BACKGROUND Currently, most large-scale public health programs, such as immunization or anti-parasitic deworming, work in relative isolation. Integrating efforts across programs could potentially improve their efficiency, but identifying populations that could benefit from multiple programs has been an operational challenge. METHODS We analyzed a nationally representative survey conducted in India between 2019 and 2021 to assess and map coverage of seven vaccines [Bacillus Calmette-Guérin (BCG), hepatitis B, polio, diphtheria-tetanus-pertussis (DTP), haemophilus influenza type b (Hib), rotavirus and measles-containing vaccine (MCV)], plus Vitamin A supplementation and anti-parasitic deworming treatment among 86 761 children aged 1-3 years old. RESULTS National coverage varied widely by program, from 42% (rotavirus) to 95% (BCG). There was high correlation between district-level coverage estimates (r ≥ 0.7) and extensive spatial overlap in low-coverage populations. In simulated implementation strategies, we show that an integrated strategy that targets full immunization coverage for four core vaccines (BCG, polio, DTP, MCV) would achieve similar coverage to an optimal (but unrealistic) implementation strategy and far better coverage than multiple efforts focused on individual vaccines. Targeting the most under-vaccinated districts within states based on spatial clustering or coverage thresholds led to further improvements in full coverage per child targeted. Integration of anti-parasitic deworming or rotavirus vaccination into a core vaccine delivery mission could nearly double their coverage (from ∼45% to ∼85%). CONCLUSIONS Integrated delivery and geographic targeting across core vaccines could accelerate India's progress toward full immunization coverage. An integrated platform could greatly expand coverage of non-core vaccines and other child health interventions.

中文翻译：

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2019-21 年印度各地的疫苗接种、维生素 A 和驱虫计划的空间定位和整合。


背景 目前，大多数大规模公共卫生计划，如免疫接种或抗寄生虫驱虫，都是在相对孤立的情况下进行的。跨计划整合工作可能会提高其效率，但确定可以从多个计划中受益的人群一直是一项运营挑战。方法 我们分析了 2019 年至 2021 年间在印度进行的一项具有全国代表性的调查，以评估和绘制七种疫苗 [卡介苗 （BCG）、乙型肝炎、脊髓灰质炎、白喉-破伤风-百日咳 （DTP）、乙型流感嗜血杆菌 （Hib）、轮状病毒和含麻疹疫苗 （MCV）] 的覆盖率，以及维生素 A 补充剂和抗寄生虫驱虫治疗在 86 761 名 1-3 岁儿童中。结果 全国覆盖率因项目而异，从 42%（轮状病毒）到 95%（BCG）不等。区级覆盖率估计 （r ≥ 0.7） 与低覆盖率人群的广泛空间重叠之间存在高度相关性。在模拟实施策略中，我们表明，针对四种核心疫苗（卡介苗、脊髓灰质炎、百白破、MCV）的全面免疫覆盖率的综合策略将实现与最佳（但不现实）实施策略相似的覆盖率，并且比专注于单个疫苗的多项努力要好得多。根据空间聚类或覆盖率阈值针对各州内疫苗接种率最不足的地区，进一步提高了每个目标儿童的全面覆盖率。将抗寄生虫驱虫或轮状病毒疫苗接种纳入核心疫苗交付任务，其覆盖率几乎可以翻倍（从 ∼45% 增加到 ∼85%）。结论 核心疫苗的综合交付和地理定位可以加快印度实现全面免疫覆盖的进展。 一个综合平台可以大大扩大非核心疫苗和其他儿童健康干预措施的覆盖范围。