长春市绿园区扩大免疫规划实施现状与优化对策研究
|
摘要
目的:本文通过对长春市绿园区扩大国家免疫规划实施前后三年的对比研究(2005-2010年),免疫预防服务现状的分析研究,针对存在的问题并提出对策意见,为政府制定对策提供科学依据。
方法:利用绿园区2005年-2010年中国免疫规划监测信息管理系统数据库及专病监测报告系统资料,采用Excel软件进行动态数列统计分析及对比扩免前后接种率和患病率的变化。
结果:2005-2007年,扩大免疫前,甲肝、麻风、麻腮等疫苗为二类疫苗,均属自愿接种,我们无法对接种率进行控制,以致接种水平远远低于规定标准,局部地区无法形成免疫屏障,导致风疹、腮腺炎等疾病的发病率居高不下,扩大免疫后,随着新增疫苗接种率的逐年上升,新增疫苗保护疾病的发病率得到有效控制,甲肝,流行性脑膜炎、乙型脑炎连续三年都没有病例发生,风疹的病例从2005年的121例下降到2010年的2例。基本得到控制,腮腺炎病例从2008年的105例下降到32例,疫情趋势从扩免初期的局部地区爆发控制到局部地区散发病例。到2010年底,绿园区已经基本形成覆盖全区的免疫规划服务网络。
但随着扩大免疫的逐步深入,扩大免疫规划的相关问题也暴露出来,城乡接种率差异较大、疫苗的接种过程出现断裂、异常反应、流动儿童的管理等问题,特别是工作人员逐渐减少的问题使扩大免疫工作遇到了瓶颈。由于行政区域的划分和事业单位分类改革的逐步推进,很多没有编制的医务人员和原单位解除合同。致使预防接种人员从2005年的130人减少到2010年的69人。而扩大免疫后,工作量比扩免前增加了近1/3。人员的逐步减少和工作量的增加形成了短期内无法调节的矛盾,为下一步继续扩大预防接种的范围和人群造成了一定的阻力。
结论:扩大免疫规划工作开展后,新增疫苗接种率有显著提升,但总体发展不均衡。无论是接种率,还是免疫规划常规管理工作,均存在明显的差异。流动儿童免疫程序不清,补种工作难度加大,落实接种对象也更加繁杂,严重影响了免疫规划疫苗的接种。免疫规划人员队伍严重不足,素质不高,辖区人口的增加与免疫规划人员队伍的数量不成比例,导致接种医生工作压力加大,工作缺乏积极性,严重影响免疫规划各项措施的落实。
1. Objectives:
This article makes an analysis of the preventive vaccination work of the Lu Yuan District of Chang Chun city since the implementation of the national immunization project expansion program (2005-2010) and tries to put forward some countermeasure for dealing with the existing situation so as to provide scientific evidence for the making of some related governmental policies.
2 Methods:
The data in the article derive from the data base of the information supervision system of 2005-2010 China National Immunization Program and the monitoring system of special diseases, provided by the Immunization Division of the Center for Disease Control and Prevention of Lu Yuan District. The statistical analysis of data is carried out through the Excel program.
3 Results:
The results showed that before expanding immunization, some vaccines such as Hepetitis A, leprosy, and hemp cheek are the second type of vaccine and voluntary vaccination between the year of 2005 and 2007; we can not control the vaccination rate so that the vaccination is much lower than the standard level, and some local area can not form immune barriers which leads to the diseases such as measles and mumps in high incidence rate. After expanding immunization and along with the increasing of new vaccination year by year, a new vaccine protection of the disease is effectively controlled. Hepetitis A, epidemic meningitis, epidemic encephalitis B have not occurred for three consecutive years, cases of measles from 121 cases in 2005 declined to 2 cases in 2010. Basically under control, mumps cases from 105 cases in 2008 declined to 32 cases, epidemic situation is controlled to local sporadic cases from local area outbreaks of the initial expanding immunization. By the end of 2010, the immune planning service network is almost formed.
With the deepening of expanding immunization, the related problems of expanding immunization program are exposed, such as big differences in rural and urban area, the breakage during vaccine, abnormal reactions and the management of migrant children, especially the issues of the staff gradually reducing make the expanding immunization in difficulty. Due to the administrative division and institutions reform, many medical staff are not official staff or terminate contract with the hospitals, resulting in anti-epidemic personnel reducing from 130 persons in 2005 to 69 persons in 2010. However, the workload increased nearly 1/3 compared with the preceding expanding immunization. The staff gradually reducing and the workload increasing form a contradiction which can not be adjusted in short term and have caused some resistance for going further expanding the scope of vaccination.
4 Conclusion
After the expanding immune program is carried out, the new vaccination immunization rates have significantly increased, but the overall development is not balanced. Whether immunization rates or immunization programming routine managements are plain differences. Immunization procedures of the immigrant children are not clear, which make resowing much more difficult, and make the vaccination target clear more complicated, so those seriously influence the vaccination of immunization program. With lacking of and low quality of immunization program staff, and no balance between the increasing of covered area population and the amount of immunization program staff, it leads to more pressure and lack of enthusiasm of doctors in vaccination, which effect the implements of all measures of immunization program.
方法:利用绿园区2005年-2010年中国免疫规划监测信息管理系统数据库及专病监测报告系统资料,采用Excel软件进行动态数列统计分析及对比扩免前后接种率和患病率的变化。
结果:2005-2007年,扩大免疫前,甲肝、麻风、麻腮等疫苗为二类疫苗,均属自愿接种,我们无法对接种率进行控制,以致接种水平远远低于规定标准,局部地区无法形成免疫屏障,导致风疹、腮腺炎等疾病的发病率居高不下,扩大免疫后,随着新增疫苗接种率的逐年上升,新增疫苗保护疾病的发病率得到有效控制,甲肝,流行性脑膜炎、乙型脑炎连续三年都没有病例发生,风疹的病例从2005年的121例下降到2010年的2例。基本得到控制,腮腺炎病例从2008年的105例下降到32例,疫情趋势从扩免初期的局部地区爆发控制到局部地区散发病例。到2010年底,绿园区已经基本形成覆盖全区的免疫规划服务网络。
但随着扩大免疫的逐步深入,扩大免疫规划的相关问题也暴露出来,城乡接种率差异较大、疫苗的接种过程出现断裂、异常反应、流动儿童的管理等问题,特别是工作人员逐渐减少的问题使扩大免疫工作遇到了瓶颈。由于行政区域的划分和事业单位分类改革的逐步推进,很多没有编制的医务人员和原单位解除合同。致使预防接种人员从2005年的130人减少到2010年的69人。而扩大免疫后,工作量比扩免前增加了近1/3。人员的逐步减少和工作量的增加形成了短期内无法调节的矛盾,为下一步继续扩大预防接种的范围和人群造成了一定的阻力。
结论:扩大免疫规划工作开展后,新增疫苗接种率有显著提升,但总体发展不均衡。无论是接种率,还是免疫规划常规管理工作,均存在明显的差异。流动儿童免疫程序不清,补种工作难度加大,落实接种对象也更加繁杂,严重影响了免疫规划疫苗的接种。免疫规划人员队伍严重不足,素质不高,辖区人口的增加与免疫规划人员队伍的数量不成比例,导致接种医生工作压力加大,工作缺乏积极性,严重影响免疫规划各项措施的落实。
1. Objectives:
This article makes an analysis of the preventive vaccination work of the Lu Yuan District of Chang Chun city since the implementation of the national immunization project expansion program (2005-2010) and tries to put forward some countermeasure for dealing with the existing situation so as to provide scientific evidence for the making of some related governmental policies.
2 Methods:
The data in the article derive from the data base of the information supervision system of 2005-2010 China National Immunization Program and the monitoring system of special diseases, provided by the Immunization Division of the Center for Disease Control and Prevention of Lu Yuan District. The statistical analysis of data is carried out through the Excel program.
3 Results:
The results showed that before expanding immunization, some vaccines such as Hepetitis A, leprosy, and hemp cheek are the second type of vaccine and voluntary vaccination between the year of 2005 and 2007; we can not control the vaccination rate so that the vaccination is much lower than the standard level, and some local area can not form immune barriers which leads to the diseases such as measles and mumps in high incidence rate. After expanding immunization and along with the increasing of new vaccination year by year, a new vaccine protection of the disease is effectively controlled. Hepetitis A, epidemic meningitis, epidemic encephalitis B have not occurred for three consecutive years, cases of measles from 121 cases in 2005 declined to 2 cases in 2010. Basically under control, mumps cases from 105 cases in 2008 declined to 32 cases, epidemic situation is controlled to local sporadic cases from local area outbreaks of the initial expanding immunization. By the end of 2010, the immune planning service network is almost formed.
With the deepening of expanding immunization, the related problems of expanding immunization program are exposed, such as big differences in rural and urban area, the breakage during vaccine, abnormal reactions and the management of migrant children, especially the issues of the staff gradually reducing make the expanding immunization in difficulty. Due to the administrative division and institutions reform, many medical staff are not official staff or terminate contract with the hospitals, resulting in anti-epidemic personnel reducing from 130 persons in 2005 to 69 persons in 2010. However, the workload increased nearly 1/3 compared with the preceding expanding immunization. The staff gradually reducing and the workload increasing form a contradiction which can not be adjusted in short term and have caused some resistance for going further expanding the scope of vaccination.
4 Conclusion
After the expanding immune program is carried out, the new vaccination immunization rates have significantly increased, but the overall development is not balanced. Whether immunization rates or immunization programming routine managements are plain differences. Immunization procedures of the immigrant children are not clear, which make resowing much more difficult, and make the vaccination target clear more complicated, so those seriously influence the vaccination of immunization program. With lacking of and low quality of immunization program staff, and no balance between the increasing of covered area population and the amount of immunization program staff, it leads to more pressure and lack of enthusiasm of doctors in vaccination, which effect the implements of all measures of immunization program.
引文
[1] Asia Pacific Strategy for Emerging Diseases. World Health Organization South East Regional Office, New Delhi, and the WesternPacific Regional Office, and Manila 2005. (http://www.wpro.who.int/NR/rdonlyres/9E5E4116-19A1-4D0C-8991-4C0A284533DD/0/APSEDfinalendorsedandeditedbyEDTmapremovedFORMAT.pdf,accessed 25 February 2011).
[2]朱启镕.为了保障儿童健康必须重视推广预防接种[J]中国实用儿科杂志, 2010,25(3):161.
[3]钟民荣.实施扩大国家免疫规划须破“三难”[J].中国农村卫生事业管理,2009,29(2):146-148.
[4]马丽莉编译.预防接种减少的死亡率及2006-2015年全球预防接种的展望及策略[ J].中国计划免疫,2007,13( 2 ): 100.
[5]关于全球免疫远景与战略的问答[EB/OL]. http://www.who.int/immunization/givs/GIVS_QandA_CH.pdf. [2009-02-18].
[6]殷大鹏,王华庆,曹玲生等. 2006年各国纳入免疫规划疫苗概况[J].中国计划免疫, 2007, 13 ( 3) : 280 - 282.
[7]谭晓东,彭明.预防医学、公共卫生学科概念探讨[J].中国公共卫生,2005,21(1):121
[8]夏国美.公共卫生与传染病防治、挑战和对策[J].城市管理,2003,6(3): 10- 12 .
[9]温群文,孙健.公共卫生的发展与疾控中心人力资源配置[J].中国公共卫生管理,2010,26(2):132.
[10]罗春燕,李敏,张胜年,等.美国公共卫生人力面临的挑战与启示[J].中国卫生资源,2008 ,11(2):99- 100 .
[11]赵铠.扩大免疫规划范围促进疫苗产业发展[J].中国医药生物技术,2007 ,2 (3) :161.
[12] Gibbs EP, Anderson TC.‘One World - One Health’and the global challenge of epidemic diseases of viral aetiology. Veterinaria Italiana, 2009, 45:35–44.pmid:20391388
[13]郭飚. 2005年6月在北京召开的世界卫生组织西太平洋区扩大免疫规划技术咨询组会议[J].中国计划免疫,2005 ,11 (4) :332.
[14]孟庆跃,卞鹰,庄宁,等.公共卫生服务项目成本和累积成本[J].中国卫生经济,2009,20( 215) : 18- 201.
[15]王陇德.疾病预防控制专业人员培训教材-预防接种实践与管理[M].北京:人民卫生出版社,2006.6.
[16]尤尔科.浅论我国免疫规划大扩容[J].中国预防医学杂志, 2008 ,9(4):313-314.
[17]卫生部关于印发《预防接种工作规范》的通知[Z].卫疾控发[2005]373号.
[18]湖南省卫生厅疾控处.湖南省扩大免疫规划县级骨干培训讲义[EB/OL]. [2008].http://www.21hospital.com/zwgk/show.asp?id=2028.
[19]孙晓东,张金芳,张继光.上海市外来流动人口免疫状况调查及对策探讨[J].中国计划免疫,,2002,,8 (4): 214-216.
[20]王陇德.预防接种实践与管理[M].北京:人民卫生出版社, 2008: 143.
[21]许锐恒.免疫接种规划面临的重大挑战[J].广东卫生防疫,2001, 27 (1) :3– 4.
[22]孟庆普.免疫规划扩大功在千秋[N].健康报,2008-02-22(6).
[23]殷大鹏,梁晓峰.中国儿童免疫规划疫苗接种程序和相关问题[ J].中国实用儿科杂志,2010,25(3):163-166.
[24]余文周,金水高,崔钢,等.中国部分地区计划免疫工作经费投入分析[J].中国计划免疫,2005.,11( 4) : 292- 297.
[25]陈莉,樊立华,宋喜林.提升疾病控制中心人力资源地位的必要性及对策[J].中国公共卫生管理,2004,20(4):296- 298.
[26]孟庆普.免疫规划扩容-25亿大单背后的难题[N].健康报.2007-04-27(4).
[27]卢莉,金水高,于竞进,等.不同经济水平地区计划免疫服务的成本测算研究[ J].中华流行病学杂志,2009,25( 8) : 684- 687.
[28]刘萍赵艳波.预防接种工作的现状与发展[J].中国现代药物应用,2010,4(16):226-227.
[29]余文周,崔钢,于竞进.我国预防接种工作筹资机制存在的问题及对策[J].中国计划免疫,2006,12(1):64-67.
[30]罗春燕,李敏,张胜年,等.美国公共卫生人力面临的挑战与启示[J].中国卫生资源,2008 ,11(2):99- 100 .
[31]林献丹,李万仓.温州市流动儿童国家免疫规划疫苗预防接种状况凋查[J].中国疫苗与免疫,2010,16(4):354-355.
[32]周作卿.实施免疫规划工作探讨[J].浙江预防医学,2007 ,19 (5) :83.
[33]郭飚.中国免疫规划工作面临的挑战和机遇与对策[J].中国计划免疫,2006,12(5):415-419.
[34]解西伦.影响流动儿童免疫接种的因素及其管理对策[J].职业与健康,2009,25(11):1196-1197.
[35]赵维芹,孙广合,闫培亮.开展计划免疫规范化接种门诊工作的做法和效果[J].预防医学论坛,,2007, 13(8): 754-755.
[36]易美霞,田本淳,李良,等.3省区已婚妇女妇幼保健知识知晓率及影响因素研究[J].中国健康教育, 2008, 24(4): 244-246.
[37]卫生部.2008年全国计划免疫审评报告[M] .北京:人民卫生出版社, 2008
[38]陈颖.中国疫苗行业竞争格局及发展趋势[J].中国科技投资,2010,(3):38-40.
[39]刘泳洲.加强流动人口管理提高计划免疫服务质量[J].医学动物防制,2009,25(1)65-67.
[40]王克安.中国免疫预防事业的成就与展望[OL]http://doctor.51daifu.com/2007/0305/5B1367D9C964T152542.shtml[2007-03-05]
[2]朱启镕.为了保障儿童健康必须重视推广预防接种[J]中国实用儿科杂志, 2010,25(3):161.
[3]钟民荣.实施扩大国家免疫规划须破“三难”[J].中国农村卫生事业管理,2009,29(2):146-148.
[4]马丽莉编译.预防接种减少的死亡率及2006-2015年全球预防接种的展望及策略[ J].中国计划免疫,2007,13( 2 ): 100.
[5]关于全球免疫远景与战略的问答[EB/OL]. http://www.who.int/immunization/givs/GIVS_QandA_CH.pdf. [2009-02-18].
[6]殷大鹏,王华庆,曹玲生等. 2006年各国纳入免疫规划疫苗概况[J].中国计划免疫, 2007, 13 ( 3) : 280 - 282.
[7]谭晓东,彭明.预防医学、公共卫生学科概念探讨[J].中国公共卫生,2005,21(1):121
[8]夏国美.公共卫生与传染病防治、挑战和对策[J].城市管理,2003,6(3): 10- 12 .
[9]温群文,孙健.公共卫生的发展与疾控中心人力资源配置[J].中国公共卫生管理,2010,26(2):132.
[10]罗春燕,李敏,张胜年,等.美国公共卫生人力面临的挑战与启示[J].中国卫生资源,2008 ,11(2):99- 100 .
[11]赵铠.扩大免疫规划范围促进疫苗产业发展[J].中国医药生物技术,2007 ,2 (3) :161.
[12] Gibbs EP, Anderson TC.‘One World - One Health’and the global challenge of epidemic diseases of viral aetiology. Veterinaria Italiana, 2009, 45:35–44.pmid:20391388
[13]郭飚. 2005年6月在北京召开的世界卫生组织西太平洋区扩大免疫规划技术咨询组会议[J].中国计划免疫,2005 ,11 (4) :332.
[14]孟庆跃,卞鹰,庄宁,等.公共卫生服务项目成本和累积成本[J].中国卫生经济,2009,20( 215) : 18- 201.
[15]王陇德.疾病预防控制专业人员培训教材-预防接种实践与管理[M].北京:人民卫生出版社,2006.6.
[16]尤尔科.浅论我国免疫规划大扩容[J].中国预防医学杂志, 2008 ,9(4):313-314.
[17]卫生部关于印发《预防接种工作规范》的通知[Z].卫疾控发[2005]373号.
[18]湖南省卫生厅疾控处.湖南省扩大免疫规划县级骨干培训讲义[EB/OL]. [2008].http://www.21hospital.com/zwgk/show.asp?id=2028.
[19]孙晓东,张金芳,张继光.上海市外来流动人口免疫状况调查及对策探讨[J].中国计划免疫,,2002,,8 (4): 214-216.
[20]王陇德.预防接种实践与管理[M].北京:人民卫生出版社, 2008: 143.
[21]许锐恒.免疫接种规划面临的重大挑战[J].广东卫生防疫,2001, 27 (1) :3– 4.
[22]孟庆普.免疫规划扩大功在千秋[N].健康报,2008-02-22(6).
[23]殷大鹏,梁晓峰.中国儿童免疫规划疫苗接种程序和相关问题[ J].中国实用儿科杂志,2010,25(3):163-166.
[24]余文周,金水高,崔钢,等.中国部分地区计划免疫工作经费投入分析[J].中国计划免疫,2005.,11( 4) : 292- 297.
[25]陈莉,樊立华,宋喜林.提升疾病控制中心人力资源地位的必要性及对策[J].中国公共卫生管理,2004,20(4):296- 298.
[26]孟庆普.免疫规划扩容-25亿大单背后的难题[N].健康报.2007-04-27(4).
[27]卢莉,金水高,于竞进,等.不同经济水平地区计划免疫服务的成本测算研究[ J].中华流行病学杂志,2009,25( 8) : 684- 687.
[28]刘萍赵艳波.预防接种工作的现状与发展[J].中国现代药物应用,2010,4(16):226-227.
[29]余文周,崔钢,于竞进.我国预防接种工作筹资机制存在的问题及对策[J].中国计划免疫,2006,12(1):64-67.
[30]罗春燕,李敏,张胜年,等.美国公共卫生人力面临的挑战与启示[J].中国卫生资源,2008 ,11(2):99- 100 .
[31]林献丹,李万仓.温州市流动儿童国家免疫规划疫苗预防接种状况凋查[J].中国疫苗与免疫,2010,16(4):354-355.
[32]周作卿.实施免疫规划工作探讨[J].浙江预防医学,2007 ,19 (5) :83.
[33]郭飚.中国免疫规划工作面临的挑战和机遇与对策[J].中国计划免疫,2006,12(5):415-419.
[34]解西伦.影响流动儿童免疫接种的因素及其管理对策[J].职业与健康,2009,25(11):1196-1197.
[35]赵维芹,孙广合,闫培亮.开展计划免疫规范化接种门诊工作的做法和效果[J].预防医学论坛,,2007, 13(8): 754-755.
[36]易美霞,田本淳,李良,等.3省区已婚妇女妇幼保健知识知晓率及影响因素研究[J].中国健康教育, 2008, 24(4): 244-246.
[37]卫生部.2008年全国计划免疫审评报告[M] .北京:人民卫生出版社, 2008
[38]陈颖.中国疫苗行业竞争格局及发展趋势[J].中国科技投资,2010,(3):38-40.
[39]刘泳洲.加强流动人口管理提高计划免疫服务质量[J].医学动物防制,2009,25(1)65-67.
[40]王克安.中国免疫预防事业的成就与展望[OL]http://doctor.51daifu.com/2007/0305/5B1367D9C964T152542.shtml[2007-03-05]