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...     

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。本部分共识包括总则以及乙型肝炎疫苗、卡介苗、含脊髓灰质炎成分疫苗、含百日咳/白喉/破伤风成分疫苗、含麻疹/风疹/流行性腮腺炎成分疫苗、乙型脑炎疫苗、脑膜炎球菌疫苗、甲型肝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(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。     

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     

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。     

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。     

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。     

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。     

1例接种百白破联合疫苗和口服脊灰减毒活疫苗后死亡事件的调查

目的 调查1例接种疫苗后死亡案例,为类似事件的调查处置提供参考.方法 收集疫苗受种方、接种方、生产企业方等相关材料,对患儿接种疫苗后死亡事件进行调查.结果 专家组结合现场调查、查阅资料和现场询问,确定患儿接种疫苗后出现的过敏性休克死亡属于预防接种异常反应.结论 应切实做好接种前问询诊和知情告知工作,严格落实受种者疫苗接...     

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.     

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.     

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.     

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.     

Antibody responses to intradermal recombinant hepatitis B immunization among HIV-positive subjects

We conducted a randomized, controlled clinical trial to determine the immunogenicity of intradermal immunization with recombinant hepatitis B vaccine among HIV-positive subjects. Induction of antibody concentration over 10 IU/L or four-fold increase in the antibody concentration against hepatitis B surface antigen was regarded a successful immunization. Intradermal immunization induced protective immunity in 39% of participants who received three doses of recombinant hepatitis B vaccine. Intradermal immunization may provide a way to improve the outcome of hepatitis B vaccination among HIV-infected persons. Three doses of intradermal immunization alone induces protective immunity against hepatitis B as often as intramuscular immunization.     

Immunization status and risk factors of migrant children in densely populated areas of Beijing,China

Objective

To properly evaluate the immunization status and determine risk factors of migrant children in 23 densely populated towns and townships in Beijing.

Methods

A household cluster sampling survey was implemented and standard face-to-face interviews were conducted with 1820 migrant children aged 12–35 months. Demographic characteristics of the child and primary caregiver, the child's migrant characteristics, the primary caregiver's knowledge and attitude toward immunization, information about immunization services provided by the local clinic, and the child's immunization history were obtained. Weighted up-to-date (UTD) and age-appropriate immunization rates for the following four vaccines were assessed: three doses of diphtheria, tetanus and pertussis combined vaccine (DTP); three doses of oral poliomyelitis vaccine (OPV); three doses of hepatitis B vaccine (HepB); and one dose of Measles-containing vaccine (MCV). Weighted UTD and age-appropriate immunization rates for the overall series of these four vaccines (the 3:3:3:1 immunization series) were also estimated. Risk factors for not being UTD, being invalid and being delayed for the 3:3:3:1 immunization series were explored using both single-level and multi-level multinomial logistic regression models.

Results

For each antigen, the weighted UTD immunization rate was above 83%, but the age-appropriate immunization coverages for HepB, OPV, DPT, and MCV were only 45.6%, 49.6%, 50.8% and 54.7%, respectively. The 1st dose was most likely to be invalid or delayed within HepB, OPV and DPT series. For the 3:3:3:1 immunization series, the weighted UTD and age-appropriate immunization rates were 78.1% and 20.5%, respectively. Immunization status of migrant children tended to be homogenous within a village and therefore, multi-level model was more appropriate for assessing risk factors. Besides demographic characteristics, several other factors were significantly associated with age-appropriate immunization coverage. These factors included: the child's migrant characteristics; the primary caregiver's awareness of the importance of vaccination, and outreach services provided by immunization clinics including notification services and supplementary immunization activities (SIAs). The frequency and duration of clinical immunization sessions significantly influenced the UTD immunization rate but not the age-appropriate immunization rate. The degree of the primary caregiver's satisfaction with clinic services and convenience to vaccination clinic had no impact on the child's immunization status.

Conclusion

Alarmingly low age-appropriate immunization coverage of migrant children in densely populated areas demanded immediate intervention. Community context was an important factor to a migrant child's vaccination status and should be considered when taking measures. Strategies to strengthen outreach immunization service need to be developed to effectively improve the age-appropriate immunization coverage of migrant children.     

Antibody responses to intradermal recombinant hepatitis B immunization among HIV-positive subjects

We conducted a randomized, controlled clinical trial to determine the immunogenicity of intradermal immunization with recombinant hepatitis B vaccine among HIV-positive subjects. Induction of antibody concentration over 10 IU/L or four-fold increase in the antibody concentration against hepatitis B surface antigen was regarded a successful immunization. Intradermal immunization induced protective immunity in 39% of participants who received three doses of recombinant hepatitis B vaccine. Intradermal immunization may provide a way to improve the outcome of hepatitis B vaccination among HIV-infected persons. Three doses of intradermal immunization alone induces protective immunity against hepatitis B as often as intramuscular immunization.