自从美国常规接种水痘疫苗以来，与水痘相关的门诊就诊和住院治疗有所减少。
Decline in varicella-related ambulatory visits and hospitalizations in the United States since routine immunization against varicella.
机构信息
Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
出版信息
Pediatr Infect Dis J. 2010 Mar;29(3):199-204. doi: 10.1097/INF.0b013e3181bbf2a0.
BACKGROUND
Widespread varicella vaccination has led to substantial decreases in varicella-related mortality and hospitalizations. The effect of the vaccine on ambulatory care utilization is poorly defined.
OBJECTIVE
To determine trends in varicella-related ambulatory care and hospital discharges before and after vaccine licensure.
DESIGN, SETTING, AND PARTICIPANTS: Estimates of varicella-related ambulatory and hospital discharges were calculated for the pre- (1993-1995) and post- (1996-2004) vaccine licensure periods using the National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, and National Hospital Discharge Survey.
MAIN OUTCOME MEASURE
Ambulatory and hospital discharge rates for varicella.
RESULTS
The rate of varicella-related ambulatory discharges decreased by 66% from 106.6 per 100,000 (95% confidence interval [CI]: 80.5-132.6) in the prelicensure period to 36.4 per 100,000 population (95% CI: 29.3-43.5) in the post-licensure period (P < 0.001). The decrease was significant across all age groups <45 years, with the greatest reduction (98%) occurring among patients 0 to 4 years of age. The incidence of varicella-related hospital discharges decreased by 53% from 30.9 per 100,000 (95% CI: 24.4-37.3) to 14.5 per 100,000 population (95% CI: 12.1-16.8; P < 0.001). This difference was significant among patients <14 years of age. Rates of varicella-related ambulatory discharges decreased significantly for both whites and non-whites in the postlicensure period, but postlicensure ambulatory discharge rates remained higher for non-whites than for whites. Decreases in varicella-related hospital discharges were statistically significant for whites and non-whites. Racial differences in the incidence of varicella-related hospital discharges also persisted following vaccine licensure.
CONCLUSIONS
Varicella-related ambulatory visits and hospitalizations have decreased significantly in the period after licensure of the varicella vaccine.
背景
广泛的水痘疫苗接种导致与水痘相关的死亡率和住院率大幅下降。疫苗对门诊护理利用的影响还没有明确的定论。
目的
确定疫苗获得许可前后与水痘相关的门诊护理和住院出院趋势。
设计、地点和参与者：使用国家门诊医疗调查、国家医院门诊医疗调查和国家医院出院调查，计算疫苗获得许可前（1993-1995 年）和后（1996-2004 年）两个时期与水痘相关的门诊和住院出院率。
主要观察指标
水痘相关的门诊和住院出院率。
结果
与水痘相关的门诊出院率从获得许可前的每 10 万人 106.6 例（95%置信区间：80.5-132.6）下降了 66%，至获得许可后的每 10 万人 36.4 例（95%置信区间：29.3-43.5）（P < 0.001）。所有<45 岁的年龄组都显著下降，其中 0 至 4 岁的患者降幅最大（98%）。与水痘相关的医院出院率下降了 53%，从每 10 万人 30.9 例（95%置信区间：24.4-37.3）降至每 10 万人 14.5 例（95%置信区间：12.1-16.8；P < 0.001）。这一差异在<14 岁的患者中显著。获得许可后，白人患者和非白人患者的与水痘相关的门诊出院率均显著下降，但非白人患者的门诊出院率仍高于白人患者。与水痘相关的医院出院率下降在白人患者和非白人患者中均具有统计学意义。疫苗获得许可后，与水痘相关的医院出院率的种族差异仍然存在。
结论
水痘疫苗获得许可后，与水痘相关的门诊就诊和住院治疗显著减少。
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