齐河县基础免疫接种率的监测与评价

现对全县１９９５～１９９９年卡介苗 (ＢＣＧ )、脊髓灰质炎疫苗(ＯＰＶ )、百白破三联 (ＤＴＰ)制剂、麻疹疫苗 (ＭＶ)四种疫苗 (以下简称“四苗”)的基础免疫接种率监测结果分析、评价如下。１资料与方法１ １报告接种率 :来源于全县２２个接种门诊１９９５～１９９９年年终基础免疫接种率报表的汇总统计。１ ２调查接种率 :来源于全县１９９５～１９９９年计划免疫年终考核情况统计。１ ３接种率评估 :采用差值 (Ｄ)评价法 ［１］,比较各年度报告接种率与估算接种率之间的差距 ,以评价报告接种率的可信程度。估计接种率＝报告接种人次数…     

焦作市2005年常规免疫接种率报告分析

目的 客观评价焦作市2005年常规免疫接种率报告情况.  方法 按卫生部<全国常规免疫接种率监测方案>规定方法进行差值(D)和比值(R)评价.  结果   2005年基础免疫报告接种率均在95%以上,报告接种率和估计接种率间存在一定偏差,但D值评价仅乙型肝炎疫苗接种率为可疑,R值评价,全市有3个区级单位出现不可信结果.  结论 应进一步完善和提高常规接种率报告系统和报告质量,提高报表报告专业人员的工作责任心和业务素质;加强城区预防接种门诊规范化接种和管理工作.     

汕头市潮阳区2000～2004年常规免疫接种率报告与监测评价

目的了解汕头市潮阳区常规免疫接种率报告情况及存在问题,指导常规免疫监测工作.方法通过计算报告接种率和估算接种率,并进行差值(D)和比值(R)评价.结果卡介苗、脊髓灰质炎疫苗、百白破混合制剂、麻疹疫苗、乙肝疫苗报告接种率分别为:97.56%、97.38%、96.77%、97.35%、90.1 7%,估算接种率分别为:91.03%、89.35%、96.77%、89.02%、41.02%;D值评价卡介苗、脊髓灰质炎疫苗可信度相对较高,百白破混合制剂、麻疹疫苗可信度差,乙肝疫苗不可信,R值评价均为可信.结论切实摸清本地儿童数,认真做好常规免疫接种率报告工作,提高报告表的准确性是今后工作重点.     

某县2012年常规免疫接种率的监测分析

目的分析正阳县常规免疫监测的最终结果,对监测系统进行研究与评价,从而为防控措施的选定提供科学的依据。方法合理分析2012年常规免疫接种率监测结果采用差值(D)和比值(R)评价方法。结果 2012年常规免疫接种卡介苗、乙肝疫苗、口服脊髓灰质炎疫苗、麻疹疫苗以及百白破混合制剂的报告率均在100%。估算接种率88.30%⁸8.70%。通过D值、R值综合评价,22个乡镇及县直,判定为可疑。结论进一步做好常规免疫接种率报告的同时,需加强常规免疫薄弱地区的免疫规划工作。     

济源市2009年扩大国家免疫规划疫苗报告接种率及其影响因素分析

目的  客观评价济源市2009年扩大国家免疫规划疫苗的报告接种率,并分析其影响因素。方法  按卫生部《预防接种工作规范》规定,运用比较法、差值（D）和比值（R）法进行评价。结果  济源市2009年扩大国家免疫规划疫苗基础免疫报告接种率和调查接种率均>95%。乙型脑炎疫苗、A群脑膜炎球菌多糖疫苗的调查接种率均高于调查合格接种率。D值评价,除乙型肝炎疫苗为可疑外,其余疫苗均为不可信,但所有疫苗的估算接种率均高于报告接种率。R值评价,全市有3个单位出现不可信结果。结论  在进行D值和R值评价时,应充分考虑到超生儿童及流动儿童对结果的影响。此外,应进一步完善和提高常规免疫接种率报告系统和报告质量,提高专业报告人员的工作责任心和业务素质;并经常开展接种率报告评价,及时发现和查明数据偏差的原因。     

某区儿童计划免疫接种率及其影响因素研究

目的了解武汉市江夏区儿童免疫接种率,分析影响儿童免疫接种的因素,以期为控制相关传染病提供依据。方法选取我区居住3个月及以上的常住居民,不论户籍所在地,将自2009年1月至2011年12月共新出生儿童578名均作为常规免疫调查研究对象。调查所有研究对象的单苗接种率,五种常规疫苗的全程合格接种率、乙肝疫苗的首针及时接种率,以及扩大免疫规划的3种免疫疫苗接种率。结果 578名研究对象中常住儿童423名,流动儿童155名;经过调查发现所有儿童的建卡率、建证率均为100%,其中卡证相符者531人(91.87%)。本次共入户调查80名儿童的卡痕,其中无卡痕者4名,阳性率为95.00%。经过调查可见,BCG接种人数551人,接种率为95.33%、OPV接种人数536人,接种率为92.73%、DPT接种人数534人,接种率为92.39%、MV接种人数542人,接种率为93.77%、HBV接种人数551人,接种率为95.33%,五种疫苗全接种人数527人,接种率为91.18%。结论重视接种疫苗的宣讲工作,尤其是针对家长进行疫苗相关知识的宣教,应是提高接种率的有效途径。     

海淀田村地区第二类疫苗接种情况分析

目的分析海淀田村地区5种第二类疫苗接种情况。方法选取田村地区3618例3～4周岁儿童为研究对象,分析其第二类疫苗接种情况。结果本市儿童5种第二类疫苗接种率在22%～78%之间,平均接种率为60.6%,各种疫苗接种率间差异具有统计学意义;流动儿童5种第二类疫苗接种率在17%～53%之间,平均接种率为40.4%,各种疫苗接种率间差异具有统计学意义;本市儿童5种第二类疫苗接种率高于流动儿童5种第二类疫苗接种率。结论加大国家免疫规划投入,将更多的第二类疫苗种类纳入第一类疫苗管理,对流动儿童家长加强宣传,能提高第二类疫苗的接种率,降低相应传染病的发病率。     

1999～2003年常规免疫接种率及监测情况分析

目的 了解商丘市常规免疫接种率监测现状,促进接种工作的改善。方法 利用1999年以来的常规接种率监测资料,采用差值(D)评价和比值(R)评价方法进行比较分析。结果 全市9个县(市、区)级报告的及时率和完整率1999年分别为89．75％和99．98％,至2003年均100％。1999～2003年卡介苗、口服脊髓灰质炎疫苗、百白破混合制剂、麻疹疫苗的常规免疫报告接种率为98．87％～99．63％,4种疫苗5年平均估算接种率为86．67％-95．60％,与报告接种率之间还有差距。D值显示4个县的资料为可信;3个县可疑;2个县为不可信。结论 计划免疫工作各县间发展不平衡,主要与流动儿童的计划免疫管理不完善和部分县(市、区)工作薄弱有关。应加强技术培训,做好流动人口免疫接种管理,提高报告接种率的可信性。     

2008～2010年我院辖区儿童三种疫苗接种影响因素分析

目的:了解佳木斯大学附属第一医院所辖社区儿童计划免疫接种情况及可能存在的影响因素。方法:2008—03—31-2010—04—01,采用抽样方法抽取佳木斯大学附属第一医院辖区(含13个社区)2001—01—01-2010—11—20之间出生的辖区内户籍登记儿童200名进行三种疫苗(卡介苗、脊髓灰质炎疫苗和麻疹疫苗)接种情况的调查,并采用非条件Logistic回归分析其可能存在的影响因素。结果:佳木斯大学附属第一医院辖区内接受调查的12月龄以上儿童200名,卡介苗、脊髓灰质炎疫苗和麻疹疫苗合格接种率分别为98.5%、96.5%、99.2%,同时期及时接种率为54.2%、53.8%和61.2%。多因素非条件Logistic回归分析结果显示儿童及时接种率较低的主要原因有:儿童长期居住地与户籍登记不一致、家长对疫苗知识了解少、家长重视程度不足等原因。结论:佳木斯大学附属第一医院辖区儿童计划免疫基础疫苗接种情况较好,但疫苗接种及时率仍受到儿童在本地居住时间长短等原因影响,对此类情况应当加强管理。     

2006—2012年山西省脊髓灰质炎减毒活疫苗免疫效果分析

目的评价山西省脊髓灰质炎减毒活疫苗(OPV)免疫接种率及效果。方法通过OPV常规免疫报告接种率、估算接种率、调查接种率、补充免疫接种率、历年人群OPV抗体水平检测结果,对全省的OPV免疫接种情况和效果进行评价。结果山西省2006—2012年<12月龄OPV第3剂次(OPV3)报告接种率为99.72%,48月龄OPV报告接种率为99.58%;以当年乙型肝炎疫苗首针和含麻类疫苗实种人数估算OPV接种率分别为97.24%和101.22%;调查接种率为98.21%;补充免疫接种率一轮和二轮分别为98.39%和98.49%;健康人群脊灰抗体阳性率Ⅰ、Ⅱ、Ⅲ型分别为96.69%、96.10%、96.69%。结论山西省OPV接种率和健康人群中脊灰抗体阳性率较高。     

A new combination vaccine for measles, mumps, rubella and varicella

ProQuad is a recently approved combination vaccine for simultaneous vaccination against measles, mumps, rubella and varicella in children aged 12 months to 12 years. It combines two well-established vaccines: Measles, Mumps, Rubella Virus Vaccine Live (M-M-R II) and Varicella Virus Vaccine Live (Varivax with higher varicella-zoster titer). Whereas vaccination against measles, mumps and rubella has almost 100% coverage, vaccination against varicella shows a significantly lower uptake of approximately 84%. Clinical studies on the immunogenicity and efficacy of ProQuad demonstrated seroconversion rates and a magnitude of antibody response similar to those observed after administration of its individual components, M-M-R II and Varivax vaccines. The incidence of local side effects (pain/tenderness/soreness, erythema, swelling, ecchymosis and rash) and systemic adverse effects (fever, irritability, rash, upper respiratory infection, viral exanthema and diarrhea) is similar to or lower than that observed in component vaccines. ProQuad is a highly immunogenic combination vaccine with a good safety profile. The use of ProQuad combination vaccine will simplify immunization delivery by providing protection against more diseases with fewer injections and less pain, improve timely vaccination coverage and reduce the health-care costs for additional health visits. The ProQuad combination vaccine facilitates implementation of varicella vaccination into routine childhood immunization schedules and will help to protect children against these four potentially serious diseases.     

Private-sector vaccine purchase costs and insurer payments: a disincentive for using combination vaccines?

Combination vaccines have been endorsed as a means to decrease the number of injections needed to complete the childhood immunization schedule, yet anecdotal reports suggest that private providers lose money on combination vaccines. The objective of this study was to determine whether practices purchasing combination vaccines had significantly different vaccine costs and reimbursement compared to practices that were not purchasing combination vaccines. Using cross-sectional purchase and insurer payment data collected from a targeted sample of private practices in five US states, we calculated the average total vaccine cost and reimbursement across the childhood immunization schedule. The average vaccine purchase cost across the childhood schedule was significantly higher for practices using a combined vaccine with diphtheria, tetanus, acellular pertussis vaccine, inactivated polio vaccine, and Hepatitis B vaccine (DTaP-IPV-HepB) than for practices using either separate vaccine products or a combined vaccine with Haemophilus influenzae, type b vaccine and Hepatitis B vaccine (Hib-HepB). The average insurer payment for vaccine administration across the childhood schedule was significantly lower for practices using DTaP-IPV-HepB combination vaccine than for practices using separate vaccine products. This study appears to validate anecdotal reports that vaccine purchase costs and insurer payment for combination vaccines can have a negative financial impact for practices that purchase childhood vaccines.     

Immunization in patients with HIV infection: are practical recommendations possible?

The purpose of this article is to review immunization recommendations for HIV-infected individuals in resource-constrained countries, particularly in sub-Saharan Africa. Recent evidence suggests that HIV-infected children are at risk for low immunization coverage in sub-Saharan Africa. Routine immunization is recommended for these children. In comparison with immunocompetent children, recommendations for live-attenuated vaccines differ in HIV-infected children. However, limited laboratory capacity to diagnose HIV infection amongst young children prevents the implementation of these HIV-specific guidelines in resource-constrained countries. Re-immunization has been the focus of recent research in high- and middle-income countries. Findings show that children established on highly active antiretroviral therapy have suboptimal vaccine-specific immunity and may benefit from re-immunization. Before re-immunization guidelines can be formulated for resource-constrained countries, several questions should be addressed, including whether all HIV-infected children will benefit from routine re-immunization and what optimal number of vaccine doses should be administered. Pneumococcal and influenza infections are important causes of morbidity and mortality amongst HIV-infected individuals. There is compelling evidence showing that pneumococcal conjugate vaccines will protect HIV-infected and uninfected children against invasive infection. Pneumococcal conjugate vaccines should be prioritized for introduction in countries with high HIV prevalence. Although, annual influenza immunization is recommended for HIV-infected individuals, the effectiveness in Africa remains unclear.In conclusion, this brief overview has identified several limitations of current immunization policy and practice for HIV-infected individuals living in resource-constrained countries.     

Cost effectiveness of pneumococcal conjugate vaccination against acute otitis media in children: a review

While pneumococcal conjugate vaccines have shown to be highly effective against invasive pneumococcal disease, their potential effectiveness against acute otitis media (AOM) might become a major economic driver for implementing these vaccines in national immunization programmes. However, the relationship between the costs and benefits of available vaccines remains a controversial topic. Our objective is to systematically review the literature on the cost effectiveness of pneumococcal conjugate vaccination against AOM in children. We searched PubMed, Cochrane and the Centre for Reviews and Dissemination databases (Database of Abstracts of Reviews of Effects [DARE], NHS Economic Evaluation Database [NHS EED] and Health Technology Assessment database [HTA]) from inception until 18 February 2010. We used the following keywords with their synonyms: 'otitis media', 'children', 'cost-effectiveness', 'costs' and 'vaccine'. Costs per AOM episode averted were calculated based on the information in this literature. A total of 21 studies evaluating the cost effectiveness of pneumococcal conjugate vaccines were included. The quality of the included studies was moderate to good. The cost per AOM episode averted varied from &U20AC;168 to &U20AC;4214, and assumed incidence rates varied from 20,952 to 118,000 per 100,000 children aged 0-10 years. Assumptions regarding direct and indirect costs varied between studies. The assumed vaccine efficacy of the 7-valent pneumococcal CRM197-conjugate vaccine was mainly adopted from two trials, which reported 6-8% efficacy. However, some studies assumed additional effects such as herd immunity or only took into account AOM episodes caused by serotypes included in the vaccine, which resulted in efficacy rates varying from 12% to 57%. Costs per AOM episode averted were inversely related to the assumed incidence rates of AOM and to the estimated costs per AOM episode. The median costs per AOM episode averted tended to be lower in industry-sponsored studies. Key assumptions regarding the incidence and costs of AOM episodes have major implications for the estimated cost effectiveness of pneumococcal conjugate vaccination against AOM. Uniform methods for estimating direct and indirect costs of AOM should be agreed upon to reliably compare the cost effectiveness of available and future pneumococcal vaccines against AOM.     

A combination vaccine against measles, mumps, rubella and varicella

A new combination vaccine against measles, mumps, rubella and varicella (MMRV) from GlaxoSmithKline Biologicals has recently been approved in Europe. It combines the components from two well-established, live, attenuated vaccines against measles, mumps and rubella. This review presents a summary of the development of this MMRV vaccine from published clinical studies. Seroconversion rates and antibody titers after the first and second dose are similar to those observed after concomitant administration of the MMR and varicella vaccines. Furthermore, the clinical profile of this combination vaccine, in terms of injection- site and general tolerability, is similar to that of the component vaccines. A higher incidence of low-grade fever has been noted following the first dose of MMRV vaccine, although it is no different from component vaccines following the second dose. MMRV vaccines were recommended in Germany in 2006 for administration in two doses to children aged 11-14 months and 15-23 months. They offer a convenient way to implement varicella vaccination and to achieve high vaccine coverage rates mirroring those of MMR vaccines. For other countries considering introducing these vaccines, the advantages for children, parents and healthcare providers of protecting against four diseases in a single vaccine should be noted.     

The 1996 pertussis epidemic in New Zealand: descriptive epidemiology

AIM: To describe the 1996 pertussis epidemic. METHODS: Hospitalisation, notification and laboratory data were used to describe the 1996 pertussis epidemic and compare it with previous epidemics. RESULTS: The 1996 epidemic spanned 24 months. The crude hospitalisation rate from 1 June 1995 to 31 May 1997, was 10.1 per 100,000 person years, being highest for children aged six weeks to two months (42 to 90 days old inclusive; 1402 per 100,000). The 1996 epidemic involved more hospitalisations than the 1991 and 1986 epidemics, and a greater proportion for children under the age of one year (77%), compared to previous epidemics (60-70%). There were no deaths. Pertussis only became notifiable from 1 June 1996. The crude notification rate for the following twelve months was 19.8 per 100,000 (equivalent hospitalisation rate 6.7 per 100,000); children aged six weeks to two months of age had the highest notification rate (531 per 100,000; equivalent hospitalisation rate 1021 per 100,000). In 1996-97, children aged under 15 months accounted for 21% of notifications, but 82% of hospitalisations. Europeans tended to have higher rates of notifications than non-Europeans, but lower rates of hospitalisation. CONCLUSIONS: New Zealand continues to experience high rates of pertussis as a result of inadequate immunisation coverage. The increase in hospitalisations during the 1996 epidemic may reflect a real increase in the population-based incidence, or other changes (e.g. hospitalisation practice, increase in vulnerable children with poor access to primary care). Improved rates, accuracy and completeness of pertussis notifications will improve the ability of notification data to accurately describe future epidemics and estimate vaccine effectiveness. Further debate is required regarding the aims of pertussis immunisation; accelerating the timing of the first three doses and adding further doses of pertussis vaccine on the national immunisation schedule; and the role of acellular pertussis vaccines. In the meantime, the priority must be increasing on-time immunisation coverage.     

Adolescents and immunization: tips for the primary care provider

Despite high immunization rates in this country, many adolescents do not receive all of the recommended vaccines. Each year, more than 3.5 million adolescents in the U.S. enter adulthood lacking recommended immunizations. This article will review the current recommendations for immunization for adolescents, including those for the meningococcal vaccine. The vaccine schedule is continually changing, and it is important that health care providers be up to date and utilize available resources with current information. Primary care providers should review and update immunization records with their adolescent patients on a routine basis.     

细菌性联合疫苗研究进展

随着生物技术的发展,在过去的几十年里越来越多细菌性联合疫苗被批准上市,不仅提高了疫苗覆盖率和接种率,而且减少疫苗管理上的各种成本,同时也减少了由于多次免疫接种给接种者所带来的痛苦。就当前细菌性联合疫苗发展现状以及面临的挑战进行综述,希望对国内细菌性联合疫苗的研发及免疫策略的优化提供一定参考。