外来人口聚集地流动儿童免疫接种情况及影响因素调查

目的了解贵港市外来人口聚集地流动儿童的计划免疫接种情况,以便为流动儿童的计划免疫工作管理提供科学的依据。方法对贵港市外来人口聚集地之一的红砖厂所有0~6岁流动儿童及其家长进行计划免疫接种情况和知晓情况调查。结果共查出外来儿童126名,其建卡率、建证率、卡疤率、“五苗”(卡介苗、口服脊髓灰脊炎疫苗、百白破疫苗、麻疹疫苗、乙肝疫苗)全程免疫覆盖率、乙肝疫苗首针及时接种率分别为:36.51%、16.67%、14.29%、10.00%、11.90%,流动儿童住院分娩率9.52%。调查的85名儿童家长:51.76%未上过学或小学未毕业,88.10%的流动儿童家庭全年人均收入低于1000元。流动儿童未接种的主要原因是:不知道要接种(71.60%)。结论要重视流动儿童的计划免疫管理工作,加大流动儿童集居地的计划免疫宣传力度,提高流动儿童家长预防卫生保健意识和计划免疫的知晓率,提高基础免疫覆盖率,消除免疫空白人群。     

济宁市学龄前儿童计划免疫及时接种率及其影响因素分析

目的了解济宁市学龄前儿童计划免疫工作的实施情况,为制定传染病控制措施提供科学依据。方法采用整群抽样,收集济宁市6所托幼机构2076名儿童的免疫接种相关资料进行统计学分析。结果卡介苗、脊髓灰质炎糖丸、百白破三联制剂、乙肝疫苗全程和麻疹疫苗首针及时接种率分别为9.7%,84.8%,89.9%,87.4%,90.4%;及时接种率常住儿童明显高于流动儿童,基础疫苗高于季节性疫苗,季节性疫苗高于自费疫苗。Logistic多因素分析显示,居住地更换、接种次数多、母亲文化程度、家长对接种疫苗的态度、家长计划免疫相关知识的掌握程度5项因素是影响“五苗”及时接种的主要因素。结论济宁市儿童家长计划免疫知识相对匮乏,流动儿童及时接种率较低,应采取措施积极应对。     

流动儿童与本地儿童监护人计划免疫知识、态度和行为的对比分析

目的 调查流动儿童与本地儿童监护人对计划免疫接种的知识、态度和行为情况。方法 采用一般资料调查表和计划免疫接种的知识-态度-行为问卷对620名流动儿童监护人和635名本地儿童监护人进行调查。结果 流动儿童和本地儿童监护人对计划免疫知识的知晓率分别为14.7%～96.6%和66.8%～99.1%,除了“接种疫苗后在接种地点的观察时间”和“出生24小时内接种的疫苗”外,本地儿童监护人其他知识的知晓率均高于流动儿童监护人（P＜0.001）。流动儿童和本地儿童监护人对计划免疫接种的态度分别为89.8%和100.0%,具有统计学差异（P＜0.001）。流动儿童和本地儿童监护人对计划免疫接种的行为分别为74.5%和97.2%,差异有统计学意义（P＜0.001）。结论 流动儿童监护人对计划免疫的知识、态度和行为的肯定情况均低于本地儿童监护人,社区管理人员应根据流动儿童监护人的具体情况,加强疫苗重要性的普及,提高监护人对计划免疫的认知,提高行为践行率,从而提高流动儿童的疫苗接种率。     

攀枝花市某区流动儿童计划免疫现状与对策

目的:分析攀枝花市某区流动儿童的计划免疫现状,为制定相应的计划免疫策略提供科学依据。方法:对1078名流动儿童进行5种疫苗接种情况的调查。结果:流动儿童建卡建证率为97.71%,基础免疫5种疫苗接种率分别为:卡介苗85.09%,脊灰糖丸全程94.72%,百白破联合疫苗全程89.91%,麻疹疫苗88.99%,乙肝疫苗全程83.94%,其中乙肝疫苗首针及时接种率75.23%,5种疫苗全程接种率为74.54%。加强免疫3种疫苗接种率分别为:百白破联合疫苗86.88%,麻疹疫苗89.11%,脊灰糖丸86.97%。结论:流动儿童的基础免疫、加强免疫以及乙肝疫苗首针及时接种率均较低;应重视流动儿童计划免疫工作中存在的问题,加强流动儿童计划免疫管理。     

2003年福建省5岁以下儿童计划免疫接种率调查

[目的]了解儿童实际接种率,评价和改进免疫规划工作策略。[方法]2003 年 9 月,在福建省 9 个设区市抽取18个县、36个乡和9个流动人口聚集地,对5岁以下儿童计划免疫接种情况进行调查。[结果]调查本地儿童 2 127 人,流动儿童276人。1999~2002年出生的本地儿童,BCG、OPV、DPT、MV、HBV的接种率均在 90%以上,HBV首针及时接种率73 49%,“五苗”全程合格接种率86 27%。经济情况好的和差的调查点儿童全程接种率差异无统计学意义;流动儿童各种疫苗的接种率均低于本地儿童。[结论]福建省儿童计划免疫各种疫苗的接种率较高,HBV首针及时接种率较低,流动儿童计划免疫工作有待加强。     

流动儿童计划免疫现状及管理对策

概述了当前中国流动儿童计划免疫状况,从流动儿童父母的文化程度和职业、居住时间、卫生资源投入的比重偏低等方面论述了开展流动儿童计划免疫工作难的原因。此外还提出了流动儿童计划免疫的管理对策,即加强部门合作、加强宣传教育、增加卫生经费投入、提高基层计免医生的素质、推广应用"金卡"及"多联多价"疫苗使用、加强全国儿童预防接种信息系统平台建设等。     

广东省2003年儿童计划免疫接种率调查

目的　了解 2 0 0 3年广东省儿童计划免疫疫苗接种率 ,以指导今后儿童计划免疫接种工作。方法　采用分层多阶段随机抽样方法 ,调查广东省 7个市 (县、区 ) 2 8个村 (居委会 )的 85 3名本地儿童和 3个区流动人口聚集地 89名流动儿童的免疫接种状况。结果　广东省本地儿童计划免疫建证率为 97 7% ,疫苗接种率分别为卡介苗 99 2 %、脊髓灰质炎疫苗 99 5 %、百白破疫苗 99 4 %、麻疹疫苗 99 4 %、“四苗”覆盖率为 96 4 % ,乙肝疫苗接种率为 98 8% ,首针及时接种率为 6 9 2 %。流动儿童建证率为 88 8% ,疫苗接种率分别为脊髓灰质炎疫苗 92 1%、百白破疫苗 89 9%、麻疹疫苗88 8%、乙肝疫苗 88 8% ,均低于本地儿童 (均P <0 0 5 )。不同年份出生及不同经济水平的儿童“四苗”及乙肝疫苗接种率差异均无统计学意义 (均P >0 0 5 ) ,经济较差的地区乙肝首针及时率(6 4 0 3% )低于经济较好的地区 (75 6 % ) (P <0 0 5 )。儿童家长对计免知识的知晓率不高 ,而且接种知识的信息来源比较单一。结论　广东省 2 0 0 3年儿童计划免疫接种率仍保持较高水平 ,但流动儿童接种率较低。今后计划免疫工作重点是加强流动儿童的管理 ,提高乙肝疫苗的首针及时率 ;同时要提高群众参与计划免疫的意识。     

广州市流动儿童计划免疫状况调查分析

目的了解广州市流动儿童计划免疫接种情况。方法对广州市13个区(市)的26个居委(村)1~4岁流动儿童进行计划免疫相关情况调查。结果231名流动儿童的建证率为99.6%,建卡率为91.3%。计划免疫四苗全程接种率为79.7%,乙肝疫苗接种率为85.3%,百白破加强免疫接种率为86.8%;五种疫苗超期接种占不合格接种总人数的71.8%。对相关情况进行多因素Logistic回归分析表明,分娩情况和免疫卡有无对接种合格率的影响有统计学意义(院内分娩者OR为3.41,有免疫卡者OR为4.23)。结论广州市流动儿童计划免疫接种合格率较低,应加强该人群尤其是院外分娩者及未建卡儿童的计划免疫的规范接种工作。     

河南省流动儿童免疫状况及影响因素调查

为了加强流动儿童的计划免疫管理 ,于 1999年 1月在河南省开展了流动儿童计划免疫状况调查。按照不同地理位置及聚集特点将流动人口聚居地分为 4类 ,在调查点内采取挨门逐户调查流动儿童的免疫接种情况。结果发现 :河南省流动儿童四种疫苗接种率均 <6 0 % ,“四苗”全程免疫覆盖率为 32 0 % ;大型农贸市场、建筑工地等流动儿童“四苗”全程免疫覆盖率(2 0 8% )低于其它类型地区 ;流动商贩子女的“四苗”全程免疫覆盖率 (2 5 1% )低于其它职业。说明流动性大是造成该人群免疫接种率低的主要原因 ,流动儿童家长对计划免疫工作的不理解及针对流动儿童的计划免疫服务存在漏洞 ,也是计划免疫工作存在的重要问题 ,提示流动儿童的免疫接种已成为制约我省计划免疫工作深入开展的关键。今后要进一步加大计划免疫的宣传力度 ,改进计划免疫服务方式 ,加强流动人口的计划免疫管理     

流动儿童计划免疫疫苗接种影响因素调查

目的　了解流动人口中的儿童(以下简称“流动儿童”)计划免疫疫苗接种影响因素,为做好流动儿童计划免疫工作提供依据。方法　采用分层多阶段随机抽样法,对流动儿童监护人进行问卷调查。结果　流动儿童监护人的文化程度、儿童家庭经济收入、儿童出生地点、是否参加计划免疫保偿等是影响计划免疫疫苗接种的重要因素。结论　应进一步加强计划免疫宣传教育,尤其是要加强对文化低和经济收入低的流动人口的宣传教育,提高他们参与计划免疫的主动性。同时加强流动儿童计划免疫服务和管理。     

Vaccination, smallpox, and a culture of immunization in Brazil

The aim of this paper is to discuss the emergence and establishment of a "culture of immunization" in the contemporary Brazil from the eradication of smallpox. This culture is associated with a long process of introduction of vaccines, vaccination campaigns and mass vaccination undertaken by the Brazilian government since the late nineteenth century. Particular importance is attributed to the campaign to eradicate smallpox in Brazil (1966-1973). The experience of mass vaccination of the population against smallpox is contrasted with episodes of resistance as the "revolt against the vaccine", and regarded as crucial in shaping new policies and new understandings about the role of immunization in public health and its place in society Brazil.     

Vaccines and vaccination against yellow fever: WHO Position Paper,June 2013—Recommendations

This article presents the World Health Organizations (WHO) evidence and recommendations for the use of yellow fever (YF) vaccination from “Vaccines and vaccination against yellow fever: WHO Position Paper – June 2013” published in the Weekly Epidemiological Record [1]. This position paper summarizes the WHO position on the use of YF vaccination, in particular that a single dose of YF vaccine is sufficient to confer sustained life-long protective immunity against YF disease. A booster dose is not necessary. The current document replaces the position paper on the use of yellow fever vaccines and vaccination published in 2003 [2].Footnotes to this paper provide a number of core references. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO's Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its April 2013 meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html.     

Rabies vaccines: WHO position paper,April 2018 – Recommendations

This article presented the World Health Organization’s (WHO) recommendations on the use of Rabies vaccines excerpted from the Rabies vaccines: WHO position paper – April 2018 published in the Weekly Epidemiological Record [1] This position paper replaces the 2010 WHO position paper on rabies vaccines [2]. It presents new evidence in the field of rabies and the use of rabies vaccines, focussing on programmatic feasibility, simplification of vaccination schedules and improved cost-effectiveness. The recommendations concern the 2 main immunization strategies, namely vaccination for post-exposure prophylaxis and vaccination for pre-exposure prophylaxis. In the context of post-exposure prophylaxis, recommendations are also provided on the use of rabies immunoglobulins.Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation tables. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO’s current position on the use of vaccines in the global context. Recommendations on the use of cholera vaccines were discussed by the Strategic Advisory Group of Experts (SAGE) in October 2017; evidence presented at these meetings can be accessed at:http://www.who.int/immunization/sage/meetings/2017/october/presentations_background_docs/en/.     

Cost-effectiveness and economic benefits of vaccines in low- and middle-income countries: A systematic review

Background

Public health interventions that prevent mortality and morbidity have greatly increased over the past decade. Immunization is one of these preventive interventions, with a potential to bring economic benefits beyond just health benefits. While vaccines are considered to be a cost-effective public health intervention, implementation has become increasingly challenging. As vaccine costs rise and competing priorities increase, economic evidence is likely to play an increasingly important role in vaccination decisions.

Methods

To assist policy decisions today and potential investments in the future, we provide a systematic review of the literature on the cost-effectiveness and economic benefits of vaccines in low- and middle-income countries from 2000 to 2010. The review identified 108 relevant articles from 51 countries spanning 23 vaccines from three major electronic databases (Pubmed, Embase and Econlit).

Results

Among the 44 articles that reported costs per disability-adjusted life year (DALY) averted, vaccines cost less than or equal to $100 per DALY averted in 23 articles (52%). Vaccines cost less than $500 per DALY averted in 34 articles (77%), and less than $1000 per DALY averted in 38 articles (86%) in one of the scenarios. 24 articles (22%) examined broad level economic benefits of vaccines such as greater future wage-earning capacity and cost savings from averting disease outbreaks. 60 articles (56%) gathered data from a primary source. There were little data on long-term and societal economic benefits such as morbidity-related productivity gains, averting catastrophic health expenditures, growth in gross domestic product (GDP), and economic implications of demographic changes resulting from vaccination.

Conclusions

This review documents the available evidence and shows that vaccination in low- and middle-income countries brings important economic benefits. The cost-effectiveness studies reviewed suggest to policy makers that vaccines are an efficient investment. This review further highlights key gaps in the available literature that would benefit from additional research, especially in the area of evaluating the broader economic benefits of vaccination in the developing world.     

Human papillomavirus vaccines: WHO position paper,May 2017–Recommendations

This article presents the World Health Organization’s (WHO) recommendations on the use of human papillomavirus (HPV) vaccines excerpted from the WHO position paper on Human papillomavirus vaccines: WHO position paper, May 2017, published in the Weekly Epidemiological Record [1]. This position paper replaces the 2014 WHO position paper on HPV vaccines [2].The position paper focuses primarily on the prevention of cervical cancer, but also considers the broader spectrum of cancers and other diseases preventable by HPV vaccination. It incorporates recent developments concerning HPV vaccines, including the licensure of a nonavalent (9-valent) vaccine and recent data on vaccine effectiveness, and provides guidance on the choice of vaccine. New recommendations are proposed regarding vaccination strategies targeting girls only or both girls and boys, and vaccination of multiple birth cohorts [3].Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation table. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. Recommendations on the use of HPV vaccines were discussed by SAGE in October 2016; evidence presented at these meetings can be accessed at: www.who.int/immunization/sage/meetings/2016/october/presentations_background_docs/en/.     

Assessing equivalence: an alternative to the use of difference tests for measuring disparities in vaccination coverage

Eliminating health disparities in vaccination coverage among various groups is a cornerstone of public health policy. However, the statistical tests traditionally used cannot prove that a state of no difference between groups exists. Instead of asking, "Has a disparity--or difference--in immunization coverage among population groups been eliminated ?," one can ask, "Has practical equivalence been achieved?" A method called equivalence testing can show that the difference between groups is smaller than a tolerably small amount. This paper demonstrates the method and introduces public health considerations that have an impact on defining tolerable levels of difference. Using data from the 2000 National Immunization Survey, the authors tested for statistically significant differences in rates of vaccination coverage between Whites and members of other racial/ethnic groups and for equivalencies among Whites and these same groups. For some minority groups and some vaccines, coverage was statistically significantly lower than was seen among Whites; however, for some of these groups and vaccines, equivalence testing revealed practical equivalence. To use equivalence testing to assess whether a disparity remains a threat to public health, researchers must understand when to use the method, how to establish assumptions about tolerably small differences, and how to interpret the test results.     

Childhood vaccination: achievements and challenges

As the goal of eradicating smallpox was being met, the World Health Organization created its Expanded Programme on Immunisation (EPI) in 1974 and reached its initial goal of achieving full vaccination of 80% of the world's children by 1990. This effort was aided by the creation of "cold chain" delivery systems and resulted in the annual saving of 3.5 million children in less-developed countries. Current EPI vaccination goals include 1) eradication of poliomyelitis by the year 2000, 2) elimination of neonatal tetanus by the year 1995, 3) control of measles and hepatitis B, and 4) immunization of 90% of the world's children 1 year or younger by the year 2000. Goals of the Children's Vaccine Initiative (formed in 1991) include 1) provision of an adequate supply of affordable, safe, and effective vaccines; 2) production of improved and new vaccines; and 3) simplification of the logistics of vaccine delivery. Future challenges are to sustain high vaccination coverage, reach the unreached, achieve proper storage of vaccines and reduce waste, integrate new vaccines into national programs, and achieve vaccine self-sufficiency. The fact that these challenges will be difficult to achieve is illustrated by the situation in Africa where the high immunization levels achieved in 1990 have dropped dramatically. Those who must act to implement immunization programs are health personnel, families, governments, and development partners. In order to achieve equity in health, every child must be reached, governments must be made accountable for programs, health workers must convince families of the importance of vaccination, delivery systems must be in place to take advantage of the new vaccines being delivered, and a multisectoral approach must be taken to assure sustainability.     

WHO position on the use of fractional doses – June 2017, addendum to vaccines and vaccination against yellow fever WHO: Position paper – June 2013

This article presents the World Health Organization’s (WHO) recommendations on the use of fractional doses of yellow fever vaccines excerpted from the “Yellow fever vaccine: WHO position on the use of fractional doses – June 2017, Addendum to Vaccines and vaccination against yellow fever WHO: Position Paper – June 2013″, published in the Weekly Epidemiological Record [1], [2].This addendum to the 2013 position paper pertains specifically to use of fractional dose YF (fYF) vaccination (fractional dose yellow fever vaccination refers to administration of a reduced volume of vaccine dose, which has been reconstituted as usual per manufacturer recommendations) in the context of YF vaccine supply shortages beyond the capacity of the global stockpile. The current WHO position on the use of yellow fever (YF) vaccine is set out in the 2013 WHO position paper on vaccines and vaccination against YF and those recommendations are unchanged.Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation table. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. Recommendations on the use of Yellow Fever vaccines were discussed by SAGE in October 2016; evidence presented at these meetings can be accessed at: www.who.int/immunization/sage/meetings/2016/October/presentations_background_docs/en/.     

Risk factors of underutilization of childhood immunizations in ultraorthodox Jewish communities in Israel despite high access to health care services

Background

The risk factors of underutilization of childhood vaccines in populations with high access to health services are not fully understood.

Objectives

To determine vaccination coverage and factors associated with underutilization of childhood vaccines in a population with sub-optimal vaccination compliance, despite a high health care access.

Methods

The study was conducted among 430 children from ultraorthodox Jewish communities in the Bnei Brak city and Jerusalem district. Data on immunization status, socio-demographic factors and on parents’ attitudes regarding vaccines were obtained from medical records and through parents’ interviews.

Results

The proportion of fully vaccinated children was 65% in 2- to 5-year-old ultraorthodox children from Jerusalem district, and 86% in 2.5-year-old children from Bnei Brak city. The factors that were significantly associated with vaccines underutilization in Bnei Brak were having >6 siblings, maternal academic education, parental religious beliefs against vaccination, perceived risk of vaccine preventable diseases as low, and mistrust in the Ministry of Health (MOH). Similarly, in Jerusalem, religious beliefs against vaccination, and the perceived low risk of vaccine preventable diseases significantly increased the likelihood of under-immunization, while having a complementary health insurance was inversely related with vaccines underutilization.

Conclusions

The risk factors of under-immunization are in part modifiable, by means of health education on the risks of vaccine preventable diseases and by improving the trust in the MOH. The leaders of the ultraorthodox communities could play an important role in such interventions.     

国内外儿童用联合疫苗免疫原性、安全性和社会价值

联合疫苗含有两种或多种抗原，研究认为接种联合疫苗后能预防多种疾病，同时可减少接种次数。本文对国内外儿童用联合疫苗，如无细胞百白破疫苗（DTaP）、麻疹-风疹-腮腺炎疫苗（MMR）等免疫原性和安全性进行综述，并从儿童家长、预防接种工作者和卫生服务方面进行社会价值探究，为我国推动联合疫苗研发和使用提供决策证据。研究发现，联合疫苗对儿童、家长、预防接种工作者和卫生服务方面均产生较好的收益，能够保证其良好的免疫原性和安全性，增强家长的接种便利和经济性，提高预防接种工作者的工作效率，同时能弥补新发疫情对免疫服务造成的影响，提高接种覆盖率和及时率，增加社会收益。目前我国联合疫苗的推广受到技术瓶颈多，人群接种认知水平低等限制。建议加强联合疫苗安全性、有效性和卫生经济学等方面研究，科学评估联合疫苗的价值；增强公众对联合疫苗的认知和信任度；促进多联多价疫苗研发应用；政府应完善法规协助联合疫苗发展。