6～50月龄儿童流感疫苗接种现状及影响因素研究

目的：分析6～50月龄儿童流感疫苗接种现状。分析影响接种流感疫苗的因素。为流感预防工作提供依据。方法：以36月龄为界将6月～50月龄儿童分为两个层次。每个年龄层按照等距抽样原则抽取250例儿童进行调查。采用知识问卷的方式对儿童家长进行调查。查看6～50月龄儿童流感疫苗的接种率。结果：500例儿童家长问卷调查中,接种者98例（19.6%）,未接种者402例（80.4%）;312例（62.4%）儿童家长表示愿意接种流感疫苗。188例（37.6%）儿童家长表示不愿意接种流感疫苗;197例（39.4%）儿童家长对流感疫苗接种知识回答正确。303例（60.6%）儿童家长对流感疫苗接种知识回答不正确。质疑疫苗效果、家长对疫苗认知、担心疫苗安全性及暴发流感时再接种为影响儿童接种的主要因素,上述因素在两组间差异有统计学意义（P＜0.05）。结论：6～50月龄儿童流感疫苗接种率较低。同时儿童家长对接种流感疫苗的认识度也较低。家长对疫苗认知、质疑疫苗效果、担心疫苗安全性及暴发流感时再接种为影响儿童接种的主要因素。预防工作中应加强针对性干预措施提高儿童流感疫苗接种率。     

孕妇疫苗认知情况、接种行为调查及干预建议

摘要：目的:了解我院就诊孕妇对疫苗的认知情况及接种行为,依据目前疫苗接种政策,提出干预建议,为健康教育策略提供依据。方法:以参加我院孕妇学校课程的孕妇为研究对象,现场对其进行问卷调查,对孕妇疫苗认知情况和接种行为进行描述统计,并采用χ~2检验或Fisher’s精确检验的方法分析孕妇疫苗认知情况和接种行为的部分影响因素。结果:439例孕妇参与调查,平均年龄为(31.83±4.21)岁;文化教育程度以大专或本科为主(73.6%),其次是研究生教育(20.3%)。疫苗认知调查中,孕期可接种疫苗的正确率为2.1%;接种人乳头瘤病毒(HPV)疫苗后需定期筛查宫颈癌的正确率为91.1%;流感疫苗优先接种人群的正确率为26.9%,仅有34.2%的参与者认为孕妇为流感疫苗的优先接种人群。孕期接种疫苗127人(32.1%)。文化程度与孕期疫苗接种行为可能有关(P<0.05),推测文化程度越高,接种比例越高。结论:尽管我院就诊孕妇文化教育水平较高,但孕期认知情况仍存在不足,必要的疫苗接种行为较少,应加强孕妇对疫苗知识学习,强调疫苗的安全性和有效性。     

西安市家长对儿童疫苗的接种态度与迟疑情况调查

目的：了解城市儿童家长对儿童接种疫苗的态度,测量其迟疑情况,发现预防接种存在的问题。方法：采用多水平抽样,2016年11月在西安市6个城区的每个区内抽取一个社区进行调查,调查地点是社区卫生服务中心,共对455名儿童家长进行了调查。采用已开发并验证的量表（Parents Attitude of Children Vaccinate,PACV）为调查工具,对其进行修改使用。量表含3部分：（1）免疫行为;（2）疫苗安全性与有效性的信念;（3）整体态度与信念,共18个题目。同时,对18名家长进行了访谈。结果： 455名家长中,15.8%的家长PACV得分≥ 50。分别有69.5%和66.6%的家长担心疫苗的副作用和安全性。43.7%的家长表示不能完全信任接种医生;23.7%的家长对儿童接种疫苗存在迟疑。结论：西安市相当一部分家长对于儿童接种疫苗态度迟疑,对儿童基础免疫和二类疫苗的接种产生了潜在威胁。迫切需要对儿童家长疫苗接种的态度加强引导,提升疫苗接种的监管水平,提高家长对预防接种的信任和接种安全的信心。     

中山市某区学校学生家长对流感疫苗接种状况影响分析

目的分析中山市某区学校学生家长对流感疫苗接种状况的影响,为服务的改进提供参考。方法对2011年4月～2012年9月中山市某区每个年龄层按照等距抽样原则抽取小学与幼儿园儿童各200名,采用相关知识问卷及核查流感疫苗接种记录的方式对入组儿童的疫苗接种情况进行统计,同时对儿童家长文化程度、家长对接种疫苗相关知识的掌握程度、态度及接种服务需求等情况做详细调查。结果本组儿童流感疫苗接种率为37．5％,其中幼儿园儿童接种率为42．5％;小学1-2年级接种率为41．18％;小学3-6年级接种率为28．03％。幼儿园与小学1～2年级接种率高于高年龄接种率。孩子身体健康而无需接种、不相信疫苗效果、流感流行时再接种、文化程度、家长认知水平、担心疫苗的安全性是影响疫苗接种率的主要因素,以上因素在两组间差异均有统计学意义（P〈0．05）。结论中山市某区学校流感疫苗接种率低,家长对流感疫苗接种重要性认识不足及担心疫苗的安全性等是主要影响因素,对此,应采取有效的措施,加强宣传与沟通,提高儿童流感疫苗的接种率。     

家长在儿童预防接种过程中的心理需求及护理干预

目的对家长在儿童预防接种过程中的心理需求及护理干预进行研究分析。方法选取2013年5月至2014年2月400名带幼儿来我社区门诊接种的儿童家长,采用调查问卷调查家长的心理需求及预防接种知识的知晓情况,针对家长在儿童预防接种过程中不同的心理需求予以护理干预。结果家长首要的心里需求为安全有效接种疫苗(100.0%),98%以上的家长希望知道疫苗接种的不良反应及接种后注意事项;家长知晓率最高的为疫苗接种后的注意事项(70.3%),知晓率最低的为如何处理接种反应(58.0%),家长最希望获得知识的途径为发放疫苗接种知识手册(81.3%)。结论改善接种环境,确保接种的安全性,提高服务质量及普及预防接种的相关知识是预防接种工作顺利开展的保障。     

接种无细胞百白破疫苗的不良症状及处理措施分析规范化疫苗

目的探讨接种无细胞百白破疫苗的不良症状及处理措施分析规范化疫苗。方法选取笔者所在辖区(2014年10月~2016年10月)接受无细胞百白破疫苗接种的600例3个月以上儿童(600位家长),观察600例接受无细胞百白破疫苗接种的儿童临床症状,再实施相应的预防护理工作。分析600例婴幼儿的不良反应发生率、婴幼儿家长对护理工作总满意度(采取问卷调查表)、不同年龄阶段(3个月、4个月、5个月、18~24个月)异常反应发生率等参数指标。结果 600例接受无细胞百白破疫苗接种的婴儿中有20例出现不良反应,占3.33%(20/600),未出现不良反应者占96.67%(580/600);20例不良反应中3个月婴儿异常反应发生率为5.00%(1/20)、4个月婴儿异常反应发生率为10.00%(2/20)、5个月婴儿异常反应发生率为50.00%(10/20)、18~24个月幼儿异常反应发生率为35.00%(7/20),不同年龄阶段不良反应发生率比较,差异有统计学意义(P<0.05);采取针对性的护理措施后,婴幼儿家长对护理工作总满意率达99.67%(598/600)、不满意率为0.33%(2/600),两组数据比较,差异有统计学意义(P<0.05)。结论接种无细胞百白破疫苗的不良反应发生率比较高,在对婴幼儿进行疫苗接种时要严格规范好操作方法。     

儿童家长在预防接种过程中的心理及护理需求调查

目的：了解儿童家长在孩子接种疫苗时的心理及护理需求。方法采用自行设计的儿童家长心理需求及护理需求调查表,随机抽取预防接种的648名儿童家长进行问卷调查。同时,将2组儿童父母随机分组进行研究,对照组为未行护理干预,观察组家长行健康教育护理干预,比较2组接种疫苗儿童的不良反应的发生率和儿童父母家长希望获得健康教育知识的途径。结果儿童父母对于疫苗接种后的不良反应、疫苗接种后的注意事项、接种护士的沟通能力、国产疫苗和进口疫苗的选择和接种疫苗不良反应出现后的处理,均表现为最高需求,需求率大于95％,而对于疫苗接种的种类需求最低,需求率为76膊．1％。经过健康教育后,对2组儿童父母的最担心问题进行调查,发现观察组在调查的所有问题中,其表示担心的例数均明显低于对照组,差异有统计学意义（ P ＜0．05）。儿童父母对于健康教育知识的获取方式最希望通过宣传卡片的形式获得,希望率为57．9％。结论护士根据儿童家长在接种过程中的心理需求和服务需求而采取有效的干预措施,减少护理工作的盲目性和片面性,有利于预防接种工作的顺利开展。     

儿童家长疫苗接种知识水平调查及健康指导后效果评价

儿童计划免疫是针对某些传染病而采取免疫程序有计划地预防接种。目前预防接种的主要对象是儿童,而儿童与家长的合作程度是预防接种日常工作能否顺利进行疫苗注射后获得最佳效果的保证。由于儿童家长对预防接种知识的认知程度直接影响儿童免疫规划中疫苗的接种率,针对我院接种门诊中1～3月龄的儿童家长,给予预防接种及针对疾病防治的健康干预,使家长了解疫苗接种的重要性,由被动接受转变为主动参与,取得了很好地效果。     

社区儿童免疫接种和健康体检研究

目的:研究社区儿童免疫接种和健康体检的方法及效果。方法:选取从2013年1月至2018年1月于我社区进行免疫接种于健康体检的86例儿童作为研究对象,对儿童开展健康体检以及疫苗接种,为提高儿童接种疫苗率,在体检过程中对儿童家长开展相关知识宣教,观察儿童达到疫苗接种率、家长满意率、以及家长在健康体检前后对儿童健康知识、疫苗接种知识的掌握情况。结果:86名儿童均完成健康体检,有85名儿童接种疫苗,疫苗接种率为98.84%,家长满意率为97.67%,此外家长的儿童健康知识、疫苗接种知识掌握情况也较体检前显著提升,p0.05。结论:儿童免疫接种、健康体检对于儿童的健康成长具有重要意义,需要对儿童的身高、体重、头围、胸围、颅缝、牙齿进行检查,并接种基础疫苗,同时在儿童健康体检的过程中建议对家长开展相关知识宣教,使家长对能够对儿童健康、疫苗接种等必要知识有一定掌握,这助于家长对儿童健康的日常监护,也利于免疫接种工作的有效开展。     

某县儿童计划免疫及时接种情况的调查与分析

目的调查彰武县儿童计划免疫及时接种情况并分析其影响因素。方法采用随机抽查与普查相结合的调查问卷方式,对彰武县儿童计划免疫及时接种情况进行调查分析。结果卡介苗接种率100%;乙型肝炎疫苗接种率99.92%;脊髓灰质炎疫苗接种率99.88%;百白破接种率99.84%;麻风疫苗接种率99.87%;甲型肝炎疫苗接种率99.87%;白破疫苗接种率99.81%;麻腮风疫苗接种率99.86%;流行性乙型脑炎疫苗接种率为99.88%。A群流行性脑脊髓膜炎疫苗接种率为99.93%;A+C流行性脑脊髓膜炎疫苗接种率为99.73%。母亲文化程度、接种次数多、居住地更换、家长计划免疫相关知识的知晓率和家长对接种疫苗的态度5项因素对"五苗"的接种及时性有影响。结论彰武县儿童计划免疫及时接种率较高,但仍需加强免疫宣传工作,完善流动人口的疫苗集中管理规定,提高适龄儿童家长计划免疫的意识及相关知识的知晓率。     

家长对儿童药物临床试验认知与态度调查

目的:了解家长对儿童药物临床试验的认识和态度,为开展儿童药物临床试验提供参考。方法:选择2017 年1-8 月在上海交通大学医学院附属新华医院、复旦大学附属儿科医院、上海交通大学附属儿童医院、哈尔滨儿童医院住院患儿家长,自愿参加问卷调查,收集有效问卷468 份。重点调查内容为儿童药物临床试验目的、意义、必要性、现状以及家长顾虑等。结果:9.4%的家长了解儿童药物临床试验目的,不同学历家长的认识差异有统计学意义(P<0.05);71.6% 的家长认为儿童用药缺乏依据,66.2%家长认为有必要开展药物临床试验,不同学历家长的认识差异有统计学意义(P<0.05);17.9% 的家长认为临床试验管理比较规范,不同学历家长的认识差异无统计学意义(P>0.05);不需要及不知道药物临床试验需要医院伦理委员会审查的家长小学学历占比最高,分别为13.6% 和50.0%,不同学历家长对医院伦理委员会审查的认知差异有统计学意义( P<0.05);担忧孩子身体受伤害的家长占78.8%,担心药物副作用大的家长占69.0%,不同学历的家长对这两方面的认识差异均有统计学意义(P<0.05)。结论:大部分家长对儿童药物临床试验的认识存在偏差,针对不同学历的家长通过加强宣传、沟通,提高家长对儿童药物临床试验的正确认识,是顺利开展儿童药物临床试验的前提条件。     

Implementation of a motivational interviewing-based decision tool to improve childhood vaccination rates: Pilot study protocol

BackgroundParental concerns regarding the safety and efficacy of vaccines have been on the rise over the past decade, resulting in a decline in comprehensive vaccine coverage in children. Healthcare practitioners face many challenges when recommending childhood vaccinations, with many parents refusing vaccination due to these and other concerns. Effective communication strategies and tools can equip providers to communicate with vaccine hesitant parents, but validated tools are currently lacking.ObjectivesThis study aims to develop a validated parental communication tool utilizing motivational interviewing to increase vaccination adherence in children ages 6 years and younger.MethodsThe MOTIVE (Motivational Interviewing Tool to Improve Vaccination Adherence) tool will first be developed based on the most recent literature regarding vaccine hesitancy and related health beliefs. Following tool development, the tool will be reviewed via an external review process to ensure practicality of the tool for use in clinical practice. In implementing the MOTIVE tool, providers and clinic staff will be trained regarding vaccine hesitancy and motivational interviewing. The tool will then be implemented in routine well-child appointments. The primary outcome of this study is the percentage of children 0–6 years of age completing all recommended doses of the core vaccine series after implementation of the MOTIVE tool as compared to prior vaccination years. Secondary outcomes will also include parental attitudes towards vaccines and provider knowledge regarding motivational interviewing components and vaccine hesitancy.Project impactFollowing completion of this study, the MOTIVE tool will be made available for other providers for use in their own clinical practice. The availability of effective communication tools will allow healthcare providers to engage in productive conversations regarding vaccination, aiming to increase vaccine uptake.     

Restoring confidence in vaccines by explaining vaccine safety monitoring: is a targeted approach needed?

Public trust in childhood vaccines is crucial to achieving adequate immunisation coverage to ensure population-level immunity. However, in the UK, immunisation uptake has been adversely affected by vaccine safety scares, such as those surrounding whooping cough and measles, mumps and rubella (MMR). It is our belief that greater public awareness of safety surveillance schemes may play a key role in improving trust in vaccine safety. Many parents of vaccination-age children are unaware of the procedures in place for postmarketing surveillance of vaccines. Thus, we propose specific steps for generating such awareness, such as assisting parents to report suspected adverse reactions directly to the Medicines and Healthcare products Regulatory Agency (MHRA) via the Yellow Card scheme, providing information about adverse reaction reporting with vaccination information packs, and displaying posters and leaflets to convey the message that patient concerns and experiences are taken seriously by the MHRA and to generate further awareness about the scheme. In addition, healthcare staff should be encouraged to report suspected adverse reactions relating to vaccine products. Unresolved issues about the scientific usefulness of data reported by parents and the potential for these steps to increase parental concern and expectations require further investigation.     

The feasibility and acceptability of a pilot randomized controlled trial testing pharmacy-based HPV vaccine completion

ObjectiveImmunizing pharmacists can administer vaccines; however, they are less likely to administer adolescent vaccines such as vaccines that protect against human papillomavirus (HPV). Although past research has recommended incorporating pharmacists to increase adolescent vaccination, few intervention studies have tested healthcare delivery models that incorporate pharmacists to aid in vaccine series completion. This research explored the feasibility and acceptability of an intervention in which pharmacists administered booster doses of the HPV vaccine series.MethodsBetween April 2019 and February 2020, the research team recruited participants for a pilot randomized controlled trial hosted in one federally qualified health center (FQHC) clinic. Researchers asked intervention group participants to complete the HPV vaccine series with their community pharmacists and control group participants to complete the series at their FQHC. We conducted a pre- and post-intervention surveys and in-depth interviews with both intervention and control group participants.ResultsA total of 33 parents of children who received the first dose of the HPV vaccine enrolled in the study of whom 8 intervention and 11 control group participants completed post-intervention data collection. Although there were no statistically significant changes in vaccine completion and in psychometric variables, we did find that pharmacist-delivered HPV vaccination was acceptable, due, primarily, to convenience. Barriers to receiving pharmacist-administered vaccines included pharmacies’ lack of stocking the vaccine and insurance-related barriers to care.ConclusionAlthough a promising and acceptable healthcare delivery approach, there are still barriers for caregivers to have their children vaccinated against HPV at their community pharmacies.     

Surveillance systems and methods for monitoring the post-marketing safety of influenza vaccines at the Centers for Disease Control and Prevention

ABSTRACT

Introduction: Annual influenza vaccine safety monitoring is an important component of the influenza vaccination program in the United States to ensure that vaccines are safe, which is important for maintaining public trust in the national vaccination program. This is specially the case for influenza vaccines since the antigen composition of the viruses of which the vaccine is made often changes from one season to the next, based on the circulating strain of influenza virus.

Areas covered: This review describes the two surveillance systems used by the Centers for Disease Control and Prevention (CDC) to monitor the safety of influenza vaccines: 1) the Vaccine Adverse Event Reporting System (VAERS); and 2) the Vaccine Safety datalink (VSD).

Expert opinion: VAERS and VSD are used routinely to monitor the safety of influenza vaccines in the United States, and over the years they have demonstrated their value in monitoring vaccine safety since their implementation in 1990. Both systems, although different, complemented each other well to study febrile seizures in young children following influenza vaccination during the 2010–2011 influenza season. Other examples of potential safety concerns after influenza vaccines are also presented and discussed.     

Factors Associated With Parental Rules for Adolescent Alcohol Use

This study used the Resilient Families baseline survey to examine associations between the connectedness of parents within the school and parents' rules regarding their children's use of alcohol, prior participation in parenting education, and parents' demographic characteristics. The study involved parents of Year 7 students (mean age 12 years) at secondary schools in Melbourne, Australia (N = 1,238; 2004). Most parents (54%) had no connections with parents of other children in their child's school year. Allowing children to have sips of alcohol or drinks on special occasions was reported by 23% and 6% of parents, respectively, but neither was significantly associated with parental connectedness.     

Factors Associated with Parents' Belief in the Appropriateness of Providing Alcohol to their Child

Background: Parental provision of alcohol to their underage child has been associated with risky adolescent drinking. While parents' belief in the appropriateness of providing their child with alcohol may influence their provision behaviors, research into the factors associated with this belief is lacking. Objectives: This study sought to identify the factors associated with parents' belief in the appropriateness of providing alcohol to their underage child. Methods: Western Australian parents of 12–17 year olds (n = 443) completed an online survey assessing their drinking habits, alcohol provision behaviors, alcohol-related beliefs and attitudes, their child's alcohol consumption, and demographics. Results: Nearly half (44%) the parents surveyed reported providing their underage child with alcohol. Parents of older children and parents who (i) did not believe in the harms and recommendations associated with alcohol use in youth, (ii) agreed with youth-related drinking myths, and (iii) reported more occasions of alcohol consumption by their child were more likely to believe that it was appropriate to provide alcohol to their underage child. Those who believed providing alcohol to their underage child was appropriate were in turn more likely to provide alcohol. Conclusions: Interventions aiming to reduce parental provision of alcohol to children should focus on changing parents' beliefs that this is an appropriate harm minimization behavior. Belief change may be facilitated by the implementation of public education campaigns that increase parents' belief in the alcohol-related harms associated with youth drinking and debunk youth-related drinking myths.     

早产儿疫苗免疫接种研究进展

目的：疫苗的免疫程序和疫苗使用指导原则是保证疫苗免疫效果的重要环节,也是《疫苗管理法》的重要内容之一。早产儿免疫系统发育不成熟,对于各种疫苗免疫反应低于足月儿。本综述为制定早产儿免疫程序提供参考。方法：本文对在早产儿中使用灭活脊髓灰质炎疫苗、百日咳-白喉-破伤风疫苗、乙型肝炎疫苗、肺炎链球菌疫苗、脑膜炎球菌结合疫苗和流感嗜血杆菌疫苗、轮状病毒疫苗、麻疹、腮腺炎、风疹和水痘疫苗等疫苗的免疫效果、安全性及耐受性研究进展进行了归纳整理。结果：本文对早产儿在接种不同疫苗、采取不同免疫策略时体液免疫和细胞免疫效果的研究进行了归纳总结,结果表明虽然早产儿的免疫功能相对较弱,但参照足月新生儿免疫方案接种疫苗后,大部分早产儿可以具有足够的免疫保护力。结论：本文为疫苗免疫程序的制定提供更全面的理解,为制定疫苗使用指导原则提供参考。