本文摘譯自MASSDEVICE?2020年5月12日新聞

以下為詳文

根據(jù)美國(guó)疾病控制和預(yù)防中心（CDC）研究人員的數(shù)據(jù)，由于COVID-19大流行，社區(qū)采取強(qiáng)制執(zhí)行的隔離保護(hù)措施，使父母和孩子遠(yuǎn)離醫(yī)生辦公室，這種情況促使了美國(guó)兒童常規(guī)疫苗接種量急劇下降。

3月13日宣布全國(guó)緊急狀態(tài)后，小兒疫苗接種量急劇下降，這表明某些兒童患上其他嚴(yán)重傳染性疾病（例如麻疹）的風(fēng)險(xiǎn)可能會(huì)增加。

CDC截

研究人員把2020年1月6日至4月19日聯(lián)邦資助疫苗的每周訂單與2019年的同期訂單進(jìn)行了比較。

他們特別提到，到研究期結(jié)束時(shí)，CDC免疫實(shí)踐咨詢(xún)委員會(huì)推薦的兒童常規(guī)小兒非流感疫苗訂單，COVID-19相關(guān)的累積劑量下降了250萬(wàn)劑，此外，麻疹疫苗訂單的累積劑量下降了25萬(wàn)劑。

CDC發(fā)言人Richard Quartarone表示，研究期間的疫苗接種，總體下降幅度較大。上述數(shù)字的下降，顯然與COVID-19大流行有關(guān)。

在2020年3月16日開(kāi)始的一周內(nèi)，為≥24個(gè)月的孩子訂購(gòu)的麻疹疫苗周數(shù)量急劇下降到500份左右；在3月23日開(kāi)始的一周內(nèi)，進(jìn)一步下降到約250份；直到4月13日開(kāi)始的那一周，一直保持這個(gè)水平。相比之下，宣布緊急狀況之前，即在3月2日開(kāi)始的一周內(nèi)，訂購(gòu)了2500多份。

對(duì)于2歲以下的兒童，下降幅度明顯較小。從3月23日開(kāi)始的一周內(nèi)，這些孩子的訂單下降到約750份左右，不過(guò)，3周內(nèi)略有上升。相比之下，在3月2日的那一周，這些孩子的疫苗訂單大約是2000份。

5月8日在線發(fā)表在《CDC發(fā)病率和死亡率周報(bào)》上的這項(xiàng)調(diào)查結(jié)果，來(lái)自對(duì)聯(lián)邦兒童疫苗計(jì)劃（VFC）訂購(gòu)數(shù)據(jù)的分析，以及來(lái)自CDC疫苗追蹤系統(tǒng)和疫苗安全協(xié)作數(shù)據(jù)鏈（VSD）的疫苗管理數(shù)據(jù)。

CDC截圖

對(duì)于18歲或18歲以下的，VFC為他們大約有一半的人數(shù)免費(fèi)提供聯(lián)邦購(gòu)買(mǎi)的疫苗。VSD與CDC免疫安全辦公室和全國(guó)八家大型醫(yī)療機(jī)構(gòu)在疫苗覆蓋率方面進(jìn)行合作。疫苗接種覆蓋率是評(píng)估疫苗使用情況的常用指標(biāo)，提供方的指令和給藥劑量是兩個(gè)替代措施。

來(lái)自CDC免疫服務(wù)部門(mén)、國(guó)家免疫和呼吸系統(tǒng)疾病中心的研究人員強(qiáng)調(diào)，在大流行期間保持定期接種疫苗非常重要，并指出：“常規(guī)的兒童疫苗訂購(gòu)和使用劑量的確定下降數(shù)據(jù)可能說(shuō)明，美國(guó)兒童及其社區(qū)面臨著疫苗可預(yù)防疾病爆發(fā)的風(fēng)險(xiǎn)增加。”因此，應(yīng)該提醒父母，必須保護(hù)自己的孩子免受疫苗可預(yù)防疾病的侵害。

研究人員預(yù)測(cè)，隨著社區(qū)隔離的緩和，未接種疫苗的兒童將更容易感染其他嚴(yán)重疾病。他們總結(jié)道：“地方、州、聯(lián)邦各級(jí)的醫(yī)療保健提供者和公共衛(wèi)生官員之間，需要繼續(xù)協(xié)調(diào)努力，有必要實(shí)現(xiàn)快速補(bǔ)種疫苗。”

原文：

COVID-19 Fears Tied to Dangerous Drop in Child Vaccinations

Medscape Medical News? ? ?Diana Swift? ? ?May 12, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The social distancing and sheltering in place mandated because of the COVID-19 pandemic are keeping parents and kids out of their doctors' offices, and that has prompted a steep decline in recommended routine vaccinations for US children, according to Centers for Disease Control and Prevention (CDC) researchers.

Pediatric vaccinations dropped sharply after the national emergency was declared on March 13, suggesting that some children may be at increased risk for other serious infectious diseases, such as measles.

The researchers compared weekly orders for federally funded vaccines from January 6 to April 19, 2020, with those during the same period in 2019.

They noted that by the end of the study period, there was a cumulative COVID-19–related decline of 2.5 million doses in orders for routine noninfluenza pediatric childhood vaccines recommended by the CDC's Advisory Committee on Immunization Practices, as well as a cumulative decline in orders of 250,000 doses of measles vaccines.

Although the overall decrease in vaccinations during the study period was larger, according to CDC spokesperson Richard Quartarone, the above figures represent declines clearly associated with the pandemic.

The weekly number of measles vaccines ordered for children aged 24 months or older fell dramatically to about 500 during the week beginning March 16, 2020, and fell further to approximately 250 during the week beginning March 23. It stayed at that level until the week beginning April 13. By comparison, more than 2500 were ordered during the week starting March 2, before the emergency was declared.

The decline was notably less for children younger than 2 years. For those children, orders dropped to about 750 during the week starting March 23 and climbed slightly for 3 weeks. By comparison, during the week of March 2, about 2000 vaccines were ordered.

The findings, which were published online May 8 in the CDC's Morbidity and Mortality Weekly Report, stem from an analysis of ordering data from the federal Vaccines for Children (VFC) Program, as well as from vaccine administration data from the CDC's Vaccine Tracking System and the collaborative Vaccine Safety Datalink (VSD).

The VFC provides federally purchased vaccines at no cost to about half of persons aged 18 years or younger. The VSD collaborates on vaccine coverage with the CDC's Immunization Safety Office and eight large healthcare organizations across the country. Vaccination coverage is the usual metric for assessing vaccine usage; providers' orders and the number of doses administered are two proxy measures, the authors explain.

"The substantial reduction in VFC-funded pediatric vaccine ordering after the COVID-19 emergency declaration is consistent with changes in vaccine administration among children in the VSD population receiving care through eight large US health care organizations," write Jeanne M. Santoli, MD, and colleagues, of the CDC's Immunization Services Division, National Center for Immunization and Respiratory Diseases. "The smaller decline in measles-containing vaccine administration among children aged ≤24 months suggests that system-level strategies to prioritize well child care and immunization for this age group are being implemented," they state.

Santoli, who is an Atlanta-based pediatrician, and associates stress the importance of maintaining regular vaccinations during the pandemic. "The identified declines in routine pediatric vaccine ordering and doses administered might indicate that US children and their communities face increased risks for outbreaks of vaccine-preventable diseases," they write. "Parental concerns about potentially exposing their children to COVID-19 during well child visits might contribute to the declines observed." Parents should therefore be reminded of the necessity of protecting their children against vaccine-preventable diseases.

In 2019, a Gallup survey reported that overall support for vaccination continued to decline in the United States.

The researchers predict that as social distancing relaxes, unvaccinated children will be more susceptible to other serious diseases. "In response, continued coordinated efforts between health care providers and public health officials at the local, state, and federal levels will be necessary to achieve rapid catch-up vaccination," they conclude.