徐州市预防接种医务人员二类疫苗推荐意愿及影响因素研究

目的了解徐州市预防接种医务人员对二类疫苗的推荐意愿及影响因素,为优化二类疫苗接种策略提供参考。方法采用一般情况调查表和二类疫苗推荐意愿调查表,结合典型抽样与整群抽样,抽取徐州市450例预防接种医务人员进行问卷调查。对数据进行探索性因子分析、单因素分析和多因素logistic回归分析。结果仅有150人表示愿意向儿童家长推荐二类疫苗,推荐意愿率为35.2%。多因素logistic回归分析显示,女性(OR=3.612,95%CI:1.936～6.739)、工龄高(OR_11～20年=12.369,95%CI:3.148～48.600;OR≥21年=17.838, 95%CI:3.662～86.888)、用工形式为正式编制(OR_临时合同=0.151,95%CI:0.068～0.335;OR_其他形式=0.070, 95%CI:0.026～0.186)的接种人员推荐意愿较高;疫苗负性事件对工作造成影响的接种人员推荐意愿较低(OR=0.428, 95%CI:0.238～0.770);疫苗接种条件(OR=6.963,95%CI:3.926...     

北京市通州区医务人员接种和推荐接种新型冠状病毒疫苗意愿调查

目的 了解北京市通州区医务人员接种和推荐接种新型冠状病毒疫苗(以下简称新冠疫苗)意愿及影响因素,为新冠疫苗上市后推广和防控提供参考依据.方法 在全区各级医疗机构抽取1 774人,采用问卷星进行线上调查,Excel 2007软件整理数据,SPSS 19.0进行统计分析,采用单因素和多因素分析,P＜0.05为差异有统计学意...     

区域医联体内≥50岁医务人员带状疱疹疫苗接种意愿及影响因素分析

目的医疗机构内水痘-带状疱疹病毒(varicella-zoster virus,VZV)传播是一个公认的医学和公共卫生问题,医务人员作为带状疱疹(herpes zoster,HZ)患者的密切接触者,其HZ患病风险大大增加。本研究分析东莞长安区区域医联体内≥50岁医务人员带状疱疹疫苗(herpes zoster vaccine,HZV)接种意愿及影响因素,为HZV上市后高风险人群接种策略的制订提供理论依据。方法采用整群抽样方法,于2019-04-01-06-30抽取394名东莞长安区域医联体内(7所综合医院及1所社区卫生服务机构)≥50岁医务人员为调查对象,开展HZV接种意愿调查,对数据进行单因素及多因素logistic回归分析。结果 394名调查对象中对接种HZV知识整体认知水平明显偏低(中位数=24.49,四分位数间距22.00～28.00);仅8.63%被调查者表示愿意接种HZV,其中愿意接种的主要因素为能有效预防HZ(14名,41.18%)。单因素分析结果显示危害认知(χ~2=25.357,P<0.001)、疫苗认知(χ~2=4.635,P=0.031)、政策认知(χ~2=16.994,P<0.001)、年龄(χ~2=3.102,P=0.021)、职称(χ~2=6.048,P=0.005)、岗位(χ~2=8.511,P=0.004)、服务机构层级(χ~2=28.820,P<0.001)对HZV接种意愿率有影响。多因素Logistic回归分析结果显示,危害认知得分(OR=0.006,95%CI为0.001～0.017,P<0.001)、年龄(OR=21.589,95%CI为1.559～298.973,P=0.022)、职称(OR=0.280,95%CI为0.107～0.732,P=0.009)、服务机构层级(OR=7.224,95%CI为2.288～2.804,P=0.001)是接种意愿危险因素。结论医联体内≥50岁医务人员HZV接种意愿较低,知晓感染VZV的危害、50～60岁、高级职称、社卫机构服务的医务人员更愿意选择接种HZV。     

北京市东城区重组带状疱疹疫苗受种者疫苗认知及推荐意愿调查

目的 评价北京市东城区带状疱疹疫苗（herpes zoster vaccine,HZV）受种者对带状疱疹患病及其疫苗接种的认知情况以及向他人推荐的意愿。方法 通过问卷调查收集2020年8月1日—2021年9月1日在北京市东城区预防接种门诊全程2剂次HZV的≥50岁受种者信息,采用logistic回归分析受种者对带状疱疹患病及其疫苗接种各项知识的知晓率、向他人推荐接种的比例及影响因素。结果 共有303名受种者自愿参与调查,其中65.68%的受种者为通过家人朋友推荐而接种的疫苗。对于各项带状疱疹患病知识的知晓率为23.76%～95.71%,对于各项带状疱疹疫苗知识的知晓率为40.59%～77.23%,88.78%受种者表示愿意推荐家人朋友接种带状疱疹疫苗。多因素logistic分析显示,接受疫苗价格、知晓带状疱疹可复发及知晓带状疱疹需就医治疗为受种者推荐意愿的影响因素[OR (95%CI):2.83(1.13～7.14)、 3.25 (1.48～7.17)、 3.51 (1.59～7.75)]。结论北京市东城区受种者对带状疱疹发病原理知晓程度较低,缺少对带状疱疹疫苗保护作用的了解,仍需加强...     

郑州地区≥50岁居民带状疱疹疫苗接种意愿及影响因素调查

目的 探讨郑州地区≥50岁居民带状疱疹疫苗接种意愿及影响因素。方法 2021年4月采用多阶段分层抽样方法抽取郑州市5个社区或城镇,每个社区或城镇随机抽取6个居委或村,对抽中居委或村中年龄≥50岁的居民开展带状疱疹及带状疱疹疫苗相关知识、带状疱疹疫苗接种意愿的问卷调查,采用描述性分析方法对带状疱疹疫苗相关知识知晓情况及疫苗接种意愿进行分析,并采用单、多因素分析方法对带状疱疹疫苗接种意愿影响因素进行分析。结果 3 014名调查对象中,年龄50~78岁,以50~59岁所占比例最大,占50.43%。男女性别比为1.41∶1。愿意接种带状疱疹疫苗1 268人,接种意愿率为42.07%。共1 309人知晓带状疱疹,比例为43.43%。多因素Logistic回归分析结果显示,年龄（OR=0.402、0.776）、听说过带状疱疹疫苗（OR=3.367）、担心自己患带状疱疹（OR=6.265）及认为疫苗可预防带状疱疹（OR=4.272）是带状疱疹疫苗接种意愿的影响因素。结论 郑州地区≥50岁居民带状疱疹疫苗接种意愿较低,知晓带状疱疹相关知识比例较低,年龄、听说过带状疱疹疫苗、担心自己患带状疱疹及认为疫苗可预防带状疱疹是影响居民接种带状疱疹疫苗的主要因素。     

上海市崇明区50岁及以上成人带状疱疹疫苗接种意愿及影响因素分析

目的 了解上海市崇明区50岁及以上成人带状疱疹疫苗的接种意愿及影响接种因素。方法 采用横断面调查方法,二阶段随机抽取2021年8—9月上海市崇明区18个乡镇845名50岁及以上成人,调查其对带状疱疹疫苗接种意愿、疾病知识及家庭和社会因素,利用χ²检验和多因素logistic回归分析疫苗接种意愿的影响因素。结果 上海市崇明区845名调查对象中,370人(43.79%)愿意接种(含已接种)带状疱疹疫苗。非条件logistic回归分析显示：听说过带状疱疹疫苗知识、周围人曾患过带状疱疹的人更倾向于接种带状疱疹疫苗(OR=0.521,95%CI:0.369～0.735;OR=0.716,95%CI:0.524～0.978)。不愿意接种带状疱疹疫苗的原因为疫苗价格太贵;身体健康不需要接种;接种疫苗副作用大;带状疱疹是小病,不会造成严重后果。结论 建议卫生行政部门制定相关优惠政策、“量身定做”针对中老年开展健康宣传以及加强医护人员相关培训、推荐接种疫苗等来提高崇明区50岁及以上成人带状疱疹疫苗接种率。     

新疆地区高级职称医务人员离职意愿现状及其影响因素分析

目的调查新疆地区高级职称医务人员离职意愿现状及影响因素,为稳定高级职称卫生人才队伍提供针对性建议。方法以分层整群抽样方式选取调研对象。采用问卷网开展调查,运用SPSS 20.0统计软件对数据进行统计分析。结果共调查3 226人,其中不可能离职的有2 397人,可能离职的有829人。个人属性中,不同岗位类别和工作年限对离职意愿有影响（P＜0.05）;工作属性中,工作压力、晋升机会、与同事关系、与领导关系、管理制度、工作量等对离职意愿有影响（P＜0.05）。结论为减少高级职称医务人员流失,有关部门应出台相关政策,完善现有收入分配方式和福利待遇;医院管理者应改善工作环境,减轻高级职称医务人员工作量和工作压力,优化晋升机制,完善高级职称评审政策。     

上海市宝山区预防接种门诊医护人员非免疫规划疫苗推荐意愿和影响因素北大核心

目的了解预防接种门诊医护人员非免疫规划(Expanded Program on Immunization,EPI)疫苗推荐意愿和影响因素。方法选取上海市宝山区17家预防接种门诊医护人员开展问卷调查,分析非EPI疫苗推荐意愿及其影响因素。结果调查对象非EPI疫苗总推荐意愿率为42.97%(107/249)。多因素Logistic回归分析显示,工作年限≥10年、认为领导重视、认为非EPI疫苗效果好、认为非EPI疫苗接种程序合理、认为受疫苗相关事件影响、认为非EPI疫苗不增加接种工作量者的非EPI疫苗推荐意愿高[OR(95%CI):3.17(1.12-8.96)、5.04(1.12-22.73)、6.78(1.76-26.07)、5.28(1.24-22.44)、3.94(1.98-7.81)、4.57(1.36-15.41)]。结论预防接种门诊医护人员非EPI疫苗推荐意低;建议制定非EPI疫苗预防接种管理和保障措施,减轻预防接种门诊医护人员工作压力。     

山西省县级公立医院医务人员改革意愿研究

[目的]了解山西省县级公立医院医务人员对改革现状的认知情况,分析影响改革意愿的相关因素,提出合理的政策建议。[方法]2013年11月至12月,调研组随机抽取山西省的5家县级公立医院,对305名医务人员进行问卷调查,运用统计软件SPSS对数据进行处理。[结果]此次调查共回收有效问卷281份。对结果进行分析发现县级公立医院医务人员对医改政策了解不够深入,对目前医院的绩效考核制度和管理状况方面的满意度较低。经过Logistic回归分析可知对医改政策了解程度、业绩考核及医院管理状况为影响医务人员改革意愿的3个主要因素。[结论]相关部门应加大医改政策宣传力度,建立健全绩效考核制度,加快管理体制改革进度,从而提高医务人员对改革工作的积极性。     

成都市三级医院医务人员参与双向转诊的意愿调查及影响因素分析

目的 了解成都市三级医院医务人员参与双向转诊的意愿及影响因素,针对显著性影响因素提出建议,为进一步落实双向转诊提供理论依据.方法 采用分层随机抽样方法,对成都市6个区10所三级医院中的208名医务人员进行问卷调查,分析调查对象的基本特征和转诊意愿,采用多因素Logistic回归分析方法分析医务人员参与双向转诊意愿的影响...     

Background paper to the decision not to recommend a standard vaccination with the live attenuated herpes zoster vaccine for the elderly in Germany

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz -     

Evaluation of the incidence of herpes zoster after concomitant administration of zoster vaccine and polysaccharide pneumococcal vaccine

In 2009, a revision to the zoster vaccine package insert was approved stating that the zoster vaccine and the pneumococcal vaccine should not be given concurrently because concomitant use resulted in reduced immunogenicity of the zoster vaccine. We conducted an observational study to evaluate if concomitant vaccination reduces the protective effect of the zoster vaccine. The study was conducted in Kaiser Permanente Southern California. Incidence of herpes zoster (HZ) after vaccination with a zoster vaccine in the population receiving both vaccines on the same day was compared to that in the population receiving a pneumococcal vaccine within one year to 30 days prior to zoster vaccine. Vaccinations and incident HZ cases were identified by electronic health records. The hazard ratio for incident HZ associated with concomitant vs. nonconcomitant vaccination was estimated using the Cox proportional hazard model. There were 56 incident HZ cases in the concomitant vaccination cohort and 58 in the nonconcomitant vaccination cohort, yielding a HZ incidence of 4.54 (95% confidence interval [CI], 3.43-5.89) and 4.51 (95% CI, 3.42-5.83) per 1000 person-years, respectively. The hazard ratio comparing the incidence rate of HZ in the two cohorts was 1.19 (95% CI, 0.81-1.74) in the adjusted analysis. In this study, we found no evidence of an increased risk of HZ in the population receiving zoster vaccine and pneumococcal vaccine concomitantly. The revision of the product information needs to be carefully assessed to avoid introducing barriers to patients and providers who are interested in these two important vaccines.     

Patient report of herpes zoster pain: Incremental benefits of zoster vaccine live

IntroductionPain following herpes zoster (HZ) can persist for months and negatively impact quality of life. To evaluate the effect of zoster vaccine live (ZVL) on progression of pain following HZ, we conducted a prospective cohort study of HZ cases at Kaiser Permanente Southern California.MethodsZVL vaccinated and unvaccinated members aged ≥60 years with laboratory-confirmed HZ from January 18, 2012 to February 26, 2015 were followed up within 5 days of HZ diagnosis, and at 30, 60, and 90 days after diagnosis. Pain was assessed with the Zoster Brief Pain Inventory (ZBPI) on a 0–10 scale, using cut-points of ≥3, ≥5, and ≥7, with postherpetic neuralgia (PHN) defined as pain ≥3 at 90 days. Log binomial regression was used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) associated with pain, comparing vaccinated versus unvaccinated HZ patients.ResultsWe interviewed 509 vaccinated and 509 unvaccinated HZ patients. ZVL was associated with significantly lower risks of HZ-related pain at all time-points. The risk of PHN in vaccinated and unvaccinated patients, respectively, was 9.2% and 15.4% (aRR = 0.594, 95% CI: 0.413, 0.854); 2.0% and 4.8% of these patients reported pain ≥7 (aRR = 0.332, 95% CI: 0.153, 0.721). Irrespective of vaccination, the risk of PHN was lower in adults aged <70 years versus those ≥70 years and was similar or lower in females versus males.ConclusionWe used laboratory confirmation of HZ cases and patient survey to show that aside from preventing HZ, ZVL reduced HZ-related pain and prevented PHN among vaccine recipients who experienced HZ. Observational studies will be needed to evaluate long-term effectiveness of the new recombinant zoster vaccine and its benefits in protecting patients against PHN.     

Determining the optimal strategy for the live-attenuated herpes zoster vaccine in adults

The optimal strategy for the vaccinating against herpes zoster (HZ) vaccine remains unknown. Cost-effectiveness analyses provide insight to the most cost-effective age groups but results vary across studies. The optimal strategy is important given that vaccine efficacy and duration vary depending on vaccination age. Therefore, small changes from the optimal age can affect long-term outcomes and produce sub-optimal results. The objective of this research was to determine the optimal timing policy for HZ vaccination. We simulated cohorts of men and women and use stochastic dynamic programming to evaluate the decision to vaccinate or defer each year from age 50 to 100. If the decision was to defer, the cohort risked developing HZ. If HZ occurred, the cohort was subjected to cost and quality-adjusted life year (QALY) loss for a typical HZ infection (including complications) at that age. If HZ did not occur, the decision was evaluated at the next age. Then, we extend the model to consider the case in which a booster vaccine is available. A set of probabilistic sensitivity analyses were conducted to check model robustness. Results show the optimal policy for women is to vaccinate between ages 66 and 77, and for men between ages 66 and 74, assuming a willingness to pay (WTP) of $100,000 per QALY. It becomes optimal to vaccinate earlier if a booster vaccine is available, and women have a wider range of ages than men. This research is the first to examine exactly when the HZ vaccine should be administered. It is also the first study, to our knowledge, that used stochastic dynamic programming to examine the question of a second dose for any vaccine. This research provides the first simple policy on when to vaccinate and re-vaccinate against HZ.     

Cost of herpes zoster and herpes zoster-related complications among immunocompromised individuals

Herpes zoster (HZ) is a painful dermatomal rash caused by reactivation of latent varicella-zoster virus. The incidence of HZ is increased for immunocompromised (IC) individuals. The objective of this study is to assess the healthcare costs incurred by IC individuals who develop HZ with or without associated complications. We conducted a retrospective case-control study across the US over a 5-year period, based on health insurance claims data for individuals aged ≥50 years identified as IC by disease or immunosuppressive treatment. A cohort of 30,107 IC individuals who experienced HZ was matched to a cohort of 113,875 IC individuals without HZ. Average all-cause healthcare costs over 18 months were calculated and compared between IC individuals with and without HZ. In addition, the costs of HZ in IC individuals with HZ-related complications were compared to the costs of those with uncomplicated HZ. During the year following HZ onset, IC individuals with HZ had on average total unadjusted costs that were US$3879 higher than the controls. After adjusting costs, controlling for comorbidities and healthcare costs before the onset of HZ, the average annual costs for HZ cases and controls without HZ were similar. HZ-related complications led to increases in average adjusted annual costs compared to uncomplicated HZ ranging from US$612 for eye complications to US$4535 for neurologic complications. In conclusion, in IC individuals, episodes of HZ lead to substantially increased unadjusted annual healthcare costs. HZ-related complications add considerably to adjusted annual healthcare costs compared to uncomplicated HZ.     

Safety,tolerability, and immunogenicity of zoster vaccine in subjects with a history of herpes zoster

Background

Prior clinical studies of zoster vaccine enrolled subjects without a history of herpes zoster (HZ), so there are limited data on safety and immunogenicity in vaccinees with a prior history of HZ. This study was conducted to evaluate the safety and immunogenicity of zoster vaccine recipients who had a prior episode of HZ.

Methods

A total of 101 subjects ≥50 years of age with a prior history of HZ were enrolled. They were stratified by number of years since their HZ (5 to 9 years and ≥10 years, in an approximate 2:1 ratio), and randomized 1:1 to one of two vaccination groups. On day 1, Group I was administered zoster vaccine and Group II received placebo. At week 4, Group I received placebo and Group II received zoster vaccine. Subjects were followed for adverse experiences (AEs), exposure to varicella or HZ, and development of any varicella/varicella-like or HZ/HZ-like rashes, for 28 days after each injection. Blood samples were obtained prior to study injection on day 1 and week 4, and at week 8. Serum was assessed for varicella-zoster virus (VZV) antibody concentration by glycoprotein enzyme-linked immunosorbent assay.

Results

No serious AEs were reported within the 28-day safety follow-up period following any vaccination. Although a higher percentage of subjects reported injection-site AEs after receiving zoster vaccine than did placebo recipients, the proportion of subjects reporting systemic clinical AEs was similar in both groups. Zoster vaccine induced a VZV antibody response at 4 weeks post-vaccination. The estimated geometric mean titer (GMT) ratio (vaccine/placebo) was 2.07 (95% CI: 1.48, 2.88). The geometric mean fold-rise (GMFR) from prevaccination to week 4 post-vaccination was 2.1 in zoster vaccine recipients, versus 1.0 in placebo recipients.

Conclusions

In HZ history-positive adults ≥50 years of age, zoster vaccine: (1) was well tolerated; and (2) significantly boosted the level of VZV antibody from baseline to 4 weeks post-vaccination as measured by GMT and GMFR. These data support the Advisory Committee on Immunization Practices’ recommendation for routine zoster vaccination for all immunocompetent persons ≥60 years of age irrespective of HZ history.     

带状疱疹疫苗的研究成果及其在老年人中的使用

带状疱疹（HZ）是由水痘-带状疱疹病毒（varicella-zoster virus,VZV）复发感染所致,患者多见于老年人以及免疫低下人群。疫苗在控制HZ方面有着重要作用。该文对近年来国内外有关HZ疫苗的研究成果及使用情况进行综述,为疫苗的使用及带状疱疹的预防提供参考。     

农民参加新型农村合作医疗意愿的影响因素分析

目的了解河南、吉林两省试点地区农村居民对新型农村合作医疗的认知、参保意愿及其影响因素,为增强新型农村合作医疗的可持续发展提供对策和建议。方法自行设计问卷,采用分层整群随机抽样方法,对947名农户进行入户访谈式问卷调查。结果调查对象中,93.5%的农村居民参加了新型农村合作医疗。89.6%的农村居民愿意参加下一年的合作医疗。Logistic回归结果显示:参合报销情况、卫生服务需要利用(过去一年内家人慢性病罹患情况)、新型农村合作医疗相关知识的认知情况(政策知晓、对合作医疗的担心)是影响农村居民参合意愿的主要因素,R2=0.202。结论宣传和健康教育是增强农民参合积极性的重要途径。