Gugelmann R J, Freed G L, Desgrandchamps D, Diebold P
Cecil G. Sheps Center for Health Services Administration, University of North Carolina, Chapel Hill.
Soz Praventivmed. 1998;43 Suppl 1:S57-60, S130-3. doi: 10.1007/BF02042177.
Difficulties with the acceptance of immunization recommendations by physicians have been documented. A recommendation for universal hepatitis B vaccination was published in 1998 for Switzerland. We conducted a qualitative study of pediatricians and family physicians in the fall of 1996 with eight focus groups stratified by region of the country and medical specialty. Sixty-two physicians participated. Most participants felt that universal hepatitis B immunization would be useful. Pediatricians in the French-speaking part of the country were more willing to implement such a recommendation, while family physicians in the German-speaking regions were least willing. Before supporting universal hepatitis B immunization, physicians stated that they need more information about the epidemiology of the infection, the effectiveness and safety of the vaccine, and the perceived high cost of an immunization program. Participants felt that two injections per visit was the maximum tolerable for infants and young children. Many preferred to immunize older children or adolescents against hepatitis B, both because fewer injections are currently recommended at that age and because adolescence is a developmentally appropriate age to address sexuality and drug abuse. Physicians expected the population to be reluctant to accept universal hepatitis B vaccination, partly because of a lack of understanding of the disease and partly because of a feeling that children already receive more than enough immunizations. While the general sentiment for a universal hepatitis B immunization recommendation in Switzerland seems to be positive among physicians, concerns regarding its implementation linger. It remains to be seen how hepatitis B will be perceived in the population, and how willing parents and adolescents will be to get their children and themselves vaccinated. Helping physicians to understand the importance of this measure, in addition to convincing them to immunize their patients, will be an important first step towards achieving sufficient hepatitis B immunization coverage.
医生在接受免疫接种建议方面存在困难，这一点已有文献记载。1998年，瑞士发布了一项关于普遍接种乙型肝炎疫苗的建议。1996年秋季，我们对儿科医生和家庭医生进行了一项定性研究，通过八个焦点小组进行，这些小组按国家地区和医学专业进行了分层。62名医生参与了研究。大多数参与者认为普遍接种乙型肝炎疫苗会有用。该国法语区的儿科医生更愿意实施这样的建议，而德语区的家庭医生最不愿意。在支持普遍接种乙型肝炎疫苗之前，医生们表示他们需要更多关于该感染的流行病学、疫苗的有效性和安全性以及免疫接种计划的高昂成本等方面的信息。参与者认为每次就诊注射两针是婴幼儿能够耐受的最大限度。许多人更倾向于为年龄较大的儿童或青少年接种乙型肝炎疫苗，这既是因为目前该年龄段推荐的注射次数较少，也是因为青春期是一个在性和药物滥用方面进行适当教育的合适年龄阶段。医生们预计民众会不愿接受普遍接种乙型肝炎疫苗，部分原因是对该疾病缺乏了解，部分原因是感觉儿童已经接种了过多的疫苗。虽然瑞士医生中对于普遍接种乙型肝炎疫苗建议的总体态度似乎是积极的，但对其实施的担忧依然存在。乙型肝炎在民众中的接受程度如何，以及父母和青少年为其子女及自身接种疫苗的意愿如何，还有待观察。除了说服医生为其患者接种疫苗外，帮助医生理解这一措施的重要性将是实现足够的乙型肝炎疫苗接种覆盖率的重要第一步。
