Pahud Barbara, Clark Shannon, Herigon Joshua C, Sherman Ashley, Lynch Daryl A, Hoffman Amber, Jackson Mary Anne
Divisions of Infectious Diseases,
Divisions of Infectious Diseases.
Hosp Pediatr. 2015 Jan;5(1):35-41. doi: 10.1542/hpeds.2014-0027.
Screening of immunization status at each health care encounter is recommended to improve immunization coverage rates but is often limited to primary care practices. A pilot intervention study was performed to ascertain the immunization status of hospitalized children and determine if development of an immunization plan before discharge would improve the vaccination status for such children.
On the basis of power calculations estimated to detect an increase in immunization status from 60% to 70% with 80% power, 356 randomly selected children were enrolled between March 6, 2012 and June 14, 2012. Immunization records were obtained, immunization status determined, and parent/guardian informed if catch-up dose(s) were needed. If parent requested vaccine dose(s), they were administered before discharge.
Vaccination status was current per Advisory Committee on Immunization Practices guidelines in 73% of hospitalized children, and 27% children required catch-up dose(s) (200 doses for 95 children). Human papilloma virus vaccine (dose 1), varicella zoster vaccine (dose 2), and meningococcal conjugate vaccine were the most commonly identified dose(s) needed. Of those requiring catch-up dose(s), 25% were caught up, increasing vaccination status to 80% at 1-month post hospital discharge.
This is the first study to determine the immunization status of hospitalized pediatric patients of all ages, including adolescents, providing new data on the immunization status of the inpatient pediatric population. A pilot intervention consisting of obtaining immunization records, determining immunization status, and discussing catch-up dose(s) before discharge resulted in improvement of immunization status, suggesting that the inpatient setting may be used along with many other national strategies to help address missed vaccination opportunities.
建议在每次医疗保健就诊时筛查免疫接种状况，以提高免疫接种覆盖率，但这通常仅限于初级保健机构。开展了一项试点干预研究，以确定住院儿童的免疫接种状况，并确定出院前制定免疫接种计划是否会改善此类儿童的疫苗接种状况。
根据功效计算，估计以80%的功效检测免疫接种状况从60%提高到70%，在2012年3月6日至2012年6月14日期间随机选取356名儿童入组。获取免疫接种记录，确定免疫接种状况，并在需要补种时通知家长/监护人。如果家长要求接种疫苗，则在出院前进行接种。
根据免疫实践咨询委员会的指南，73%的住院儿童目前的疫苗接种状况良好，27%的儿童需要补种（95名儿童共需200剂）。人乳头瘤病毒疫苗（第1剂）、水痘带状疱疹疫苗（第2剂）和脑膜炎球菌结合疫苗是最常确定需要接种的疫苗。在需要补种的儿童中，25%的儿童完成了补种，出院1个月后疫苗接种状况提高到80%。
这是第一项确定包括青少年在内的各年龄段住院儿科患者免疫接种状况的研究，提供了关于住院儿科人群免疫接种状况的新数据。一项试点干预措施，包括获取免疫接种记录、确定免疫接种状况以及在出院前讨论补种事宜，导致免疫接种状况得到改善，这表明住院环境可与许多其他国家战略一起用于帮助解决错过的疫苗接种机会。
