三明市沙县区451例老年糖尿病患者肺炎球菌疫苗接种意愿及影响因素分析

目的 探析老年糖尿病患者肺炎球菌疫苗接种意愿及影响因素。方法 2022年7—10月对三明市沙县区院内就医的老年糖尿病患者进行问卷调查,调查患者基本情况及23价肺炎球菌多糖疫苗（PPV23）接种意愿,采用多因素logistic回归分析糖尿病患者PPV23接种意愿的影响因素。结果 共调查451例老年糖尿病患者,平均年龄（67.9±6.8）岁,其中334例（74.06%）愿意接种PPV23。多因素分析结果显示,对自身健康关注（OR=7.700）、对PPV23了解（OR=6.851）、知晓PPV23接种地点（OR=3.750）、认为老年人和慢性病人群患肺炎后果更严重（OR=1.850）的老年糖尿病患者愿意接种PPV23的可能性越大。结论 对疾病和疫苗的认识程度、是否知晓疫苗接种地点、对自身健康关注程度是老年糖尿病患者PPV23接种意愿的影响因素。     

海曙区老年人群肺炎疫苗接种意愿及影响因素分析

目的了解海曙区家庭医生签约门诊老年人群肺炎疫苗接种意愿及影响因素。方法采用分层随机抽样方法对宁波市海曙区两个社区卫生服务中心和两个镇卫生院签约门诊管理的65岁以上老年人进行肺炎疫苗接种意愿调查,对数据进行χ~2检验、二分类多因素Logistic回归分析。结果在568名调查对象中,32.92%签约门诊老年人表示愿意接种肺炎疫苗,5.99%签约门诊老年人表示曾经接种了肺炎疫苗。多因素Logistic回归分析结果显示,65～74年龄组、有医保历年余额、有肺炎疫苗免疫史、有流感疫苗免疫史、两种以上慢性病患病史、签约门诊医务人员推荐接种是老年人群肺炎疫苗接种意愿的影响因素。结论海曙区家庭医生签约门诊老年人群肺炎疫苗接种意愿较低,应开展肺炎疫苗接种知识宣传、签约门诊肺炎疫苗接种健康处方等干预措施提高老年人群的肺炎疫苗接种意愿,从而提高老年人群的肺炎疫苗接种率。     

广州市老年人23价肺炎球菌多糖疫苗接种意愿及影响因素分析

目的 了解广州市老年人23价肺炎球菌多糖疫苗（23-valent pneumococcal polysaccharide vaccine,PPV23）的接种意愿、接种率及其影响因素,为广州市制定老年人肺炎疫苗接种策略提供依据。方法 于2022年7月10—31日在广州市11个区采取方便抽样开展调查,以≥60岁老年人作为调查对象,采用多因素logistic回归分析老年人PPV23的接种意愿和接种率的影响因素。结果共调查1316人,其中1 157人（87.92%）表示愿意接种PPV23,186人（14.13%）接种了PPV23。老年人愿意接种PPV23的原因主要为可有效减少患肺炎的可能性（82.80%）、肺炎疫苗安全可靠（60.67%）和临床医生推荐接种（47.28%）;老年人更关注肺炎疫苗是否有效（77.81%）、是否安全（76.44%）和自身能否接种（68.62%）,更希望通过接种门诊工作人员（64.06%）、电视或广播（54.18%）和临床医生（51.22%）获得肺炎疫苗的信息。多因素分析结果显示,过去一年出现发热伴咳嗽、咳痰情况（OR=1.68,95%CI:1.09～2.59）、既往...     

2型糖尿病患者流感疫苗和23价肺炎疫苗接种意愿调查

目的了解2型糖尿病(T2DM)患者流感疫苗和23价肺炎疫苗接种意愿,并分析其影响因素,为T2DM患者防控流感和肺炎提供依据。方法于2018年11—12月采用多阶段随机抽样方法抽取嘉兴市秀洲区4个乡镇(街道)各200例T2DM患者为调查对象。采用自行设计的调查问卷收集人口学信息、流感疫苗和23价肺炎疫苗接种知识、意愿及行为。采用多因素Logistic回归模型分析T2DM患者流感疫苗和/或23价肺炎疫苗接种意愿的影响因素。结果共发放问卷800份,回收有效问卷789份,回收有效率为98.63%。知晓流感疫苗322例,占40.81%;知晓23价肺炎疫苗255例,占28.52%;认为T2DM患者需要接种流感疫苗和/或23价肺炎疫苗204例,占25.86%。如果医务人员推荐,愿意接种流感疫苗和/或23价肺炎疫苗335例,占42.46%。近3年接种过流感疫苗55例,占6.97%;近3年接种过23价肺炎疫苗22例,占2.79%。多因素Logistic回归分析结果显示,小学文化程度(OR=0.332,95%CI:0.140～0.789)、在婚(OR=1.912,95%CI:1.082～3.378)、认为T2DM患者需要接种流感疫苗和/或23价肺炎疫苗(OR=4.000,95%CI:2.730～5.861)、参加过流感疫苗和/或23价肺炎疫苗相关知识讲座或宣传(OR=2.522,95%CI:1.528～4.163)是T2DM患者流感疫苗和/或23价肺炎疫苗接种意愿的影响因素。结论 T2DM患者流感疫苗和/或23价肺炎疫苗的接种意愿率仅为42.46%,接种意愿与文化程度、婚姻状况、是否认为T2DM患者需要接种流感疫苗和/或23价肺炎疫苗、是否参加过流感疫苗和/或23价肺炎疫苗相关知识讲座或宣传有关。     

社区慢性阻塞性肺疾病患者流感和肺炎疫苗接种意愿及影响因素

[目的]了解慢性阻塞性肺疾病(COPD)患者流感、肺炎疫苗接种意愿和影响因素,为在COPD患者中开展相关健康教育和疫苗接种推广提供参考。[方法]以浙江省宁波市3个区的629名60~74岁COPD患者为调查对象,于2013年10—11月对调查对象进行问卷调查,内容包括个人基本信息、职业和收入、疫苗接种意愿与行为等。对疫苗接种意愿的影响因素进行多因素非条件logistic回归分析。[结果]5年内流感、肺炎疫苗接种率为10.49%,有意愿自费去社区医院自行接种流感、肺炎疫苗的比例为36.88%。有助于疫苗接种意愿的影响因素为个人收入高、5年内有疫苗接种史;阻碍疫苗接种意愿的影响因素为年龄大、认为流感疫苗接种后不良反应可能性高。[结论]应进一步开展成人疫苗接种的健康教育,对于老年人、COPD患者等特殊人群,政府应提供免费的流感、肺炎疫苗接种,提高此类人群的疫苗接种率。     

23价肺炎球菌疫苗防治老年人肺炎的临床观察

目的观察23价肺炎球菌多糖疫苗(PPV23)防治老年人肺炎的临床效果。方法选取老年肺部疾病患者126例,随机分为对照组和疫苗组各63例,对照组给予常规对症治疗,疫苗组在常规对症治疗的基础上给予PPV23皮下注射,随访2年,观察两组患者肺炎发生次数、发作间隔天数、住院次数、住院天数、死亡率、疫苗接种后不良反应及效益成本比(BCR)。结果疫苗组患者肺炎发作次数减少,间隔时间延长,住院次数减少及住院时间缩短,死亡率明显降低,差异有统计学意义(P0.01)。疫苗组接种PPV23后的效益成本比为25.79,净效益为374 803.89元。不良反应的总发生率为25.39%,均于12~72 h内未经特殊处理自行缓解。结论慢性肺部疾病的老年人接种PPV23后可以减少肺炎发作次数及住院的天数,具有较好的安全性,临床效果良好。     

常熟市≥65岁老年人23价肺炎球菌多糖疫苗接种现状及影响因素

目的 了解常熟市≥65岁老年人23价肺炎球菌多糖疫苗（PPV23）接种现状及主要影响因素,为政府制定更优的老年人肺炎疾病免疫预防策略提供科学依据。方法 于2021年10月—2022年11月,采用多级抽样的方法,随机抽取常熟市4个乡镇（街道）,再从每个乡镇（街道）中随机抽取1个乡镇卫生院（社区卫生服务中心）中65～84岁本地户籍老年人进行面对面的问卷调查,获取其PPV23接种相关信息,并从江苏省预防接种综合服务管理信息系统中获取PPV23的接种情况,采用二元logistic回归模型分析常熟市老年人接种PPV23的主要影响因素。结果 共收回2 402份调查问卷,有效问卷2 310份,问卷有效率为96.17%。40.39%(933/2 310)的老年人接种了PPV23,肺炎疫苗的接种意愿率为47.14%(1 089/2 310)。logistic回归分析显示,远离市中心、70～79岁、无糖尿病、居住或工作学习场所未使用空气净化器或新风系统的老年人更愿意接种PPV23(P <0.05);平均月收入为3 000～4 999元、总体健康状况差、没有听说过肺炎疫苗、不愿意和不清楚是否要接种肺炎...     

杭州市老年慢性病患者流感疫苗接种意愿及影响因素分析

目的 调查杭州市老年慢性病患者流感疫苗未来一年接种意愿及其影响因素,为制定流感疫苗接种政策提供参考。方法 于2021年7—8月采用多阶段抽样方法对杭州市老年慢性病患者进行面对面问卷调查,使用χ²检验进行单因素分析,采用二分类logistic回归分析识别老年慢性病患者流感疫苗接种意愿的主要影响因素。结果 未来一年具有接种意愿占32.78%(196/598)。二分类logistic回归分析结果显示,过去一年有流感疫苗接种史者(OR=17.41,95%CI=10.835～27.97)、对流感态度正向者(OR=2.09,95%CI=1.28～3.40)、会主动了解流感及流感疫苗的相关知识者(OR=2.95,95%CI=1.89～4.78)、社会支持为高水平者(OR=2.57,95%CI=1.14～5.81)的老年慢性病患者未来一年更愿意接种流感疫苗。结论 杭州市老年慢性病患者对流感疫苗接种意愿较低,相关部门和社区应当做好流感与疫苗的宣传教育工作,在流感预防以及流感疫苗接种中,家庭应提供更多的精神和经济支持,以提高老年慢性病患者对流感及疫苗相关的认知水平、学习积极主动性和社...     

上海市嘉定区老年人肺炎疫苗接种意愿及影响因素调查

目的探索影响老年人肺炎疫苗接种意愿的因素,为制定老年人肺炎链球菌性疾病免疫策略及政策提供依据。方法以居委为单位进行随机整群抽样,抽取493名60岁以上的户籍老年人,采用自行设计的《老年人群肺炎疫苗接种情况调查表》进行调查。结果愿意免费接种肺炎疫苗的为264人,占53.5%。不愿意接种的原因主要是:担心发生不良反应(39.0%)、觉得没必要(31.8%)、接种禁忌证(12.1%)。Logistic回归模型显示老年人接种肺炎疫苗的意愿与其年龄有关。结论应通过有针对性的宣传等干预措施增加老年人肺炎疫苗接种意愿,从而降低老年人肺炎发病率。     

宝山社区老年人肺炎疫苗接种行为影响因素分析及家庭医生健康干预效果

目的通过调查分析宝山社区老年人肺炎疫苗接种意愿及行为的影响因素,探索建立基于家庭医生服务模式为基础的健康干预方案,以提高宝山社区肺炎疫苗接种意愿和接种率。方法随机选取宝山社区两个居委会,合计500名60岁及以上常住老年人进行肺炎疫苗内容的相关问卷调查,在调查的基础上,从不愿意接种疫苗的287名老年人中再随机抽取100名作为研究对象,分为干预组和对照组,各50名。由家庭医生对干预组制定和实施干预方案,比较干预前后两组肺炎疫苗接种意愿及行为改变的情况。结果 500名调查对象完成调查问卷(合格率100%),宝山社区老年人对肺炎疫苗知识的知晓率较低,仅占21%;老年人不愿意接种肺炎疫苗原因主要有担心疫苗有不良反应(31.01%)、身体不好不愿意接种(28.92%)和身体好不要接种(24.04%);主动获取肺炎知识、曾患肺炎、老慢支等呼吸系统疾病以及医生曾建议接种肺炎疫苗这些因素是影响老年人接种肺炎疫苗意愿的影响因素;家庭医生实施健康干预后,干预组肺炎知识、肺炎疫苗知识知晓率高于对照组(均P0.05),干预组肺炎疫苗的接种率高于对照组(P0.05)。结论加强对肺炎疫苗接种项目的社区宣传,并通过家庭医生实施发放宣传资料、开展知识讲座、知识竞赛等多种形式的健康干预,对提高老年人群肺炎和肺炎疫苗知识的知晓率、提高肺炎疫苗接受度和接种意愿、改变接种行为具有一定意义。     

中国老年人肺炎球菌疫苗接种意愿影响因素的Meta分析

目的 系统评价中国老年人肺炎球菌疫苗(pneumococcal vaccine,PV)接种意愿的影响因素.方法 首先检索PubMed、Cochrane Library、Web of Science、EMbase、CBM、中国知网、维普网和万方数据知识服务平台中涉及中国老年人PV接种意愿影响因素研究;再由2名研究人员独立...     

上海市大学生新型冠状病毒疫苗接种意愿及影响因素

目的 了解上海市大学生接种新型冠状病毒疫苗(新冠疫苗)的意愿及影响因素.方法 选择2021年2月23日-2021年3月15日上海市四所不同学科类别院校的学生进行在线问卷调查,分析新冠疫苗接种意愿率,采用多因素Logistic回归分析模型探讨影响新冠疫苗接种意愿的因素.结果 4462名被调查者接种意愿率为78.04％,L...     

慢性阻塞性肺疾病患者流感疫苗和23价肺炎球菌多糖疫苗接种研究进展

近年来国内外慢性阻塞性肺疾病（COPD）患者流感疫苗和23价肺炎球菌多糖疫苗（PPV23）接种有效性的相关研究发现,接种流感疫苗和PPV23可显著降低COPD患者的流感和肺炎感染风险,减少疾病的急性加重以及与之相关的住院,尤其是接种流感疫苗还可降低患者诱发缺血性心脏病、急性冠脉综合征、室性心律失常、肺癌、痴呆和死亡的风险,二者联合接种保护作用更加显著。国内外权威指南、共识均建议COPD患者接种流感疫苗和PPV23。目前国内流感疫苗和肺炎球菌疫苗接种率均偏低,且在COPD患者中的应用研究较少。应采取有效措施加强知识普及和指南宣传,提高疫苗接种率。同时还应进一步加强COPD患者接种流感和PPV23的临床研究,尤其是联合接种的临床效益分析,以切实改善COPD患者的生存现状和预后。     

某区5岁及以下儿童家长手足口病认知和EV71疫苗接种意愿调查

目的 了解某区5岁及以下儿童家长对手足口病的认知情况和EV71疫苗接种意愿,为制定EV71疫苗免疫策略和健康促进提供科学依据。方法 采用整群随机抽样从北京市某区44家社区卫生服务中心抽取6家,对6家社区卫生服务中心接种门诊接种日当天带领儿童来进行预防接种的5岁及以下儿童家长进行面访并填写调查问卷。结果 该区5岁及以下儿童家长对手足口病防治知识知晓率为71%(95%CI=66%~76%),对预防措施的认知好于对传播途径的认知。儿童母亲(OR=2.77,95%CI=1.67~4.57)、本科/大专以上学历的儿童家长(OR=2.10,95% CI =1.24~3.56)、高年龄儿童的家长(OR=1.58,95%CI=1.10~2.26)知晓率更高。75%的被调查儿童家长表示会为孩子接种EV71疫苗,其中58%的家长更希望能够以“一类疫苗”和28%认为“一类疫苗或二类疫苗都行”的形式提供接种服务;知道我国正在研制EV71疫苗的家长接种意愿高于不知道者(OR=2.57,95%CI=1.17~5.65);25%的被调查儿童家长不会给孩子接种EV71疫苗,“担心疫苗不安全”(67%)和“担心疫苗效果不好”(34%)是最主要原因。结论 对低年龄儿童的家长、低学历家长更应加强手足口病知识宣传,以提高手足口病知识知晓程度。建议优先考虑将EV71疫苗作为一类疫苗进行接种,并通过多种途径向公众报告疫苗研究进展和EV71疫苗宣传,尤其提供预防接种服务的医务人员应积极向儿童家长宣传接种EV71疫苗,以提高儿童家长接种意愿。     

Effectiveness of 23-valent pneumococcal polysaccharide vaccine and seasonal influenza vaccine for pneumonia among the elderly – Selection of controls in a case-control study

We conducted a case-control study to elucidate associations between pneumonia in elderly individuals and 23-valent pneumococcal polysaccharide vaccine (PPSV23) and seasonal influenza vaccine (influenza vaccine). Here, we examined selection of controls in our study using an analytic epidemiology approach. The study period was from October 1, 2009 through September 30, 2014. Cases comprised ≥65-year-old patients newly diagnosed with pneumonia. For every case with pneumonia, two patients with other diseases (one respiratory medicine, one non-respiratory medicine) who were sex-, age-, visit date- and visit hospital-matched were selected as controls. Odds ratios (ORs) and 95% confidence intervals (CIs) of vaccination for pneumonia were calculated using conditional logistic regression model. Similar analyses were also conducted based on the clinical department of controls. Analysis was conducted in 234 cases and 438 controls. Effectiveness of pneumococcal vaccination or influenza vaccination against pneumonia was not detected. Proportions of either vaccination in controls were greater among respiratory medicine (pneumococcal vaccine, 38%; influenza vaccine, 55%) than among non-respiratory medicine (23%; 48%). Analysis using controls restricted to respiratory medicine showed marginally significant effectiveness of pneumococcal vaccination (OR, 0.59; 95%CI, 0.34–1.03; P = 0.064) and influenza vaccination (0.64; 0.40–1.04; 0.072). However, this effectiveness might have been overestimated by selection bias of controls, as pneumonia cases are not necessarily respiratory medicine patients. In the analysis using controls restricted to non-respiratory medicine, OR of pneumococcal vaccination for pneumonia was close to 1, presumably because the proportion of pneumococcal vaccination was higher in cases than in controls. Because pneumococcal vaccine was not routinely administered during the study period, differences in recommendations of vaccination by physician in different clinical departments might have greatly affected vaccination proportions. When we select controls, we should consider the background factors (underlying diseases, clinical department, etc.) which affect physicians’ recommendation of vaccination.     

Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in middle-aged and older adults: A matched case–control study

The 23-valent polysaccharide pneumococcal vaccine is currently recommended in elderly and high-risk adults. Its efficacy against invasive pneumococcal disease has been demonstrated, but its effectiveness in preventing pneumonia remains uncertain. This study assessed the clinical effectiveness of vaccination against pneumonia among middle-aged and older adults. We conducted a population-based case–control study including 304 case patients over 50 years old with radiographically confirmed pneumococcal pneumonia (94 bacteremic and 210 nonbacteremic cases) and 608 outpatient control subjects (matched by primary care centre, age, sex and risk stratum). Adjusted odds ratios (ORs) for vaccination were calculated using conditional logistic regression, controlling for underlying conditions. Vaccine effectiveness against all pneumococcal pneumonia was 48% (OR: 0.52; 95% confidence interval [CI]: 0.37–0.73). Vaccination was effective against bacteremic cases (OR: 0.34; 95% CI: 0.27–0.66) as well as nonbacteremic cases (OR: 0.58; 95% CI: 0.39–0.86). Vaccine effectiveness was highest against bacteremic infections caused by vaccine types (OR: 0.24; 95% CI: 0.09–0.66). These findings confirm the effectiveness of the vaccine against invasive disease, but they also support the benefit of vaccination in preventing nonbacteremic pneumococcal pneumonia.     

Revaccination with the 23-valent pneumococcal polysaccharide vaccine in middle-aged and elderly persons previously treated for pneumonia

Revaccination with the 23-valent pneumococcal polysaccharide vaccine (PPV) has remained controversial due to lack of immunological data and fear of side effects. We re-vaccinated 61 elderly patients (median age 75 years), who had a history of hospital treatment for pneumonia, with PPV on average 5.3 years after their primary vaccination. Revaccination resulted in significant increases of the geometric mean antibody concentration (GMC) and the geometric mean antibody fold increase (GMFI), although to lower levels than after primary vaccination. 36/61 (59%) of the patients responded with a GMFI of > or =2 to > or =2 of six serotypes. Local reactions to revaccination were common (63%), but mild, and there were no serious adverse events. We conclude that revaccination of elderly with PPV after 5-10 years is safe and induce a significant immune response in a majority of persons.     

The 23-Valent Pneumococcal Polysaccharide Vaccine. Part I. Efficacy of PPV in the Elderly: A Comparison of Meta-Analyses

A 23-valent polysaccharide pneumococcal vaccine (PPV) has been available in the UK for more than 20 years and is currently recommended for use in high-risk groups (HRG) of 2+ years of age. The degree of protection afforded by the PPV remains a critical issue, although a number of randomised clinical trials and case-control studies (CCS) have been published. The aim of this work is to review the estimates on the efficacy of PPV against pneumococcal pneumonia and invasive pneumococcal disease (IPD) in the elderly and to perform a meta-analysis in order to obtain a pooled estimate of the level of protection in high and low risk individuals. These two groups of individuals are at the centre of the current debate on whether or not to extend the vaccination programme to all elderly individuals 65+. Only randomised and quasi-randomised studies are included in the analysis and results are compared with previous meta-analyses. The effect of the inclusion of observational studies is investigated in the sensitivity analysis. When taken with the results of other meta-analyses and observational studies, it appears that PPV offers protection against IPD in the general elderly population (VE = 65%; 95% CI: -49-92%) whereas it has a moderate effect in the high-risk elderly (VE = 20%; 95% CI: -188-78%). The vaccine has little or no effect against pneumonia (VE = 16% in the general elderly and -20% in HRG).     

怀化市医疗机构工作人员新型冠状病毒疫苗接种意愿及影响因素

目的 了解怀化市医疗机构工作人员新型冠状病毒疫苗(简称新冠疫苗)接种意愿及影响因素,为新冠疫苗的接种工作提供依据。 方法 采用多阶段分层抽样法选取怀化市市、县/区、乡镇三级23家医疗机构的工作人员,开展网络问卷调查;采用χ²检验、logistic回归分析其影响因素。 结果 3 392名(85.70%)调查对象愿意接种新冠疫苗;logistic回归分析显示,乡镇级、县级医疗机构调查对象、临床医生、护理人员的接种意愿更高[OR(95%CI):1.558(1.148~2.114)、1.386(1.112~1.726)、1.550(1.008~2.384)、1.747(1.165~2.618)];硕士及以上学历者接种意愿更低[OR(95%CI):0.446(0.243~0.816)];认为新冠肺炎危害严重、认可疫苗的安全性、有效性、在 2020年接种过流感疫苗者更愿意接种新冠疫苗[OR(95%CI):1.493(1.221~1.825)、2.134(1.669~2.728)、2.546(1.925~3.366)、2.185(1.287~3.709)]。 结论 怀化市医疗机构工作人员新冠疫苗的接种意愿总体较高,应加强新冠疫苗相关知识宣传,增强该人群对疫苗接种的信心,进一步提高新冠疫苗的实际接种率。     

Declining invasive pneumococcal disease in the U.S. elderly

In 2000, pneumococcal conjugate vaccine (PCV7) was recommended for young children. By 2002-2003, 48.6% had been fully immunized. Using Medicare administrative, we found that the rates of invasive pneumococcal disease (IPD) hospitalizations in the elderly in the 2000-2001, 2001-2002 and 2002-2003, were 22.6, 30.2, and 40.6% lower, respectively, than during the baseline period, 1996-1997 through 1999-2000 (range 35.1/100,000 to 38.3/100,000). Pneumococcal polysaccharide vaccine (PPV23) has been recommended for the elderly, since 1989. PPV23 vaccination rates in the elderly increased by 25.2% during the baseline period but by <5% during the period PCV7 has been available. Thus, during the period that PCV7 vaccine has been used in children, rates of IPD in the elderly have declined appreciably more compared to the immediately prior period when PPV23 was the only vaccine available.