Vaccination is one of the basic public health services in the mainland. At present, the vaccines of the mainland immunization programme have been expanded to 14, but some children with birth defects, immune defects, or allergies, infectious diseases, nervous system diseases, etc. have encountered vaccination difficulties because of the risk of vaccination. In order to solve this problem, the Beijing Shunyi District Center for Disease Control and Prevention, together with a number of community health service centers in the district, spent 6 years exploring and expanding the immunization program for children with special health status vaccination routes
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The number of "distressed" children is enormous
In 2016, yue yue (pseudonym) was diagnosed with β thalassemia syndrome shortly after she was born.
According to the doctor's instructions, Yue Yue's parents pay great attention to Yue Yue's nutritional balance and dietary hygiene, and Yue Yue's parents are eager to help Yue Yue improve her resistance through vaccination.
But in this matter, Yue Yue has hit a wall many times. Every time their parents took Yueyue to get vaccinated, the vaccinating doctor reluctantly told them that there were clear contraindications to vaccine use. For example, the instruction manual points out that patients with acute diseases, serious chronic diseases, acute onset and fever of chronic diseases are contraindicated, and those with immunodeficiency, immunocompromise or who are receiving immunosuppressive treatment are contraindicated.
In this way, Yue Yue did not receive any vaccines until she was two years old. However, according to the national immunization program vaccine child immunization program, children should have completed nearly 10 vaccinations such as BCG vaccine, hepatitis B vaccine, and DTP vaccine before the age of two.
Wang Fengshuang, head of the immunization planning section of the Shunyi District CDC, is quite touched by the vaccination dilemma suffered by children with special health conditions. Wang Fengshuang often receives consultation calls from various community health service centers in the district, but because the types of diseases children suffer from involve different clinical departments, they are often unable to give specific answers.
How many children are struggling with vaccination? Wang Fengshuang introduced that congenital heart disease, neonatal biliary atresia, congenital hypothyroidism, febrile convulsions from 3 months to 5 years old and previous asthma history of children under 14 years old, history of allergic rhinitis, history of eczema, etc. are common diseases in children, "According to the overall incidence rate, in Beijing alone, about 70,000 children with the above 7 diseases face the dilemma of vaccination every year."
The child's problem can't afford to wait
In 2015, Wang Fengshuang used the District CdC as a platform to invite multidisciplinary experts in epidemiology, clinical, pharmacy and other disciplines to meet, try to classify and demonstrate children's diseases, and finally form a consensus recommendation for vaccination experts, and then guide the community health service center to implement it. Yue Yue became a beneficiary of this work.
In 2018, Yue Yue went to the Fengbo Community Health Service Center in Nancai Town, Shunyi District under the leadership of her mother. Children with thalassemia syndrome are not common in the Beijing area, and Liu Yuan, head of the preventive health care department of the center, sorted out a full set of medical records of Yue Yue and submitted them to the district CDC.
A week later, Wang Fengshuang invited 7 chief physicians from the Institute of Immunology planning of the Beijing Municipal Center for Disease Control and Prevention, the Department of Allergies and Hematology of the Capital Pediatric Research Institute, and the Department of Hematology of Beijing Children's Hospital to hold a special disease discussion based on the medical records and literature prepared in advance.
Among the commonly used clinical classifications of thalassemia syndrome, which type should be considered for vaccination? How to distinguish between light, medium and heavy? What complementary tests are needed before vaccination... The expert seminar lasted 4 hours. On the basis of full consideration of feasibility, the experts of the Immunization Planning Department of the Shunyi District CDC wrote the preliminary vaccination recommendations for thalassemia syndrome.
After expert research, revision and final confirmation, a "Principled Recommendation on Vaccination for Children with a History of Thalassemia Syndrome (Trial)", including vaccination recommendations, data reports, etc., was issued to 27 vaccination units in Shunyi District.
According to the recommendation that "children with a history of thalassemia syndrome use blood or blood products, such as blood transfusions or use of concentrated red blood cells, etc., measles vaccine and chickenpox vaccination should be arranged after 11 months of use, and those who have received antibody-containing blood products within the first 6 weeks should be cautious about giving live attenuated attenuated vaccines", combined with the national immunization program vaccine for children, Liu Yuan first vaccinated Yue Yue with hepatitis B vaccine. Since then, Yue Yue has successively re-injected other vaccines that she missed before the age of two.
Liu Yuan followed up with Yue Yue and found no abnormal reactions.
Formation of vaccination recommendations for 40 diseases
From 2015 to 2021, the Beijing Shunyi District Center for Disease Control and Prevention held a total of 12 expert demonstration meetings, forming expert consensus recommendations (trial) for vaccination of 40 diseases such as Kawasaki disease, congenital biliary atresia, congenital esophageal atresia, and congenital bile duct dilation. At present, a total of 1163 children with special health status have been vaccinated with 11262 doses of the vaccine, and no adverse reactions have occurred in follow-up.
Wang Fengshuang introduced that the multidisciplinary expert demonstration of the vaccination recommendation for children with special health conditions has been supported by experts from the Beijing Municipal Center for Disease Control and Prevention, the China Institute of Pharmaceutical and Biological Products Verification, the Beijing Children's Hospital affiliated to Capital Medical University, Peking Union Medical College Hospital, the Capital Pediatric Research Institute, and the Third Hospital of Peking University. At present, the CDC has built an experienced team of experts to provide "hard-core" professional support for the continuous implementation and promotion of the model.
In 2018, the Shunyi District CDC led the exploration of the vaccination path for children with special health conditions and was approved as a special project for the development of health science and research in the capital. Chaoyang District of Beijing Municipality, Handan City of Hebei Province, Luoyang City of Henan Province and other places invited project team members to train local vaccination outpatient medical personnel and guide the vaccination of children with special health. At the same time, Wang Fengshuang established the "Vaccination Work Group for Children with Underlying Diseases" to solve the doubts of more than 200 front-line vaccination doctors across the country. Not long ago, in the first China Community Health Association Science and Technology Award, this research achievement won the third prize.
Text: Gao Yankun, a reporter of The Health Daily
Editor: Zhang Fangfei
Review: Xu Bingnan Yan Gong
