Riley D J, Mughal M Z, Roland J
Department of Paediatrics, St Mary's Hospital, Manchester.
BMJ. 1991 Jan 5;302(6767):31-3. doi: 10.1136/bmj.302.6767.31.
To study the need for and effectiveness of a ward based opportunistic immunisation policy.
A six month prospective study.
An acute medical paediatric ward of an inner city teaching hospital.
296 children admitted to the ward who lived within Central Manchester Health Authority boundaries and were aged from 5 months to 6 years.
Completion of immunisation schedule appropriate for age.
56 children were three or more months behind with immunisations. The parent's history was not reliable for 18 children. Accessing health authority immunisation records was not difficult. The main reasons for falling behind were the mobility of the families (15 children), lack of motivation (14), and frequent minor illnesses (9). 40 children were immunised before discharge, but three could not be because of valid contraindications. Of the 16 children requiring more immunisations after discharge, only four obtained them at the correct time and five children not at all.
An opportunistic immunisation policy is an important means of immunising a vulnerable group of children who would often default on routine immunisations, and such policies should operate whenever possible. Our ward based policy can achieve immunisation of three quarters of possible children without change or inconvenience to the daily ward work, but efficacy relies on adequate levels of enthusiastic staff. The system can be improved by having accurate and updated immunisation records available in the hospital, and by encouraging nursing staff to participate.
研究基于病房的机会性免疫政策的必要性及有效性。
为期六个月的前瞻性研究。
市中心一家教学医院的儿科急症病房。
296名入住该病房的儿童，他们居住在曼彻斯特中央卫生局辖区内，年龄在5个月至6岁之间。
完成适合年龄的免疫接种计划。
56名儿童的免疫接种落后三个月或更长时间。18名儿童的家长提供的病史不可靠。获取卫生局的免疫记录并不困难。免疫接种落后的主要原因是家庭流动性大（15名儿童）、缺乏积极性（14名）以及频繁患小病（9名）。40名儿童在出院前接受了免疫接种，但有3名因有有效的禁忌证而未能接种。在出院后需要更多免疫接种的16名儿童中，只有4名在正确时间接种，5名儿童根本未接种。
机会性免疫政策是为一组易漏种常规疫苗的弱势儿童进行免疫接种的重要手段，此类政策应尽可能实施。我们基于病房的政策可以在不改变日常病房工作或造成不便的情况下，为四分之三可能接种的儿童实现免疫接种，但效果依赖于有足够热情的工作人员。通过在医院提供准确和最新的免疫记录，并鼓励护理人员参与，可以改进该系统。
