Desjardins Michaël, Boucoiran Isabelle, Paquet Caroline, Laferrière Céline, Gosselin-Brisson Anne, Labbé Annie-Claude, Martel-Laferrière Valérie
Faculté de médecine, Université de Montréal, Montréal, QC; Centre hospitalier de l'Université de Montréal, Montréal, QC.
Faculté de médecine, Université de Montréal, Montréal, QC; Centre hospitalier universitaire Sainte-Justine, Montréal, QC.
J Obstet Gynaecol Can. 2018 Apr;40(4):405-409. doi: 10.1016/j.jogc.2017.10.023. Epub 2017 Dec 21.
Serological testing guidelines for vaccine-preventable infectious diseases in pregnant women are heterogeneous. It is unclear how vaccination history influences health care workers' (HCWs) attitudes about testing. The aim of this study was to describe current practices in screening for rubella, hepatitis B, and varicella-zoster virus (VZV) in pregnant women in the province of Québec.
In 2015, an electronic survey was distributed to HCWs who followed the case of at least one pregnant woman in the previous year and who could be contacted by email by their professional association.
A total of 363 of 1084 (33%) participants were included in the analysis: general practitioners (57%), obstetrician-gynaecologists (20%), midwives (41%), and nurse practitioners (31%). For rubella, 48% of participants inquired about vaccination status, and of these, 98% offered serological testing for unvaccinated women versus 44% for vaccinated women. Similarly, of the 48% of participants who asked about hepatitis B vaccination status before offering testing, 96% ordered testing for hepatitis B surface antigen, 28% ordered testing for hepatitis B surface antibody, and 1% ordered no serological testing to unvaccinated women versus 72%, 46%, and 8%, respectively, for vaccinated women. Among the 81% of respondents who discussed VZV during prenatal care, 13% ordered serological testing if patients had a history of VZV infection, 87% if the VZV history was uncertain, and 19% if patients had a positive history of vaccination.
Asking about vaccination status influences HCWs' attitudes about serological testing for rubella, hepatitis B, and VZV. In the context of increasing vaccination coverage in women of child-bearing age, it is important to clarify the impact of vaccination status in serological screening guidelines in pregnant women.
针对孕妇中疫苗可预防传染病的血清学检测指南各不相同。目前尚不清楚疫苗接种史如何影响医护人员（HCWs）对检测的态度。本研究的目的是描述魁北克省孕妇风疹、乙型肝炎和水痘 - 带状疱疹病毒（VZV）筛查的当前做法。
2015年，向在前一年至少跟踪过一名孕妇且其专业协会可通过电子邮件联系到的医护人员进行了电子调查。
1084名参与者中有363名（33%）纳入分析，包括全科医生（57%）、妇产科医生（20%）、助产士（41%）和执业护士（31%）。对于风疹，48%的参与者询问了疫苗接种状况，其中，98%为未接种疫苗的女性提供血清学检测，而接种疫苗的女性这一比例为44%。同样，在检测前询问乙型肝炎疫苗接种状况的48%的参与者中，96%为未接种疫苗的女性开具了乙型肝炎表面抗原检测，28%开具了乙型肝炎表面抗体检测，1%未对未接种疫苗的女性进行任何血清学检测，而接种疫苗的女性相应比例分别为72%、46%和8%。在产前护理期间讨论VZV的81%的受访者中，13%在患者有VZV感染史时开具血清学检测，VZV病史不确定时为87%，有疫苗接种阳性史时为19%。
询问疫苗接种状况会影响医护人员对风疹、乙型肝炎和VZV血清学检测的态度。在育龄妇女疫苗接种覆盖率不断提高的背景下，明确疫苗接种状况对孕妇血清学筛查指南的影响非常重要。
