2008年小学新生入学查验预防接种证现况调查

目的了解合肥高新技术开发区2008年小学入学新生免疫规划疫苗接种现状,为进一步提高规划疫苗接种率,加强学校传染病的预防控制提供科学依据。方法采用整群随机抽样的方法,选取合肥高新区6所小学,使用调查表,对2008年入学新生进行预防接种证现场检查。对持证率、五苗全程接种率、五苗补种情况及疫苗完成情况进行统计分析。结果新生预防接种证持证率为96.89%,补证率100%;五苗全程完成率72.34%;6岁学生乙脑全程完成率74.54%,流脑A群完成率83.52%,流脑A＋C群完成率78.94%。结论合肥高新区内个别学校新生查验预防接种证工作不容乐观,应当加强流动儿童预防接种证查验和补种工作。     

山东省小学新生预防接种状况调查

目的了解山东省2002年儿童入学查验预防接种证制度执行情况和新入小学儿童的常规免疫接种状况.方法采用横断面调查方法,对济南(城区常住儿童A小学、流动儿童B小学)、泰安(计免工作开展较好和一般的农村C、D小学)和菏泽市(计免工作开展较差农村E小学)的5所小学共889名2002年入学新生常规免疫接种记录进行调查.结果只有济南市城区的2所小学新生入学时进行体检和查验接种证,但查验接种证仅限于形式,要求不严格;5所小学家庭预防接种证持有率常住儿童和流动儿童分别为60.87%、38.32%,学校以A小学最高,E小学最低,分别为86.70%和13.93%;C和D小学无接种证者,均能在乡镇卫生院查到其接种卡.新生的平均卡疤率为84.93%.常住儿童BCG、OPV、DPT、MV基础免疫全程接种率均在90%左右,但加强免疫接种率较低,Hep B基础免疫全程接种率E小学最低,仅为2.68%;流动儿童各种疫苗接种率均低于常住儿童,在40%左右.结论建立并严格执行儿童入托入学查验接种证制度,加强各种疫苗的基础免疫和加强免疫及时上证、上卡工作,提高农村计免薄弱地区各种疫苗的免疫接种率,制定流动儿童计划免疫管理的措施.     

14所基层医疗机构医院感染管理探讨

目的了解基层医疗机构医院感染管理现状,为加强医院感染管理工作,逐步提高本区医院感染管理的整体水平提供依据。方法根据《医院感染管理规范》、《医院消毒技术规范》的要求制定统一检查评分标准,对14所基层医疗机构的医院感染管理现状进行调查。结果14所基层医疗机构的医院感染管理工作均存在不同程度的问题:发病率高(15.7%),漏报率高(67.7%),抗感染药物使用率高(71.2%),医院感染病例病原学送检率低(12.9%),无医院感染监测数据及反馈,病区和诊室洗手设备不规范。结论重视医院感染管理工作、完善监控网络、培养高素质的医院感染管理专职人员,是基层医疗机构医院感染管理工作健康发展的关键。     

Vaccination coverage against 2009 seasonal influenza in chronically ill children and adults: Analysis of population registries in primary care in Madrid (Spain)

Using electronic clinical records in primary care (ECRPC) of the entire population living in the Autonomous Community of Madrid, Spain (5,102,568 persons) as a data source, this study aimed to ascertain seasonal anti-influenza vaccination coverage in the chronically ill at-risk children (aged 6 months to14 years) and adults (15–59 years).     

Vaccination against influenza: results of a study on vaccination coverage among health care workers in the Croix-Rousse Hospital (Hospitals of Lyon)

INTRODUCTION: The aim of this study was to evaluate the vaccinal status among Croix-Rousse Hospital workers, attitude towards this vaccination, and the information delivered in order to promote this vaccination. METHODS: Questionnaires were delivered by electronic mailing. RESULTS: Six hundred (and) twenty-nine questionnaires were analyzed (26.7% of hospital workers); 30.7% of responders were vaccinated against influenza, 89.2% of responders were aware of influenza and vaccine. Vaccine coverage was lower in younger workers, non health-care workers, non physician health-care workers, and surgeons who responded. Motivation and reserve varied according to the status, position, and age, with some discrepancies. CONCLUSION: These results suggest implementing a better targeted vaccination campaign, according to the various categories of personnel.     

Assessing Disparities in Adult Vaccination Using Multimodal Approaches in Primary Care Offices: Methodology

Racial disparities in invasive pneumococcal disease and pneumococcal polysaccharide vaccination (PPV) persist despite significant progress. One reason may be that minority patients receive primary care at practices with fewer resources, less efficient office systems, and different priorities. The purposes of this paper are: (1) to describe the recruitment of a diverse array of primary care practices in Pittsburgh, Pennsylvania serving white and minority patient populations, and the multimodal data collection process that included surveys of key office personnel, observations of practice operations and medical record reviews for determining PPV vaccination rates; and (2) to report the results of the sampling strategy. During 2005, 18 practices participated in the study, six with a predominantly minority patient population, nine with a predominantly white patient population, and three with a racial distribution similar to that of this locality. Eight were solo practices and 10 were multiprovider practices; they included federally qualified health centers, privately owned practices and faculty and University of Pittsburgh Medical Center community practices. Providers represented several racial and ethnic groups, as did office staffs. PPV rates determined from 2,314 patients’ medical records averaged 60.3 ± 22.6% and ranged from 11% to 97%. Recruitment of practices with attention to location, patient demographics, and provider types results in a diverse sample of practices and patients. Multimodal data collection from these practices should provide a rich data source for examining the complex interplay of factors affecting immunization disparities among older adults. Zimmerman, Nowalk, Raymund, Tabbarah, and Fox are with the Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Zimmerman and Terry are with the Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Wilson is with the UPMC St. Margaret Family Medicine Residency, Pittsburgh, PA, USA.     

Vaccination status of Burgundy inhabitants: a survey in various institutions

AIM: The authors had for aim to determine the vaccination coverage in Burgundy. This study was based on data collection from institutions either in charge of vaccination or controlling the vaccination coverage of given target populations. METHOD: The concerned institutions were asked to provide a representative sample of the population controlled between September 2000 and June 2001 and a longitudinal study was carried out on the data. The analysis of vaccination coverage was made by institution and included i) the rate of people carrying a document proving their vaccination, ii) the rate of minimal vaccination coverage, and iii) the rate of maximal vaccination coverage. RESULTS: 4,159 people participated in the study. The analysis revealed that, on the first university medical follow-up, young people rarely carried a vaccination certificate. This rate increased in occupational medicine and in healthcare institutions. The minimum rates of vaccination coverage against tetanus strongly decreased for population of over 60 years of age (39.6%), and adults living in precariousness (44.3%). In occupational medicine, 34.2% of women ignored their vaccinal status against rubella, almost 10% said that they had not contracted the disease and were not vaccinated. CONCLUSION: This survey confirmed the urgent need to improve the vaccination coverage against tetanus for people over 60 years of age, and vaccination against rubella for women of reproductive age. It also demonstrated the need to provide adults with an appropriate vaccination file allowing recording and saving their respective vaccination status.     

湖北省2006年儿童入托和入学查验预防接种证效果评价

目的评价湖北省儿童入托和入学查验预防接种证的效果,探讨有效管理方法。方法收集儿童入托和入学查验预防接种证和补证、补种疫苗的报表资料,并进行分类比较和统计分析。结果湖北省2006年有95个县（市、区）开展儿童入托和入学查验预防接种证工作,占全省县（市、区）数的93．14％（95／102）。共查验小学9490所、托幼机构4947所,分别占应查小学、托幼机构的86．03％（9490／11031）和89．44％（4947／5531）。查验儿童1501715人,占应查验人数的81．36％（1501715／1845875）。需补办儿童预防接种证250649人,占查验儿童的16．69％（250649／1501715）,补办儿童预防接种证185816人,占需补证人数的74．13％（185816／250649）。需补种疫苗283667人,占查验儿童的18．89％（283667／1501715）,补种疫苗241140人,占需补种疫苗人数的85．01％（241140／283667）。卡介苗（BCG）、口服脊髓灰质炎（OPV）、麻疹（MV）、乙肝（HepB）、百白破（DPT）和白破疫苗（Td）,分别补种13588人次、90235剂次、151666人次、57064人次、73944人次和99622人次,占应补种疫苗人次数的75．12％、90．82％、91．43％、78．28％、88．32％和87．66％。6种疫苗补种人／剂次百分率差异有非常显著性意义（18．27〈χ^2〈11647,P〈0．001）。儿童平均补种疫苗2．02针／剂次。结论湖北省2006年儿童入托和入学查验预防接种证工作取得明显成效,但查验工作的质量尚有待提高,教育、卫生部门的协调和配合还需进一步加强。     

北京市2005年接种吸附百白破联合疫苗后107例无菌化脓流行病学分析

目的了解北京市2005年接种吸附百白破联合疫苗(DPT)后无菌化脓病例增多的原因,保证安全接种。方法对北京市2005年接种DPT后107例无菌化脓进行描述流行病学分析。结果北京市2005年共报告107例无菌化脓,发生率为19.58/10万人次。83%(15/18)的区(县)报告了无菌化脓,共涉及6个批号DPT,其中80%的病例涉及2个批号,发生率分别为27/10万人份、15/10万人份。结论北京市2005年接种DPT后无菌化脓病例增多主要原因可能为:①DPT更换生产厂家,部分批号DPT的质量可能存在问题;②预防接种不良反应监测系统敏感性提高。疫苗生产厂家应改善工艺、提高质量,建议使用无细胞百白破联合疫苗。     

The development of the Primary Care Clusters Multidimensional Assessment (PCCMA): A mixed-methods study

A strong primary care (PC) system is essential for an efficient and high-quality healthcare service. Many countries have adopted a model of PC that encourages different healthcare providers to work together, at scale, in multidisciplinary/multiagency teams (PC clusters). The aim of the present work was to develop a quantitative instrument for the systematic and comprehensive assessment of PC clusters. This was a non-experimental, mixed-methods study grouping four work packages (WP), and involving PC cluster leads and a wide range of key stakeholders from across Wales. Interviews with 22 PC cluster leads (34 %) investigated the clusters' functioning (WP1). A systematic review identified relevant PC assessment frameworks and instruments (WP2). An expert group reviewed the evidence and drafted the new assessment tool, further evaluated and amended in two stakeholder workshops (WP3).Thirty-eight cluster leads (62 %) completed the newly developed online assessment (WP4). The final instrument consisted of 53 indicators, across 11 systemic dimensions of PC and produced a comprehensive assessment of the functioning of PC clusters in Wales. This rigorous early development of an innovative instrument to evaluate PC at a scaled-up (cluster) level (particularly in the format of a 360-degree assessment) can inform healthcare policy decisions regarding the expansion and ongoing adjustment of the model in response to local needs and challenges.     

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.     

原发性不孕症与继发性不孕症受精率的比较分析

摘要:比较原发性与继发性不孕症患者行常规体外受精-胚胎移植术（IVF-ET）的受精率差异,为今后选择合适的治疗方式提供参考。方法　（1）将行IVF-ET的患者分为原发性不孕症组和继发性不孕症组,比较两者的受精率差异;（2）按照精液的正常与否、不孕年限的长短及在不同疾病中的表现,比较两者的统计学差异。结果　（1）所有分组均提示原发性不孕症组和继发性不孕症组比较两者在MII形成率和受精率上无统计学差异（P＞0.05）;（2）精液检查正常组与异常组比较受精率有统计学差异（P＜0.01）。结论　（1）原发性不孕症本身不是受精障碍的影响因素,弱精子症是影响受精的主要因素;（2）对于原发性不孕症、不孕年限长、弱精的患者仍有自然受精的机会,可行短时受精,建议不要盲目扩大人卵胞浆内单精子显微注射技术（ICSI）的指征。     

Efficacy of a modified live porcine reproductive and respiratory syndrome virus (PRRSV) vaccine in pigs naturally exposed to a heterologous European (Italian cluster) field strain: Clinical protection and cell-mediated immunity

The purpose of this study was to assess clinical protection in pigs vaccinated with a commercially available attenuated porcine reproductive and respiratory syndrome virus (PRRSV) vaccine (Porcilis^® PRRS) and then naturally exposed under field conditions to a heterologous (Italian cluster) strain of virulent PRRSV. A total of 30, 4-week-old pigs seronegative for PRRSV were allocated to 1 of 3 groups (IM, ID, and C groups). At 5 weeks of age, pigs of groups IM (n = 10 pigs) and ID (n = 10 pigs) were vaccinated intramuscularly and intradermally, respectively, with modified live PRRSV-1 vaccine (Porcilis^® PRRS). Pigs of group C (n = 10 pigs) were kept as non-vaccinated controls. At post-vaccination (PV) days 0, 7, 14, 28, and 45, blood samples were collected for detection of vaccine virus (PCR) and antibody response (ELISA), identification of changes in lymphocyte subpopulations by cytometry, and IFN-γ PRRSV-specific secreting cells (SC) by ELISpot. At PV day 45, pigs of A, B, and C groups were moved to a site 3 conventional finishing herd with a history of respiratory disease caused by PRRSV and the most common bacteria to be exposed to a natural challenge. The PRRSV field strain, belonging to the Italian cluster of the PRRSV-1, demonstrated a 84% identity with the vaccine virus (DV strain) at ORF5 sequencing. At 0 (exposure day = 45 days PV), 4, 7, 11, 14, 19, 21, 28, and 34 days post-exposure (PE) blood samples were collected for detection and titration of PRRSV and antibody, as well as for lymphocyte and IFN-γ measurement as described above. Throughout the post-exposure period, all pigs were observed daily for clinical signs. The overall clinical signs were reduced by 68 and 72%, respectively in the intramuscularly and intradermally vaccinated pigs compared to controls. Respiratory signs were reduced by 72 and 80%, respectively in the IM and ID groups. Clinical protection was associated with marked activation of cell-mediated immune response. The highest levels of specific IFN-γ production at 21–34 days PE were concomitant and associated to changes in natural killer (NK) cells, γ/δ T, and cytotoxic T lymphocytes in the blood. In our field study, evidences of EU attenuated vaccine-induced clinical protection against natural exposure to a genetically diverse (84% homology) PRRSV-1 isolate (Italian cluster) was demonstrated by the statistically significant reduction in clinical signs in terms of incidence, duration and severity and by a more efficient cell-mediated immune response in the vaccinated pigs as compared to the unvaccinated controls.     

Sharing knowledge about immunisation (SKAI): An exploration of parents’ communication needs to inform development of a clinical communication support intervention

IntroductionThe SKAI (Sharing Knowledge About Immunisation) project aims to develop effective communication tools to support primary health care providers' consultations with parents who may be hesitant about vaccinating their children.AimThis study explored parents’ communication needs using a qualitative design.MethodsParents of at least one child less than five years old were recruited from two major cities and a regional town known for high prevalence of vaccine objection. Focus groups of parents who held similar vaccination attitudes and intentions were convened to discuss experiences of vaccination consultations and explore their communication needs, including preferences. Draft written communication support tools were used to stimulate discussion and gauge acceptability of the tools.ResultsImportant differences in communication needs between group types emerged. The least hesitant parent groups reported feeling reassured upon reading resources designed to address commonly observed concerns about vaccination. As hesitancy of the group members increased, so did their accounts of the volume and detail of information they required. Trust appeared to be related to apparent or perceived transparency. More hesitant groups displayed increased sensitivity and resistance to persuasive language forms.     

Vaccination coverage of health care personnel working in health care facilities in France: results of a national survey, 2009

We conducted a national cross-sectional survey to investigate vaccination coverage (VC) in health care personnel (HCP) working in clinics and hospitals in France. We used a two-stage stratified random sampling design to select 1127 persons from 35 health care settings. Data were collected by face-to-face interviews and completed using information gathered from the occupational health doctor. A total of 183 physicians, 110 nurses, 58 nurse-assistants and 101 midwives were included. VC for compulsory vaccinations was 91.7% for hepatitis B, 95.5% for the booster dose of diphtheria-tetanus-polio (DTP), 94.9% for BCG. For non-compulsory vaccinations, coverage was 11.4% for the 10 year booster of the DTP pertussis containing vaccine, 49.7% for at least one dose of measles, 29.9% for varicella and 25.6% for influenza. Hepatitis B VC did not differ neither between HCP working in surgery and HCP in other sectors, nor in surgeons and anaesthesiologists compared to physicians working in medicine. Young HCP were better vaccinated for pertussis and measles (p<0.01), and those working in an obstetric or a paediatric ward were better vaccinated for influenza and pertussis (p<0.01). HCP are overall well covered by compulsory vaccinations, whereas VC for non-compulsory vaccinations is very insufficient. The vaccination policy regarding these latter vaccinations should be reinforced in France.