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目的探讨提高贫困地区新生儿首针乙肝疫苗及时接种率的免疫服务模式。方法采用不同的免疫服务模式,分别由不同的接种人员采用不同的方式为不同的接种对象提供首针乙肝疫苗接种服务,分析比较不同服务模式对提高贫困地区新生儿首针乙肝疫苗及时接种率的效果。结果项目实施后,预充疫苗组和常规疫苗组乙肝疫苗首针及时率较项目前均有了较大幅度的提高,前者明显高于后者(χ2=16.03,P<0.01);在家分娩新生儿由村医接种者及时接种率高于乡级防保员接种者,使用预充疫苗者高于常规疫苗者(χ2=20.09,P<0.01;χ2=16.03;P<0.01);筛查阳性孕妇分娩新生儿乙肝疫苗首针及时接种率为94.4%,远高于未筛查组(χ2=26.51,P<0.01)。结论采用自毁型预充式乙肝疫苗,并且在冷链外存放,由村医负责首针乙肝疫苗接种是提高在家分娩新生儿乙肝疫苗首针及时接种率的最佳服务模式。开展孕妇筛查对阳性母亲所生新生儿及时接种乙肝疫苗,能阻断母婴传播和减少接种后发生异常反应的风险,是值得进一步探讨的课题。
Objective To explore the immune service mode to improve the timely immunization rate of the first-dose hepatitis B vaccine for newborns in poor areas. Methods Different modes of immunization service were used. Different vaccinations were given different ways to provide the first-dose hepatitis B vaccination service to different inoculation subjects. Analysis and comparison of different service modes to improve timely vaccination rate of new-born first-dose hepatitis B vaccine in poor areas effect. Results After the implementation of the project, the first needle-in-time rate of hepatitis B vaccine in the pre-vaccination group and the conventional vaccine group was significantly higher than that of the previous project, the former was significantly higher than the latter (χ2 = 16.03, P <0.01) Children vaccinated by village doctors inoculated in a timely manner were higher than those who were vaccinated by township level defenders. Those who used pre-vaccinated vaccines were higher than those who used conventional vaccines (χ2 = 20.09, P <0.01; χ2 = 16.03; P <0.01) The first-time inoculation rate of neonatal hepatitis B vaccine in pregnant women was 94.4%, much higher than that of the non-screening group (χ2 = 26.51, P <0.01). Conclusion The self-destruct pre-filled hepatitis B vaccine is stored outside the cold chain, and the village doctor is responsible for the first-dose hepatitis B vaccination. This is the best service mode to improve timely vaccination rate of newborn hepatitis B vaccine at home. Carrying out screening for pregnant women to timely immunization of newborn infants born by positive mothers can delay the transmission of mother-to-infant and reduce the risk of abnormal reaction after inoculation, which is worth discussing further.