预防接种知情告知专家共识(下)

《中华人民共和国疫苗管理法》和其他相关法律法规对受种者或其监护人的疫苗和预防接种工作知情提出了要求,对预防接种告知方式和内容作出了规定。本共识以该法和《预防接种工作规范》为基础,借鉴国内外经验,阐述了预防接种知情告知的发展和形式,制定了预防接种知情告知理论框架、标准流程和信息、非免疫规划疫苗知情告知原则以及各疫苗知情同意书格式,为疾病控制和预防保健人员在预防接种服务中参考。本部分共识包括流感病毒疫苗、肺炎球菌疫苗、含b型流感嗜血杆菌成分疫苗、肠道病毒71型灭活疫苗、轮状病毒疫苗、水痘减毒活疫苗、带状疱疹疫苗、人乳头瘤病毒疫苗、人用狂犬病疫苗、肾综合征出血热疫苗、钩端螺旋体疫苗、炭疽疫苗、戊型肝炎疫苗、霍乱疫苗、伤寒疫苗、森林脑炎疫苗预防接种知情告知内容。     

预防接种知情告知专家共识（上）

《中华人民共和国疫苗管理法》和其他相关法律法规对受种者或其监护人的疫苗和预防接种工作知情提出了要求,对预防接种告知方式和内容作出了规定。本共识以该法和《预防接种工作规范》为基础,借鉴国内外经验,阐述了预防接种知情告知的发展和形式,制定了预防接种知情告知理论框架、标准流程和信息、非免疫规划疫苗知情告知原则以及各疫苗知情同...     

预防接种知情告知专家共识(下)

《中华人民共和国疫苗管理法》和其他相关法律法规对受种者或其监护人的疫苗和预防接种工作知情提出了要求,对预防接种告知方式和内容作出了规定.本共识以该法和《预防接种工作规范》为基础,借鉴国内外经验,阐述了预防接种知情告知的发展和形式,制定了预防接种知情告知理论框架、标准流程和信息、非免疫规划疫苗知情告知原则以及各疫苗知情同...     

疫苗知情同意书,别不当回事!

<正>我们都知道,疫苗接种前,接种医生需要向家长进行知情告知,家长阅读知情同意书或听取知情告知后,均需要签字。你是每次拿到或听取了知情告知后,就直接签字了事,还是会详细了解一番呢?千万别漏掉了你需要了解的重要信息哦!每次接种疫苗前,都得签署知情同意书吗?是的,这是一项必不可少的流程。我国的《疫苗流通和预防接种管理条例》中规定:医疗卫生人员在实施接种前,应当告知受种者或者其监护人所接种疫苗的品种、作用、禁忌、不良反应以及     

微信公众号上实现全省疫苗接种知情告知的实践

目的分享建立"福建省预防接种"微信公众号,实现疫苗知情同意风险沟通的经验与方法。方法用过程管理方法探讨在微信上实现全省疫苗接种知情告知的实践。结果在微信上实现全省疫苗接种知情告知,具有依靠平台强大、功能定位独立准确、界面清晰友好、内容实用准确等特点,得到免疫规划人员和儿童家长的高度认可。结论微信实现全省疫苗接种知情告知,为福建全省全面准确实现疫苗接种知情告知提供了重要手段。     

企业改制医院免疫规划工作面临的问题及对策

对国有大型企业改制分流医院免疫规划工作中面临的问题进行分析,制订应对策略:严格落实国家政策,对免疫规划工作提供必要的经费保障;加强流动儿童预防接种管理;积极开展社会宣传动员;接种疫苗前严格执行知情告知制度,履行告知义务;妥善处理预防接种反应;加强专业人员培训和教育,不断提高专业技术水平和各项素质。     

预防接种门诊的告知义务与受种对象的知情同意权

医护人员告知义务与受种者的知情权是对应的权利和义务关系,我国从行政法规及部门规章的规定告知义务,同时赋予了受种对象的知情同意权。该文主要论述告知义务包括预防接种政策的告知和疫苗针对疾病与疫苗相关知识的告知、一般接种禁忌证的告知,疫苗接种程序的、疫苗效果和费用的、疫苗接种后注意事项的及疫苗接种反应处理的告知等。护士履行告知义务要利用多种形式和契机随时随地地进行,并及时记录告知内容,以保障受种对象的知情同意权。取得受种监护人（家长）的积极配合,有利于提高疫苗接种质量减少医患纠纷建立相互信任、互相理解的医患关系有着至关重要的意义。     

多学科专家论证川崎病儿童预防接种模式应用

目的 解决基层接种医生对患有川崎病儿童的预防接种难题。方法 采用组织临床儿科、流行病学、疫苗学等相关领域专家对川崎病儿童进行论证,形成川崎病预防接种共识建议,对符合接种建议患儿进行接种前告知,获得监护人同意后接种疫苗,进行接种疫苗后的安全性观察。结果 形成川崎病儿童的预防接种专家共识建议,分别对未发生并发症的川崎病患儿、发生并发症的患儿以及复发的川崎病患儿接种进行建议,已指导6名川崎病儿童进行疫苗接种,均未发生不良反应。结论 采用组织专家对川崎病儿童论证形成预防接种共识建议的方法,指导接种医生对患病儿童接种疫苗,可以提高该群体儿童接种率,确保接种安全,其方法安全可行。     

预防接种人员法律意识现状及应对措施

国家《疫苗流通和预防接种管理条例》(以下简称《条例》)已于2005年6月1日实施。《条例》中对开展疫苗预防接种的各个环节包括疫苗公示、接种单位与人员资质、接种前的询问与告知、各种卡证表记录等等均为法律行为。     

一起接种甲肝疫苗引起不良反应的流行病学调查

目的了解群体不良反应发生的原因及事件特征,及时采取有效措施控制事件的发展及蔓延。方法由市、县两级疾病预防控制人员对疫苗生产厂家、经营单位资质及疫苗质量进行调查,对儿童接种时间、接种部位、接种剂量、接种时疫苗禁忌证及注意事项告知情况、知情告知书签发情况进行入户问卷调查。结果经现场调查及临床检验,确定这是一起因村医违反《疫苗流通和预防接种管理条例》的规定,导致部分接种儿童出现以呼吸道感染症状为主,甚至出现了肾脏改变的不良反应事件。结论需采取多种措施,科学规范实施疫苗接种,降低不良反应发生率。     

Consent for Adolescent Vaccination: Issues and Current Practices

ABSTRACT: To identify and describe implementation of state-level informed consent requirements for adolescent immunizations, current state regulations on informed consent and immunization services for children and adolescents were identified through the LEXIS-NEXIS® legal data base. Regulations were coded for informed consent characteristics, consent exemptions, and current immunization requirements. State immunization program directors, project managers, and state hepatitis coordinators were surveyed to catalogue how regulations were implemented and document new policies or regulations under consideration.
Parental consent for immunizations is standard practice in 43 states. Most states (n=34) require separate consent for each injection when more than one injection is required to complete a vaccination, but only for a limited number of medical procedures. Nine states allow adolescents to self-consent for hepatitis B vaccination in sexually transmitted disease clinics and family planning clinics as part of the exemption for minors' receipt of sexual health services.
Most states require consent for vaccination services provided to adolescents. Parental consent requirements are a potential barrier to vaccinating adolescents in some settings.     

Vaccination in juvenile correctional facilities: state practices, hepatitis B, and the impact on anticipated sexually transmitted infection vaccines

OBJECTIVES: Juvenile correctional facilities are an ideal setting to provide preventive vaccines to adolescents who are at risk. In many instances of incarceration, facilities overcome the need for parental consent by making young people wards of the state and the state providing consent. The authors investigated current state practices for administering hepatitis B vaccine to incarcerated adolescents. These may impact the delivery of anticipated sexually transmitted infection (STI) vaccines to incarcerated adolescents. METHODS: From June to August 2004, interviews were conducted with state Immunization Program Managers by telephone about hepatitis B vaccination and consent policies in juvenile correctional facilities. RESULTS: Forty-five states were able to provide information about hepatitis B immunization in publicly funded juvenile correctional facilities. Forty-one of the 45 states offered hepatitis B vaccine to adolescents who were sentenced and thereby considered to be wards of the state. Of those 41 states, 20 also made hepatitis B vaccine easily accessible to detained adolescents (no parental consent required). Those 20 states considered detained adolescents as wards of the state (n=13), or allowed them to self-consent for the vaccine (n=7). CONCLUSIONS: Most states offer hepatitis B vaccination to sentenced adolescents in correctional facilities. Just over half of these states also vaccinate detained adolescents. Juvenile correctional facilities have experience administering vaccines, and this might allow for expansion of vaccination services when new STI vaccines become available. Still, there are major barriers to universal vaccination of incarcerated adolescents, including the issue of consent.     

Varicella vaccination for grades 4 and 5 students: from theory to practice

BACKGROUND: In 2002-2003, as part of a pilot project, varicella vaccination was offered to susceptible students in grades 4 and 5 in schools whose health services are provided by a local community services centre in Montréal. This immunization campaign was merged with the hepatitis B immunization programme. OBJECTIVES: To calculate the proportion of grade 4 and 5 students susceptible to varicella; to calculate the proportion of susceptible students who agree to be vaccinated; to compare the proportion of susceptibles who agree to be vaccinated when varicella vaccination is offered with the first or the second dose of hepatitis B; and to assess whether a catch-up varicella immunization programme would affect the vaccine coverage of a concurrent hepatitis B vaccination programme. METHODS: The proportions of susceptible students and of parents of susceptibles who consented to vaccination were calculated. The proportions of parents of susceptibles who consented to vaccination were compared for both immunization strategies: varicella vaccination given with the first or second dose of hepatitis B vaccine. Logistic regression was performed to identify possible associations between consent to varicella vaccination and the various variables collected. Rates of vaccine coverage against hepatitis B after two doses were compared for the years 2000-2001 and 2002-2003. RESULTS: Of 3,856 registered students, 3,486 (90.4%) returned consent forms. Among the 3,272 students for whom information was available, 441 (13.5%) were susceptible, including 394 (89.3%) who consented to vaccination. The rates of vaccine coverage in the schools after two doses of hepatitis B vaccine were exactly the same for the 2000-2001 and 2002-2003 school years. CONCLUSION: Varicella vaccination of susceptible grade 4 and 5 students associated with a coincident hepatitis B vaccination campaign can be performed without negative impact on the hepatitis B vaccination programme.     

Challenges and opportunities of a new HPV immunization program perceptions among Swedish school nurses

Aim

To investigate school nurses’ perceptions of HPV immunization, and their task of administering the vaccine in a planned school-based program in Sweden. Method: Data were collected through five focus group interviews with school nurses (n = 30). The interviews were recorded, transcribed verbatim and analyzed using content analysis.

Findings

The theme Positive attitude to HPV immunization despite many identified problems and challenges summarizes the results. The school nurses saw the program as a benefit in that the free school-based HPV immunization program could balance out social inequalities. However, they questioned whether this new immunization program should be given priority given their already tight schedule. Some also expressed doubts regarding the effect of the vaccine. It was seen as challenging to obtain informed consent as well as to provide information regarding the vaccine. The nurses were unsure of whether boys and their parents should also be informed about the immunization.

Conclusion

Although some positive aspects of the new HPV immunization program were mentioned, the school nurses primarily identified problems and challenges; e.g. regarding priority setting, informed consent, culture and gender. In order to achieve a good work environment for the school nurses, and obtain a high coverage rate for the HPV immunization, these issues need to be taken seriously, be discussed and acted upon.     

儿童家长对疫苗接种及不良反应的知识、态度、行为调查

目的：了解儿童家长对预防接种及预防接种不良反应的知识、态度和行为状况,分析深圳泰康乙肝疫苗事件发生前后,家长对于儿童预防接种知识、态度和行为的改变,为进一步改善免疫接种工作提供科学依据。方法自行设计调查问卷,采取整群抽样的方法,对在深圳市福田区接种门诊进行预防接种的504名儿童家长进行问卷调查。结果97.42%的家长知道孩子出生时需要接种疫苗;孩子性别不同的家长,在是否带孩子按时接种国家免疫规划疫苗方面差异有统计学意义;文化程度不同的家长,在孩子出生后是否办理预防接种证与是否带孩子按时接种国家免疫规划疫苗方面差异有统计学意义;认为预防接种有必要的家长中,85.32%的家长会主动带孩子进行预防接种。有98.21%的家长听说过深圳康泰乙肝疫苗事件,47.42%的家长认为此事件中儿童的死亡可能与疫苗有关;在此事件发生前后,对我国乙肝疫苗安全性持中立态度的家长所占比例明显增加。结论家长对儿童预防接种及不良反应的知识、态度和行为普遍较好,深圳泰康乙肝疫苗事件对家长的态度有一定的影响。     

天津市２～１３岁儿童乙肝疫苗查漏补种项目实施及效果评价

摘要：目的　了解天津市２００５年２～１３岁人群乙肝疫苗查漏补种情况并评价其实施５年后效果,为制定乙
肝免疫策略提供科学依据。方法　２００５年天津市对２～１３岁人群开展了乙肝疫苗的查漏补种工作,同时做
了本底血清学监测,５年后对该人群进行抽样,采血检测乙肝病毒表面抗原（ＨＢｓＡｇ）、抗乙肝病毒表面抗
原抗体（Ａｎｔｉ ＨＢｓ）、抗乙肝病毒核心抗原抗体（Ａｎｔｉ ＨＢｃ）。结果　本次查漏补种共查出符合补种条件的
适龄儿童共４５１４１４人,最终完成全程接种儿童４２７５５２人,接种率达９４．７１％。血清学监测结果显示,查
漏补种５年后该人群抗 ＨＢｓ阳性率为６２．９０％,比查漏补种前的４３．３５％显著提高了４５．１０％。本次查漏补
种预计减少ＨＢｓＡｇ携带者４１９１人,慢性乙肝１０４８人,肝硬化１０５人,肝癌１１人。结论　乙肝疫苗查漏
补种是巩固和提高乙肝疫苗免疫屏障的重要手段。
关键词：２～１３岁人群;乙肝疫苗;查漏补种;效果
中图分类号：Ｒ５１２．６＋２,Ｒ１８６　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０３ ０２３５ ０３     

克拉玛依市乙肝疫苗纳入儿童免疫规划后接种率调查与评价

目的评价克拉玛依市乙型肝炎（乙肝）疫苗纳入儿童免疫规划后的工作质量和效果。方法采用按容量比例概率抽样方法随机调查305名儿童乙肝疫苗（HB—VAX）接种情况；开展3岁以下儿童乙肝病毒感染标志的血清学监测；调查在医院出生的2500名新生儿首针HB—VAX接种情况。结果新生儿首针HB—VAX接种率为97．36％，及时接种率为95．12％；儿童首针及时接种率为75．74％，全程及时接种率81．97％，全程接种率88．52％，HB—VAX全程接种率和首针及时接种率均呈逐年上升趋势；HB—V．AX免疫后抗-HBs阳性率为93．45％。结论HB—VAX纳入儿童免疫规划工作后，有效提高了儿童HB—VAX接种率、首针及时接种率和全程及时接种率。但还应重视在家里出生的新生儿和流动儿童HB—VAX接种率的提高。