背景:在美国(美国),有三种疫苗可用于预防侵袭性脑膜炎球菌病(IMD),严重和可能致命的感染:针对血清群A的四价结合疫苗,C,W,Y(MenACWY),和针对血清群B(MenB)的单价疫苗以及新批准的五价疫苗(MenABCWY),B,C,W,和Y。CDC的免疫实践咨询委员会(ACIP)通常建议MenACWY疫苗用于所有11至12岁的儿童,并在16岁时加强剂量。建议根据16至23岁的共享临床决策(SCDM)进行MenB疫苗接种。最近,ACIP推荐了五价脑膜炎球菌疫苗(MenABCWY).在全国范围内,脑膜炎球菌疫苗的摄取并不理想,特别是在社会经济地位较低的个人中(SES),尽管有这些建议。空间分析的目的是评估MenACWY和MenB疫苗的放养之间的关系,区域级SES,和国家层面的政策。
方法:疫苗接种者储存的MenACWY和MenB剂量的数量是从IQVIA和CDC的儿童疫苗(VFC)计划中获得的,并汇编到2016年至2019年的县级数据集。SES,使用CDC的社会脆弱性指数(SVI)衡量,州级学校的建议,和普遍采购计划是主要的县级协变量之一,以控制可能影响库存的因素。数据按公共和私人市场分层。建立了贝叶斯空间回归模型来量化两种疫苗的库存率和相对库存率的变化。
结果:在考虑了县级特征之后,在公共和私人市场上,相对于MenACWY,较低的SES县的MenB剂量往往较少。较低的SES县往往有更多的公共供应与私人剂量。通用采购计划对两种疫苗的市场都产生了巨大影响,几乎所有剂量都转移到了公共市场。学校疫苗接种策略是提高储存率的关键。
结论:总体而言,结果表明,相对于美国的MenB,MenACWY的股票更多。在没有疫苗接种入学要求的脆弱地区,这种差异加剧,并导致疫苗供应不平等。除了州级政策和SES差异之外,SCDM建议可能是一个促成因素,尽管我们的模型没有直接评估.
BACKGROUND: In the United States (US), three types of vaccines are available to prevent invasive meningococcal disease (IMD), a severe and potentially fatal infection: quadrivalent conjugate vaccines against serogroups A, C, W, Y (MenACWY), and monovalent vaccines against serogroup B (MenB) as well as a newly licensed pentavalent vaccine (MenABCWY) protecting against serogroup A, B, C, W, and Y. The CDC\'s Advisory Committee on Immunization Practices (ACIP) routinely recommends MenACWY vaccine for all 11- to 12-year-olds with a booster dose at 16 years. MenB vaccination is recommended based on shared clinical decision-making (SCDM) for 16- to 23-year-olds. Recently, the pentavalent meningococcal vaccine (MenABCWY) was recommended by the ACIP. Meningococcal vaccine uptake is suboptimal across the country, particularly among individuals with lower socioeconomic status (SES), despite these recommendations. The objective of the spatial analyses was to assess the relationship between stocking of MenACWY and MenB vaccines, area-level SES, and state-level policies.
METHODS: The number of MenACWY and MenB doses stocked by vaccinators was obtained from IQVIA and the CDC\'s Vaccine for Children (VFC) program and compiled into a county-level dataset from 2016 to 2019. SES, as measured using the CDC\'s Social Vulnerability Index (SVI), state-level school recommendations, and universal purchasing programs were among the main county-level covariates included to control for factors likely influencing stocking. Data were stratified by public and private market. Bayesian spatial regression models were developed to quantify the variations in rates of stocking and the relative rates of stocking of both vaccines.
RESULTS: After accounting for county-level characteristics, lower SES counties tended to have fewer doses of MenB relative to MenACWY on both public and private markets. Lower SES counties tended to have more supply of public vs. private doses. Universal purchasing programs had a strong effect on the markets for both vaccines shifting nearly all doses to the public market. School vaccination strategy was key for improving stocking rates.
CONCLUSIONS: Overall, the results show that MenACWY has greater stock relative to MenB across the US. This difference is exacerbated in vulnerable areas without school entry requirements for vaccination and results in inequity of vaccine availability. Beyond state-level policy and SES differences, SCDM recommendations may be a contributing factor, although this was not directly assessed by our model.