国际旅行卫生保健中心发展趋势

〔目的〕探讨在全球经济一体化导致国际间人员流动频繁及流量增加的情况下,国际旅行卫生保健中心如何加强发展,做好应对突发公共卫生事件工作。〔方法〕根据突发公共卫生事件的因素条件,查阅大量相关文献资料,结合国际旅行卫生保健中心的实际情况进行分析、归纳和总结。〔结果〕按照突发公共卫生事件的发生条件,国际旅行卫生保健中心应主要做好旅行者健康管理,加强预防接种工作,以及预防突发公共卫生事件的应急管理。〔结论〕国际旅行卫生保健中心应该从旅行者健康信息管理、信息平台构建、预防接种、旅行者信息反馈、做好口岸急救应急准备等5个方面来加强发展,为预防和应对突发公共卫生事件提供技术保障,发挥主力军作用。     

黄热疫苗接种人群不良反应分析

〔目的〕回顾调查国际旅行者黄热疫苗预防接种资料,为监测黄热疫苗预防接种不良反应提供参考。〔方法〕对辽宁国际旅行卫生保健中心和沈阳国际旅行卫生保健中心2005—2007年的黄热疫苗预防接种资料进行统计学分析。〔结果〕2005—2007年共有8492人次接种黄热疫苗,预防接种后出现副反应者共有150例,副反应发生率为1.77%。经统计学分析,不同年龄段的不良反应发生率有显著差异,而性别与不良反应的发生没有明显相关性。〔结论〕接种黄热疫苗发生不良反应与年龄有关,与性别无关,因此在接种过程中对可能出现的不良反应要根据不同年龄段对接种人员给予相应的解释和说明,并且应做好相应的预防措施,避免严重不良反应发生。     

国际旅行与预防接种

国际旅行已成为人们日常生活的一部分,在国际旅行中罹患传染病的情况频频发生,而预防接种可以有效地预防国际旅行中某些传染病的发生.目前,我国的大多数旅行者在出境前未去检验检疫机构的国际旅行卫生保健中心进行保健咨询和预防接种.本文从:国际预防接种计划,国际旅行者的预防接种要求,国际预防接种证书,国际预防接种疫苗的种类、剂量与方法及接种对象,国际预防接种疫苗的保护期限与复种,预防接种的禁忌症和预防接种反应和处理及预防等七个方面探讨了如何作好国际旅行中的预防接种.     

日照、烟台、临沂国际旅行卫生保健中心医务人员预防接种知信行现状调查

目的了解国际旅行卫生保健中心医务人员预防接种知识、态度、行为(知信行)现状及影响因素,为国际旅行预防接种工作提供理论依据。方法对日照、烟台、临沂国际旅行卫生保健中心的医务人员开展预防接种知信行问卷调查,获得有效问卷59份,同时开展医务人员服务满意度调查,获得有效问卷400份。结果国际旅行卫生保健中心医务人员预防接种知识、态度、行为得分分别为(11.88±2.55)分、(7.41±1.02)分、(2.95±1.58)分,态度总得分率较高(92.6%),主动咨询(49.2%)等行为较差。影响医务人员预防接种知识的主要因素是学历、岗位;影响医务人员行为的主要因素为是学历。旅行者问卷调查显示,医务人员关注旅行者健康(100.0%)、接种史(98.8%)等行为较好,视情况推荐疫苗(89.1%)、询问旅行计划(79.5%)、介绍国外疾病流行情况(73.3%)等行为仍需改善,旅行者对医务人员咨询答复、接种技术、服务态度等行为的非常满意度分别为74.0%、62.0%、60.5%。结论国际旅行卫生保健中心医务人员预防接种知信行有待进一步提升,应加强医务人员预防接种知识储备。     

境外来华人员预防接种与旅行卫生保健需求研究及其影响因素分析

目的了解境外来华人员的预防接种及旅行卫生保健需求、对口岸国际旅行卫生保健中心医疗服务的需求与利用的现状,分析其利用的主要影响因素,为国际旅行卫生保健中心医疗服务的合理设置,构建与国际旅行者需求相适应的口岸医疗服务体系提供依据。方法抽取2014年1-4月期间上海口岸入境并于上海国际旅行卫生保健中心完成法定入境体检项目的外籍人员2 000名,采用自行设计调查问卷对该群体开展调查。结果共计1 970名外籍人员入组(应答率98.50%)。境外来华人员有或可能有旅行计划的占84.56%,50.34%的旅行者知道中国有合格的旅行门诊,选择中国政府机构下的旅行门诊者仅占23.90%。影响境外来华人员选择医疗机构进行旅行保健服务的因素中,最大的是专业水平,其他依次为就诊环境、服务质量、医疗设备等。境外来华人员最想获取的旅行医学咨询为食物、水的预防措施,旅行者腹泻,疫苗接种推荐等;认为在中国最易暴露的疾病依次为禽流感、流感和乙型肝炎等。旅行者中,63.29%的成人及72.07%的儿童希望在中国进行疫苗接种,仅有8.54%的旅行者希望选择中国政府机构下属的旅行门诊。旅行者最想在中国进行接种的三类疫苗分别是流感、乙型肝炎和甲型肝炎疫苗。结论境外来华人员的预防接种及旅行卫生保健需求处于较高水平,但对国际旅行卫生保健中心医疗服务利用度较低。境外来华人员具有一定人群特征,且对旅行卫生保健服务和预防接种的需求具有一定特点。国际旅行卫生保健中心应根据需求调整业务方案,不断提高医疗服务质量,给境外来华人员带来便捷高效的旅行卫生保健服务。     

论国际旅行卫生保健中心在应对突发公共卫生事件的作用

目的探讨在全球经济一体化导致国际间人员流动频繁及流量增加的情况下,国际旅行卫生保健中心如何加强自身发展,发挥在应对突发公共卫生事件中的作用。方法根据突发公共卫生事件的因素条件,查阅大量相关杂志文献和教学资料,结合国际旅行卫生保健中心现在的实际情况进行分析、归纳和总结。结果按照突发公共卫生事件的发生条件,国际旅行卫生保健中心应主要做好对旅行者健康管理,加强预防接种工作,以及加强预防突发公共卫生事件的应急管理。结论国际旅行卫生保健中心应该从旅行者健康信息管理、信息平台构建、预防接种、旅行者信息反馈、做好口岸急救应急准备等五方面来加强自身发展,为预防突发公共卫生事件提供技术保障,发挥主力军作用。     

国际旅行卫生保健咨询现状与思考

目的开展多样化的国际旅行卫生保健咨询,提高保健中心为出入境人员服务质量,保障出入境人员国际旅行健康安全。方法针对莆田口岸的国际旅行人员的特点,综合分析旅行者可能遇到的危害旅行健康的因素,从保护旅行者身心健康的角度提出旅行卫生保健和旅行咨询的构想,并就如何具体、全面实施具有实际指导性意义提出了建设性意见或建议。结论通过开展国际旅行卫生保健咨询,有效提高了国际旅行卫生保健中心整体服务水平,更好更实际地保护旅行者身心健康,也有利于提升国际旅行卫生保健中心的品牌服务。     

天津国际旅行卫生保健中心

<正>天津国际旅行卫生保健中心是天津出入境检验检疫局直属事业单位,依法负责:出入境的中国公民、外籍人员、港澳台胞和国际交通员工的体检;为中外旅行者提供旅行保健咨询、旅行健康评估和预防接种等工作,保障中外旅行者的健康和安全。天津国际旅行卫生保健中心内设综合办公室、海港门诊部和空港门诊部。空     

国际旅行者健康体检、预防接种网络远程申报及信息服务系统的研究

随着我国对外交流的不断扩大，出入境商务、劳务、留学以及旅游人员的数量与日俱增；国际旅行者对卫生保健服务的质量及要求亦在不断提高。实现国际旅行者信息服务的电子管理，是国际旅行卫生保健工作的重要内容。国内外还没有有关国际旅行者健康体检、预防接种网上申报及预约系统的报道。为切实做好出入境人员的国际旅行卫生保健工作，山东出入境检验检疫局主持研发了国际旅行者健康体检、预防接种网络远程申报及信息服务系统。     

天津国际旅行卫生保健中心

天津国际旅行卫生保健中心（天津保健中心）是天津出入境检验检疫局直属事业单位,依法负责出入境的中国公民、外籍人员、港澳台胞和国际交通员工的体检;为中外旅行者提供旅行保健咨询、旅行健康评估和预防接种等工作,保障中外旅行者的健康和安全。     

Vaccination against hepatitis B virus in workers of a general hospital in Athens

BACKGROUND: Protection against hepatitis B virus infection by vaccination is considered to be an important preventive measure for health care workers. OBJECTIVES: Investigation of vaccination coverage against hepatitis B virus in health care workers of a regional general hospital in Athens and assessment of predictive factors possibly associated with the likelihood of vaccination. METHODS: In a cross-sectional study, a questionnaire survey was carried out on 175 health care workers of a regional general hospital in Athens. The questionnaire included questions concerning socio-demographic factors, HBV vaccination status and reasons for non-vaccination, as well as questions about knowledge of routes of transmission and the complications of HBV infection. Compliance with preventive practices against HBV infection was also assessed. RESULTS: Overall vaccination coverage was 57.1%. Logistic regression analysis revealed that occupation and use of gloves were independently associated with the likelihood of vaccination against HBV Doctors recorded an odds ratio (OR) for vaccination of 4.45 in comparison with nurses/paramedics. Health care workers who wore gloves always/most times demonstrated an odds ratio of 2.79 for vaccination against HBV in comparison with those who never/rarely used them. CONCLUSIONS: Our study illustrates the characteristics of health care workers with lower prevalence of vaccination against HBV in a representative sample of these workers in a regional general hospital in Athens: nurses/paramedics, those with low level of compliance with use of gloves, and those in non surgical departments. Educational interventions as part of a vaccination programme and continuing education on universal precautions could help increase HBV vaccination coverage among health care workers of the hospital under study.     

Mandatory Influenza Vaccination for Health Care Workers as the New Standard of Care: A Matter of Patient Safety and Nonmaleficent Practice

A growing body of literature defends the efficacy of seasonal influenza vaccination for health care workers in reducing the mortality of hospitalized patients. I review the evidence concerning influenza vaccination, concluding that universal vaccination of health care workers against influenza should be considered standard patient care and that nonvaccination represents maleficent care. I further argue that the ethical responsibility to ensure universal vaccination of staff against seasonal influenza lies not only with individual health care providers but with each individual health care institution.Seasonal influenza remains a major cause of morbidity and mortality in the industrialized world. The World Health Organization estimates that each year seasonal influenza infects 5% to 15% of the world’s population, produces 3 to 5 million cases of severe illness, and leads to 250 000 to 500 000 deaths.1 The United States alone averages more than 23 000 influenza-associated deaths annually, with $10.4 billion in direct medical costs and an estimated total annual economic burden of $87.1 billion.2,3 Moreover, hospital-acquired influenza infection has a particularly high mortality rate; in a recent review of 12 hospital influenza outbreaks the median mortality was 16%, ranging as high as 60% in at-risk patient groups such as organ transplant recipients and intensive care unit patients.4,5As of 1981 the Centers for Disease Control and Prevention and its Advisory Council for Immunization Practices have recommended regular influenza vaccination of all health care workers, yet vaccination rates among health care workers in the United States vary and are often poor.6 In 5 studies the mean vaccination rate of US health care workers ranged from 41% to 57%, with lower rates among minorities, nurses, and nurse’s aides.7–11 This is problematic because vaccination limits the spread of infectious diseases to susceptible individuals (i.e., unvaccinated patients), and modeling of a hospital influenza-outbreak ward suggests that a significant fraction of nosocomial influenza is vaccine preventable.12Mandatory vaccination policies are uncommon in US hospitals.13 However, a growing movement among clinicians, ethicists, and legislators supports mandatory seasonal influenza vaccination for health care workers: such mandates have been advocated by the American College of Physicians, the American Academy of Pediatrics, the National Patient Safety Foundation, the Infectious Disease Society of America, the National Foundation for Infectious Diseases, the Society for Healthcare Epidemiology of America, and the Association for Professionals in Infection Control, and 19 states have enacted some form of vaccination mandate for health care workers.14,15 Given the mounting evidence for the efficacy of influenza vaccination in infection control, I argue that the provision of health care by nonvaccinated health care workers is not merely suboptimal health care, but it is also at variance with generally accepted principles of health care ethics. Therefore, institutions are obligated to enforce universal vaccination of their health care workers against seasonal influenza. By the term health care worker I mean professionals employed by a health care institution or providing care pursuant to privileges granted by the health care institution who have regular personal interaction with patients, including physicians, nurses, physical and respiratory therapists, and similar ancillary medical staff. By health care institution I mean organizations offering inpatient medical care, including hospitals, nursing facilities, and rehabilitation centers. I would not yet include organizations offering solely outpatient care because the clinical evidence on which my arguments stand derive solely from the inpatient setting. Of note, this article aims to define ethical obligations and does not address the myriad legal issues surrounding health care worker vaccination.     

Factors and considerations for establishing and improving seasonal influenza vaccination of health workers: Report from a WHO meeting,January 16–17, Berlin,Germany

Health workers represent an important target group for seasonal influenza vaccination because of their increased risk of infection as well as the risk of transmitting infection to vulnerable patients in the health care setting. Moreover, seasonal vaccination of health workers contributes to pandemic preparedness. However, many countries, especially in Africa and Asia, do not have policies for health worker influenza vaccination. In countries where such policies exist, vaccination coverage is often low. The World Health Organization (WHO) is developing a manual to guide the introduction of seasonal influenza vaccination of health workers. An Independent External Advisory Group (IEAG) that is advising WHO on the content of the manual met to discuss issues that are relevant and often unique to health worker vaccination. This meeting report summarizes the main issues that were discussed and the outcomes of the discussion. The issues include policy considerations, including the evidence in support of health worker vaccination; categorization and prioritization of health workers; the choice of vaccination strategy; its integration into broader health worker vaccination and occupational health policies; planning and management of vaccination, particularly the approaches for communication and demand generation; and the challenges with monitoring and evaluation of health worker vaccination, especially in low and middle-income countries.     

Hepatitis B vaccination among primary health care workers

Health care workers' immunization against hepatitis B is an essential measure to avoid occupational transmission of hepatitis B virus at primary health care centers. The aims of this study were to investigate the prevalence of complete-series vaccination against hepatitis B, estimate the prevalence of confirmed immunity, and verify the factors associated with complete-series vaccination among primary health care workers in Florianópolis, Santa Catarina State, Southern Brazil. A total of 1,249 primary health care workers participated in this study. The prevalence of complete hepatitis B vaccination was 64.61%, and 29.82% of workers indicated knowing they were immunized after taking a serological test to confirm immunity. In the adjusted analysis, complete-series vaccination was positively associated with higher level of schooling and contact with potentially infectious materials or sharps, and negatively associated with precarious employment status and current smoking. Educational measures are recommended to achieve vaccination of health workers who have not been vaccinated or have not completed the series and to inform on the need for vaccine response monitoring.     

What's public? What's private? Policy trade-offs and the debate over mandatory annual influenza vaccination for health care workers

Policy decisions about public health services differ from those for personal health services. Both require trade-offs between such policy goals as liberty, security, efficiency, and equity. In public health, however, decisions about who will approve, pay for, and deliver services are often accompanied by decisions on when and how to compel individual behaviour. Policy becomes complex because different stakeholders interpret evidence differently: stakeholders may assign different weights to policy goals and may even define the same goals differently. In the debate over mandatory annual influenza vaccination for health care workers, for example, proponents as well as opponents of mandatory vaccination may convey arguments in security terms. Those in favour of mandatory vaccination emphasize subclinical infections and duty of care (public security) while those opposed emphasize risk of adverse events (personal security). Proponents assert less worker absenteeism (efficiency) while opponents stress coercion and alternate personal infection control measures (liberty and individual rights/responsibilities). Consequently, stakeholders talk past each other. Determining the place of mandatory influenza vaccination for health care workers thus demands reconciling policy trade-offs and clarifying the underlying disputes hidden in the language of the policy debate.     

Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP)

This report updates the previously published summary of recommendations for vaccinating health-care personnel (HCP) in the United States (CDC. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices [ACIP] and the Hospital Infection Control Practices Advisory Committee [HICPAC]. MMWR 1997;46[No. RR-18]). This report was reviewed by and includes input from the Healthcare (formerly Hospital) Infection Control Practices Advisory Committee. These updated recommendations can assist hospital administrators, infection-control practitioners, employee health clinicians, and HCP in optimizing infection prevention and control programs. The recommendations for vaccinating HCP are presented by disease in two categories: 1) those diseases for which vaccination or documentation of immunity is recommended because of risks to HCP in their work settings for acquiring disease or transmitting to patients and 2) those for which vaccination might be indicated in certain circumstances. Background information for each vaccine-preventable disease and specific recommendations for use of each vaccine are presented. Certain infection-control measures that relate to vaccination also are included in this report. In addition, ACIP recommendations for the remaining vaccines that are recommended for certain or all adults are summarized, as are considerations for catch-up and travel vaccinations and for work restrictions. This report summarizes all current ACIP recommendations for vaccination of HCP and does not contain any new recommendations or policies. The recommendations provided in this report apply, but are not limited, to HCP in acute-care hospitals; long-term-care facilities (e.g., nursing homes and skilled nursing facilities); physician's offices; rehabilitation centers; urgent care centers, and outpatient clinics as well as to persons who provide home health care and emergency medical services.     

广东省13家医院医护人员严重急性呼吸综合征医院内感染情况

目的　分析收治严重急性呼吸综合征 (SARS)患者重点医院医护人员发生SARS院内感染的因素 ,评价干预措施。方法　通过对 13家重点医院收治SARS患者的数量及病情、医护人员SARS的发病率、医院性质、病区 (科室 )环境及隔离措施调查 ,分析医护人员发生SARS院内感染的原因。结果　 13家医院共收治SARS患者 84 1例 ,参加诊治工作的 2 36 5名医护人员中 2 85人发病。综合性医院、收治危重患者较多的医院、医护人员个人防护不到位的医院医护人员发病率较高 (93/2 85 ,32 .6 3% ) ;独立病房收治SARS患者的医院、具有感染科或隔离病区 (包括临时开设的隔离病区 )的医院医护人员发病率较低。结论　收治SARS患者的病情、医院性质、病区 (科室 )环境、个人防护状况是医护人员感染SARS的危险因素     

Hepatitis B vaccination status among healthy adults in Germany

OBJECTIVES: The hepatitis B vaccination policy in Germany was intensified by the implementation of hepatitis B vaccination for adolescents in the vaccination calendar in 1995. To investigate the effect of this measure on the hepatitis B vaccination coverage of healthy adults, we analysed the hepatitis B vaccination status of blood donors. Furthermore, the reasons for vaccination and the relationship between vaccination status and age, sex, and current profession were studied. METHOD: Using a standardised questionnaire, randomly incoming whole blood donors were asked for hepatitis B vaccination status, the reason for vaccination, gender, age and current profession. Multiple logistic regression analysis with vaccination status as dependent variable and age, gender and current profession as explanatory variables was performed. RESULTS: Overall, 1519 (22.3%) of the 6812 interviewed whole blood donors were vaccinated against hepatitis B. Younger age was significantly associated with higher acceptance of hepatitis B vaccination with already 44.1% of whole blood donors aged 18-29 years being hepatitis B immunised. Beside health care workers, teaching professions and students showed the highest hepatitis B vaccination rate. Foreign travel was nearly an equivalently important reason for hepatitis B vaccination as occupational risks. CONCLUSION: The high hepatitis B vaccination coverage among young and healthy adults indicates the success of the intensified hepatitis B vaccination policy since 1995. However, concentrating education measures on individuals with lower educational level and intensifying hepatitis B vaccination in the context of foreign travel could further increase the acceptance of hepatitis B vaccination.     

Hepatitis B vaccination status among healthy adults in Germany

ObjectivesThe hepatitis B vaccination policy in Germany was intensified by the implementation of hepatitis B vaccination for adolescents in the vaccination calendar in 1995. To investigate the effect of this measure on the hepatitis B vaccination coverage of healthy adults, we analysed the hepatitis B vaccination status of blood donors. Furthermore, the reasons for vaccination and the relationship between vaccination status and age, sex, and current profession were studied.MethodUsing a standardised questionnaire, randomly incoming whole blood donors were asked for hepatitis B vaccination status, the reason for vaccination, gender, age and current profession. Multiple logistic regression analysis with vaccination status as dependent variable and age, gender and current profession as explanatory variables was performed.ResultsOverall, 1519 (22.3%) of the 6812 interviewed whole blood donors were vaccinated against hepatitis B. Younger age was significantly associated with higher acceptance of hepatitis B vaccination with already 44.1% of whole blood donors aged 18–29 years being hepatitis B immunised. Beside health care workers, teaching professions and students showed the highest hepatitis B vaccination rate. Foreign travel was nearly an equivalently important reason for hepatitis B vaccination as occupational risks.ConclusionThe high hepatitis B vaccination coverage among young and healthy adults indicates the success of the intensified hepatitis B vaccination policy since 1995. However, concentrating education measures on individuals with lower educational level and intensifying hepatitis B vaccination in the context of foreign travel could further increase the acceptance of hepatitis B vaccination.