Study Of Monitoring And Related KAP Of Adverse Events Following Immunization In Pudong New Area

BackgroundImmunization is the most effective and economical method to prevent and control infectious disease.Immunization has already been generally launched in the whole world. As the varieties and numbers of the preventative bio-products are increasing constantly, more and more adverse events following immunization were reported, accordingly, the public pay more attention to safety of immunization day by day. Some adverse events following immunization have already caused the negative effect in society, if the events are not dealt with effectively, they will cause adverse effect of the work of expanded program on immunization. So an effectively and sensitive system to monitor adverse events following immunization is needed to set up urgently. Adverse events following immunization were required to report to Adverse Drug Reaction monitoring system of China in 2004, but this monitoring system is not known very well for professional personnel and the public. A passively report system of adverse events following immunization was set up by Center for Disease Control and Prevention of Shanghai in 2005,it was made of personal or relevant units-department of inoculate-Center for Disease Control and Prevention, among them inoculate unit is an important intermediate link to inoculate with the unit (mainly department of inoculate in Hygiene service centre of the community).At present, domestic literatures of adverse events following immunization reveal that the observation data of different area, different period differ greatly, we are lack of effective analysis and appraisal basis. The incidence reports of adverse events following immunization are influenced by many kinds of factors such as monitoring standard, medical worker's sense of responsibility, parents' cognition degree of adverse events following immunization at the same time, the credibility and authenticity need discussions.In order to get more safety of immunization, it is necessary to improve efficiency and sensitiveness of adverse events following immunization monitoring system, especially to do a good job of department of inoculate,because it's an important intermediate link of monitoring. Objects1.To know status of adverse events following immunization monitoring in department of inoculate, to analyze the possible influence factors of monitoring knowledge-attitude-practice (KAP) in the givers and accepters of inoculation in departments of inoculate.2.To know the problem of monitoring in departments of inoculate, to offer the basis of guiding for improving of adverse events following immunization monitoring in Pudong New Area and then serve for ensuring the security of immunization in Pudong New Area.Methods1.Relevant materials of immunization in Pudong Center for Disease Control and Prevention.2.To investigate the present situation of adverse events following immunization monitoring in Pudong New Area. The respondents were 32 persons in charge of immunization business in departments of inoculate in Pudong New Area. The method was questionnaire investigation.3.To investigate all staff members of departments of inoculate in Pudong New Area to know their knowledge, attitude and practice (KAP) about monitoring of adverse events following immunization.4.Adopt the proportional sampling method of capacity, collect 1163 children according to the quantity of inoculation in departments of inoculate in 2007, then carry on KAP investigation.Main findings and results1.The present situation of adverse events following immunization monitoring in departments of inoculate of Pudong New Area.(1)General information. There were 32 departments of inoculate in Pudong New Area.,each departments of inoculate differed greatly from area and population, the departments of inoculate in villages and towns served more outside children than others in the streets. Departments of inoculate were insufficient in manpower, appraised according to"Shanghai departments of inoculate work norm",only 34.38% departments of inoculate were coincidence.(2)Report sensitiveness of adverse events following immunization was improved year by year, from 26.7/100,000 pharmaceutical times in 2006 to 57.7/100,000 pharmaceutical times in 2008.The count of participate in report increased from 25 in 2006 to 30 in 2008,the proportion of participating in report was up to 93.8%.(3)Special messengers were arranged for responsible for monthly AEFI monitor report all.(4) Hardware for monitoring in departments of inoculate. Special-purpose computer rate, internet report rate, special telephone line rate, and special-purpose printer rate were 68.7%,37.5%,78.1%, and 37.5%,respectively.(5)The information source of adverse events following immunization of departments of inoculate was mainly in order to plant the reports from children's parents, accounted for than 96.9%.The main way which children parents report AEFI was by telephone, accounted for 84.4%.(6) Failure to register and report. In 2008,37.5% of departments of inoculate admit they failed to report. The reasons of failure to report,58.3% of the objects thought it was because they were too busy.58.3% thought that there were too many contents to report and the procedure is too tedious.2.To investigate all staff members of departments of inoculate to know their knowledge-attitude-practice (KAP) about monitoring of adverse events following immunization.(1)General situation:There were 158 staff members in all departments of inoculate who works one or more times ever week. The mean age was 39.0 year old, female accounted for 85.4%,77.8% of the objects were graduated from special secondary school and junior college.(2)Professional situation:55.1% professional title of the objects were elementary, 36.0% had no professional title. It was 8.79 years to be engaged in the working time of immunization on average; 89.9% of the objects had cards on duty of immunization; 68.45% participated in the work of treatment of adverse events following immunization.84.2% were trained of AEFI monitoring. (3)Knowledge of AEFI monitoring. The knowing rate of relevant knowledge to AEFI was 70.7%. The rates of knowing concept of AEFI, generally happening time, and demands of reporting time of AEFI, were 58.9%,84.8% and 73.4% respectively. Age and working time engaged in immunization were 2 significance influence factor to the rates of knowing concept of AEFI.(4) Attitude to AEFI monitoring.69.9% of the objects thought both security of immunization and prevention result of immunization were important,94.3% thought it was necessary and very necessary to do AEFI monitoring in departments of inoculate.66.5% thought it was necessary to monitor even slight general response of immunization.66.5% thought it was necessary to do monitoring voluntarily. And 49.4% thought it was necessary to as to make reporting rate of AEFI as a working examination index.(5) Relevant behaviors.76.6% of professional personnel had registered and reported AEFI according to the fixed routine,22.8% had not because they thought the symptoms was light,53.3% had not consulted literature in 2008.Actually in 2008,79.2% of objects had reported all information to AEFI monitoring system,19.8% only reported the serious incident.99.0% of the source of the reports was from guardians.3.To investigate guardians to know their knowledge-attitude-practice (KAP) about monitoring of adverse events following immunization.(1)General situation:A total of 1163 children aged 1-3 years participated in the survey. The mean age was 1.8 years old,59.3% were local, and 38% were from other cities and lived in Shanghai more than 3 months.88.7% of the guardians of children were parents, the mean age was 32.3 years old,87% were 20-40 years old, and 61.3% were female.(2) Relevant situation. Relevant situations:97.2% of the objects were born at hospital, the education situation of mothers was similar with fathers, and most were from junior college and above, nearly half. Then junior middle school, the third one is from high school or special secondary school.50% of the objects have annual incomes as 30,000-100,000 Yuan. (3)Knowledge of AEFI monitoring. The knowing rate of relevant knowledge to AEFI was 69.1%,49.2% of the objects knew over 3 kinds of AEFI,67.5% knew generally happening time of AEFI.(4) Attitude to AEFI monitoring.88.2% of the objects thought it was necessary and very necessary to do AEFI monitoring in departments of inoculate.59.8% thought both security of immunization and prevention result of immunization were important. If AEFI happened,61.0% of the objects won't report if the event was a general light response,if the event was a serious one,46.6% would report it to departments of inoculate, hold to inoculate with clinic people to report to attitude account for 46.6%,32.8% report to related departments.10.7% of objects had never thought about reporting AEFI.(5)Relevant behaviors.The ways that guardians would choose to report AEFI were by going to departments of inoculate immediately, telephone, going to departments of inoculate for immunization next time, and the rates were 70.2%, 52.3% and 27.9%.but 42.8% did not know the telephone number of departments of inoculate.22.3% had no consciousness of reporting.Conclusion and suggestion1.The amount of AEFI was rising year by year as the varieties and numbers of the preventative biological were increasing constantly. It was an important part of the work to count assortment2.Department of inoculate was an important intermediate link in monitoring of AEFI.In staff members of departments of inoculate, the knowing rate of relevant knowledge to AEFI was good, it was that professional personnel know the intensity to the monitoring, most departments of inoculate were insufficient in manpower.3.Because of overloading work, contents to report and tedious procedure, some departments of inoculate failed to report. To improve sensitiveness of AEFI monitoring. We should increase manpower, and simplify the procedure of reporting. Guardians were the first people to report AEFI;they thought that security of immunization was important. Nearly half of the guardians knew telephone number of departments of inoculate.So it was necessary to do it well the propaganda educational work of AEFI.