医务人员对HIV感染儿童疫苗接种认知情况调查
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摘要
目的了解医疗卫生机构承担预防接种的人员对感染艾滋病病毒(HIV)儿童预防接种知识的了解情况。方法设计调查问卷对湖南省城、乡医疗机构有疫苗接种资格的医务人员进行调查,问卷内容包括明确诊断HIV感染的儿童是否可以接种疫苗、可以接种何种疫苗、不能接种何种疫苗以及提供疫苗接种建议的依据及考虑因素等,对影响预防接种正确选择的因素进行统计分析。结果 810名受访者中,558人(68.9%)认为要选择性接种疫苗,但只有167人(20.6%)能完全正确选择适种疫苗,提供正确预防接种建议。在提供接种建议时首要考虑因素是患儿的病情,是否有临床症状及患儿的免疫状态,11.3%(91/808)选择参照国家指南。对知晓HIV感染的儿童应选择性接种疫苗的医务人员的多因素分析显示,在提供正确预防接种建议方面,公共卫生专业是临床医学的医生的3.36倍[95%可信区间(CI):1.71～6.58];工作6～10年的医务人员是工作0～5年的2.21倍(95%CI:1.34～3.64);工作在城市的医务人员是工作在农村地区的0.38倍(95%CI:0.24～0.62)。结论承担预防接种的医务人员对于HIV感染儿童接种疫苗知识掌握不足,不同专业、工作年限及城乡之间认知差别较大,需要加强对《国家免疫规划儿童免疫程序及说明(2016年版)》的学习。
Objective To learn the health care professional's knowledge of the vaccination of children infected with HIV in public health institutions in Hunan province.Methods A questionnaire was developed to investigate health care professionals to see whether they know that children diagnosed as HIV-infection could be vaccinated,what vaccines could and could not be vaccinated,as well as the basis and consideration factors for vaccination recommendations.Statistical analysis was conducted on the factors influencing vaccination.Results Out of the 810 health professionals surveyed,558(68.9%)answered that HIV-infected children could be vaccinated,but only 167(20.6%)knew the right vaccines and could provide proper vaccination recommendations.The primary consideration in making vaccination recommendations was the children's condition,i.e.their clinical symptoms and immune status.91people(11.3%)chose to refer to the national guidelines.Multi factors statistical analysis showed that public health professionals were 3.36 times more likely than clinicians(95%CI:1.71-6.58)to provide accurate vaccination advice;medical staff having worked for 6-10 years were 2.21 times more than those having worked for 0-5years(95%CI:1.34-3.64),and medical staff working in urban areas were 0.38 times more than those working in rural areas(95%CI:0.24-0.62).Conclusion Professionals in public health institutions have insufficient knowledge of the vaccination of children infected with HIV and there are great differences in cognition between different professional working years and between urban and rural areas.Therefore,it is necessary to strengthen the training of the children immunization procedures and instructions of the national immunization program(2016edition).
Objective To learn the health care professional's knowledge of the vaccination of children infected with HIV in public health institutions in Hunan province.Methods A questionnaire was developed to investigate health care professionals to see whether they know that children diagnosed as HIV-infection could be vaccinated,what vaccines could and could not be vaccinated,as well as the basis and consideration factors for vaccination recommendations.Statistical analysis was conducted on the factors influencing vaccination.Results Out of the 810 health professionals surveyed,558(68.9%)answered that HIV-infected children could be vaccinated,but only 167(20.6%)knew the right vaccines and could provide proper vaccination recommendations.The primary consideration in making vaccination recommendations was the children's condition,i.e.their clinical symptoms and immune status.91people(11.3%)chose to refer to the national guidelines.Multi factors statistical analysis showed that public health professionals were 3.36 times more likely than clinicians(95%CI:1.71-6.58)to provide accurate vaccination advice;medical staff having worked for 6-10 years were 2.21 times more than those having worked for 0-5years(95%CI:1.34-3.64),and medical staff working in urban areas were 0.38 times more than those working in rural areas(95%CI:0.24-0.62).Conclusion Professionals in public health institutions have insufficient knowledge of the vaccination of children infected with HIV and there are great differences in cognition between different professional working years and between urban and rural areas.Therefore,it is necessary to strengthen the training of the children immunization procedures and instructions of the national immunization program(2016edition).
引文
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[11]国家卫生和计划生育委员会办公厅.关于全面开展预防艾滋病、梅毒和乙肝母婴传播工作的通知.国卫办妇幼发(2015)23号[EB/OL].(2015-06-16)[2018-03-10]http://www.moh.gov.cn/fys/s3581/201506/4f2123fa955a44afa75a75da2ad35d6e.shtml.
[12]国家卫生和计划生育委员会.《国家免疫规划儿童免疫程序及说明(2016年版)》国卫办疾控发(2016)52号[EB/OL].(2016-12-29)[2018-03-10]http://www.nhfpc.gov.cn/jkj/s3581/201701/a91fa2f3f9264cc186e1dee4b1f24084.shtml.2016-12-29.
[2]王丽艳,秦倩倩,丁正伟,等.中国报告15岁以下儿童艾滋病病例流行特征分析[J].疾病监测,2017,32(3):227-231.
[3]张夏燕,李萌,冯一冰,等.中国2011-2014年艾滋病母婴阻断效果的Meta分析[J].中国艾滋病性病,2015,21(4):275-279.
[4]王奇,马楠,司珩,等.河南省2002-2014年HIV暴露儿童死亡水平及影响因素分析[J].中华流行病学杂志,2017,38(12):1629-1633.
[5]George K Siberry,Mark J Abzug,Sharon Nachman,et al.Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children[J].Pediatr Infect Dis J,2013,32(2):i-KK4.
[6]WHO.Measles vaccines:WHO position paper-28 April 2017,Grading of scientific evidence in support of key recommendations[EB/OL][2018-03-10].http://www.who.int/immunization/measles_grad_HIV.pdf?ua=1&ua=1.
[7]WHO.Safety update of BCG vaccine[EB/OL].http://www.who.int/vaccine_safety/committee/topics/bcg/June_2017/en/published in the WHO Weekly Epidemiological Record of 14July 2017.
[8]Edwin J Asturias,Melinda Wharton,Robert Pless,et al.Contributions and challenges for worldwide vaccine safety:The Global Advisory Committee on Vaccine Safety at 15years[J].Vaccine,2016,34(29):3342-3349.
[9]殷大鹏,郑景山,周玉清,等.人类免疫缺陷病毒(HIV)阳性的儿童和HIV阳性母亲的新生儿接种疫苗的策略[J].中国疫苗和免疫,2008,14(1):79-85.
[10]国家卫生计生委办公厅关于印发预防接种工作规范(2016年版)的通知.国卫办疾控发(2016)51号[EB/OL].(2016-12-29)[2018-03-10]http://www.nhfpc.gov.cn/jkj/s3581/201701/8033406a995d460f894cb4c0331cb400.shtml.
[11]国家卫生和计划生育委员会办公厅.关于全面开展预防艾滋病、梅毒和乙肝母婴传播工作的通知.国卫办妇幼发(2015)23号[EB/OL].(2015-06-16)[2018-03-10]http://www.moh.gov.cn/fys/s3581/201506/4f2123fa955a44afa75a75da2ad35d6e.shtml.
[12]国家卫生和计划生育委员会.《国家免疫规划儿童免疫程序及说明(2016年版)》国卫办疾控发(2016)52号[EB/OL].(2016-12-29)[2018-03-10]http://www.nhfpc.gov.cn/jkj/s3581/201701/a91fa2f3f9264cc186e1dee4b1f24084.shtml.2016-12-29.