Hurie M B, Saari T N, Davis J P
Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison, Wisconsin 53701-2659, USA.
Pediatrics. 2001 Apr;107(4):755-8. doi: 10.1542/peds.107.4.755.
To determine the impact of the American Academy of Pediatrics/US Public Health Service (AAP/USPHS) joint statement on thimerosal in vaccines on hospital infant hepatitis B vaccination policies in Wisconsin.
The nurse managers of hospital newborn nurseries (n = 110) were surveyed by mail. Nonresponders were resurveyed. Twelve hospitals no longer provided obstetric services. Of the remaining 98 hospitals, 84 (86%) responded to the initial mailing and 14 (14%) responded to the second mailing. The number of hospitals that offered hepatitis B vaccine to infants before July 1999 was compared with that in March 2000. The number of hospitals that had policies in place to vaccinate infants whose mothers' hepatitis B surface antigen status (HBsAg) was positive or unknown during the thimerosal alert (July 1999 through November 1999) was compared with that in March 2000.
Before July 1999, 81% of the hospitals representing 84% of reported Wisconsin births routinely offered hepatitis B vaccine to all infants. By March 2000, 50% of hospitals, representing 43% of births, had resumed routine infant hepatitis B vaccination. Physician decision to use a combination Haemophilus influenzae type b hepatitis B vaccine was the most frequently given reason for not reinstituting infant hepatitis B vaccination. During the thimerosal alert, 23% of hospitals did not have policies to vaccinate infants whose mothers were HBsAg-positive and 51% did not have policies to vaccinate infants whose mothers' HBsAg status was unknown. By March 2000, 6% of hospitals still did not have policies to vaccinate infants whose mothers were HBsAg-positive and 24% did not have policies to vaccinate infants whose mothers' HBsAg status was unknown.
The AAP/USPHS joint statement on thimerosal in vaccines has resulted in a 38% decrease in the number of hospitals routinely offering infants hepatitis B vaccine. Although thimerosal-free hepatitis B vaccine is now available, some hospitals still do not have appropriate policies in place for vaccinating infants whose mothers' HBsAg status is positive or unknown. In the future, policymakers should include anticipated consequences that may result from changes in immunization policy in their recommendations.
确定美国儿科学会/美国公共卫生服务部（AAP/USPHS）关于疫苗中硫柳汞的联合声明对威斯康星州医院婴儿乙肝疫苗接种政策的影响。
通过邮件对医院新生儿重症监护室的护士长（n = 110）进行调查。对未回复者进行再次调查。12家医院不再提供产科服务。在其余98家医院中，84家（86%）回复了首次邮件，14家（14%）回复了第二次邮件。比较1999年7月前为婴儿提供乙肝疫苗的医院数量与2000年3月的数量。比较在硫柳汞警报期间（1999年7月至1999年11月）制定了对母亲乙肝表面抗原状态（HBsAg）为阳性或未知的婴儿进行疫苗接种政策的医院数量与2000年3月的数量。
1999年7月前，代表威斯康星州84%上报出生数的医院中，81%的医院常规为所有婴儿提供乙肝疫苗。到2000年3月，代表43%出生数的50%的医院恢复了常规婴儿乙肝疫苗接种。医生决定使用b型流感嗜血杆菌乙肝联合疫苗是未重新开展婴儿乙肝疫苗接种最常见的原因。在硫柳汞警报期间，23%的医院没有对母亲HBsAg阳性的婴儿进行疫苗接种的政策，51%的医院没有对母亲HBsAg状态未知的婴儿进行疫苗接种的政策。到2000年3月，6%的医院仍然没有对母亲HBsAg阳性的婴儿进行疫苗接种的政策，24%的医院没有对母亲HBsAg状态未知的婴儿进行疫苗接种的政策。
AAP/USPHS关于疫苗中硫柳汞的联合声明导致常规为婴儿提供乙肝疫苗的医院数量减少了38%。尽管现在有不含硫柳汞的乙肝疫苗，但一些医院仍然没有针对母亲HBsAg状态为阳性或未知的婴儿进行疫苗接种的适当政策。未来，政策制定者应在其建议中纳入免疫政策变化可能产生的预期后果。
