济南市1614名HBsAg阳性产妇新生儿首针乙肝疫苗接种时间分布及影响因素

Time distribution and influencing factors of hepatitis B vaccine birth dose in 1,614 newborns of HBsAg positive women, Jinan City

目的 了解济南市HBsAg阳性产妇所生新生儿首针乙肝(hepatitis B vaccine, HepB)疫苗接种时间分布,评价医疗机构母婴阻断实施工作存在的问题和困难。方法 采用描述性统计方法对目标人群的人口学特征、首针HepB疫苗接种情况进行描述,χ^(2)检验和Logistic回归方法分析及时接种的影响因素。定性资料采用主题框架法对产科母婴阻断实施操作现状和存在问题进行分析归纳和总结。结果 2020年济南市住院分娩HBsAg阳性产妇共计1 614名,其新生儿HepB疫苗24 h内和12 h内首针接种率分别为98.76%和78.81%。新生儿出生时间在8~11时、14~16时(产科接种高峰时段)的新生儿接种及时性最高。多因素分析结果显示,与>12 h接种有关联的因素包括阴道分娩(OR=2.083)、新生儿低出生体质量(OR=2.793)、出生时间在夜间(OR=1.260)、头胎(OR=1.515),P均<0.05。定性访谈发现,首针接种时限要求提高后,人员和培训需求增加。结论 2020年济南市HBsAg阳性产妇新生儿HepB疫苗首针接种及时率较高。剖宫产、非出生低体质量、非头胎、接近接种高峰时段前出生的新生儿更容易及时接种。人员和培训需求是时限要求提高后的主要诉求。建议从医疗机构产科操作层面加强人员培训,合理安排接种班次,进一步提高及时接种率。

Objective To investigate the time distribution of the birth dose of hepatitis B(HepB) vaccine in newborns of HBsAg-positive mothers in Jinan, and to evaluate possible problems and difficulties of hospitals in implementing the scheme. Methods Descriptive analysis was applied to describe general information and distribution of birth dose of HepB vaccine. Chi-square test and binary Logistic regression were used to analyze influencing factors. Qualitative field interview materials were analyzed and summarized with subject frame method to investigate the status and problems of current implementation practice. Results In 2020, 1,614 HBsAg positive pregnant women were hospitalized and gave birth at hospital. The rate of HepB vaccine birth dose within 24 hours and 12 hours were 98.76% and 78.81%, respectively. Newborns born at 8-11 and 14-16 o’clock had the highest timely vaccination rate. Natural birth(OR=2.083), low birth weight(OR=2.793), birth time at night(OR=1.260) and first birth(OR=1.515) were risk factors affecting timely vaccination(all P<0.05). Qualitative interviews found that personnel and training needs increased after stricter time limit was issued. Conclusion The timely vaccination rate of HepB birth dose among infants of HBsAg positive women was high in 2020 in Jinan. Newborns delivered by caesarean section, with non-low birth weight, non-first-born and born before the peak time of obstetrical vaccination are more likely to be vaccinated in time. Personnel and training needs are the main concerns after stricter time limit is issued. It is suggested to strengthen the training of medical personnel and arrange the vaccination shifts reasonably in order to improve the timely vaccination rate.