预防接种异常反应的补偿机制探讨

本文阐述预防接种异常反应的概念及补偿机制。     

预防接种异常反应补偿救济机构的探讨

2005年6月1日正式实施的《疫苗流通和预防接种管理条例》（以下简称《管理条例》）对预防接种异常反应及补偿救济的责任主体做了明确的规定，但在理论和实践中仍存在不少问题，如补偿的性质、原则、范围和程序等等，再加上存在两种不同性质的预防接种方式，预防接种异常反应纠纷的处理显得更加复杂和困难，为此就其补偿救济机制探讨如下。     

国内外关于预防接种异常反应的经济补偿

预防接种异常反应法律责任特殊,各方均不存在过错。公民为了公共健康利益接种疫苗,让受种者单独承担不幸有失公平,因此应给予其一定的经济补偿。但是各省(自治区、直辖市)以前出台的补偿实施细则及赔付标准大多数已经不能满足实际工作需要,受种者难以得到等同丧失利益的救济,免疫规划工作也因此受到很大的负面影响。该文介绍了一些国家和地区预防接种异常反应补偿办法,描述了中国预防接种异常反应补偿的现状,并针对存在的问题提出了一些建议。     

预防接种异常反应补偿机制态度调查分析

目的探索中国预防接种异常反应(异常反应)补偿机制和补偿标准,为各省(自治区、直辖市,下同)制订异常反应补偿办法提供参考。方法依据经济水平分层随机抽取6个省免疫规划相关工作人员521名,采用问卷方式进行调查。结果32.8%被调查者选择省级卫生行政部门负责第一类疫苗异常反应的补偿事务,63.3%选择由第一类疫苗异常反应补偿管理机构负责对第二类疫苗异常反应的补偿;如果省、设区的市(地区、州)、县(区、市)异常反应诊断结论同时存在,84.3%认为应以上级结论作为补偿依据;67.0%认为使用其它预防用生物制品引起的异常反应亦应给予补偿,选择诱发或者加重原有疾病、不明原因反应给予补偿的分别占71.2%和46.6%;疑似异常反应"计算损害所致实际损失给予一次性补偿"选择率均明显高于"按伤残等级拟定标准给予一次性补偿",85.0%认为应以因果关联程度确定补偿的比例;77.0%认为对于《疫苗流通和预防接种管理条例》(《条例》)实施以前发生的未曾补偿或者补偿不足的异常反应案例,不可按新制定的补偿办法进行补偿或者追加补偿。结论由省级卫生行政部门统一管理一、二类疫苗的补偿事务;异常反应诊断小组结论经逐级审核后作为补偿依据;受种者在得到异常反应诊断或鉴定结果后12个月以内提出申请;根据异常反应损害所致实际损失测算补偿费用,并依据因果关联程度确定补偿比例;《条例》出台以前发生的异常反应案例不纳入新的补偿办法的补偿范围。     

290例疑似预防接种异常反应监测情况分析

<正>疑似预防接种异常反应是指在预防接种过程中或接种后发生的可能造成受种者机体组织器官、功能损害,且怀疑与预防接种有关的反应[1]。开展疑似预防接种异常反应监测,对于评价疫苗的安全性,改善预防接种服务质量,从而增强公众对预防接种的信心,具有重要意义[2]。     

一类疫苗预防接种异常反应补偿补充保险初步探索

目的总结盐城市盐都区实施一类疫苗预防接种异常反应补偿补充保险试点工作的成效与经验,推动该项工作规范化、深入化。方法收集相关资料进行描述性分析。结果盐都区自2015年10月起实施一类疫苗预防接种异常反应补偿补充保险试点工作,截止2016年12月31日,门诊开展覆盖率100%,儿童家长告知率100%,全区共投保8 828人,其中特惠保障1 152人,占13.05%,基本保障6 371人,占72.17%,优质保障919人,占10.41%,钻石保障386人,占4.37%。保险项目启动后新登记儿童投保7 233人,投保率89.93%。结论盐都区一类疫苗预防接种异常反应补偿补充保险试点工作取得初步成效,需采取一系列措施将试点工作规范化、深入化,并向全省、全国推广。     

预防接种异常反应分析及处理

预防接种疫苗后,产生可预防相应疾病免疫力的同时,也可能使极个别个体产生对疫苗免疫的异常反应或免疫损伤[1]。关于疫苗接种后出现的异常反应,其危险性也一直被人们所关注,直接影响到群众对免疫接种的认识程度,有时造成的影响很大,甚至引起纠纷,妨碍预防接种工作的正常开展。为了解大规模人群历年接种疫苗的异常反应发生情况,现将我站接种门诊发生的预防接种异常反应病例进行统计分析,报告如下。对象与方法对象来源于本市预防接种门诊1999~2004年度的预防接种反应档案,所有异常反应病例均由市卫生防疫站计划免疫专业人员进行个案调查,填写…     

深圳市实施预防接种异常反应补偿的做法与成效

目的总结深圳市预防接种异常反应处理工作的过去与现在,推动该项工作的规范化建设。方法描述性研究方法。结果2005年6月-2011年12月,由于广东省没有适时出台相关政策,深圳市预防接种异常反应补偿纠纷的处理,确实比较混乱。2012年开始,广东省预防接种异常反应补偿办法及实施细则施行,深圳市大力贯彻,已经从根本上扭转了比较混乱的局面。结论深圳市基本实现树立法律、规章至上的理念;拒绝”私了”已经成为大家的共识;初步实现预防接种异常反应处置规范化。按章办事的最大受益者是整个社会。     

广东省2011-2012年疑似预防接种异常反应监测数据分析

目的分析广东省2011-2012年疑似预防接种异常反应（AEFI）的发生特征,评价AEFI信息管理系统运转情况及预防接种安全性。方法通过全国AEFI信息管理系统收集2011年1月1日至2012年12月31日报告的AEFI个案数据．通过广东省疫苗月报告系统收集同期全省疫苗接种数据,采用描述性流行病学方法对AEFI发生特征进行流行病学分析。结果2011-2012年广东省共报告AEF1个案9753例（报告发生率为89．77／100万剂次）,男、女性分别5945、3808例;以≤1岁、2～7岁人群为主,分别占65．75％（6413／9753）、32．29％（3149／9753）。一般反应6211例（63．68％,6211／9753）,其平均报告发生率为57．17／100万剂次,以发热、红肿、硬结为主;异常反应2969例（30．44％,2969／9753）,平均报告发生率为27．33／100万剂次,以过敏性皮疹（2399例）、卡介苗淋巴结炎（137例）和血管性水肿（125例）为主,共占89．63％（2661／2969）,其中严重异常反应193例（1.98％,193／9753）,平均报告发生率为1．79／100万剂次,以过敏性休克（57例）、血小板减少性紫癜（20例）和过敏性紫癜（16例）为主,共占48．19％（93／193）。87．41％（8525／9753）AEF1个案发生在接种后当天或第2天,治愈和好转占97．75％（9534／9753）。异常反应调查诊断结论92．49％（2746／2969）由疾控机构调查组作出,89．59％（2660／2969）由县级机构作出。结论广东省AEFI监测敏感度较高,AFEI常发生在小年龄组和接种后当天或第2天,预后良好。     

广东省2012-2013年第一类疫苗预防接种异常反应补偿情况分析

目的 分析广东省2012-2013年第一类疫苗预防接种异常反应补偿情况。方法 收集2012-2013年广东省第一类疫苗预防接种异常反应补偿个案资料,采用描述流行病学方法进行分析。结果 2012-2013年广东省第一类疫苗疫苗接种异常反应补偿个案66例,涵盖18个地级市35个县(市、区),涉及11种疫苗。核算补偿金额502.54万元,其中残疾补偿费占63.74%;实际补偿金额491.86万元,平均每例补偿7.45万元,前3位分别是口服脊髓灰质炎减毒活疫苗(OPV)29.73万元、麻疹减毒活疫苗(MV)17.01万元、A群脑膜炎球菌多糖疫苗(MPV-A)12.67万元;补偿申请书平均审核时间47个工作日。结论 2012-2013年广东省第一类疫苗预防接种异常反应平均每例补偿金额7.45万元,95.45%个案核算补偿金额低于一次性补偿金额上限。     

麻疹疫苗预防接种异常反应及处理原则

为探讨麻疹疫苗预防接种的异常反应及处理原则,作者查阅了近年来有关麻疹疫苗预防接种异常反应的文献报道,结果表明,接种麻疹疫苗后,可发生过敏性反应、心因性反应、疫苗相关病等,还可以诱发和偶合多种疾病。处理原则主要是抗过敏、对症、心理疏导和暗示治疗：对于偶合疾病,要由有关部门及时做出权威的诊断,以免引起医患纠纷。     

江苏省卡介苗疑似预防接种异常反应监测分析及处理对策

目的分析江苏省卡介苗(Bacille Calmette-Guerin Vaccine,BCG)疑似预防接种异常反应(Adverse Events Following Im-munization,AEFI)的发生特征,评价BCG预防接种安全性和监测处置情况,探讨BCG AEFI原因及护理对策。方法通过中国免疫规划信息管理系统和AEFI信息管理系统收集江苏省2008—2013年报告的接种BCG数据及接种后AEFI个案数据,采用描述性方法对相关指标进行流行病学分析。结果 2008—2013年江苏省共报告接种后AEFI 713例,报告发生率为132.04/100万剂,其中不良反应698例,报告发生率为129.26/100万剂。不良反应中,一般反应378例,报告发生率为70.00/100万剂;异常反应320例,报告发生率,为59.26/100万剂。报告最多的异常反应为BCG淋巴结炎,共159例,报告发生率为29.44/100万剂。严重异常反应中,全身播散性BCG感染报告3例,报告发生率为0.56/100万剂。BCG接种事故以接种部位错误、误种其他疫苗和接种过量为主,经过相应的对症处理,都能得到改善和恢复。结论 BCG安全性尚可,BCG淋巴结炎、全身播散性BCG感染等异常反应报告发生率,均低于预期水平。应继续加强培训和督导,提高接种人员接种技术及BCG AEFI监测敏感性;增强调查和诊断异常反应的能力,提高临床救治水平,减少严重病例的发生。依据原因对症采取相应措施,可提高BCGAEFI的恢复效果。     

Mothers' and Adolescents' Beliefs about Risk Compensation following HPV Vaccination

PurposeTo examine the prevalence and predictors of the belief that human papillomavirus (HPV) vaccination will result in “risk compensation,” that is, will increase risky sexual behavior.MethodsTwo surveys were carried out: with 332 mothers (Study 1) and 360 adolescent girls (Study 2). The outcome measure was the score on a risk compensation scale tapping beliefs that HPV vaccination would increase risky sexual behavior.ResultsAmong mothers, those from the lowest income group (F = 4.38, p < .01), from ethnic minority backgrounds (F = 7.41, p < .01), and who did not attend cervical screening (F = 9.96, p < .01), had the highest risk compensation scores. Among adolescents, girls with lower educational attainment (F = 4.14, p < .05), from ethnic minority backgrounds (F = 6.60, p < .001), and who felt themselves to be less sexually experienced than their peers (F = 3.31, p < .05), had the highest scores. Girls showed lower belief in risk compensation in relation to their own behavior (personal compensation) than for “girls in general” (general compensation; t = 13.68, p < .001). Lower knowledge of HPV was associated with higher personal risk compensation beliefs (F = 4.26, p < .05).ConclusionsA significant minority of mothers and adolescents themselves say that HPV vaccination would increase the chance of risky sexual behavior. Because risk compensation beliefs are likely to predict HPV vaccine acceptance, identifying the basis for these beliefs and providing appropriate information and education to parents and adolescents will be vital. Following the introduction of vaccination, it will be important to discover whether risk compensation actually takes place, and every effort should be made to ensure it does not.     

对预防接种后异常反应和事故善后处理经费来源渠道的思考

通过当地发生的一起预防接种后常反应的处理，提出了新时期发生类似件善后处理经费来源渠道的思考。     

论医疗事故赔偿纠纷程序法的适用

由于我国医疗故事赔偿纠纷处理的有关法律、行政法规及司法解释之间存在着不、不协调的矛盾。在审理医疗事故赔偿纠纷案时医患双方的分歧颇大。这既不利于正确地维护医患双方的合法权益，也不利于医疗纠纷的顺利解决及社会循序的稳定。因此，正确地认识和解决医疗事故赔偿纠纷法律适用中的矛盾，具有重要的意义。     

我国新型农村合作医疗中中医药补偿政策的现状调查

为了解我国新型农村合作医疗中中医药补偿政策的制定情况,向全国31个省份发放调查问卷,收回29份.各地在引导参合农民选择中医药服务方面进行了积极探索,所有省份均要求将中医医疗机构和中医药服务纳入补偿范围,超过一半的省份要求提高中医药服务的补偿比例,以发挥中医药简便验廉的优势,提高参合农民的补偿水平.     

Ethics and Childhood Vaccination Policy in the United States

Childhood immunization involves a balance between parents’ autonomy in deciding whether to immunize their children and the benefits to public health from mandating vaccines. Ethical concerns about pediatric vaccination span several public health domains, including those of policymakers, clinicians, and other professionals.In light of ongoing developments and debates, we discuss several key ethical issues concerning childhood immunization in the United States and describe how they affect policy development and clinical practice. We focus on ethical considerations pertaining to herd immunity as a community good, vaccine communication, dismissal of vaccine-refusing families from practice, and vaccine mandates.Clinicians and policymakers need to consider the nature and timing of vaccine-related discussions and invoke deliberative approaches to policymaking.Following the December 2014 measles outbreak at a popular amusement park in California,1,2 which spread to other states, Canada, and Mexico, there has been increased attention to US childhood immunization practices. A recent study attributed the outbreak to underimmunization,3 and several policymakers have called for an end to religious and philosophical (i.e., personal-belief) exemptions altogether, with the state of California passing legislation removing the option of personal-belief exemptions.4,5 Political candidates have expressed various viewpoints on vaccination.6 In light of these developments, we discuss several key ethical issues concerning childhood immunization in the United States and describe how they affect policy development and clinical practice. There are a myriad of ethical issues regarding such topics as vaccination development, administration, communication, and safety monitoring. We focus on a few key ethical issues concerning childhood immunization in the United States—what we refer to as a “vaccine ethics” approach—and describe how such an approach affects policy development and clinical immunization practice.     

ELISA阳性反应阈值的确定方法探讨

本文运用统计学原理探讨了分光光度法ELISA反应系统中阳性反应判断阈值的最佳确定方法。本文还就其原理、意义和实际应用等作了讨论。     

Vaccine Preventable Diseases and Vaccination Policy for Indigenous Populations

Compared with nonindigenous people, indigenous people in first-worldcountries have experienced much higher rates of many vaccinepreventable diseases. This systematic review of published scientificliterature, government reports, and immunization guidelinesfrom Australia, Canada, New Zealand, and the United States comparespre- and postvaccination disease rates and vaccination policyfor indigenous people in these four countries. Nationally fundeduniversal vaccination programs are clearly the most effectiveway of reducing disease in indigenous populations. Most successfulhave been programs for viral diseases in which strain variationsare not important and herd immunity is high, such as measlesand hepatitis B. For bacterial infections, strain variations(pneumococcal disease), heavy nasopharyngeal colonization ofyoung infants (pneumococcal and Haemophilus influenzae typeb disease), low vaccine effectiveness in adults with a highprevalence of risk factors (polysaccharide pneumococcal vaccine),and waning immunity (pertussis) have been associated with continuingor widening disparities between indigenous and nonindigenouspopulations. However, universal vaccination programs are notalways possible. Geographic targeting of all persons in certainregions with high disease rates has been successful, as hastargeting of indigenous populations in regions where they constitutelarger proportions of the population. In national programs targetingonly indigenous people, it has been difficult to achieve highcoverage, particularly in urban areas. Innovative program approachesare particularly needed in these situations. American Native continental ancestry group • communicable diseases • Haemophilus influenzae • hepatitis • immunization • influenza, human • Oceanic ancestry group • Streptococcus pneumoniae