背景:非国家免疫计划(NIP)疫苗在中国控制疫苗可预防疾病(VPD)方面发挥了重要作用。然而,这些疫苗是自掏腰包的,还有增加保险的空间。在这项研究中,我们重点研究了四种选定的非NIP疫苗,即b型流感嗜血杆菌(Hib)疫苗,人乳头瘤病毒(HPV)疫苗,肺炎球菌结合疫苗(PCV),和轮状病毒疫苗。我们旨在对他们的疫苗接种率和卫生系统面临的主要障碍进行范围审查,提供者,和看护人增加覆盖面。
方法:我们遵循系统评价的首选报告项目和范围评价的Meta分析扩展(PRISMA-ScR)。我们搜索了五个英语数据库(PubMed,WebofScience,EMBASE,Scopus,和WHOIRIS)以及使用研究小组开发的搜索策略的四个中文数据库。两名独立审稿人筛选,选定的研究,检查他们的质量。我们总结了按疫苗划分的非NIP疫苗覆盖率数据,并应用了5A框架(Access,负担能力,验收,意识,激活)以图表和分析增加覆盖率的障碍。
结果:总共28篇文章被纳入分析(9篇与疫苗覆盖率有关,和另外19个报告增加吸收的挑战)。在选定的四种疫苗中,2016年,Hib疫苗的覆盖率最高(两次荟萃分析显示,1剂或1剂以上为54.9-55.9%),而其他3种疫苗的覆盖率低于30%.包括的9条条款中有8条提到了区域覆盖范围的差异,在欠发达地区较低。例如,东部省份三剂量Hib疫苗接种率为38.1%,而中西部省份的比率为34.3%和26.2%,分别在2017年。在5A框架内,接受,意识,和负担能力是最突出的主题。在确定的12个次主题中,高价格,疫苗意识低,对疫苗安全性和有效性的担忧是增加摄取的最多障碍。
结论:迫切需要增加非NIP疫苗的覆盖率,并减少各地区获得这些疫苗的差距。政府的共同努力,公众,社会需要解决这项研究中确定的障碍和挑战,在需求和供应方面,确保每个人在中国都能平等获得拯救生命的疫苗。特别是,政府应采取审慎的态度,逐步将非NIP疫苗纳入NIP,并根据疾病负担等关键因素制定优先战略,财政资源,和市场准备,特别关注高危人群和欠发达地区。
BACKGROUND: Non-National Immunization Program (NIP) vaccines have played an important role in controlling vaccine-preventable diseases (VPDs) in China. However, these vaccines are paid out of pocket and there is room to increase their coverage. We focused on four selected non-NIP vaccines in this study, namely Haemophilus influenzae type b (Hib) vaccine, human papillomavirus (HPV) vaccine, pneumococcal conjugate vaccine (PCV), and rotavirus vaccine. We aimed to conduct a scoping
review of their vaccination rates and the major barriers faced by health systems, providers, and caregivers to increase coverage.
METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). We searched five English databases (PubMed, Web of Science, EMBASE, Scopus, and WHO IRIS) and four Chinese databases using the search strategy developed by the study team. Two independent reviewers screened, selected studies, and examined their quality. We summarized the non-NIP vaccine coverage data by vaccine and applied the 5A framework (Access, Affordability, Acceptance, Awareness, Activation) to chart and analyze barriers to increasing coverage.
RESULTS: A total of 28 articles were included in the analysis (nine pertaining to vaccine coverage, and another 19 reporting challenges of increasing
uptake). Among the four selected vaccines, coverage for the Hib vaccine was the highest (54.9-55.9% for 1 dose or more from two meta-analyses) in 2016, while the coverage of the other three vaccines was lower than 30%. Eight of the nine included articles mentioned the regional disparity of coverage, which was lower in under-developing regions. For example, the three-dose Hib vaccination rate in eastern provinces was 38.1%, whereas the rate in central and western provinces was 34.3% and 26.2%, respectively in 2017. Within the 5A framework, acceptance, awareness, and affordability stood out as the most prominent themes. Among the 12 identified sub-themes, high prices, low vaccine awareness, concerns about vaccine safety and efficacy were the most cited barriers to increasing the
uptake.
CONCLUSIONS: There is an urgent need to increase coverage of non-NIP vaccines and reduce disparities in access to these vaccines across regions. Concerted efforts from the government, the public, and society are required to tackle the barriers and challenges identified in this study, both on the demand and supply side, to ensure everybody has equal access to life-saving vaccines in China. Particularly, the government should take a prudent approach to gradually incorporate non-NIP vaccines into the NIP step by step, and make a prioritizing strategy based on key factors such as disease burden, financial resources, and market readiness, with special attention to high-risk populations and underdeveloped regions.