中国医疗机构工作人员流感疫苗预防接种指南

为了加强中国医疗机构工作人员流感疫苗的接种, 中华预防医学会医院感染控制分会联合中国临床实践指南联盟制定了《中国医疗机构工作人员流感疫苗预防接种指南》。本指南结合国内外研究进展和专家意见, 主要关注了7个临床相关问题, 并根据牛津循证医学中心2011版证据质量评估表对研究进行证据评级, 最终形成推荐意见。指南强调了医疗机构工作人员接种流感疫苗的重要性, 降低自身流感患病率可有效减少医院传播风险。本指南建议: 如无禁忌证, 医疗机构工作人员均应积极接种流感疫苗。推荐对感染传播风险极高的工作人员、高危人群和孕妇优先接种流感疫苗。另外, 指南还提供了疫苗的选择、接种时间及接种频次的建议。鉴于目前我国医疗机构工作人员流感疫苗接种率偏低且地区差异明显, 本指南建议进一步加强关于流感疫苗接种的健康教育, 根据各个省市区具体情况, 采取"多元化"方法, 积极开展有组织的接种活动。     

栖霞市某卫生院流感疫苗预防接种分析

流行性感冒是由流感病毒引起的传染性很强的疾病,因病毒的变异性大,给流感的防疫带来困难,中西医对流感的治疗又没有特效的抗病毒药物.近几年来,我院除宣传卫生知识外采用流感疫苗接种预防流感,现就我们运用国产疫苗的情况报道如下.     

流感疫苗群体性预防接种的护理干预

目的:分析护理干预在流感疫苗群体性预防接种的应用效果.方法:选取2015年1月-2016年12月共计1000名接种流感疫苗儿童作为观察对象,随机分为观察组与对照组,每组500例.观察组采用优质护理干预,对照组采取常规护理干预.比较两组接种反应发生率和群体性心因反应发生率.结果:观察组在接种反应发生率和群体性心因反应发生率方面均低于对照组(P＜0.05).结论:优质护理干预在流感疫苗群体性预防接种中具有较好的应用效果,能够有效降低接种反应发生率和群体性心因反应发生率,提高接种效率和质量.     

中国流感疫苗预防接种技术指南(2021 — 2022)

流行性感冒（简称流感）与新型冠状病毒肺炎（简称新冠肺炎）均为呼吸道传染病,若二者合并感染,不但会加重病情、延长病程,且会使死亡率升高,特别是对老年人、儿童及慢性病人群风险更大,同时还会给患者个人、家庭及社会带来沉重的疾病经济负担。因此,在全球新冠肺炎大流行背景下,加强对流感的防控具有重要的现实意义。本文从中国流感防控现状和长期目标及新冠肺炎疫情防控背景下流感防控的新形势和新要求2个方面概述目前中国流感疾病负担、问题与挑战,并提出相关流感防控的应对策略。     

中国流感疫苗预防接种技术指南(2021 — 2022)

  目的  分析浙江省杭州市2019 — 2021年灭活流感疫苗（IIV）接种后疑似预防接种异常反应（AEFI）发生特征。  方法  通过浙江省疫苗和预防接种综合管理信息系统和全国AEFI信息管理系统收集2019 — 2021年IIV接种情况和AEFI报告个案,描述性分析IIV接种后AEFI报告发生率。  结果  2019 — 2021年杭州市报告IIV AEFI个案568例,报告发生率为40.48/10万剂;其中一般反应和异常反应报告发生率分别为34.70/10万剂（487例）、3.42/10万剂（48例）。 < 3、3～17、18～59和 ≥ 60岁人群接种IIV AEFI的发生率分别为88.71/10万剂（180例）、51.11/10万剂（162例）、38.87/10万剂（74例）、21.93/10万剂（152例）。接种4价IIV（IIV4）后局部红肿和局部硬结的发生率（25.64、14.13/10万剂）均高于接种3价IIV（IIV3）（9.30、5.19/10万剂）（P < 0.05）,异常反应发生率均无显著性差异（P > 0.05）。  结论  杭州市2019 — 2021年IIV AEFI报告发生率较低,IIV3和IIV4均具有良好的安全性。     

甲型H1N1流感疫苗预防接种知识

日前，卫生部官方网站发布“甲型H1N1流感疫苗预防接种知识答问”．具体内容如下：     

中国2018-2019年和2019-2020年流感季流感疫苗疑似预防接种异常反应监测

目的 分析中国流感疫苗(Influenza vaccine, InfV)疑似预防接种异常反应(Adverse events following immunization, AEFI)发生特征。方法 通过中国疾病预防控制信息系统收集2018-2019年和2019-2020年流感季InfV接种数据及AEFI报告数据,描述性分析AEFI分布特征和报告发生率。结果 两个流感季中国共报告12 383例InfV AEFI,总报告发生率为41.04/10万,其中一般反应、异常反应分别为37.41/10万、2.19/10万。一般反应中高热、局部红肿(直径>2.5cm)、局部硬结(直径>2.5cm)报告发生率分别为18.28/10万、5.95/10万、1.85/10万;异常反应中过敏性皮疹、热性惊厥、血管性水肿报告发生率分别为1.51/10万、0.16/10万、0.16/10万。结论 中国2018-2019年和2019-2020年流感季InfV不良反应报告水平在可接受范围内,应继续加强InfV AEFI监测,提高监测质量。     

2019—2021年广东省流感疫苗疑似预防接种异常反应监测分析

目的 评估广东省流感疫苗安全性。方法 通过中国疾病预防控制信息系统—免疫规划模块收集2019年1月至2021年5月广东省流感疫苗疑似预防接种异常反应（AEFI）监测数据,采用STATA 14.0进行数据分析。结果 2019年1月至2021年5月广东省流感疫苗共报告AEFI 1 431例,报告发生率20.32/10万剂次,三价流感疫苗报告发生率（21.52/10万剂次）高于四价流感疫苗（17.65/10万剂次）。不良反应1 239例,报告发生率为17.60/10万剂次。一般反应987例,报告发生率为14.02/10万剂次,以发热为主（75.76%）;异常反应252例,报告发生率为3.58/10万剂次,以过敏性皮疹为主（71.43%）。异常反应疾病转归为好转或治愈占97.62%。结论 广东省流感疫苗接种具有良好的安全性。     

2016 - 2018年浦东新区流感疫苗疑似预防接种异常反应监测结果分析

目的 评价浦东新区2016 - 2018年流感疫苗预防接种的安全性,为流感疫苗接种提供科学依据。方法 收集疑似预防接种异常反应信息管理系统中2016 - 2018年浦东新区流感疫苗疑似预防接种异常反应（adverse events following immunization,AEFI）监测数据,采用R3.4软件进行统计分析。结果 2016 - 2018年浦东新区流感疫苗AEFI报告发生率为15.72/100万剂次,其中一般反应报告发生率为15.68/100万剂次,异常反应报告发生率为0.05/100万剂次,未发现偶合症和心因性反应。2016 - 2018年接种疫苗发热者288例,占82.76%;局部红肿64例,占18.39%,局部硬结14例,占4.02%,其他症状间73例,占20.98%。接种0.25 ml剂量发热者199例(69.10%),接种0.50 ml剂量发热者89例(30.90%),不同接种剂量发热率差异有统计学意义（P = 0.040）。结论 浦东新区流感疫苗AEFI报告发生率低于其他省份,应继续强化接种门诊人员培训,积极开展预防接种宣传,加强流感疫苗AEFI监测,提升疫苗AEFI数据的可信性。     

甲型H_1N_1流感疫苗的疑似预防接种异常反应监测

目的监测分析大规模甲型H1N1流感疫苗的安全性和疑似预防接种异常反应(AEFI)发生特征,评价AEFI监测系统运转状况。方法通过浙江省预防接种个案信息系统和国家AEFI监测系统,收集2009年10月29日-2010年1月15日报告的接种信息和AEFI个案数据,采用描述性分析方法对AEFI的分布特征及相关指标进行统计分析。结果全省共报告约189万名接种个案信息和433例AEFI,发生率为22.83/10万,20～44岁的成人发生率较高;AEFI发生主要集中在接种后24h内,AEFI1d报告率73%,1d调查率92%;AEFI临床损害以发热、红肿最为多见,观察到的所有AEFI预后良好。结论浙江省AEFI监测的敏感性和及时性较好;大规模接种甲型H1N1流感疫苗AEFI发生率较低,具有良好的安全性。     

我国6个省份全人群流感疫苗接种及认知情况调查

目的 了解调查地区全年龄组人群流感预防知识的认知及流感疫苗接种情况，探索影响流感疫苗接种的相关因素。方法 采用横断面调查设计，选择北京市、内蒙古自治区、上海市、广东省、云南省和甘肃省6个省份，通过12320卫生热线采用随机数字表拨打电话的抽样方法，于2018年3-5月开展全年龄组人群的流感防控知识、流感疫苗接种情况的电话调查，调查估计样本量为9 438人。结果 本调查应答率为46.4%（10 045/21 658），10 045名调查对象中，"流感和普通感冒有区别"的知晓率为75.3%（7 564/10 045），"流感病毒会引起严重后果"的知晓率为82.0%（8 241/10 045）。出现流感样症状后采取频繁洗手、戴口罩和自我隔离的健康行为率分别为80.4%（7 936/9 873）、75.8%（7 506/9 899）和73.6%（7 228/9 822）。最近1年流感疫苗接种率为5.7%（570/10 037）。最近1年流感疫苗接种率的相关多因素logistic回归分析结果显示，调查对象来自甘肃省或北京市、职业是医务人员或全日制学生、调查对象共同居住人数≥ 2人、出现流感样症状后戴口罩，最近1年流感疫苗接种率相对较高。结论 6个省份调查对象流感相关知识的知晓率、出现流感相关症状后的健康行为率和最近1年流感疫苗接种率均有待进一步提高。应加强流感预防知识和疫苗接种的健康教育，探索流感疫苗免费接种策略。     

Seasonal influenza vaccination policies in the Eastern Mediterranean Region: Current status and the way forward

Background

The World Health Organization recommends annual influenza vaccination, especially in high-risk groups. Little is known about the adoption and implementation of influenza vaccination policies in the Eastern Mediterranean Region.

Mandatory policies for influenza vaccination: Views of managers and healthcare workers in England

Introduction

Mandatory policies have the potential to increase uptake of influenza (‘flu’) vaccination among healthcare workers (HCWs), but concerns have been expressed about their acceptability and effectiveness. We explored views on three mandatory policies (declination forms, face masks or reduced patient contact, and mandatory vaccination) among both HCWs and flu vaccination programme managers in the National Health Service (NHS) in England.

Importance of vaccination habit and vaccine choice on influenza vaccination among healthy working adults

This randomized cluster trial was designed to improve workplace influenza vaccination rates using enhanced advertising, choice of vaccine type (intranasal or injectable) and an incentive. Workers aged 18–49 years were surveyed immediately following vaccination to determine factors associated with vaccination behavior and choice. The questionnaire assessed attitudes, beliefs and social support for influenza vaccine, demographics, and historical, current, and intentional vaccination behavior. Of the 2389 vaccinees, 83.3% received injectable vaccine and 16.7% received intranasal vaccine. Factors associated with previous influenza vaccination were older age, female sex, higher education and greater support for injectable vaccine (all P < .02). Current influenza vaccination with intranasal vaccine vs. injectable vaccine was associated with higher education, the study interventions, greater support for the intranasal vaccine and nasal sprays, less support of injectable vaccine, more negative attitudes about influenza vaccine, and a greater likelihood of reporting that the individual would not have been vaccinated had only injectable vaccine been offered (all P < .01). Intentional vaccine choice was most highly associated with previous vaccination behavior (P < .001). A key to long term improvements in workplace vaccination is to encourage first time influenza vaccination through interventions that include incentives, publicity and vaccine choice.     

Overview of the influenza vaccination activities and legal frameworks in 26 Swiss cantons during the influenza season 2019/20

BackgroundIn Switzerland, the implementation of national health and prevention strategies is regulated at the cantonal level. To date, no in-depth inventory outlining the cantonal health activities and legal frameworks for influenza vaccination exists.ObjectiveTo assess the activities and legal frameworks for influenza vaccination during the 2019/20 season across all 26 Swiss cantons.MethodSurvey using a structured closed-ended questionnaire.ResultsThe activities’ range across the cantons is broad from 11 activities in the canton Vaud to one in cantons Grisons and Jura. French/Italian-speaking cantons conduct 1.5 times more influenza vaccination activities on average than the German-speaking cantons. 23 of 26 cantons authorize influenza vaccination by pharmacists. All cantons allow nurses to vaccinate under the responsibility of a doctor.ConclusionInfluenza vaccination activities and vaccination-specific legal frameworks vary by canton and linguistic regions. Future vaccination strategies should consider concerted approaches to optimize their successful implementation.     

上海市中小学生接种甲型H1N1流行性感冒疫苗的成本-效益分析

目的 评价上海市中小学生接种甲型H1N1 流行性感冒(简称甲流)病毒裂解疫苗(简称甲流疫苗)的成本效益.方法 采用准试验设计,在上海市6个区县的中小学生中开展甲流疫苗接种和效益评估,共观察414 636名中小学生.按自愿原则,将研究对象分为接种组(233 445名)和对照组(181 191名).采用问卷调查方法在上海市19个区县预防接种机构收集疫苗接种成本信息;通过问卷调查和回顾性病历摘录等方法收集就医成本信息,其中包括31例轻症、15例重症甲流病例.最后采用卫生经济学评估方法进行流行性感冒(简称流感)疫苗的成本-效益分析.结果 共观察414 636名中小学生,其中接种组233 445名,占56.3%,对照组181 191名.疫苗接种后,接种组流感罹患率为0.61%(1433/233 445),对照组罹患率为1.76%(3166/181 191),接种组流感样病例保护率为65.34% [(1.76-0.61)/1.76].人均接种甲流疫苗的成本为36.81元.轻症甲流病例门诊费用为(358.3±243.6)元,甲流重症病例住院费用为(49 188.4±99 917.3)元.中小学生甲流疫苗接种总效益为19 155 566.3元;接种净效益为10 560 673.7元,效益-成本比为2.24:1.结论 上海市中小学生接种甲流疫苗有一定的保护效果,具有较好的效益,是一种值得尝试的干预策略.

Abstract：

s of retrospective medical records,which included 31 mild cases and 15 severe cases.The cost-benefit analysis was conducted by health economic evaluation.Results In total,there were 414 636 students enrolled in this study; while 233 445 (56.3%) students were in the vaccinated group and 181 191 in the control group.The attack rate in vaccinated group and control group was 0.61%(1433/233 445) and 1.76%(3166/181 191) respectively.The protection ratio was 65.34% ((1.76-0.61)/1.76) in the vaccinated group.The average cost of Influenza H1N1 was 36.81 yuan/person; and the average cost of medical treatment was (358.3±243.6) yuan/mild case and (49 188.4±99 917.3) yuan/severe case.The total benefit of vaccination in schools was 19 155 566.3 yuan,and the net 1.Conclusion Influenza H1N1 vaccine could protect the students from Influenza H1N1 infection,and the cost-benefit analysis showed that the intervention strategy was worth trying.     

我国两个地区儿童流感疫苗与肺炎疫苗接种现状与影响因素分析

目的 了解儿童流感疫苗和肺炎疫苗的接种行为与影响因素。方法 采用两阶段整群抽样,在北京市通州区和甘肃省白银市对适龄儿童家长开展横断面问卷调查,分析儿童流感疫苗和肺炎疫苗接种率及影响因素。结果 共纳入2 377名儿童,儿童流感疫苗接种率为35.93%,肺炎疫苗接种率为16.58%,两种疫苗均接种率为11.65%。接种两种疫苗的理由占比前三位分别为认为疾病严重（流感疫苗：36.02%;肺炎疫苗：49.61%）、学校、单位要求接种（流感疫苗：28.76%;肺炎疫苗：25.45%）和认为疾病易感（流感疫苗：26.41%;肺炎疫苗：13.88%）;未接种疫苗的理由前三位分别为个人方面、疫苗本身和疫苗供应。家庭居住地为农村是影响两类疫苗接种的重要因素。子女数量>1个的家庭、家庭居住地为农村和家庭人均年收入较低与两类疫苗的接种呈负相关。结论 调查地区儿童流感疫苗和肺炎疫苗接种率较低,农村家庭、多子女家庭是扩大疫苗接种的重点关注人群。加强疫苗相关知识宣教,引导家长正确认知疫苗安全性问题,协调疫苗供应与降低疫苗价格对提高流感疫苗和肺炎疫苗接种率具有促进作用。     

流感疫苗在高危人群中应用安全性、有效性及接种现状研究新进展

对2020年国内外不同高危人群流感疫苗应用情况发表的相关研究进展进行综述。流感疫苗在高危人群中接种的重要性得到了更多大样本、多中心、高质量循证证据的支持。接种流感疫苗是预防流感最经济有效的措施,目前我国流感疫苗接种率很低,需进一步加大对各类人群流感疫苗接种的科普宣传与教育。建议流感季来临前对研究证据明确的疫苗接种安全有...     

Barriers and facilitators to uptake and promotion of influenza vaccination among health care workers in the community in Beijing,China: A qualitative study

BackgroundIn the prevention and control of influenza, it is important for healthcare workers (HCWs) to be vaccinated and recommend influenza vaccines to their patients. However, there is limited evidence on the factors influencing uptake and promotion of influenza vaccination to patients among HCWs in China.MethodsWe conducted in-depth interviews among HCWs in community health centers, including general practitioners (GPs) and preventive health workers (PHWs), during January to February 2017. A total of 21 individuals, purposively selected from six community health centers covering central districts and remote suburbs in Beijing, were interviewed using semi-structured topic guides. Thematic analysis was used to analyze the interviews and coding framework was developed both inductively and deductively.ResultsIdentified factors influencing influenza vaccine uptake included knowledge, perception and recognition, and prior experience of vaccine uptake. All PHWs conservatively recommended influenza vaccine because of concerns about potential patient–doctor disputes. GPs rarely recommended vaccination under their own initiative because vaccine promotion was not their duties. Notably, we found that the division of work was an underlying reason for the different behaviors regarding vaccine uptake and promotion between GPs and PHWs.ConclusionsOur findings highlighted a combination of misconceptions and cognitive biases limiting influenza vaccine uptake among HCWs in China. Our findings indicate that promotion of health education regarding influenza vaccination should be implemented among HCWs. Importantly, the division of work greatly affects the behaviors of HCWs. GPs, who are at the front line in the doctor–patient relationship, have a critical role in influenza vaccination programs.     

Parental perceptions of childhood seasonal influenza vaccination in Singapore: A cross-sectional survey

PurposeSeasonal influenza vaccination is recommended in children aged 6–59 months, but little is known about child vaccination coverage and determinants in Asian settings. We report the results of a survey of knowledge, attitudes, practices, and determinants of child influenza vaccination in Singapore.MethodsIn December 2015-March 2016, we conducted a survey of 332 parents of children aged 6 months to 5 years attending pre-schools. We assessed child influenza vaccine coverage and parental knowledge, attitudes, and practices of child influenza vaccination. We used multivariable regression and structural equation models to identify factors associated with child influenza vaccination.ResultsKnowledge about influenza, perceived benefit of vaccination, and willingness to vaccinate were high. However, only 32% of children had ever received influenza vaccine, and only 15% in the past year. Factors independently associated with child influenza vaccination included: being recommended influenza vaccine by a child’s doctor (prevalence ratio (PR) = 2.47, 95% CI: 1.75–3.48); receiving influenza vaccine information from a private general practitioner (PR = 1.47, 95% CI: 1.05–2.04); regularly receiving pre-travel influenza vaccine (PR = 1.64, 95% CI: 1.19–2.25); higher willingness to vaccinate (PR = 1.58, 95% CI:1.24–2.04 per unit increase in willingness score); and feeling well-informed about influenza vaccine (PR = 1.44, 95% CI: 1.04–1.99). Parents who obtained influenza vaccine information from television were less likely to have vaccinated their child (PR = 0.44, 95% CI: 0.23–0.85). Path analysis indicated that being recommended vaccination by a child's doctor increased willingness to vaccinate and self-efficacy (feeling well-informed about influenza vaccine). Median willingness-to-pay for a dose of influenza vaccine was SGD30 (interquartile range: SGD20-SGD50), and was higher in parents of vaccinated compared with unvaccinated children (SGD45 vs SGD30, p = 0.0012).ConclusionKnowledge and willingness to vaccinate was high in this parent population, but influenza vaccine uptake in children was low. Encouraging medical professionals to recommend vaccination of eligible children is key to improving uptake.