接种流感疫苗是医生的职业责任

华盛顿——美国疾病控制预防中心(CDC)的最新数据显示，去年大约42%的美国人和67%的医务人员接种了流感疫苗。

美国国家传染性疾病基金会(NFID)前主席、范德堡大学预防医学系主任、教授William Schaffner博士在新闻发布会上称，自2010年CDC推荐6个月及以上所有人群接种广谱流感疫苗以来，美国流感预防工作已逐步走向正轨，但仍有许多改善空间，而临床医生在这项工作中起着关键性作用。

Schaffner博士认为，医务人员预防接种兼有伦理和职业双重责任。原因有二：首要也是最重要的是患者安全问题，医务人员不能将流感传播给患者；另一原因是，当流感来袭时，医务人员不能病倒，而应该向大众提供医疗服务。

众多因素使得人们目前接种流感疫苗比以前更为容易，这些因素包括疫苗供应充足和接种地点多样化，例如人们可以在工作场所进行接种。此外，正确的洗手方法、咳嗽及打喷嚏礼仪以及及时使用抗病毒药物等对于预防和控制流感传播也至关重要。


William Schaffner博士

美国医学会(AMA)的Litjen Tan博士认为，对于哪些对流感疫苗接种持观望态度的患者而言，医生的建议可能具有决定性作用。CDC最新资料显示，孕妇得到医生推荐后接种几率提高5倍，44%的未打算接种疫苗的65岁以上成人在得到医生推荐后接种了疫苗。他指出，每位医生在流感季节均有机会提醒患者接种疫苗，心脏病、妇产科、胸肺科以及内分泌科医生应建议其高危患者在可能的情况下尽快接种流感疫苗。

CDC国家免疫与呼吸疾病中心的Daniel Jernigan博士称，本流感季节大约已有850万剂流感疫苗供应到位，加之尚在运输途中的疫苗，共计约1350万剂。今年的疫苗含有一种新型流感A和一种新型流感B病毒株，但截至目前仅发现少数上述病毒株。他表示，虽然最佳接种时间是在流感季节开始之前，但鉴于难以确定流感从何时何地开始，所以建议在整个流感季节期间均可接种疫苗。

美国健康和人类服务部的Howard Koh博士指出，尽管去年流感季节是自1982年以来最为温和的一年，但医生不应对自己及其患者的接种情况感到自满。近年来的情况表明流感是不可预测的，2009~2010年流感大流行后2011~2012年流感季节异乎寻常温和，但流感相关的住院和死亡病例每年均有发生。他强调说，我们不能依据过去预测未来。

Koh博士还重点介绍了近来接种覆盖率方面取得的进展情况，相关数据在线发表在9月27日的《发病率与死亡率周报》上(2012;61:753-63)。

总体上，在2011~2012流感季节， 6个月~17岁儿童接种率为52%，6~23个月儿童接种率为75%，与上一季度相当。但青少年接种率仍面临挑战，13~17岁儿童接种率仅为34%。去年65岁及以上成人接种率为65%，比2008~2009流感季节的74%有所下降。孕妇接种覆盖率与上一年度相当，为47%，仍明显高于2008~2009年流感季节之前的30%。连续第2年未见儿童接种率存在种族或族裔差异，尽管成人间的差异仍然存在。

新闻发布会由NFID赞助。有关医务人员和孕妇流感疫苗接种情况的完整报告参见MMWR网站。

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By: HEIDI SPLETE, Clinical Endocrinology News Digital Network

WASHINGTON – Approximately 42% of the U.S. population and 67% of health care workers received influenza vaccinations last year, according to data from the Centers for Disease Control and Prevention.

Since the CDC’s 2010 recommendation for universal flu vaccination for everyone aged 6 months and older, "we seem to be on track in protecting the nation against influenza," Dr. William Schaffner, past president of the National Foundation for Infectious Diseases, said at a press conference.

But there is room for improvement, and clinicians play a key role, said Dr. Schaffner, who also serves as a professor and chair of preventive medicine at Vanderbilt University in Nashville, Tenn.

"I believe that the immunization of the health care provider community is both an ethical and professional responsibility," he said. "It is for two reasons: The first and most important is a patient safety issue, so we do not transmit our influenza infection to our patients."

"The other reason is, when influenza strikes, we need to be vertical, not horizontal," he continued. "We need to be ready to provide health care during that period of great community stress."

"There are many factors that make it easier than ever for everyone to receive flu vaccination," including a plentiful vaccine supply and a variety of venues, including workplaces, where individuals can be vaccinated, said Dr. Schaffner. Proper handwashing, cough and sneeze etiquette, and the prompt use of antivirals also are important to prevent and limit the spread of the flu.

"A physician’s recommendation can be the deciding factor for patients who are sitting on the fence" about getting a flu vaccination, said Litjen Tan, Ph.D., director of medicine and public health for the American Medical Association.

Recent CDC data indicate that pregnant women whose doctors recommended flu vaccination were five times as likely to get a vaccination, and 44% of adults above age 65 who didn’t intend to get vaccinated did so when a doctor recommended it, Dr. Tan said.

"Every physician has an opportunity this flu season to remind their patients to get vaccinated," he said. "Physicians such as cardiologists, obstetricians and gynecologists, pulmonologists, and endocrinologists, who all have high-risk patients, should encourage their patients to seek influenza vaccinations as soon as they are available."

Approximately850万85 million doses of flu vaccine have been distributed so far this season, with more on the way, for a total of about 135 million doses, said Dr. Daniel Jernigan, deputy director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases.

"The best time to get vaccinated is before the flu season starts," he said. "It is hard to know when the flu will start and where it will start," but vaccination is still recommended throughout the flu season.

This year's vaccine contains a new A virus and a new B virus.

"The few strains we have seen so far match what’s in the vaccine," Dr. Jernigan said.

Although last year’s flu season was the mildest since 1982, clinicians should not be complacent about vaccination for themselves and their patients, said Dr. Howard Koh, assistant secretary for health at the U.S. Department of Health and Human Services.

"The last few years have demonstrated that the flu is predictably unpredictable," Dr. Koh said. The flu pandemic of 2009-2010 was followed by an unusually mild flu season in 2011-2012, but flu-related hospitalizations and deaths occur every year.

"We can’t look to the past to predict the future," he emphasized.

Dr. Koh highlighted data on the recent progress in vaccination coverage, which appeared in Morbidity and Mortality Weekly Report online Sept. 27 (2012;61:753-63).

Overall, 52% of children aged 6 months to 17 years were vaccinated during the 2011-2012 season, approximately the same rate as the previous year, with a rate of 75% among children aged 6 months to 23 months.

However, vaccination of adolescents remains a challenge; 34% of children aged 13-17 years were vaccinated, said Dr. Koh. Adults aged 65 years and older had a 65% vaccination rate last year, but this was a drop from 74% in 2008-2009.

Vaccination coverage among pregnant women was consistent with the previous year, at 47%, remaining significantly higher than the 30% rate before the 2008-2009 flu season.

For the second year in a row, no racial or ethnic disparities were seen in vaccination rates for children, although these disparities persist among adults, Dr. Koh said.

The press conference was sponsored by the National Foundation for Infectious Diseases. For the complete report on flu vaccination in health care personnel and in pregnant women, visit the MMWR website here