长沙市居民甲型H1N1流感知识态度行为调查

目的 了解湖南省长沙市城乡居民关于甲型H1N1流感的知识、态度、行为现状,为开展社区健康教育提供依据.方法 运用多阶段随机抽样的方法,对长沙市城乡地区14-65岁常住居民1 294人进行人户调查,调查内容包括个人基本资料、预防甲型H1N1流感相关知识态度行为、疫苗接种及对媒体需求等情况.结果 1 294人中,不知道甲型H1N1流感流行者占14.1%;对甲型H1N1流感相关知识的知晓率为18.2%～88.6%,其中对感染甲流不一定会发热的知晓率最低(18.2%);农村居民的知晓率普遍低于城市和城镇居民;大流行期间外出戴口罩的比例为36.1%,就医戴口罩为39.3%;出现发热及呼吸道症状后选择自己买药治疗者占47.8%;在公共场所打喷嚏时用纸巾遮掩者为24.0%,在家打喷嚏时用纸巾遮掩者为24.7%;既往从未接种过普通流感疫苗者占80.3%;甲型H1N1流感疫苗接种率为10.4%,未接种者中不愿意接种甲型H1N1流感疫苗占37.1%.结论 长沙市特别是农村地区居民对甲型H1N1流感及流感疫苗相关知识了解不足且不全面,个人防护意识差,进一步开展健康教育工作有利于加强流感防控.     

影响医务人员感染甲型H1N1流行性感冒因素的病例-对照研究

目的 探讨影响医务人员感染甲型H1N1流行性感冒(简称流感)的因素.方法 搜集2009年8月30日至2010年1月31日北京市公立医院中医务人员甲型H1N1流感确诊病例.按1:4配对的病例-对照研究设计,在医院内分别选择感染过和未感染过甲型H1N1流感的医务人员做为病例组(54例)和对照组(216名).通过问卷调查,收集其工作和家庭卫生信息.运用条件logistic回归分析医务人员感染甲型H1N1流感的影响因素.结果 研究对象年龄为(29.6±7.4)岁,其中男性占17.4%(47/270).病例组和对照组医务人员中,分别有3例(5.6%)和74名(34.3%)接种了甲型H1N1流感疫苗,10例(18.5%)和88名(40.1%)在甲流期间使用了防护级别更高的口罩,33例(61.1%)和161名(74.5%)延长了戴口罩的时间,13例(24.1%)和85名(39.4%)使用一次性纸巾擦手,24例(44.4%)和46名(21.3%)认为根据以往经验自己比他人更易患呼吸道传染病.单因素条件logistic回归分析显示使用一次性纸巾擦手(OR=0.15,95%CI=0.04～0.57)、延长戴口罩的时间(OR=0.43,95%CI=0.20～0.92)、使用防护级别更高的口罩(OR=0.26,95%CI=0.11～0.58)、接种甲型H1N1流感疫苗(OR=0.04,95%CI=0.01～0.32)、据以往经验自己比别人更易患呼吸道传染病(OR=2.85,95%CI=1.44～5.62)等与感染甲型H1N1流感有关.多因素条件logistic回归分析结果表明,甲型H1N1流感疫苗接种史(OR=0.18,95%CI=0.06～0.51)、使用防护级别更高的口罩(OR=0.05,95%CI=0.01～0.35)、据以往经验自己比别人更易患呼吸道传染病(OR=3.69,95%CI=1.58～8.63)等3个因素与感染甲型H1N1流感有关.结论 接种甲型H1N1流感疫苗、疾病流行期间使用更高防护级别的口罩、提高自身对呼吸道疾病的抵抗能力等措施是医务人员预防甲型H1N1流感的重要手段.     

甲型H1N1流感流行对广东省居民健康行为影响情况调查

目的了解甲型H1N1流感流行对广东省居民健康行为的影响及不同特征居民健康行为改变情况。方法发生过和没有发生过甲型H1N1流感疫情的地市均作为调查地区,采用多阶段整群抽样方法抽取调查对象。全省共调查18～70岁居民5901人。结果甲型H1N1流感流行期间,居民咳嗽、打喷嚏时遮掩口鼻等6项健康行为形成率均高于甲型H1N1流感发生前,6项健康行为增加比例在3.6%～12.1%之间,差异均有统计学意义（P〈0.05）。不同特征居民甲型H1N1流感发生后咳嗽、打喷嚏时遮掩口鼻等6项健康行为形成率增加比例不同。40～49岁居民咳嗽、打喷嚏时遮掩口鼻、洗手、通风和锻炼增加比例高于其他年龄组,农村居民咳嗽、打喷嚏时遮掩口鼻、通风、锻炼和每月聚餐少于4次增加比例高于城市,疫情地区居民咳嗽遮掩口鼻、洗手、通风和锻炼增加比例高于非疫情地区。结论甲型H1N1流感疫情流行,能够在一定程度上促使居民健康行为的形成。不同特征居民健康行为改变不同,在传染病等突发公共卫生事件预防控制中,要根据不同人群采取针对性的干预措施,促使居民形成健康的行为生活方式。     

甲型H1N1流感患者卫生行为习惯及影响因素分析

目的了解甲型H1N1流感(以下简称"甲流")患者患病期间相关卫生行为习惯及其影响因素,为今后流感等呼吸道传染病流行时期提供有针对性的健康教育提供依据。方法以统一设计的调查问卷,委托国家12320卫生热线对北京、福建和河南三省市896例甲流患者开展电话调查。结果甲流患者在生病期间,去医院就诊戴口罩的比例为75.1%,但去人员密集的公共场所后戴口罩的比例仅为39.0%,乘坐交通工具后戴口罩占62.9%,与他人密切接触时戴口罩为60.6%;打喷嚏时遮挡占75.0%,其中遮挡方式主要为用手(42.7%),其次为纸巾(38.7%),上衣袖(9.4%)。接受过健康教育的患者卫生行为习惯表现较好;与医院隔离和居家隔离的患者比较,住院后居家隔离(出院时未痊愈)的患者卫生行为习惯较差,差异有统计学意义(P0.05)。结论需要对流感等呼吸道传染病患者加大宣传正确的个人卫生行为习惯;特别是出院时未痊愈的流感或其他呼吸道传染病患者进行出院健康教育,改善不良行为习惯。     

甲型H1N1流感不同流行时期农民知信行变化趋势分析

目的了解流行高峰期和流行后期某市郊区农民甲型H1N1流感和季节性流感知识、态度、行为(KAP)及流感疫苗接种情况的变化趋势。方法采用分阶段按容量比例概率抽样法(PPS),分别于甲型H1N1流感流行高峰期和流行后期对某市郊区农民进行两次电话调查。结果两次电话调查分别完成有效调查表202份和201份,接通电话的有效应答率分别为60.48%和60.73%。流行高峰期与流行后期农民对甲型H1N1流感传播方式的知晓率差异无统计学意义(P﹥0.05)。出现流感样症状时,流行高峰期去县级及县级以上医院就诊的比例高于流行后期(P﹤0.05),但在咳嗽打喷嚏时遮掩口鼻、洗手时用肥皂/洗手液和外出戴口罩等的比例差异无统计学意义(P﹥0.05)。普通流感疫苗的接种率在流行后期高于流行高峰期(P﹤0.05),但不同时期甲型H1N1流感疫苗的接种率及接种意愿等未见统计学差异(P﹥0.05)。结论该市郊区农民对甲型H1N1流感知识掌握不全面,甲型H1N1流感流行高峰期和流行后期农民的知识、态度、行为未见明显改变。     

甲型H1N1流感疫苗免疫效果及影响因素研究

目的了解学生大规模接种甲型H1N1流感疫苗的免疫效果及影响因素,为探索甲型H1N1流感免疫策略和防控措施提供科学依据。方法分别对344名中学生在甲型H1N1流感疫苗接种前及接种后1个月采集血清标本,进行抗体水平的检测。并收集中学生在接种疫苗前季节性流感疫苗接种史、流感样症状等有关流行病学信息,评价甲型H1N1流感疫苗的免疫效果及影响因素。结果 344名中学生在免前H1N1流感抗体几何平均滴度(GMT)为1∶16.97(95%CI:1∶14.49~1∶19.86),抗体阳性率为36.50%(95%CI:31.35%~41.89%);免后GMT为1∶167.41(95%CI:1∶145.08~1∶193.18),阳性率为89.91%(95%CI:86.19%~92.91%),阳转率为72.54%(95%CI:67.76%~77.32%),均明显高于免前。接种疫苗前3个月的季节性流感疫苗接种史、流感样症状史等因素分组后,各组间免疫学效果指标间差异无统计学意义(P>0.05)。结论接种甲型H1N1流感疫苗后免疫成功率70%以上,符合欧盟和美国FDA的有关规定,免疫效果良好。季节性流感疫苗接种史、流感症状史等对疫苗的免疫学保护效果无明显影响。     

北京市东城区居民甲型H1N1流感认知及态度调查

目的了解北京市东城区居民对甲型H1N1流感的基本认知和态度,为制定适宜的健康教育策略提供科学依据。方法采用分层随机抽样方法,选择北京市东城区2个社区,2家医院,2所学校、3个行业单位,共557人进行自填式问卷调查。结果93．9％的被调查者能够正确判断甲型H1N1流感是呼吸道传染病。居民对于“经常用肥皂和清水洗手”和“不去人群拥挤的场所”可以预防甲型H1N1流感的知晓率比较高,分别为88．9％和80．6％;而对“避免接触流感症状或肺炎等呼吸道疾病患者”和“咳嗽或打喷嚏时用纸巾遮住口鼻”等预防措施的知晓率较低,分别为28．2％和37．9％。72．0％的人认为甲型H1N1流感“有所控制,但仍在扩散”;与甲型H1N1流感暴发前相比,85．1％的人比以前更关注健康相关信息,84．4％的人比以前更注重自己的个人卫生习惯,89．6％的人去医院就诊／探视病人时会主动佩戴口罩。超过80％的居民对政府采取的防控措施和信息发布工作表示满意。结论居民对甲型H1N1流感知识掌握不全面,倾向于采取健康行为,通过大众传媒等途径开展的流感健康教育还应进一步加强。     

辽宁省丹东市大学生甲型H1N1流感知识、态度和行为调查

目的了解辽宁省丹东市大学生对甲型H1N1流感的认知、态度、行为,及大学生采取预防措施的效果,为今后在大学生中进一步开展甲型H1N1流感的健康教育提供依据。方法采用随机整群抽样方法,对丹东市某大学在校学生以无记名方式进行有关甲型H1N1流感知信行认知、态度、行为及预防技能等的问卷调查。结果被调查大学生均关注甲型H1N1流感,对甲型H1N1流感基本知识和预防措施了解程度较高,但"接触甲型H1N1流感感染者物品后触摸口鼻传播"、"不能通过食用猪肉传播"的正确率仍较低。97.5%的学生采取了预防措施,而采取"预防性服药"、"避免用手接触口鼻"、"咳嗽打喷嚏用纸巾遮掩口鼻"的比例较少,分别为15.6%、27.1%和33.6%。在预防技能调查中,能"正确测量腋下体温"者仅占55.0%,"正确洗手方法"最低,仅占32.4%。多数学生(83.6%)认为疫苗接种的预防效果比较确切。69.9%的学生认为甲型H1N1流感可防可控,但具有恐慌心理的占14.1%。结论大学生对甲型H1N1流感知识及预防措施有一定了解,今后应重点加强行为技能的健康教育。     

黑龙江省甲型H1N1流感感染血清学调查分析

目的了解黑龙江省甲型H1N1流感病毒感染状况,为评估研判疫情发展趋势提供信息支持。方法应用常规微量血凝抑制实验,对2009年12月～2010年3月共4次采集的医院门诊的就诊患者血清1 624份进行甲型H1N1流感抗体水平检测。结果黑龙江省甲型H1N1流感抗体阳性率为20.01%(325/1 624),疫苗的有效率为52.11%(37/71),自然感染率仅为12.04%(288/1 553)。黑龙江省医院、哈尔滨市儿童医院、哈尔滨市血站三家医疗机构中儿童医院的抗体阳性率最高(27.07%);甲型H1N1流感病毒HI抗体阳性率在性别上无显著差异,但在年龄组上有显著差异,6～17岁年龄组抗体阳性率最高33.57%(94/280),0～5岁年龄组次之为26.91%,56岁以上年龄组抗体阳性率最低为3.21%。结论甲型H1N1流感已经在黑龙江省流行,但人群抗体阳性率仅为20.01%,远低于70%的保护水平,有可能还会出现暴发流行疫情,应进一步加强甲型H1N1流感疫苗接种,特别是56岁以上的老年人应重点防护。     

东莞市中小学生、工人和居民甲型H1N1流感防治知信行现况调查

目的了解东莞市中小学生、工人和居民甲型H1N1流感防治知识、态度及行为现况,为下一步防控工作提供科学依据。方法选择东莞市小学、初中、工厂各1间,居民社区1个,其中小学和初中每个年级选择两个班进行整群抽样,社区和工厂采取随机抽样方法选取对象,采用自填式问卷调查甲型H1N1流感防治知识的认知水平、日常行为习惯及对待甲型H1N1流感的态度等。结果调查对象对甲型H1N1流感总体知晓率为69.63%,其中中小学生为75.32%,工人为64.10%,居民为52.46%,三者知晓率之间差异有统计学意义(χ2=45.98,P0.05);中小学生不带病上课、打喷嚏或咳嗽时捂嘴、每天洗手次数、洗手时点和洗手方式等卫生习惯方面均优于工人及居民,差异有统计学意义;有27.24%的调查对象认为甲型H1N1流感可怕,认为可怕的原因主要是甲型H1N1流感难以预防(52.68%)、该病易病死(46.34%)和没有特效药(41.22%);在未接种过甲型H1N1流感疫苗的调查对象中,仅58.10%表示愿意接种免费的甲型H1N1流感疫苗,不愿意接种的原因主要是担心疫苗的安全性。结论东莞市中小学生在甲型H1N1流感防治知识、态度及行为等方面均优于工人及居民,应在特定人群中有针对性地开展甲型H1N1流感可防可治、疫苗安全有效、不带病工作及正确洗手方法等关键知识点的宣传教育。     

Monitoring pandemic influenza A(H1N1) vaccination coverage in Germany 2009/10 - results from thirteen consecutive cross-sectional surveys

To monitor pandemic influenza A(H1N1) vaccine uptake during the vaccination campaign in Germany 2009/10, thirteen consecutive cross-sectional telephone-surveys were performed between November 2009 and April 2010. In total 13,010 household-interviews were conducted. Vaccination coverage in persons >14 years of age remained low, both in the general population (8.1%; 95%CI: 7.4-8.8) and in specific target groups such as healthcare workers and individuals with underlying chronic diseases (12.8%; 95%CI: 11.4-14.4). Previous vaccination against seasonal influenza was a main factor independently associated with pandemic influenza vaccination (Odds ratio = 8.8; 95%CI: 7.2-10.8). The campaign failed to reach people at risk who were not used to receive their annual seasonal influenza shot.     

Willingness of healthcare workers to accept voluntary stockpiled H5N1 vaccine in advance of pandemic activity

Healthcare workers may be at risk during the next influenza pandemic. Priming with stockpiled vaccine may protect staff and reduce nosocomial transmission. Despite campaigns to increase seasonal influenza vaccine coverage, uptake among healthcare workers is generally low; creating uncertainty whether they would participate in pre-pandemic vaccine programmes. We conducted a cross-sectional questionnaire survey of healthcare workers in a UK hospital during, and 6 months after, a period of media reporting of an H5N1 outbreak at a commercial UK poultry farm. A total of 520 questionnaires were returned, representing 20% of frontline workforce. More respondents indicated willingness to accept stockpiled H5N1 vaccine during the period of media attention than after (166/262, 63.4% vs. 134/258, 51.9%; p = 0.009). Following multivariate analysis, factors associated with willingness to accept H5N1 vaccine included: previous seasonal vaccine (OR 6.2, 95% CI 3.0–12.8, p < 0.0001), awareness of occupational seasonal vaccine campaigns (OR 2.2, 95% CI 1.4–3.5, p = 0.001), belief that seasonal vaccine benefits themselves (OR 2.5, 95% CI 1.6–4.0, p < 0.0001) or the hospital (OR 3.6, 95% CI 2.3–5.8, p < 0.0001), belief that pandemic risk is high/moderate (OR 14.1, 95% CI 7.6–26.1, p < 0.0001) and would threaten healthcare workers (OR 2.9, 95% CI 1.8–4.5, p < 0.0001). Those who would not accept vaccine (220 respondents, 42.7%) if offered before the pandemic do not perceive pandemic influenza as a serious threat, and have concerns regarding vaccine safety. A majority of healthcare workers are amenable to accept stockpiled H5N1 vaccine if offered in advance of pandemic activity.     

Seasonal and Pandemic A (H1N1) 2009 influenza vaccination coverage and attitudes among health-care workers in a Spanish University Hospital

Influenza vaccination coverage among health-care workers (HCWs) remains the lowest compared with other priority groups for immunization. Little is known about the acceptability and compliance with the pandemic (H1N1) 2009 influenza vaccine among HCWs during the current campaign. Between 23 December 2009 and 13 January 2010, once the workplace vaccination program was over, we conducted a cross-sectional, questionnaire-based survey at the University Hospital 12 de Octubre (Madrid, Spain). Five hundred twenty-seven HCWs were asked about their influenza immunization history during the 2009–2010 season, as well as the reasons for accepting or declining either the seasonal or pandemic vaccines. Multiple logistic-regression analysis was preformed to identify variables associated with immunization acceptance. A total of 262 HCWs (49.7%) reported having received the seasonal vaccine, while only 87 (16.5%) affirmed having received the pandemic influenza (H1N1) 2009 vaccine. “Self-protection” and “protection of the patient” were the most frequently adduced reasons for acceptance of the pandemic vaccination, whereas the existence of “doubts about vaccine efficacy” and “fear of adverse reactions” were the main arguments for refusal. Simultaneous receipt of the seasonal vaccine (odds ratio [OR]: 0.27; 95% confidence interval [95% CI]: 0.14–0.52) and being a staff (OR: 0.08; 95% CI: 0.04–0.19) or a resident physician (OR: 0.16; 95% CI: 0.05–0.50) emerged as independent predictors for pandemic vaccine acceptance, whereas self-reported membership of a priority group was associated with refusal (OR: 5.98; 95% CI: 1.35–26.5). The pandemic (H1N1) 2009 influenza vaccination coverage among the HCWs in our institution was very low (16.5%), suggesting the role of specific attitudinal barriers and misconceptions about immunization in a global pandemic scenario.     

中国内地居民2000-2009年被动吸烟率Meta分析

目的 运用Meta分析综合评价中国内地居民2000-2009年被动吸烟率,并分析其在性别、城/乡及不同经济发展水平地区、场所等因素间的差别.方法 检索万方数据库、维普信息资源系统、中国期刊全文数据库、中国生物医学文献数据库及PubMed数据库,收集所有关于居民吸烟的调查研究,再从中筛选出有关被动吸烟的研究报告.各资料间进行异质性检验,以确定采用固定模型或随机模型进行合并分析,采用秩相关检验法进行发表偏倚的评估.结果 共入选相关文献19篇,累计不吸烟人数为195 349人,被动吸烟人数为70 781人,总被动吸烟率为47.04%(95%CI:38.88%～55.27%).将被动吸烟率按照性别、城/乡、研究年份、研究地区和被动吸烟场所进行分层分析,男、女性被动吸烟率分别为44.80%(95%CI:34.07%～55.79%)和49.09%(95%C:39.62%～58.59%),P＜0.05;城市、农村地区合并的被动吸烟率分别为46.10%(95%CI:28.88%～63.82%)和47.55%(95%CI:17.85%～78.25%),P＜0.05;研究年份在2000-2004年被动吸烟率合并为47.59%(95%CI:38.31%～56.95%),2005-2009年为46.90%(95%CI:33.19%～60.87%),P＜0.05;东、西部地区居民被动吸烟率分别为41.38%(28.88%～54.47%)和74.38%(95%CI:59.08%～87.10%),P＜0.05;家庭、工作场所、公共场所被动吸烟率分别为73.03%(95%CI: 60.41%～84.00%)、14.72%(95%CI:8.83%～21.82%)和25.90%(95%CI:5.65%～54.24%),P＜0.05.结论 合并的被动吸烟率女性高于男性,农村地区高于城市,研究年份为2005-2009年的被动吸烟率低于2000-2004年,西部地区居民被动吸烟率高于东部地区,家庭内被动吸烟率高于工作场所和公共场所.

Abstract：

Objective To analyze the prevalence of passive smoking among inland residents in China from 2000 to 2009 and to analyze the differences between sex, urban/rural geographic distribution, different levels of economic development etc.. Methods Electronic search strategy was carried out, using WanFang database, China Journal Full-text database, VIP database, CBM and PubMed database to collect data on smoking, and passive smoking status, among residents in China.Fixed effects model or random effects model was employed according to statistical tests for homogeneity. Publication bias was assessed by rank correlation test. All statistical analysis was conducted with R 2.8.0. Results Nineteen studies were selected with a total of 195 349 non-smokers and 70 781 passive smokers involved. The overall prevalence of passive smoking was 47.04%(95%CI: 38.88%-55.27%). The prevalence of passive smoking was stratified by factors as sex, urban/rural, year and areas of the study, and areas where passive smoking was studied. The pooled prevalence rates of passive smoking were as follows: 44.80% (95%CI: 34.07%-55.79%) and 49.09%(95%CI:39.62%-58.59%) ,P＜0.05 for male and female;46.10%(95%CI:28.88%-63.82%),47.55%(95% CI: 17.85%-78.25% ), P＜0.05 for urban and rural, respectively. The pooled prevalence rates of passive smoking were 47.59% (95% CI: 38.31%-56.95% ) in the study year of 2000-2004 and 46.90% (95%CI: 33.19%-60.87% ) in 2005-2009 (P＜0.05). The pooled prevalence rates of passive smoking for eastern and western areas were 41.38%(28.88%-54.47%) and 74.38%(95%CI: 59.08% -87.10% ) (P＜0.05), and 73.03% (95%CI: 60.41% - 84.00% ), 14.72% (95%CI: 8.83%-21.82% )and 25.90% (95% CI: 5.65% - 54.24% ) for family, workplace and public place, respectively (P＜0.05). Conclusion The pooled prevalence of passive smoking was higher in females than males, in rural than in urban and in the western area than in the eastern areas. The prevalence of passive smoking in the study year of 2005-2009 was lower than of 2000-2004. The pooled passive smoking rate in the family was higher than in the workplace or in public.     

Diminished immunogenicity to pandemic H1N1 2009 influenza vaccine in subjects with severe motor and intellectual disability

Subjects with severe motor and intellectual disability (SMID) are considered to be debilitated and at high risk of influenza infection. However, the safety and immunogenicity of pandemic H1N1 (pH1N1) vaccine in these subjects have not been reported. We measured the hemagglutination inhibition antibody titer and calculated the geometric mean titer ratio (GMTR), seroprotection rate, and seroconversion rate in 104 subjects with SMID (mean age ± standard deviation 40.1 ± 12.9 years), and in 179 healthcare workers (40.7 ± 10.4 years) in a long-term care facility. Antibody responses after the first dose of pH1N1 vaccine among workers were greater than the European Medicines Evaluation Agency criteria and US Food and Drug Administration (FDA) criteria: the seroprotection rate was 79.9% (95% confidence interval (CI) 73.3-85.5), the seroconversion rate was 77.9% (95%CI: 70.8-84.0), and GMTR was 7.3 (95%CI: 6.9-7.8). Responses among subjects with SMID were lower than the FDA criteria: the seroprotection rate was 56.3% (95%CI: 46.2-66.1), the seroconversion rate was 54.1% (95%CI: 43.7-64.2), and GMTR was 5.4 (95%CI: 4.9-5.9). Any additional antibody response induced by the second dose of vaccine among subjects with SMID was limited. Multivariate analysis indicated that subjects with SMID had a significantly lower seroprotection rate (odds ratio (OR) 0.37, 95%CI: 0.20-0.66) and seroconversion rate (OR 0.34, 95%CI: 0.20-0.59) than healthcare workers. No serious adverse reaction was reported in either group. These results indicate that a single dose of pH1N1 vaccine does not induce sufficient immunity among subjects with SMID, and a second dose is likely to be ineffective because of diminished immunogenicity. Further study is required to determine if vaccination over consecutive influenza seasons can improve immunogenicity in subjects with SMID.     

不同流感样病例定义对住院儿童流感监测结果的影响

  目的   了解不同流感样病例定义对住院儿童流感监测结果的影响。   方法   利用2017年10月-2018年5月苏州大学附属儿童医院呼吸道疾病综合监测的病原学和临床症状等数据, 计算符合中国、欧盟疾病预防控制中心(European center for disease prevention and control, ECDC)和世界卫生组织(world health organization, WHO)的流感样病例定义时的流感病毒检出率, 以流感病毒检出为金标准, 分别分析三种流感样病例定义确诊的灵敏度、特异度、阳性预测值、阴性预测值与受试者工作特征曲线(receiver operator characteristic curve, ROC)下面积, 并采用多因素Logistic回归分析模型分析流感病毒阳性率的相关因素。   结果   研究共纳入1 459例呼吸道感染住院病例, 其中流感病毒阳性者204例, 阳性率14.0%。ECDC定义的灵敏度最高(91.7%, 95% CI:87.9%~95.5%), 但其特异度最低(44.6%, 95% CI:41.9%~47.4%); WHO定义的灵敏度最低(70.6%, 95% CI:64.3%~76.8%); 中国定义的灵敏度(91.2%, 95% CI:87.3%~95.1%)和特异度(51.5%, 95% CI:48.8%~54.3%)均较高, 且其ROC曲线下面积最大(71.2%, 95% CI:67.9%~74.5%)。多因素分析发现有发热症状(≥38℃)患儿的流感病毒检出率高于不发热患儿(OR=7.03, 95% CI:3.89~12.70)。   结论   在住院儿童中开展流感监测时, 采用中国流感监测的流感样病例定义可以获得较好的效果。     

Low vaccination coverage for seasonal influenza and pneumococcal disease among adults at-risk and health care workers in Ireland, 2013: The key role of GPs in recommending vaccination

The World Health Organization (WHO), and European Agencies recommend influenza vaccination for individuals at-risk due to age (≥65 years), underlying diseases, pregnancy and for health care workers (HCWs) in Europe. Pneumococcal vaccine is recommended for those at-risk of pneumococcal disease. In Ireland, vaccination uptake among at-risk adults is not routinely available. In 2013, we conducted a national survey among Irish residents ≥18 years of age, to estimate size and vaccination coverage of at-risk groups, and identify predictive factors for influenza vaccination.We used computer assisted telephone interviews to collect self-reported information on health, vaccination status, attitudes towards vaccination. We calculated prevalence and prevalence ratios (PR) using binomial regression.Overall, 1770 individuals participated. For influenza, among those aged 18–64 years, 22% (325/1485) [95%CI: 17%–20%] were at-risk; 28% [95%CI: 23%–33%] were vaccinated. Among those aged ≥65 years, 60% [95%CI: 54%–66%] were vaccinated. Influenza vaccine uptake among HCWs was 28% [95%CI: 21%–35%]. For pneumococcal disease, among those aged 18–64 years, 18% [95%CI: 16%–20%] were at-risk; 16% [95%CI: 12%–21%] reported ever-vaccination; among those aged ≥65 years, 36% [95%CI: 30%–42%] reported ever-vaccination. Main reasons for not receiving influenza vaccine were perceptions of not being at-risk, or not thinking of it; and among HCWs thinking that vaccination was not necessary or they were not at-risk. At-risk individuals were more likely to be vaccinated if their doctor had recommended it (PR 3.2; [95%CI: 2.4%-4.4%]) or they had access to free medical care or free vaccination services (PR 2.0; [95%CI: 1.5%-2.8%]).Vaccination coverage for both influenza and pneumococcal vaccines in at-risk individuals aged 18–64 years was very low. Influenza vaccination coverage among individuals ≥65 years was moderate. Influenza vaccination status was associated with GP vaccination recommendation and free access to vaccination services. Doctors should identify and recommend vaccination to at-risk patients to improve uptake.     

Improved neutralizing antibody response in the second season after a single dose of pandemic (H1N1) 2009 influenza vaccine in HIV-1-positive adults

Neutralizing antibody titers were determined before and after a single dose of pandemic (H1N1) 2009 influenza vaccine in HIV-1-positive Japanese adults in the first season of the pandemic and in those in the second season who had already received the vaccine in the first season. The antibody response rate at 2-month post-vaccination increased significantly from 49.0% (50/102, 95%CI: 39.0-59.1%) in the 2009/2010 season to 66.7% (42/63, 95%CI: 53.7-78.1%) in the 2010/2011 season. Geometric mean antibody titers (fold dilution) at baseline, at 2 months, and at 4 months also increased significantly from 4.4 (95%CI: 3.3-5.7), 19.0 (95%CI: 13.4-26.8) and 13.7 (95%CI: 9.3-20.2), respectively, in the 2009/2010 season to 8.3 (95%CI: 5.8-11.7), 47.0 (95%CI: 32.2-68.6) and 38.2 (95%CI: 23.8-61.4), respectively, in the 2010/2011 season. Although the vaccine response was low in the first season, it was improved in the second season.     

Contact and communication with healthcare providers regarding influenza vaccination during the 2009-2010 H1N1 pandemic

Objective

The existence of two vaccines—seasonal and pandemic—created the potential for confusion and misinformation among consumers during the 2009-2010 vaccination season. We measured the frequency and nature of influenza vaccination communication between healthcare providers and adults for both seasonal and 2009 influenza A(H1N1) vaccination and quantified its association with uptake of the two vaccines.

Methods

We analyzed data from 4040 U.S. adult members of a nationally representative online panel surveyed between March 4th and March 24th, 2010. We estimated prevalence rates and adjusted associations between vaccine uptake and vaccination-related communication between patients and healthcare providers using bivariate probit models.

Results

64.1% (95%-CI: 61.5%-66.6%) of adults did not receive any provider-issued influenza vaccination recommendation. Adults who received a provider-issued vaccination recommendation were 14.1 (95%-CI: − 2.4 to 30.6) to 32.1 (95%-CI: 24.3-39.8) percentage points more likely to be vaccinated for influenza than adults without a provider recommendation, after adjusting for other characteristics associated with vaccination.

Conclusions

Influenza vaccination communication between healthcare providers and adults was relatively uncommon during the 2009-2010 pandemic. Increased communication could significantly enhance influenza vaccination rates.