Journal of The Korean Society of Maternal and Child Health (한국모자보건학회지)

The Korean Society of Maternal and Child Health (한국모자보건학회)
권호 표지

Vaccination Coverage Rate among 3 Year Olds (Cohort Born in 2007) Using Korea National Immunization Survey Method

국가표준 예방접종률 조사방법을 이용한 3세 아동의 예방접종률

  • Lee, Sok Goo (Department of Preventive Medicine, School of Medicine, Chungnam National University) ;
  • Jeon, So Youn (Department of Emergency Medical Technology, Daejeon Health Sciences College) ;
  • Ki, Moran (Department of Preventive Medicine, College of Medicine, Eulji University) ;
  • Kim, Chang Hoon (Department of Preventive Medicine, School of Medicine, Pusan National University) ;
  • Park, Eun Young (Division of VPD Control and NIP, Korea Centers for Disease Control and Prevention) ;
  • Bae, Geun Ryang (Division of VPD Control and NIP, Korea Centers for Disease Control and Prevention) ;
  • Lee, Yeon Kyeng (Division of VPD Control and NIP, Korea Centers for Disease Control and Prevention)
  • 이석구 (충남대학교 의학전문대학원 예방의학교실) ;
  • 전소연 (대전보건대학교 응급구조과) ;
  • 기모란 (을지대학교 의과대학 예방의학교실) ;
  • 김창훈 (부산대학교 의학전문대학원 예방의학교실) ;
  • 박은영 (질병관리본부 예방접종관리과) ;
  • 배근량 (질병관리본부 예방접종관리과) ;
  • 이연경 (질병관리본부 예방접종관리과)
  • Published : 2013.01.31
⟨ Previous Next ⟩

Abstract

Objectives: The purpose of measuring vaccination coverage rate is to monitor adequate vaccination status for reducing communicable disease occurrence. So lots of nations surveyed vaccination coverage by the use of various measuring methods, and developed immunization policy and program following to these survey results. This study developed standard Korea National Immunization Survey method for measuring vaccination coverage in national and metropolitan level, and then measured real status, finally, suggested further developmental directions of national standard survey method. Methods: We developed the formal process as a national standard, go through Korean national advisory committee for vaccination and then Statistics Korea. We performed the computer aided telephone interview. The source of information is household-retained vaccination cards. And survey population is 7,040 at 3-year-olds (cohort born in 2007) who registered in national immunization registry system. The unit of sampling is each metropolitan and provincial area using minimum sample size determination method (precision 5%, confidence interval 95%, assumed coverage rate 50%). Results: The national vaccination coverage per dose was 1 dose BCG 98.8%, $1^{st}$ dose Hepatitis B 99.0%, $2^{nd}$ dose Hepatitis B 99.3%, $3^{rd}$ dose Hepatitis B 98.7%, $1^{st}$ DTaP 99.6%, $2^{nd}$ dose DTaP 99.5%, $3^{rd}$ dose DTaP 99.1%, $4^{th}$ dose DTaP 93.5%, $1^{st}$ dose poliovirus 99.4%, $2^{nd}$ dose poliovirus 99.3%, $3^{rd}$ dose poliovirus 98.4%, $1^{st}$ dose MMR 99.2%, 1 dose varicella 97.7%, $1^{st}$ dose Japanese encephalitis 97.9%, $2^{nd}$ dose Japanese encephalitis 95.9%, $3^{rd}$ dose Japanese encephalitis 90.7%. Other vaccination coverage per dose was $1^{st}$ dose Hib 90.9%, $2^{nd}$ dose Hib 87.7%, $3^{rd}$ dose Hib 82.5%, $4^{th}$ dose Hib 69.4%, $1^{st}$ dose Hepatitis A 84.5%, $2^{nd}$ dose Hepatitis A 78.1%, $1^{st}$ dose pneumococcus 67.1%, $2^{nd}$ dose pneumococcus 60.5%, $3^{rd}$ dose pneumococcus 56.7%, $4^{th}$ dose pneumococcus 51.4%, $1^{st}$ dose rotavirus 6.0%, $2^{nd}$ dose rotavirus 5.5%, $3^{rd}$ dose rotavirus 5.1%. In completeness for each vaccine, total 3 doses of Hepatitis B was estimated at 98.2%, 3 doses of DTaP 99.0%, 4 doses of DTaP 93.2%, 3 doses poliovirus of 98.4%. And series vaccination coverage was 95.9% at 3:3:3:1, 91.9% at 4:3:1, 90.4% at 4:3:1:3:1, 88.7% at 4:3:1:3:1:1, 56.3% at 4:3:1:3:1:1:3. Conclusions: The Korean vaccination coverage rates are adequate in terms of the herd immunity. To improve measuring method for national vaccination coverage rate, our nation must have adequate national immunization registry system. So, we can obtain accurate and timely individual immunization records.

예방접종을 통해 감염병 발생 감소나 퇴치를 위해서는 지역사회의 적정수준 이상의 예방접종률 유지가 필요하며, 지역사회의 예방접종률이 적정수준에 있는지를 평가하고 모니터링 하기 위해서 각 국가들은 다양한 방법을 통하여 예방접종률을 조사하고 그 결과를 반영하여 정책 및 대책을 수립하고 있다. 따라서 본 연구는 우리나라의 국가 및 시도 단위의 예방접종률을 측정할 수 있는 국가표준 조사방법을 결정하고, 이를 통하여 실제 예방접종률을 측정하여 경시적으로 비교할 수 있는 토대를 마련하였으며, 향후 국가표준 조사방법의 발전방향을 제시하고자 시도되었으며 본 연구의 주요 조사방법론과 결과는 다음과 같다. 첫째, 전국 및 시도를 대표할 수 있는 예방접종률로서의 가치를 인정받는 국가표준 예방접종률 조사방법을 개발하여 예방접종전문위원회 심의와 통계청의 승인 (국가통계승인 제01201호)을 받는 등 공식화된 절차를 거쳐 최종 확정하였다. 조사대상자는 3세(2007년 1월~12월 출생자) 아동, 목표모집단은 주민등록인구, 조사모집단은 예방접종등록관리 정보시스템에 등록된 아동으로 하였다. 최소 표본수 산출시 5% p 정밀도, 95 % 신뢰수준, 50% 접종률을 고려하였으며 총 조사 대상자수는 7,040명이었다. 조사방법은 전화조사, 조사 시 자료원은 예방접종수첩이었다. 예방접종률 산출기본 단위는 국가 및 시도로 하였고, 산출지표는 접종별, 차수별 예방접종률과 완전 접종률이었다. 둘째, 국가필수예방접종의 접종별, 차수별 예방접종률은 BCG 1회 98.8%, B형간염 1차 99.0%, B형간염 2차 99.3%, B형간염 3차 98.7%, DTaP 1차 99.6%, DTaP 2차 99.5%, DTaP 3차 99.1%, DTaP 4차 93.5%, 폴리오 1차 99.4%, 폴리오 2차 99.3%, 폴리오 3차 98.4%, MMR 1차 99.2%, 수두 1회 97.7%, 일본뇌염 1차 97.9%, 일본뇌염 2차 95.9%, 일본뇌염 3차 90.7%로 나타났다. 기타예방접종의 접종별, 차수별 예방접종률은 b형 헤모필루스 인플루엔자 뇌수막염 1차 90.9%, 2차 87.7%, 3차 82.5%, 4차 69.4%, A형간염 1차 84.5%, 2차 78.1%, 폐렴구균 1차 67.1 %, 2차 60.5%, 3차 56.7%, 4차 51.4%, 로타바이러스 1차 6.0%, 2차 5.5%, 3차 5.1%이었다. 국가필수 예방접종의 접종별 완전 접종률은 B형간염 3회 98.2%, DTaP 3회 99.0%, DTaP 4회 93.2%, 폴리오 3회 98.4%, 일본뇌염 사백신 3회(생백신 2회) 61.4% 로 나타났다. 또한 시리즈별 완전 접종률은 3:3:3:1 (DTaP 3회, 폴리오 3회, B형간염 3회, BCG 1회) 시리즈 95.9%, 4:3:1(DTaP 4회, 폴리오 3회, MMR 1회) 시리즈 91.9%, 4:3:1:3:1(DTaP 4회, 폴리오 3회, MMR 1회, B형간염 3회, BCG 1회) 시리즈 90.4%, 4:3:1:3:1:1 (DTaP 4회, 폴리오 3회, MMR 1회, B형간염 3회, BCG, 1회, 수두 1회) 시리즈 88.7%, 4:3:1:3:1:1:3 (DTaP 4회, 폴리오 3회, MMR 1회, B형간염 3회, BCG, 1회, 수두 1회, 일본뇌염 사백신 3회, 생백신 2회) 시리즈 56.3%로 나타났다. 기타예방 접종의 접종별 완전 접종률은 b형 헤모필루스 인플루엔자 뇌수막염 3회 82.2%, b형 헤모필루스 인플루엔자 뇌수막염 4회 67.1%, 폐렴구균 4회 49.7%, A형간염 2회 78.1%, 로타바이러스 3회 5.1%로 나타났다. 따라서 향후 근거기반의 예방접종사업 목표 설정 및 정책 수립을 위해 체계적인 국가 단위의 조사는 계속 되어야 할 것이다.

Keywords

References

  1. Brownson RC, Baker EA, Leet TL, Gillespie KN. Evidence-based public health. Oxford university press, 2003;146-147
  2. Center for Disease Control and Prevention. National and state vaccination coverage among children aged 19-35 months-United States, 2010. MMWR 2011;60(34):1157-1163
  3. Chen SZ, Gary Z, Esther TG, Itamar G, Ronni G. The national childhood immunization registry in Israel. Procedia in Vaccinology 2011;4:9-13 https://doi.org/10.1016/j.provac.2011.07.002
  4. Crowcroft NS. Action on immunization. No data, no action. Arch Dis Child 2009;94:829-830 https://doi.org/10.1136/adc.2008.138776
  5. Fairbrother G, Freed, GL, Thompson, JW. Measuring immunization coverage. Am J Prev Med 2000;19(3):78-88 https://doi.org/10.1016/S0749-3797(00)00208-7
  6. Hinman AR, Orenstein WA, Schuchat A. Vaccinepreventable disease, immunization, and MMWR-1961-2011. MMWR 2011;60:49-53
  7. Hoshaw-Woodard S. Description and comparison of the methods of cluster sampling and lot quality assurance sampling to assess immunization coverage. WHO, 2001;2-3
  8. Hull BP, Deeks SL, McIntyre PB. The Australian Childhood Immunisation Register - a model for universal immunization registers? Vaccine 2009;27(37):5054-5060 https://doi.org/10.1016/j.vaccine.2009.06.056
  9. Immunisation Advisory Centre. Immunisation coverage and vaccine preventable diseases in New Zealand. Periodic report, 2010.
  10. Korean Institute for Health and Social Affairs. The 2009 National survey on fertility, family health and welfare in Korea. Korean Institute for Health and Social Affairs, 2009.
  11. Kim YT. Demonstration project for expansion of NIP (national immunization program) coverage. J Korean Med Assoc 2005;48(6):579-586 https://doi.org/10.5124/jkma.2005.48.6.579
  12. Lee SG, Jeon SY, Go UY, Kim MJ, Lee SH. Evaluation of data error, completeness, timeliness of national immunization registry in Korea. J Korea Soc Matern Child Health 2009;13(2):135-144
  13. Lee SG, Jeon SY, Oh HK. Qualitative views in computerized registration coverage by different cost supports for national immunization program. J Korea Soc Matern Child Health 2012;16(1):1113-1121 https://doi.org/10.1007/s10995-011-0839-0
  14. Ministry of Health. The National Childhood Immunisation Coverage Survey 2005. Public Health Intelligence Occasional Bulletin 2007;39:1-72
  15. Papania M, Rodewald L. For better immunization coverage, measure coverage better. Lancet 2006;367:925-926
  16. Park B, Lee YK, Cho LY, Go UY, Yang JJ, Ma SH, Choi BY, Lee MS, Lee JS, Choi EH, Lee HJ, Park SK. Estimation of nationwide vaccination coverage and comparison of interview and telephone survey methodology for estimating vaccination status. J Korean Med Sci 2011;26(6):711-719 https://doi.org/10.3346/jkms.2011.26.6.711
  17. Park SK. Nationwide vaccine coverage level; conceptual methodology and survey. Seoul National University, Korean Centers for Disease Control and Prevention, 2009;1-239
  18. Public Health Agency of Canada. Canadian national report on immunization, 2006. CCDR 2006;32S3:1-44
  19. Salmaso S, Rota MC, Ciofi Degli Atti ML, Tozzi AE, Kreidl P. Infant immunization coverage in Italy: estimates by simultaneous EPI cluster surveys of regions. Bulletin of the World Health Organization 1999;77(10):843-849
  20. Shin EC, Lee MS, Kweon SS, Ki MR, Kim KY, Na BJ, Nam HS, Lee SY. Development of vaccination coverage estimation methods and evaluation indicators of national immunization program in Korea. Catholic University, Korean Centers for Disease Control and Prevention, 2005;1-332
  21. The NHS Information Centre. NHS immunisation statistics England 2009-10. The NHS Information Centre, 2010;7-76
  22. Theeten H, Hens N, Vandermeulen C, Depoorter AM, Roelants M, Aerts M, Hoppenbrouwers K, Damme PV. Infant vaccination coverage in 2005 and predictive factors for complete or valid vaccination in Flanders, Belgium: an EPI-survey. Vaccine 2007;25(26):4940-4948 https://doi.org/10.1016/j.vaccine.2007.03.032
  23. WHO/UNICEF. Immunization coverage estimates, data as of July 2011
  24. World Development Report. World Development Report 1993; investing in health. Oxford university press, 1993;8
  25. World Health Organization. Training for mid-level managers: the EPI coverage survey. WHO, 1993;1-100
  26. World Health Organization. Monitoring immunization services using the Lot Quality Technique. WHO/VRO/TRAM/96.01. WHO, 1996.