沧州地区特殊健康状态儿童医学评估对预防接种的影响研究

doi:10.12183/j.scjpm.2024.0908

摘要/Abstract

摘要： 目的探讨沧州地区特殊健康状态儿童医学评估对预防接种的影响。方法选择2022年1月至2023年12月在沧州市人民医院预防接种门诊就诊的特殊健康状态儿童为研究对象,对儿童开展预防接种医学评估、提出预防接种建议及实施接种等情况进行调查。采用描述性分析方法对接种建议实施结果及接种后3个月内预防接种不良事件（AEFI）进行统计分析,并采用单、多因素分析方法分析影响沧州地区特殊健康状态儿童接种率的因素。结果共纳入2 018例特殊健康状态儿童,其中0~<12月龄占53.96%;主要特殊健康状态包括神经系统疾病、新生儿疾病、心血管系统疾病,分别占33.80%、31.96%、15.91%。经医学评估,建议按免疫程序接种/补种疫苗、接种部分疫苗、暂缓接种疫苗的儿童分别有1 459例（72.30%）、426例（21.11%）、133例（6.59%）。实际接种的儿童有1 712例（90.82%）,接种后发生AEFI有31例（1.81%）,均为一般不良反应,并在7 d内痊愈。多因素logistic回归分析结果显示,居住地（城镇OR=1.390）、家长文化程度（大专及以上OR=1.662）、家庭人均月收入（≥3 500元OR=1.677）、家长获取信息来源（儿童保健医生/妇产科医生/新生儿科医生OR=2.450,基层预防接种人员OR=2.100）、家长预防接种认知情况（好OR=1.677）均是影响沧州地区特殊健康状态儿童预防接种的独立因素（均P<0.05）。结论特殊健康状态儿童经医学评估后大部分可接种疫苗,且安全性良好。另需重点加强特殊健康状态儿童疫苗接种宣传工作,提高家长对预防接种的认知,从而提高特殊健康状态儿童接种率。

关键词: 特殊健康状态, 儿童, 医学评估, 预防接种

Abstract: Objective To explore the impact of medical evaluation of children with special health status on vaccination in Cangzhou region. Methods Children with special health status who were treated in the vaccination clinic of Cangzhou People's Hospital from January 2022 to December 2023 were selected to carry out medical evaluation of vaccination, put forward vaccination recommendations and implement vaccination. Descriptive analysis method was used to make statistical analysis of the implementation results of vaccination recommendations and adverse events following immunization (AEFI) within three months after vaccination, and univariate and multivariate analyses were used to analyze the factors affecting the vaccination rate of children with special health status in Cangzhou region. Results A total of 2 018 children with special health status were included, of which 53.96% were aged 0-<12 months. The main special health status included neurological diseases, neonatal diseases, and cardiovascular diseases, accounting for 33.80%, 31.96%, and 15.91%, respectively. According to medical evaluation, it is recommended that 1 459 (72.30%), 426 (21.11%), and 133 (6.59%) children be vaccinated/re vaccinated according to the immunization program, partially vaccinated, and temporarily vaccinated, respectively. Among them, 1 712 children (90.82%) were actually vaccinated, and 31 cases (1.81%) developed AEFI, all of which were general adverse events and recovered within 7 days. The results of multivariate logistic regression analysis showed that residence (urban OR=1.390), parents' education level (college degree or above OR=1.662), average monthly household income (≥3 500 yuan OR=1.677), parents' sources of information (child health doctors/obstetricians/neonatologists OR=2.450, primary vaccination personnel OR=2.100), and parents' awareness of vaccination (good OR=1.677) were all independent factors affecting the vaccination of children with special health status in Cangzhou region (all P<0.05). Conclusions Most of the children with special health status can be vaccinated with preventive vaccines after medical evaluation, and the safety is good. It is also necessary to focus on strengthening the publicity of vaccination for children with special health status, and to improve the parents' knowledge of preventive vaccination, so as to increase the vaccination rate of children with special health status.

Key words: Special health status, Children, Medical evaluation, Vaccination

中图分类号:

R186

李娜, 杜雨蒙, 冷燕, 冯晶晶. 沧州地区特殊健康状态儿童医学评估对预防接种的影响研究[J]. 华南预防医学, 2024, 50(10): 908-912.

LI Na, DU Yumeng, LENG Yan, FENG Jingjing. A study on the impact of medical evaluation of children with special health status on vaccination in Cangzhou region[J]. South China Journal of Preventive Medicine, 2024, 50(10): 908-912.

参考文献

[1] Zhang YF, Xia CY, Yang Q, et al.The protective effects of pediatric vaccination on multisystem inflammatory syndrome in children stratified by vaccine status, types and virus variants[J]. Int Immunopharmacol, 2023, 125(PtA): 111105.
[2] Reingold ELB, Bennion M, Meyer MN.Immunizations in children with chronic diseases: A state of the science review with implications for practice change[J]. J Pediatr Health Care, 2022, 36(4): 368-375.
[3] 宋渝丹,黎祺,黄勇,等. 中国特殊健康状态儿童疫苗接种研究进展[J]. 中国疫苗和免疫,2022,28(5):595-600.
[4] 王琳,郝利新,白云骅. 医防融合,促进特殊健康状态儿童免疫接种[J]. 中华预防医学杂志,2022,56(6):673-678.
[5] 广东省医师协会儿科医师分会. 特殊状态儿童预防接种(广东)专家共识[J]. 中华实用儿科临床杂志,2020,35(6):401-410.
[6] 韩英,胡丹丹,韦茹. 广东省特需人群接种门诊特殊健康状态儿童预防接种探索[J]. 中国疫苗与免疫,2021,27(6):678-683.
[7] 国家卫生健康委员会. 国家免疫规划疫苗儿童免疫程序及说明(2021 年版)[J]. 中国病毒病杂志,2021,11( 4):241-245.
[8] 国家卫生和计划生育委员会. 国家免疫规划疫苗儿童免疫程序及说明(2016年版)[J]. 中国病毒病杂志,2017,7(2):81-86.
[9] 国家卫生健康委办公厅. 非免疫规划疫苗使用指导原则(2020年版)[S/OL]. (2020-12-07)[2024-05-28]. http://www.nhc.gov.cn/jkj/s3581/202012/9b76584336a1483cbece7edd0abb2a7e.shtml.
[10] 孙金峤. 特殊健康状态儿童预防接种专家共识之十九——免疫抑制剂与预防接种[J]. 中国实用儿科杂志,2019,34(5):335-336.
[11] 郭翔,仇静,孙晓冬. 浅谈应用专家共识意见指导特殊健康状态儿童的疫苗接种[J]. 中华预防医学杂志,2021,55(2):284-287.
[12] 佚名. 全国疑似预防接种异常反应监测方案[ J]. 中国疫苗和免疫,2011,17(1):72-81.
[13] 王陇德,齐晓秋,于竞进. 预防接种实践与管理[M]. 北京:人民卫生出版社,2006:8-16.
[14] 张谊微,吴小丽,李彦坤,等. 天津市预防接种新媒体在线教育平台应用效果评估[J]. 中国健康教育,2022,38(1):62-66.
[15] Li M, Ji C, Wang B, Yao D, et al.Incomplete vaccination among children with special health care needs in Zhejiang, China: Analysis of retrospective data[J]. Front Pediatr, 2019, 7(1): 173.
[16] Xu B, Zhang Y, Zhou C, et al.Vaccination coverage and immunization safety among children with special health status in Chong qing, China[J]. Hum Vaccin Immunother, 2022, 18(7): 2138466.
[17] Jat NK, Bhagwani DK, Bhutani N, et al.Assessment of the prevalence of congenital heart disease in children with pneumonia in tertiary care hospital: A cross-sectional study[J]. Ann Med Surg (Lond), 2021, 73(1): 103111.
[18] 李晶晶,王楚宁,王中林,等. 2017—2019年上海市某儿科医院疫苗咨询门诊特殊健康状态儿童疫苗接种现状[J]. 中国疫苗和免疫,2024,30(1):77-82.
[19] Sowe A, Namatovu F, Cham B, et al.Starting then stopping: A nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia[J]. Glob Health Action, 2024, 17(1): 2348788.
[20] 郭静,杨志军. 濮阳市华龙区6岁以下儿童水痘疫苗接种情况及影响因素[J]. 华南预防医学,2023,49(1):112-114,119.
[21] 刘翰谕,赵天朔,韩冰峰,等. 2019年部分地区父母对儿童接种水痘疫苗的犹豫现状调查[J]. 中国疫苗和免疫,2021,27(3):302-306.
[22] Mohy A, Lagoubi Y, Gomez JA, et al.Health economic evaluation of 2-dose and 3-dose rotavirus vaccines in children below 5 years of age in Morocco[J]. Hum Vaccin Immunother, 2024, 20(1): 2353480.
[23] My C, Danchin M, Willaby HW, et al.Parental attitudes, beliefs, behaviours and concerns towards childhood vaccinations in Australia: A national online survey[J]. Aust Fam Physician, 2017, 46(3): 145-151.