麻疹179例流行特点及临床分析

目的分析地区性麻疹患者临床特点。方法收集2007年1月-2007年12月住院麻疹患者179例临床资料,从患者性别、年龄分布、发病地区、是否接种疫苗、发病季节、临床特征及主要并发症等方面进行分析。结果（1）发病季节不仅限于冬春季,夏季病人增多;（2）低龄儿童和成人发病率上升,特别是成年女性病人增多;（3）部分病人症状不典型,并发症多;（4）治疗效果好。结论成年入和婴儿麻疹有增多趋势;建议麻疹减毒活疫苗应提前接种并增加高危地区学龄前儿童的免疫范围覆盖率,同时在部分成年人中接种疫苗。     

永州市零陵区2005--2007年儿童计划免疫接种率调查

目的初步了解永州市零陵区儿童计划免疫现状,评价2005～2007年报告接种率情况,为加强计划免疫工作,有效提高接种质量提供依据。方法采取分层随机抽样的方法抽查6个街道及2个农贸市场,按《全国常规免疫接种率监测方案》的方法进行接种率进行评价,连续抽查3年。结果全区2005～2007年卡介苗（BCO）、脊髓灰员炎疫苗（OPV）、百白破（DPT）、麻疹疫苗（MV）全程接种率在2005、2006、2007年调查中分别为83.7％、93.6％、95.5％;备单苗接种率由2005年的不足84％提高到2005年的96％;乙肝疫苗（HBV）三年的接种率分别为82.4％、88．6％、86.5％;建卡率、建证率和卡疤率也提高到96％以上。结论本地区儿童计划免疫仍保持着工怍的连续性并将儿童接种率维持在一定水平,各指标逐年提高,到2007年都达到了或接近了90％,但还存在不足．     

成人流行性腮腺炎86例临床流行病学分析

目的对深圳市龙岗区流行性腮腺炎流行情况进行分析,提出预防控制措施,为有效防控流行性腮腺炎提供科学依据。方法对龙岗区2003—2007年流行性腮腺炎流行状况和预防控制措施的实施效果进行分析。结果流行性腮腺炎以春季发病为主,发病高峰在3～5月份。成人患者并发症发生率明显高于未成年患者。结论预防和控制流行性腮腺炎重点应放在保护易感人群为主导的措施上,主动对易感者接种流行性腮腺炎疫苗,是一种十分有效的手段。     

深圳市儿童麻疹疫苗接种及居住地流动情况调查

目的了解深圳市麻疹疫苗接种率及免疫接种服务供应情况。方法采用分层整群抽样的方法共抽取339名年龄在8个月-6岁的儿童为调查对象,采用入户询问调查的方法,重点调查疫苗接种情况及6个月内的居住变动情况等。结果调查儿童中乙肝疫苗、百白破疫苗、卡介苗、糖丸、麻疹疫苗接种率均超过90％,乙脑疫苗接种率为84．7％。特区内百白破、卡介苗接种率比特区外高,差异有统计学意义（P〈0．05）。深圳户籍、暂住大于三个月、暂住小于三个月及户口不详的疫苗接种率差异有统计学意义（P〈0．05）。结论深圳市儿童麻疹疫苗接种率较高,流动儿童的麻疹疫苗接种率及接种及时率均低于户籍儿童,应采取相应措施加强流动儿童的计划免疫管理。     

Interventions to increase influenza vaccination rates in veterans with spinal cord injuries and disorders

OBJECTIVE: To increase the percentage of veterans with spinal cord injuries and disorders (SCI&D) who receive annual influenza vaccinations. DESIGN: A repeated measures quality improvement project using several integrated evidence-based interventions. SETTING: 23 Veterans Affairs (VA) SCI Centers. PATIENTS: Veterans with SCI&D average age = 57.3 years (range 21-102 y). INTERVENTIONS: Patient reminder letters and education; provider reminders and posters; computerized clinical reminders for vaccination targeted to SCI & D; standing orders. MAIN OUTCOME MEASURES: Patient self-reported vaccination status. RESULTS: Baseline vaccination rate was 33% in fiscal year (FY) 2001. The percentage of veterans with SCI&D who reported receiving vaccinations increased from 62.5% in year 1 (FY2002) to 67.4% in FY2003 (P = 0.004); for individuals younger than 50 years of age, rates increased from 50% to 54%. Predictors of vaccination were age 65 years of age or older, VA health care visit in past year, nonsmoker, believing vaccination is important, having a health condition that may contribute to respiratory complications, and self-reported influenza in prior year. CONCLUSIONS: Vaccination rates were higher than baseline and higher than reported for other high-risk groups. Interventions that incorporate system-wide approaches plus patient and provider education and reminders were moderately effective in increasing vaccination rates. Targeting younger persons, smokers, and those who do not use VA care may further improve rates.     

Skin response to delayed hypersensitivity testing in persons with unilateral stroke-related paresis: implications for people with spinal cord injury

BACKGROUND: Vaccination rates among individuals with spinal cord injury (SCI) could be improved if it can be shown that vaccination performed on insensate areas is effective. This would eliminate the the risk of discomfort and soreness at the injection site. OBJECTIVE: To determine whether immune responsiveness varies between areas with intact and impaired innervation in patients with stroke-related paresis. DESIGN: Prospective trial in which each subject served as his or her own control. SETTING: Rehabilitation wards and long-term care units at a Veterans Affairs Medical Center. PATIENTS: Individuals with a history of cerebrovascular accident (CVA) affecting 1 side of the body. METHODS: The Multitest cell-mediated immunity (CMI) and purified protein derivative (PPD) of tuberculin were administered intradermally to each arm of each subject. MAIN OUTCOME MEASURES: Total millimeters of induration in response to either test and positive vs negative responses to either test were compared between the 2 arms of each subject. RESULTS: Response to delayed hypersensitivity testing did not differ between the arms affected and unaffected by CVA in each subject, and the time since CVA also did not affect the magnitude of the skin response. CONCLUSIONS: Skin testing for delayed hypersensitivity can be effectively administered in the paretic arms of persons who have experienced CVA. Although this study was performed in patients with stroke-related impairment, it has implications for vaccine administration in individuals with SCI-related neurologic deficits.     

Trends in Influenza Vaccination Coverage Rates in Germany over Six Seasons from 2001/02 to 2006/07

Abstract Background and Purpose:   Influenza is a considerable health problem all over the world. Vaccination is the most important measure for preventing influenza and reducing morbidity and mortality. The aims of this study were to assess influenza vaccination coverage from 2001 to 2007 in Germany, to understand motivations and barriers to vaccination, and to identify vaccination intentions for season 2007/08. Methods:   In representative household surveys, 12,039 telephone interviews with individuals aged ≥ 14 years were conducted between 2001 and 2007. Essentially the same questionnaire was used in all seasons. Results:   In season 2006/07, the overall influenza vaccination coverage rate dropped from 32.5% in the previous season to 27.4%. In the elderly (≥ 60 years), the rate decreased from 51.6% to 44.7% and the odds ratio of being vaccinated, compared to those not belonging to a high-risk group, remained < 5. Chronically ill elderly persons had an odds ratio of vaccination of 7, while younger chronically ill persons and health-care workers had odds ratios of about 2. Perceiving influenza as a serious illness was the most frequent reason for getting vaccinated. 14% of those vaccinated in 2006/07 indicated the threat of avian flu as a reason. The main reason for not getting vaccinated was thinking not to be likely to catch the flu. A recommendation by the family doctor/nurse was perceived as the major encouraging factor for vaccination. A total of 44.7% of the respondents intended to get vaccinated against influenza in 2007/08. Conclusion:   A trend of increasing vaccination rates was observed from 2001 to 2006 in Germany, but the rates dipped by almost a sixth after 2005/06. The loss of media interest in the threat of avian influenza after February 2006 and stalling reimbursement programs may have contributed to the recent drop in vaccination rates.      

Development and testing of a vaccination message targeted to persons with spinal cord injuries and disorders

BACKGROUND/OBJECTIVE: Individuals with spinal cord injuries and disorders (SCI&D) are at high-risk of complications and death after influenza and pneumonia. Respiratory vaccinations are effective in reducing infection and complications. The aim of this study was to test the feasibility and effectiveness of a multimedia educational message developed using a strong theoretical basis and targeted consumer input to modify negative perceptions, increase knowledge, and positively influence intentions and beliefs regarding respiratory vaccinations. METHODS: Veterans with SCI&D (n = 36) completed a pretest questionnaire, viewed the message, and, after a clinic visit, completed a posttest questionnaire. Mean differences were examined using paired t tests. Providers (n = 25) were surveyed about the content, comprehension, and reception of the message; response frequencies were examined. RESULTS: Respondents showed positive changes in beliefs from pre- to posttest on multiple items related to knowledge, severity, and self efficacy and response efficacy. There were no changes in perception of personal susceptibility to these diseases. Most providers were in favor of using the message in this population. CONCLUSIONS: A brief theory-based multimedia intervention is a feasible way to improve knowledge and attitudes about respiratory vaccinations in high-risk populations.