Kum-Nji P, James D, Herrod H G
Department of Pediatrics, University of Tennessee, Memphis, USA.
Pediatrics. 1995 Sep;96(3 Pt 1):434-8.
The purposes of this study were to determine the accuracy of the immunization histories of hospitalized preschool children, assess the sociodemographic factors associated with delayed immunizations, and interview parents or guardians concerning their views on ways of improving immunization delivery.
The immunization status of 215 preschool children admitted to a pediatric hospital was determined by interviewing parents or guardians regarding their children's immunization histories. The patient's immunization records were subsequently reviewed for confirmation. The admitting physician's history also was reviewed to determine whether the patient's immunization status had been noted. Finally, parents or guardians of all children studied were interviewed to assess their views on ways of improving the delivery of immunization services.
Only 44% of the 215 preschoolers evaluated were adequately immunized. Among those between 2 and 5 years of age, 52% were fully immunized. Only 17% of those who were inadequately immunized could have been completely updated if given an immunization at discharge. The admitting physician failed to document the immunization status of 22% of the patients. Thirty percent of the parents gave inaccurate information concerning the immunization status of their children. Most parents felt that the provision of transport (30%) or formal remainders (21%) would enhance immunization rates. Multiple regression analysis showed that a history of missed opportunity to immunize, male gender, lack of transportation, and lack of day care attendance were significant predictors of delayed immunization.
Resident physicians should be more stringent in documenting the immunization status of all admitted preschoolers so that those found to be delayed could be updated before discharge. A hospital policy of updating underimmunized children at discharge and reporting the immunization status of all discharged patients to their primary care provider could help improve the immunization coverage in this population. Transportation for routine health maintenance and telephone or mailed remainders might further improve the immunization status of inner-city children.
本研究旨在确定住院学龄前儿童免疫接种史的准确性，评估与免疫接种延迟相关的社会人口学因素，并就改善免疫接种服务的方式采访家长或监护人。
通过采访家长或监护人了解其孩子的免疫接种史，确定215名入住儿科医院的学龄前儿童的免疫接种状况。随后查阅患者的免疫接种记录进行确认。还查阅了主治医生的病史记录，以确定是否记录了患者的免疫接种状况。最后，采访了所有研究对象的家长或监护人，以评估他们对改善免疫接种服务方式的看法。
在评估的215名学龄前儿童中，只有44%的儿童免疫接种情况良好。在2至5岁的儿童中，52%的儿童完成了全部免疫接种。在免疫接种不足的儿童中，只有17%的儿童如果在出院时接种疫苗，免疫接种情况可以完全更新。主治医生未记录22%患者的免疫接种状况。30%的家长提供了关于其孩子免疫接种状况的不准确信息。大多数家长认为提供交通便利（30%）或正式提醒（21%）会提高免疫接种率。多元回归分析表明，错过免疫接种机会的病史、男性、缺乏交通便利以及未参加日托是免疫接种延迟的重要预测因素。
住院医生应更严格地记录所有入院学龄前儿童的免疫接种状况，以便发现免疫接种延迟的儿童在出院前能够更新接种情况。医院制定在出院时更新免疫接种不足儿童的疫苗接种情况并将所有出院患者的免疫接种状况报告给其初级保健提供者的政策，有助于提高该人群的免疫接种覆盖率。提供常规健康维护的交通便利以及电话或邮寄提醒可能会进一步改善市中心儿童的免疫接种状况。
