青海同德藏族自治县医院出生新生儿首针乙肝疫苗未及时接种的原因分析

Analysis of the causes of the lack of timely immunization of the first-born hepatitis B vaccine in neonatal born in hospitals in Tongde Tibetan Autonomous County of Qinghai

目的分析同德县医院出生的新生儿首剂乙肝疫苗(First Dose Hepatitis B Vaccine,Hep B1)未及时接种的原因,为提高Hep B1及时接种率提供参考。方法采取回顾性调查,连续收集同德县2012-2016年所有在医院出生的新生儿的Hep B1接种资料,分析未及时接种的原因。结果同德县2012-2016年在医院出生的新生儿共4 660人,Hep B1及时接种4 289人(92.03%)。及时接种率最低为2015年(90.65%),但不同年份差异无统计学意义(χ~2=8.19,P>0.05);不同医院差异有统计学意义(χ~2=13.59,P<0.05),其中以藏族医院最低(90.57%)。未及时接种的原因依次为新生儿出生低体重(含早产)(55.26%)、窒息(32.08%)、新生儿黄疸(10.24%)和家长拒绝接种(2.42%)。结论乙肝疫苗说明书虽然未将低体重新生儿等列为接种禁忌,但基层接种人员亦将此类列为接种禁忌,影响首针及时接种率。因此,应加强对接种人员相关知识的培训,合理掌握接种禁忌症,提高乙肝疫苗首针及时接种率。

Objective To analyze the reasons for the lack of timely immunization of First Dose Hepatitis B Vaccine（ Hep B1）born in Tongde County Hospital and to provide references for improving the timely Hep B1 vaccination rate. Methods A retrospective survey was conducted to continuously collect Hep B1 vaccination data for all hospital-born newborns in Tongde County from 2012 to 2016,and analyze the reason for the lack of timely vaccination. Results A total of 4 660 newborns were born in the hospital from 2012 to 2016 in Tongde County,and 4 289（ 92. 03%） were promptly vaccinated by Hep B1. The minimum rate of timely vaccination was 2015（ 90. 65%）,but the difference was not statistically significant in different years（ χ^2= 8. 19,P〈0. 05）. The differences among different hospitals were statistically significant（ χ^2= 13. 59,P〈0. 05）,among which the Tibetan hospital was the lowest（ 90. 57%）. The reasons for not being promptly vaccinated were newborn birth weight（ including preterm delivery）（ 55. 26%）,asphyxia（ 32. 08%）,neonatal jaundice（ 10. 24%）,and parental refusal vaccination（ 2. 42%）. Conclusion Although the hepatitis B vaccine manual did not list low birth weight newborns as vaccinations,the grass-roots vaccinators also classified such cases as vaccinations,affecting the rate of timely first vaccination. Therefore,we should strengthen the training of relevant knowledge of vaccination personnel,reasonably grasp vaccination contraindications,and increase the rate of timely vaccination against hepatitis B vaccine.