTPcv1 and DTPcv3 coverage during the pandemic, with 9 and 12 of these, respectively, falling outside the 95% confidence interval. Within-country income inequality (i.e., Gini coefficient) was associated with significant declines in DTPcv1 coverage, and cross-country income inequality was associated with declines in DTPcv1 and DTPcv3 coverages. Observed absolute and relative inequality gaps in DTPcv1 and DTPcv3 coverage between extreme country quintiles of income inequality (i.e., Q1 vs. Q5) were accentuated in 2021, as compared with the 2019 observed and 2021 predicted values. We also observed a trend between school closures and greater-than-predicted declines in DTPcv3 coverage that approached statistical significance (p = 0.06).
CONCLUSIONS: The pandemic exposed vaccination inequities in LAC and significantly impacted coverage levels in many countries. New strategies are needed to reattain high coverage levels.
摘要：
背景：在冠状病毒大流行之前和期间，拉丁美洲和加勒比地区的常规疫苗接种覆盖率下降。我们评估了大流行对国家覆盖水平的影响，并分析了金融和不平等指标，免疫政策，大流行政策与国家和地区覆盖水平的变化有关。
方法：我们使用时间序列预测模型对39个LAC国家和地区的白喉-百日咳-破伤风疫苗（DTPcv）的第一和第三剂覆盖率与预测覆盖率进行了比较。数据来自泛美卫生组织/世卫组织/儿童基金会联合报告表。还对假设在大流行期间影响报道的因素进行了二次分析。
结果：总计，在大流行期间，39个国家和地区中有31个（79％）的DTPcv1和DTPcv3覆盖率下降幅度大于预期，其中9个和12个，分别,落在95%置信区间之外。国内收入不平等(即，基尼系数）与DTPcv1覆盖率的显着下降有关，跨国收入不平等与DTPcv1和DTPcv3覆盖率的下降有关。在收入不平等的极端国家五分位数之间观察到的DTPcv1和DTPcv3覆盖率的绝对和相对不平等差距（即，Q1vs.与2019年的观察值和2021年的预测值相比，Q5）在2021年得到了强调。我们还观察到学校关闭和DTPcv3覆盖率下降幅度超过预期之间的趋势，具有统计学意义（p=0.06）。
结论：大流行暴露了LAC的疫苗接种不公平，并显著影响了许多国家的覆盖率。需要新的战略来重新达到高覆盖率。
方法：我们使用时间序列预测模型对39个LAC国家和地区的白喉-百日咳-破伤风疫苗（DTPcv）的第一和第三剂覆盖率与预测覆盖率进行了比较。数据来自泛美卫生组织/世卫组织/儿童基金会联合报告表。还对假设在大流行期间影响报道的因素进行了二次分析。
结果：总计，在大流行期间，39个国家和地区中有31个（79％）的DTPcv1和DTPcv3覆盖率下降幅度大于预期，其中9个和12个，分别,落在95%置信区间之外。国内收入不平等(即，基尼系数）与DTPcv1覆盖率的显着下降有关，跨国收入不平等与DTPcv1和DTPcv3覆盖率的下降有关。在收入不平等的极端国家五分位数之间观察到的DTPcv1和DTPcv3覆盖率的绝对和相对不平等差距（即，Q1vs.与2019年的观察值和2021年的预测值相比，Q5）在2021年得到了强调。我们还观察到学校关闭和DTPcv3覆盖率下降幅度超过预期之间的趋势，具有统计学意义（p=0.06）。
结论：大流行暴露了LAC的疫苗接种不公平，并显著影响了许多国家的覆盖率。需要新的战略来重新达到高覆盖率。
