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目的了解梅州市人用狂犬病疫苗的5针法伊森(Essen)程序接种依从性,分析Es-sen程序和4针法赞瑞博程序(2-1-1程序)的经济成本。方法依据梅州市预防接种规范化门诊人用狂犬病疫苗接种原始记录,调查2010年1—12月在全市预防接种门诊就诊的犬伤暴露患者疫苗实际接种情况,了解其接种依从性;利用梅州市所用国产人用狂犬病疫苗价格和2010年人均国民生产总值估算生产力损失,估算Essen程序和2-1-1程序的经济学成本。结果共对29 785例患者进行了疫苗接种情况核实调查和依从性分析,其中男性16 264例,女性13 521例,平均年龄30.60岁,Ⅰ、Ⅱ、Ⅲ级暴露人数分别为1 605、20 370、7 810例,全程5针接种依从率分别为20.49%(329/1 605)、75.25%(15 329/20 370)和90.24%(7 048/7 810),Ⅱ、Ⅲ级暴露患者其依从率在前3剂维持高水平(99%以上),但由第4针起开始下降,特别是Ⅱ级暴露患者第5针依从率降至75.25%。不依从的主要原因为:接种次数过多,就诊不方便(85.29%,6 038/7 079);认为无必要全程接种(32.59%,2 307/7 079);无法耐受不良反应(11.29%,799/7 079)。调查对象29 785人均未发生狂犬病。Essen程序和2-1-1程序的每人就医成本分别为591.25、398.00元。结论受调查人群的人用狂犬病疫苗的Essen程序接种依从性不高,为合理应用狂犬病疫苗、简化接种程序、提高患者全程接种依从率和节约成本减轻群众经济负担,应积极探索并推广2-1-1接种程序。
Objectives To understand the compliance with the 5-pin Essen program for human rabies vaccine in Meizhou City and to analyze the economic costs of the Es-sen program and the 4-way Frazanobab program (2-1-1 program). Methods According to the original record of rabies vaccination for standardized outpatient vaccination in Meizhou City, the actual inoculation of vaccine in dogs exposed to dogs during January to December in 2010 was investigated and the vaccination compliance was investigated. Estimates of productivity losses from human rabies vaccine prices and GNI per capita in 2010 estimate the economic costs of the Essen program and 2-1-1 program. Results A total of 29 785 patients were investigated for verification of vaccination status and compliance. Among them, 16 264 males and 13 521 females, with an average age of 30.60 years, were classified as Ⅰ 605 605 , 7 810 cases. The compliance rate of the 5-needle vaccination was 20.49% (329/1 605), 75.25% (15 329/20 370) and 90.24% (7048/7 810) respectively. Rate of the first three doses to maintain a high level (99% or more), but starting from the fourth pin began to decline, especially in patients with grade Ⅱ exposure to the 5th needle compliance rate dropped to 75.25%. The main reasons for non-compliance were: Inoculation frequency was too inconvenient to visit (85.29%, 6 038/7 079); No need of full vaccination (32.59%, 2 307/7 079); Undesirable adverse reactions (11.29% , 799/7 079). Subjects were free from rabies in 29 785 people. The cost of medical treatment for Essen program and 2-1-1 program was 591.25 and 398.00 yuan respectively. Conclusion The vaccination of human rabies vaccine against human rabies by the Essen program is not highly compliant. In order to rationally apply the rabies vaccine, simplify the vaccination procedure, improve the patient compliance rate of vaccination and reduce the economic burden of the public, we should actively explore and promote the 2-1 -1 vaccination program.