2015年江西省国家免疫规划疫苗接种率调查结果分析

目的 了解江西省2008年实施扩大国家免疫规划后疫苗接种情况。方法 采用分层按容量比例概率抽样方法,对全省11个设区市、21个县(市、区)、375个乡镇的2岁组和7岁组儿童进行接种情况调查。结果 共调查8 780名儿童,其中2岁组和7岁组各4 390名,建证率100.0%,建卡率99.7%,卡证相符率84.4%;2岁组卡证相符率明显高于7岁组,不同年龄组城市地区的卡证相符率均高于农村。全省不同年龄组国家免疫规划疫苗接种率均>95.0%。2岁组除百白破、甲肝合格接种率低于90%以外,其余各疫苗合格接种率均高于90%;7岁组除卡介苗、乙肝、白破的合格接种率高于90%外,其余各疫苗合格接种率均低于90%。7岁组中,城市与农村地区的乙肝首针及时率有统计学差异。2岁组和7岁组麻疹首针及时率均较低(69.8%和66.9%),两组间有统计学差异。结论 自实施扩大国家免疫规划后,全省国家免疫规划疫苗接种率、建证率、建卡率及乙肝首针及时接种率均较高,但仍存在合格接种率、卡证相符率、麻疹首针及时接种率较低的问题。     

Vaccination policies for healthcare workers in Europe

Health-care workers (HCWs) are at increased risk for acquisition of vaccine-preventable diseases (VPDs) and vaccination is justified in order to protect them from occupational exposure and to prevent the spread of VPDs that pose a threat to susceptible patients. Review of European vaccination policies for HCWs revealed significant differences between countries in terms of recommended vaccines, implementation frame (mandatory or recommendation), target HCW groups and health-care settings. Further, the few published studies available identified indicate significant immunity gaps among HCWs against VPDs in Europe. In order to achieve higher vaccination coverage against VPDs stronger recommendations are needed. The issue of mandatory vaccination should be considered for diseases that can be transmitted to susceptible patients (influenza, measles, mumps, rubella, hepatitis B, pertussis, varicella). The acceptance of vaccinations and of mandatory vaccinations by HCWs is a challenge and appears to be VPD-specific.     

Adverse reaction of influenza A (H1N1) 2009 virus vaccination in pregnant women and its effect on newborns

Pregnant women are reluctant to be vaccinated during their pregnancy. Their main concern is the safety of influenza vaccine. We investigated the adverse reactions of pregnant women who received the influenza A (H1N1) 2009 virus vaccination and also conditions of neonates of the vaccinated women. Various adverse reactions developed after vaccination, but the symptoms were mild and resolved within several days without requiring any treatment or hospitalization.     

不同碘营养状态对晚孕期孕妇心电图的影响

目的探讨不同碘营养状态的晚孕期孕妇心电图检查结果及其临床意义。 方法采用整群随机抽样横断面调查法随机选取2013年4月至2014年4月于辽宁省烟台市2家医院就诊的晚孕期孕妇各600例,共计1 200例为研究对象,纳入研究组。采用同样的方法选择同期在这2家医院体检的非孕期女性各300例,共计600例,纳入对照组。检测研究组孕妇体内碘含量,同时记录心电图异常情况,并与对照组非孕期女性心电图检查结果进行统计学比较。按照碘含量测定结果,将研究组晚孕期孕妇分为碘缺乏亚组(G1亚组),碘过量亚组(G2亚组)和碘正常亚组(G3亚组)。本研究遵循的程序符合上述2家收集受医院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试者本人的知情同意,并与之签署临床研究知情同意书。 结果研究组1 200例晚孕期孕妇中,纳入G1、G2、G3亚组者分别为327,79及794例。3个亚组的晚孕期孕妇的年龄和孕龄等一般临床资料比较,差异均无统计学意义(F＝1.49,2.27;P＝0.23,0.10)。3个亚组晚孕期孕妇的年龄与对照组非孕期女性比较,差异亦无统计学意义(F＝1.27,P＝0.29)。G1、G2及G3亚组晚孕期孕妇心电图正常率分别为38.5%(126/327),36.7%(29/79)及88.9%(706/794),对照组非孕期女性心电图正常率为88.5%(531/600)。G1、G2及G3亚组晚孕期孕妇与对照组非孕期女性的心电图正常率比较,差异有统计学意义(χ²＝458.70,P<0.001)。G1和G2亚组晚孕期孕妇的心电图正常率明显低于对照组非孕期女性,且差异均有统计学意义(χ²＝256.00,129.55;P<0.001);而G3亚组晚孕期孕妇与对照组非孕期女性心电图正常率比较,差异却无统计学意义(χ²＝0.059,P＝0.807)。研究组晚孕期孕妇与对照组非孕期女性的异常心电图比较结果显示,前者窦性心动过缓、窦性心动过速、窦性心律不齐、室性早搏、短P-R间期、ST-T改变、电轴左偏或右偏及传导阻滞等异常心电图发生率,均显著高于后者,差异均有统计学意义(χ²＝11.29,39.52,37.70,15.87,315.79,94.03,10.35,13.94;P<0.05),其中异常率最高的为短P-R间期;但QRS波群低电压发生率与对照组比较,差异却无统计学意义(χ²＝4.83,P＝0.163)。 结论晚孕期孕妇体内碘营养状态失衡可能导致异常心电图的发生。     

沈阳地区妊娠妇女贫血的流行病学调查

目的:调查了解沈阳地区孕妇妊娠合并贫血的现状及影响因素。方法:选择沈阳地区于沈阳市妇女儿童保健中心就诊的孕妇3 200名,对其贫血状况进行回顾性分析。结果:孕妇贫血总患病率为21.63%,孕早、中、晚期患病率之间差异有统计学意义(P<0.01)。孕期职业、学历、经济状况、地区分布的不同其妊娠合并贫血的患病率也不同,差异有统计学意义(P<0.01)。结论:孕期贫血是一个非常严重的公共卫生问题,应定期于孕中期及晚期复查血常规,加强孕期保健宣教工作,科学指导孕期饮食、提高孕妇认识水平,于妊娠期4个月起常规补充铁剂,于孕晚期复查血常规,做到早期诊断,早期治疗。     

Vaccination policies for health-care workers in acute health-care facilities in Europe

The aim of this study was to evaluate existing policies regarding recommended and mandatory occupational vaccinations for health-care workers (HCWs) in Europe. A standardized questionnaire was sent to experts in Infection Control or Occupational Health in all 27 European Union Member States, as well as Norway, Russia, and Switzerland. All 30 countries have established policies about HCW vaccination against vaccine-preventable diseases. However significant gaps and considerable country-to-country variation were found, in terms of number of recommended vaccines and target subgroups of HCWs and health-care settings. Vaccination against hepatitis B and annual vaccination against seasonal influenza are almost universally recommended for HCWs in Europe (29 countries each, including eight countries where vaccination against hepatitis B is mandatory or required for employment). Policies regarding HCW vaccination also exist against mumps (12 countries), measles or rubella (15 countries), varicella (17 countries), diphtheria-tetanus (14 countries), pertussis (9 countries), poliomyelitis (11 countries), hepatitis A (11 countries), tuberculosis (BCG vaccine) (9 countries), and against meningococcus group C or meningococci groups A, C, W135, Y (tetravalent vaccine) (in 4 countries each). Re-evaluation of occupational vaccine policies for HCWs in Europe on a consensus basis is imperative in order to promote HCW and patient safety.     

郑州地区孕妇铁营养状况及其影响因素调查

目的 探讨郑州地区孕妇铁营养状况及其影响因素。方法 以2021年4—8月在郑州市某三家医院建立健康档案并进行孕期体检的孕妇作为研究对象进行问卷调查及铁营养状况检测,采用描述流行病学方法对孕妇铁营养状态进行分析,并采用单、多因素分析方法对孕妇铁缺乏状况影响因素进行分析。结果 共有3 258例孕妇参与本次研究,其中妊娠早期989例,占30.36%,妊娠中期1 125例,占34.53%,妊娠晚期1 144例,占35.11%。在3 258名孕妇中,共有773例为铁缺乏,铁缺乏的检出率为23.73%。多因素分析结果显示,年龄≥35岁（OR=2.726）、处于妊娠的中期或晚期（OR=3.037,3.438）、月经初潮年龄<13岁（OR=2.432）、经产妇（OR=3.493）、流产次数≥3次（OR=2.648）、孕前月经量≥100 mL/次（OR=2.420）、文化程度为初中及以上（OR=0.517,0.459）、居住在农村（OR=3.684）、家庭月收入>3 000元及以上（OR=0.601,0.542）、居住房屋装修时间<1年（OR=6.449）、罹患消化系统疾病（OR=4.716）、有营养补齐剂摄入（OR=0.355）是孕妇铁缺乏的影响因素。结论 郑州市孕妇铁缺乏检出率较高,需要尽早给予针对性的干预。部分因素被确定为该地区孕妇人群发生铁元素缺乏的影响因素,可选择性的对其中危险因素给予干预。     

湖北省城乡孕妇膳食营养状况调查分析

目的:查明湖北省部分地区孕妇膳食营养现状,为制定符合湖北省实际情况的干预策略和措施提供参考。方法:抽取到医院进行产前检查的湖北省城乡孕妇进行问卷调查,采集孕妇血样测定营养生化指标,并采用t检验和χ2检验等方法对数据进行统计分析。结果:孕妇膳食结构以植物性食物为主,各类食物摄入量较丰富。农村孕妇奶类的摄入远远低于城市孕妇,粮谷类、蔬菜类的摄入较城市高,城市孕妇的水果类、大豆类、畜禽肉类、鱼虾蟹贝类食物摄入量高于农村孕妇。能量和各营养素平均摄入量总体达到RNI或AI的要求,但在部分孕妇中仍存在能量和营养素摄入明显不足的情况。营养生化指标中血清锌缺乏率最高(51.52%),尤其是农村地区。孕妇贫血患病率为35.50%,农村(50.74%)显著高于城市(13.68%)(χ2=33.5333,P<0.0001)。结论:湖北省孕妇膳食结构中食物种类多样,城市孕妇各类食物摄取都比较充足,农村孕妇膳食摄入和营养状况仍存在相对较多的问题。     

苏州市2015-2018年孕产妇季节性流感病毒感染的影响因素研究

目的 探讨2015-2018年苏州市孕产妇季节性流感病毒感染的影响因素。方法 基于2015-2018年在苏州市开展的孕产妇人群流感随访队列资料,描述队列人群的基本情况和流感病毒感染后的临床特征,采用非条件logistic回归分析孕产妇实验室确诊流感病毒感染的影响因素。结果 共招募19 006名孕产妇,其中实验室确诊流感病例479名,A（H3N2）（42.8%）为主要的病毒亚型。在有流感流行期暴露风险的人群中,非条件单因素logistic回归分析结果显示,孕产妇或者其丈夫户籍在苏州市、职业为保育员及保姆、除本人外家中常住人口>2人、在苏州市有医疗保险、在苏州有生育险、纳入时为孕晚期、近一个月有过咳嗽、第一次怀孕、已有孩子、怀孕前后户外时间比以前多、怀孕前后戴口罩频率比以前多、怀孕前后聚会频率有改变均与孕产妇流感病毒感染有关,其中第一次怀孕、怀孕前后户外时间比以前多、怀孕前后戴口罩频率比以前多、怀孕前后聚会频率有改变为保护因素;非条件多因素logistic回归分析结果显示,家中常住人口>2人（aOR=1.24,95%CI：1.01~1.52）、孕晚期（aOR=1.56,95%CI：1.26~1.91）是孕产妇感染流感病毒的危险因素。结论 家中常住人口数较多及孕晚期的孕产妇更要注意预防季节性流感。     

孕妇微量元素铁随孕周变化的规律及其意义

目的:了解孕妇在不同孕期微量元素铁的变化规律。方法:按孕周将750名孕妇分为早孕(<12周)、中孕(12~28周)、晚孕(>28周)3个实验组,126名正常体检妇女为对照组,采用原子吸收分光光度法检测孕妇及对照组妇女微量元素铁的含量,比较实验组及对照组微量元素值。结论:随着孕周的增加缺乏铁孕妇比例升高。孕早期应注意铁元素的补充。     

Vaccination of healthcare personnel in Europe: Update to current policies

We investigated and compared current national vaccination policies for health-care personnel (HCP) in Europe with results from our previous survey. Data from 36 European countries were collected using the same methodology as in 2011. National policies for HCP immunization were in place in all countries. There were significant differences in terms of number of vaccinations, target HCP and healthcare settings, and implementation regulations (recommended or mandatory vaccinations). Vaccination policies against hepatitis B and seasonal influenza were present in 35 countries each. Policies for vaccination of HCP against measles, mumps, rubella and varicella existed in 28, 24, 25 and 19 countries, respectively; and against tetanus, diphtheria, pertussis and poliomyelitis in 21, 20, 19, and 18 countries, respectively. Recommendations for hepatitis A immunization existed in 17 countries, and against meningococcus B, meningococcus C, meningococcus A, C, W, Y, and tuberculosis in 10, 8, 17, and 7 countries, respectively. Mandatory vaccination policies were found in 13 countries and were a pre-requisite for employment in ten. Comparing the vaccination programs of the 30 European countries that participated in the 2011 survey, we found that more countries had national vaccination policies against measles, mumps, rubella, hepatitis A, diphtheria, tetanus, poliomyelitis, pertussis, meningococcus C and/or meningococcus A, C, W, Y; and more of these implemented mandatory vaccination policies for HCP. In conclusion, European countries now have more comprehensive national vaccination programs for HCP, however there are still gaps. Given the recent large outbreaks of vaccine-preventable diseases in Europe and the occupational risk for HCP, vaccination policies need to be expanded and strengthened in several European countries. Overall, vaccination policies for HCP in Europe should be periodically re-evaluated in order to provide optimal protection against vaccine-preventable diseases and infection control within healthcare facilities for HCP and patients.     

Influenza vaccine acceptance among pregnant women in urban slum areas,Karachi, Pakistan

BackgroundFacilitators and barriers to influenza vaccination among pregnant women in the developing world are poorly understood, particularly in South Asia. We assessed intention to accept influenza vaccine among ethnically diverse low-income pregnant women in Pakistan.MethodsFrom May to August 2013, we conducted a cross-sectional survey of pregnant women who visited health centers in urban slums in Karachi city. We assessed intention to accept influenza vaccine against socio-demographic factors, vaccination history, vaccine recommendation sources, and other factors.ResultsIn an unvaccinated study population of 283 respondents, 87% were willing to accept the vaccine, if offered. All except two participants were aware of symptoms typically associated with influenza. Perceived vaccine safety, efficacy, and disease susceptibility were significantly associated with intention to accept influenza vaccine (p < 0.05). Regardless of intention to accept influenza vaccine, 96% rated healthcare providers as highly reliable source of vaccine information. While a recommendation from a physician was critical for influenza vaccine acceptance, parents-in-law and husbands were often considered the primary decision-makers for pregnant women seeking healthcare including vaccination.ConclusionsMaternal influenza vaccination initiatives in South Asia should strongly consider counseling of key familial decision-makers and inclusion of healthcare providers to help implement new vaccination programs.     

地中海贫血孕妇ALP、AFU和甲状腺激素变化情况

目的探讨地中海贫血孕妇早期体内碱性磷酸酶(ALP)、α-L-岩藻糖苷酶(AFU)和甲状腺激素变化情况。方法选取2016年2月-2017年3月在该院产科建档并进行产检的地中海贫血早期孕妇281例,同时设置281例正常孕周为3个月孕妇作为对照组。采集空腹静脉血2 ml注入紫色EDTA-K2抗凝管中,完成血液检测;采集空腹静脉血4 ml,静止,分离血清,检测ALP、AFU、血清游离三碘甲状腺原氨酸(FT_3)、血清游离甲状腺激素(FT_4)和促甲状腺激素(TSH),PCR+反向斑点杂交法检测确认地中海贫血。结果对照组孕妇ALP和AFU水平高于地中海贫血孕妇(P<0.05);地中海贫血孕妇TSH高于对照组孕妇(P<0.05);地中海贫血孕妇FT3和FT4低于对照组孕妇(P<0.05)。结论地中海贫血孕妇早期ALP、AFU和甲状腺激素水平受到影响。     

湖北省部分农村孕产妇并发症/合并症现况及影响因素分析

目的:探讨湖北省部分农村孕产妇并发症/合并症的现况及影响因素。方法:采用随机抽样的方法对湖北省黄冈、十堰、汉川三市农村的1 524例孕产妇进行问卷调查,对多个变量进行单因素分析。结果:1 524例孕产妇所构成的样本中,孕期并发症/合并症的发病率为14.63%。高危因素排前3位的依次为贫血、妊娠期高血压疾病和肝病。分娩地点、分娩年龄、孕产妇性格和是否进行过产检等4个变量与孕产妇妊娠期并发症的发生有着密切的联系,可能增加妊娠期并发症的发生率。其余各项因素比较差异无统计学意义。结论:加强三级保健网,加强孕期保健宣传教育工作,提高产前检查次数及质量,加强高危筛查,促进住院分娩是促进农村孕产妇保健、保障母婴安全、降低农村孕产妇并发症/合并症的关键措施。     

孕妇实验室检查结果的分析及参考值的建立

目的:调查并分析孕妇实验室检查结果,建立其参考值.方法:分别统计孕妇实验室检查项目的结果,分析趋势及原因.孕妇的Hb、WBC、PLT、ALT、AST、BUN和Cr参考值以此次就诊的543例作为抽样个体.结果:孕妇的实验室指标与正常人存在一定差异;某些实验室指标近几年也存在一定变动.结论:应建立孕妇实验室正常参考值,特别是Hb、WBC、PLT、ALT、AST、BUN、Cr等,以便医生准确诊断.实验室指标的变动对临床有一定的参考价值.     

Vaccination timeliness and co-administration among Kenyan children

BackgroundTimely administration of recommended vaccines requires children to have multiple vaccines co-administered in the first year of life. The objectives of this study were to estimate the proportion of timely vaccinations and the proportion of co-administered vaccines, and to assess the relationship between vaccine co-administration and vaccine timeliness in Kenyan children.MethodsUsing the 2014 Kenyan Demographic and Health Survey (DHS), we calculated the proportion of children who received co-administered and timely vaccine doses. Co-administration was defined as doses administered on the same day with dates recorded on vaccination cards. Vaccines were considered timely if given within four days before to four weeks after the recommended interval for administration.Results10,385 children aged 1–4 years in the Kenyan 2014 DHS dataset had vaccination cards which comprised the study sample. Analysis revealed wide a range for receipt of timely doses, from 90.2% for OPV0 to 56.0% for Measles. Co-administration of the 6-week dose was associated with 2.81 times higher odds of a timely Penta dose 1 (95% CI: 2.28, 3.46) and birth-dose co-administration was associated with a substantial increase in timely BCG vaccination: AOR 7.43 (95% CI: 6.31, 8.75).ConclusionsThough vaccine coverage in Kenya was high, timely vaccination was markedly low, with resultant implications for population immunity and potential spread of communicable diseases in unvaccinated infants. Co-administration of vaccines, place of residence, wealth index, and child age were consistently related to the odds of timely vaccine receipt. These relationships reinforce the importance of dedicating resources to programs that educate low socio-economic groups about the importance of vaccine co-administration.     

Attitudes towards Zika screening and vaccination acceptability among pregnant women in Malaysia

The aim of this study was to examine the willingness of pregnant women to have prenatal screening for the Zika virus (ZIKV). Secondly, the study also assessed the acceptability of a hypothetical Zika vaccination and its association with the health belief model (HBM) constructs. A cross-sectional study was conducted from 4th October to 11th November 2016, among pregnant women who attended antenatal care at the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. The majority (81.8%) was willing to be tested for ZIKV and 78% felt that their spouse would be willing to be tested for ZIKV. A total of 94% expressed a willingness to receive a Zika vaccination if available. The participants expressed high perceived benefits of a ZIKV vaccination. Although many have a high perception of the severity of ZIKV, the proportion with a strong perception of their susceptibility to ZIKV was low. In the multivariate analysis of all the HBM constructs, cue-to-action, namely physician recommendation (odds ratio [OR] = 2.288; 95% confidence interval [CI] 1.093–4.793) and recommendation from friends or relatives (OR = 4.030; 95% CI 1.694–9.587), were significantly associated with a willingness to be vaccinated against ZIKV. The favourable response to a Zika vaccination implies that more research attention has to be given to develop a vaccine against ZIKV. Should the vaccine be available in the future, publicity and healthcare providers would play a vital role in ensuring vaccine uptake among pregnant women.     

孕妇心理状况及其与个性和应对方式的相关性

目的:探讨孕妇心理状况及其与个性和应对方式的相关性,为进一步的医学干预提供依据。方法:采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、艾森克个性问卷(EPQ)及简易应对方式问卷(SCSQ)对113例孕中期孕妇的心理状况、个性与应对方式进行调查分析。结果:孕妇SAS及SDS总粗分显著高于全国常模(t=7.057,P=0.000;t=2.381,P=0.019),孕妇焦虑和抑郁的发生率分别为20.4%和27.8%。SAS和SDS总分均与EPQ的精神质(P)和神经质(N)维度呈显著正相关(χ2=0.307,P=0.001;χ2=0.496,P=0.000;χ2=0.416,P=0.000;χ2=0.321,P=0.001),与积极应付方式呈显著负相关(χ2=-0.208,P=0.030;χ2=-0.264,P=0.007)。结论:孕中期孕妇焦虑和抑郁的发生率较高。精神质、神经质的个性特点及应对方式的缺陷与孕妇产生焦虑抑郁情绪密切相关。临床上应在综合分析心理状态及其产生的中介机制的基础上,对伴有焦虑抑郁的孕妇进行有效的心理干预。     

孕妇不规则抗体检测结果分析的临床意义研究

目的研究孕妇RhD血型系统不规则抗体检测结果分析的临床意义。方法选取2016年10月-2018年10月于该中心检测的1348例孕妇及同期非孕女性体检者1273例,采取微柱凝胶血型定型卡和抗人球蛋白卡进行不规则抗体检测,比较不规则抗体筛查阳性率。对其中抗体阳性者采用试管抗人球方法检测抗体效价、Ig类型及37℃反应,比较不同孕周及孕次的孕妇不规则抗体筛查阳性率。结果孕妇不规则抗体筛查阳性17例,阳性率1.26%,同期非孕女性体检者不规则抗体筛查阳性4例,阳性率0.31%,两组差异具有统计学意义(P<0.05);不规则抗体筛查阳性孕妇中,抗体特异性抗E6例,阳性率35.29%,抗体效价1∶8~1∶512,Ig类型:IgG15例、IgM1例及IgM-IgG1例,37℃反应性:1+~4+;不规则抗体筛查阳性孕妇中,≤28孕周孕妇阳性率0.53%,29~37孕周孕妇阳性率3.31%,38~40孕周孕妇阳性率0.00%,差异具有统计学意义(P<0.05);不规则抗体筛查阳性孕妇中,初产妇阳性率0.72%,经产妇阳性率2.13%,差异具有统计学意义(P<0.05)。结论孕妇不规则抗体阳性率高于非孕女性,产前进行不规则抗体检测能有效预防新生儿溶血。     

唐山地区孕妇营养知识、态度及行为调查

目的:调查唐山地区孕妇的营养知识、态度及行为,为孕妇及胎儿营养保健工作提供科学依据。方法:采用问卷调查法对唐山地区300名孕妇进行调查。结果:该地区孕妇的营养KAP水平一般,孕期营养知识的平均知晓率仅为52.2%,营养态度较好,孕妇对奶类、蛋类、豆类、水产品、动物内脏和坚果类摄入频率仍显不足,营养素的补充缺乏科学指导;孕妇文化程度和职业是影响营养KAP的主要因素,与KAP之间呈正相关性;孕妇获得营养知识的主要途径是医护人员(69.7%)、科普书籍(59.2%)和亲戚长辈(57.1%),希望获取的途径是通过医护人员、营养师和专业书籍。结论:加强孕妇孕期营养知识的教育宣传,充分发挥医务人员和营养师在营养宣教中的作用,指导孕妇合理膳食,促进母婴健康。