脊髓性肌萎缩症患儿免疫规划疫苗接种率及不良反应调查

目的了解脊髓性肌萎缩症(SMA)患儿国家规定计划免疫疫苗的接种率及其不良反应的发生情况。方法2016年7月至2019年6月进行回顾性横断面调查研究。以2016年7月至2018年12月在首都儿科研究所注册登记的192例SMA患儿(1~3型,男116例、女76例)和同期朝阳区奥运村社区卫生服务中心进行接种的191名健康儿童(男115名、女76名)作为研究对象,通过问卷调查、电话随访和查阅疫苗接种记录,了解计划免疫疫苗的接种时间、接种率及不良反应的发生情况。采用t检验或χ^2检验比较不同型别的SMA患儿各疫苗接种率,SMA患儿和健康儿童的不良反应情况。结果192例SMA患儿年龄(66±43)月龄,基础计划免疫完成率为62.0%(119例);1~3型SMA患儿完成率分别为52.2%(12/23),55.7%(68/122)和83.0%(39/47),差异有统计学意义(χ^2=12.23,P=0.002);各疫苗接种率随SMA患儿年龄增长而降低:卡介苗为100.0%(192/192),第3剂乙肝疫苗为94.3%(181/192),第3剂脊髓灰质炎疫苗81.8%(157/192),第3剂百白破疫苗为88.5%(170/192),首剂A群流脑疫苗83.9%(161/192),首剂麻疹或麻风二联疫苗76.6%(147/192),首剂乙脑减毒疫苗80.2%(154/192),首剂甲肝疫苗68.2%(131/192),麻风腮疫苗69.8%(134/192),A+C群流脑疫苗54.7%(105/192)。73例未完成计划免疫的SMA患儿中78.1%(57/73)因为患儿监护人害怕加重病情而主动放弃,21.9%(16/73)是免疫接种部门因为疾病的原因而终止接种。SMA患儿疫苗接种后的一般反应发生率与健康儿童差异无统计学意义[19.8%(38/192)比18.8%(36/191),χ^2=0.055,P=0.815],均以发热和局部红肿多见;异常反应在SMA患儿和健康儿童中发生率分别为2.6%(5/192)和3.7%(7/191),差异无统计学意义(χ^2=0.355,P=0.551),主要为皮疹或神经血管水肿。SMA患儿的肺炎疫苗和流感疫苗的接种率分别为22.4%(43/192)和31.8%(61/192),接种肺炎疫苗的SMA患儿肺炎发生率从接种前的59.0%(23/39)降到41.0%(16/39),接种流感疫苗的58例SMA患儿在接种当年均未发生流感。结论SMA患儿基础计划免疫完成率低,尤以1型患儿最低,主要是由于家长主动放弃接种。SMA患儿接种疫苗后不良反应的发生率与健康儿童差异无统计学意义。肺炎疫苗和流感疫苗接种后可以预防肺炎发生或降低肺炎次数及流感的发生。

Coverage rate and adverse reactions of National Immunization Program vaccines in children with spinal muscular atrophy:a cross-sectional retrospective cohort study

Objective To investigate the coverage rate and the adverse reactions of National Immunization Program vaccines in children with spinal muscular atrophy(SMA).Methods A cross-sectional retrospective cohort study was carried out from July 2016 to June 2019,192 children(116 boys and 76 girls)with SMA registered by Capital Institute of Pediatrics and 191 healthy children(115 boys and 76 girls)vaccinated in Chaoyang Olympic Village Community Health Service Center from July 2016 to December 2018 were included.Questionnaire survey was designed to investigate the vaccination coverage rate and associated adverse events.The t-test andχ^2 test were used to compare the difference between SMA patients and healthy children.Results The coverage rate of age-appropriate immunization in SMA children was 62.0%(119/192)in general,and were 52.2%(12/23),55.7%(68/122),and 83.0%(39/47)for SMA type 1-3 patients,respectively(χ^2=12.23,P=0.002).The vaccination coverage rates of Bacillus Calmette-Guerin(BCG)vaccine,the 3rd dose of hepatitis B,the 3rd dose of polio,the 3rd dose of diphtheria-pertussis-tetanus,the 1st dose of meningococcal polysaccharide group A,the 1st dose of measles or measles and rubella vaccine,the 1st dose of Japanese encephalitis vaccine,hepatitis A,measles-mumps-rubella,and group A+C meningococcal polysaccharide vaccine were 100.0%(192 cases),94.3%(181 cases),81.8%(157 cases),88.5%(170 cases),83.9%(161 cases),76.6%(147 cases),80.2%(154 cases),68.2%(131 cases),69.8%(134 cases),54.7%(105 cases),respectively.Among the 73 patients who did not have their planned immunization completed,57 cases(78.1%)gave up the vaccination due to parents′concern of potential aggravation of their disease,and 16 cases(21.9%)had the plan discontinued by the immunization department because of the disease.Fever,local redness and swelling were the most common side-effects after vaccination both in SMA patients and healthy children(19.8%(38/192)vs.18.8%(36/191),χ^2=0.055,P=0.815).The main abnormal reactions of vaccination were rash and neurovascular edema,without significant difference between these two groups(2.6%(5/192)vs.3.7%(7/191),χ^2=0.355,P=0.551).The coverage rate of Influenza and pneumococcal vaccine in SMA patients were 22.4%(43 cases)and 31.8%(61 cases),respectively.The incidence of pneumonia in the SMA patients decreased from 59.0%(23/39)to 41.0%(16/39)after vaccination.And none of the Influenza vaccinated patients had the flu in the year of vaccination.Conclusions The coverage rate of National Immunization Program vaccines in the SMA children is low,especially in type 1 SMA patients,which is mainly due to their guardians′concern of potential adverse events,even though the incidence of adverse reactions is similar in SMA patients and healthy children.Influenza and pneumococcal vaccine can reduce the risk of pneumonia and flu in children with SMA effectively.