Implementation of a Q fever vaccination program for high-risk patients in the Netherlands
Implementation of a Q fever vaccination program for high-risk patients in the Netherlands
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DOI：
10.1016/j.vaccine.2013.03.062
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发表时间：
2013-05-28
期刊：
影响因子：
5.5
通讯作者：
Timen, Aura
中科院分区：
文献类型：
--
作者：
Isken, Leslie D.;Kraaij-Dirkzwager, Marleen;Timen, Aura
背景：2007年至2011年，荷兰面临前所未有的Q热疫情，超过4000人受到影响。奶山羊被认为是主要的感染源。除了采取兽医措施外，荷兰政府还向Q热并发症高风险患者群体提供了针对病原菌贝氏柯克斯体的未经许可的疫苗。本文介绍了2010- 2011年Q热疫苗接种计划的复杂性。方法：选择高危患者，主要由其全科医生转诊至公共资助的集中筛查和疫苗接种计划。此外，还向心血管专家和公众通报了情况。对患者进行既往感染C.通过血清学和皮肤试验检测贝氏体。结果：在2741例转介的高风险患者（男性1669例，来自高风险地区1957例）中，955例被排除在外，因为疫苗接种被认为是不必要的或距离接种门诊太远。388人（占筛查人数的22%）因皮肤试验或血清学阳性而被排除。2011年1月至6月期间，1368名患者（占筛查人数的77%）接种了疫苗。三分之二的接种者报告了不良事件。89例患者（6.6%）报告了严重不良事件。仅一名患者出现注射部位反应，考虑了可能的因果关系。结论：Q热疫苗接种计划对荷兰医疗保健系统提出了挑战。明确有关人员的作用和责任，妨碍了及时接种疫苗。通过全科医生瞄准高危人群具有挑战性，但似乎是有效的。疫苗接种被认为是安全的，筛查患者的依从性很高。(c)2013爱思唯尔有限公司保留所有权利。
Background: Between 2007 and 2011 the Netherlands was faced with an unprecedented Q fever outbreak with more than 4000 people affected. Dairy goats were considered the main source of infection. In addition to taking veterinary measures, the Dutch government offered an unlicensed vaccine against the causative bacterium Coxiella burnetii to patient groups at high-risk of Q fever complications. This article describes the complexity of the vaccination program for Q fever in 2010-2011.Methods: High-risk patients were selected and referred mainly by their general practitioner to a publicly funded centralized screening and vaccination program. In addition, cardiovascular specialists and the public were informed. Patients were screened for previous infection with C. burnetii by serology and skin-tests. Patients who tested positive were excluded from vaccination.Results: Of the 2741 referred high-risk patients (1669 male, 1957 from the high-risk area), 955 were excluded because vaccination was considered unnecessary or the distance to the vaccination clinic too far. 388 (22% of those screened) were excluded because of a positive skin-test or serology. 1368 patients (77% of those screened) were vaccinated between January and June 2011. Two-thirds of the vaccinees reported an adverse event. 89 patients (6.6%) reported serious adverse events. In just one patient, with an injection site reaction, a possible causal relationship was considered.Conclusion: This Q fever vaccination program posed challenges to the Dutch Health Care system. Creating clarity on the roles and responsibilities of those involved precluded timely vaccination. Targeting the high-risk population through GPs was challenging but appeared to be efficient. The vaccination was considered to be safe and compliance of the screened patients was high. (c) 2013 Elsevier Ltd. All rights reserved.