合并肝脏疾病特殊健康状态儿童疫苗预防接种及时性临床分析

Clinical analysis of the timeliness of vaccination in children with special health care needs complicated with liver disease

目的探讨特殊健康状态儿童(CSHCN)疫苗预防接种评估门诊合并肝脏疾病CSHCN的预防接种建议、及时性和安全性。方法选取2021年4月21日至2023年12月31日在西南交通大学附属医院/成都市第三人民医院CSHCN疫苗预防接种评估门诊咨询的142例合并肝脏疾病CSHCN患儿为研究对象。采用回顾性研究方法,对合并肝脏疾病CSHCN临床资料进行分析,包括患儿一般临床资料(年龄、性别、居住地区、疾病类型),以及预防接种建议、疫苗接种情况及接种后不良反应等。本研究经西南交通大学附属医院/成都市第三人民医院伦理委员会审查批准(审批文号:伦2024S-26)。结果本研究142例合并肝脏疾病CSHCN临床资料分析结果如下。①一般临床资料:胆汁淤积性肝病(CLD)术后服用激素与未服用激素、巨细胞病毒(CMV)感染所致急性肝炎与乙型肝炎病毒(HBV)感染、肝移植术后、肝功能不全、遗传代谢性肝病、其他合并肝脏疾病CSHCN分别占18.3%(26/142)、14.1%(20/142)、12.7%(18/142)、7.0%(10/142)、28.2%(40/142)、7.0%(10/142)、12.7%(18/142);年龄为2个月至13岁;男、女性患儿分别占44.4%(63/142)、55.6%(79/142)。②预防接种建议:建议按照《国家免疫规划疫苗儿童免疫程序及说明(2021年版)》接种/补种减毒活疫苗者为26例(18.3%),建议接种灭活疫苗者为108例(76.1%),建议暂缓接种疫苗者为8例(5.6%)。③疫苗接种情况:除2例患儿未按照本院CSHCN预防接种评估门诊建议接种疫苗外,其余140例患儿均按照建议接种疫苗。按照建议接种疫苗的140例患儿中,共接种19种疫苗1790剂次,接种后发生疫苗不良反应12剂次,总发生率为0.67%,包括发热6例,皮疹5例,不明原因一过性惊厥1例。结论合并肝脏疾病CSHCN经CSHCN疫苗预防接种评估门诊综合评估后,大部分可接种疫苗。

Objective To explore the vaccination recommendations,timeliness and safety for children with special health care needs(CSHCN)complicated with liver diseases in vaccination evaluation clinic for children with CSHCN.Methods A total of 142 children with CSHCN complicated with liver diseases who were consulted at the vaccination evaluation clinic for CSHCN of the Affiliated Hospital of Southwest Jiaotong University,the Third People's Hospital of Chengdu from April 21,2021 to December 31,2023 were selected into this study.The clinical data of children with CSHCN complicated with liver disease,including general clinical data(age,gender,residential area,and disease type),vaccination recommendations,vaccination status,and adverse reactions after vaccination were analyzed by retrospective analysis method.This study has been reviewed and approved by the Ethics Committee of the Affiliated Hospital of Southwest Jiaotong University,the Third People's Hospital of Chengdu(Approval No.2024S-26).Results The clinical data analysis results of 142 children with CSHCN complicated with liver diseases were as follows.①General clinical data:postoperative cholestatic liver disease(CLD)with use of hormone accounted for 18.3%(26/142),postoperative CLD without use of hormone for 14.1%(20/142),acute hepatitis caused by cytomegalovirus(CMV)infection and hepatitis B virus(HBV)infection for 12.7%(18/142),postliver transplantation for 7.0%(10/142),liver insufficiency for 28.2%(40/142),genetic metabolic liver disease for 7.0%(10/142),other liver diseases for 12.7%(18/142);other liver diseases for 9.2%(13/142).They were 2 months to 13 years old.And male and female children accounted for 44.4%(63/142)and 55.6%(79/142),respectively.②Vaccination recommendations:26 cases(18.3%)were recommended to vaccinate/supplement live attenuated vaccines according to the Immunization Schedule and Instructions of National Immunization Program for Children(2021 Edition),108 cases(76.1%)were recommended to vaccinate inactivated vaccines,and 8 cases(5.6%)were recommended to temporarily suspend vaccination.③Vaccination status:except for 2 cases who did not receive the vaccine according to the recommendations of vaccination evaluation clinic for CSHCN,the remaining 140 children received the vaccine according to the recommendations.Among these 140 children,a total of 1790 doses of 19 types of vaccines were administered,and 12 adverse reactions occurred after vaccination,with a total incidence rate of 0.67%,including 6 cases of fever,5 cases of rash,and 1 case of unexplained transient convulsion.Conclusion After a comprehensive assessment in the vaccination evaluation clinic for CSHCN,most children with CSHCN complicated with liver diseases can receive vaccines.