背景:COVID-19严重影响了伊拉克的常规免疫(RI)。2021年,覆盖率降至6年来的最低水平,COVID-19疫苗接种吸收缓慢。作为回应,政府实施了加强综合免疫服务(3IS),一种全国性的方法,包括为错过剂量或从未开始定期接种疫苗的儿童(零剂量儿童)定期开展COVID-19疫苗接种和RI外展会议.我们描述了3IS及其对伊拉克疫苗接种覆盖率的影响。
方法:3IS包括针对城市和农村社区的新的外展会议,这些会议的行政数据表明在覆盖方面存在差距。在2022年2月至11月期间,来自1321个初级保健中心的6名人员每月进行6次外展会议。社区参与是一个组成部分。我们比较了RI管理数据(2019-2022年)和3IS活动期间报告的数据,以评估其影响。
结果:在72,4953IS外展期间,总共施用了4,189,859剂疫苗,在这10个月内,在伊拉克接种的19,106,849剂疫苗中,有五分之一以上。其中,957,874(22.9%)是COVID-19疫苗,略微增加了国家覆盖率,3,231,985(77.1%)是RI疫苗,大大减少零剂量儿童,增加18%,25%,21%,到2022年五1、五3、麻疹首剂和MMR1疫苗覆盖率为31%,全国覆盖率达到102.2%,94.5%,在2月至11月期间,这些疫苗的比例分别为91.8%和96.3%,分别。此外,3IS会议提供了133,528剂破伤风类毒素,16,353剂成人HepB疫苗,和315,032维生素A剂量给符合条件的个体。
结论:在全球鼓励整合疫苗接种服务的背景下,伊拉克的3IS方法极大地改善了RI的覆盖范围,实际上消除了大流行期间出生的儿童的零剂量状态,以及COVID-19和成人疫苗接种的小幅改善。我们的发现为伊拉克未来实现全民健康覆盖的综合初级保健提供了经验教训,以及其他尚未进行整合的国家。
BACKGROUND: COVID-19 seriously impacted routine immunization (RI) in Iraq. Coverage declined to a 6-year low in 2021, and COVID-19 vaccination uptake was slow. In response, government implemented intensification of integrated immunization services (3IS), a nationwide approach comprising regular outreach sessions of COVID-19 vaccination and RI for children who had either missed doses or never commenced scheduled vaccination (zero-dose children). We describe the 3IS and its impact on vaccination coverage in Iraq.
METHODS: 3IS comprised new outreach sessions for urban and rural communities where administrative data suggested there were gaps in coverage. Groups of six personnel from each of 1,321 primary healthcare centres implemented six outreach sessions per month during February-November 2022. Community engagement was an integral component. We compared RI administrative data (2019-2022) and data reported during 3IS activities to assess its impact.
RESULTS: In total 4,189,859 vaccine doses were administered during 72,495 3IS outreach sessions, over one-fifth of 19,106,849 vaccine doses administered in Iraq over these 10 months. Among them, 957,874 (22.9 %) were COVID-19 vaccines, adding slightly to national coverage, and 3,231,985 (77.1 %) were RI vaccines, dramatically reducing zero-dose children, adding 18 %, 25 %, 21 %, and 31 % to 2022 penta1, penta3, measles first-dose and MMR1 vaccine coverage, and contributing to national coverage of 102.2 %, 94.5 %, 91.8 % and 96.3 % for these vaccines during February-November, respectively. Moreover, 3IS sessions delivered 133,528 doses of tetanus toxoid, 16,353 doses of adult HepB vaccine, and 315,032 vitamin A doses to eligible individuals.
CONCLUSIONS: In the context of global encouragement to integrate vaccination services, Iraq\'s 3IS approach enabled dramatic improvements in RI coverage, virtual elimination of zero-dose status among children born during the pandemic, and small improvements in COVID-19 and adult vaccination. Our findings provide lessons for future integrated primary care towards universal health coverage in Iraq, and for other countries yet to undertake integration.