目的 探讨特殊健康儿童预防接种评估及不良反应处理。方法 选取2018年1月–2022年12月经预防接种门诊主动筛选的出生日期在2004年6月1日—2022年6月1日的特殊健康儿童,收集临床资料,以此进行预防接种评估建议,随访不良反应。结果 本研究共纳入944例特殊健康儿童,其中精神发育迟滞231例（24.47%）、脑性瘫痪440例（46.61%）、先天愚型115例（12.18%）、癫痫74例（7.83%）、先天性心脏病54例（5.72%）、唐氏综合征30例（3.18%）。其中男、女分别有519例（54.98%）、425例（45.02%）。在特殊健康儿童中,建议可正常接种疫苗918例（97.25%）,建议接种灭活疫苗但避免接种减毒活疫苗8例（0.85%）,建议暂缓接种所有疫苗18例（1.91%）。建议接种疫苗的特殊健康儿童中,已接种疫苗926例（98.09%）,接种灭活疫苗842例（89.19%）,接种减毒活疫苗612例（64.83%）;926例儿童共接种疫苗8 480剂次,其中灭活疫苗6 770剂次、减毒活疫苗1 770剂次;62例儿童进行68剂次疫苗接种后出现不良反应（包括局部反应15例次、全身反应53例次）,总发生率为8.02‰（68/8 480）,其中灭活疫苗、减毒活疫苗发生率分别为6.79‰（46/6770）、1.29%（22/1 710）。所有不良反应案例经处理,除口干1例处理后好转外,其他均达治愈,治愈率达98.53%（67/68）。结论 特殊健康儿童经医学评估后大多可接种疫苗,接种后不良反应发生风险在可控范围内。

Objective To discuss the evaluation of vaccination and treatment of adverse reactions in healthy special children. Methods From January 2018 to December 2022,healthy special children with birth dates from June 1,2004 to June 1,2022 who were screened by the vaccination clinic were selected. Clinical data were collected to conduct vaccination assessment recommendations and follow up adverse reactions. Results A total of 944 healthy special children were included in this study,including 231 cases(24. 47%)of mental retardation,440 cases(46. 61%)of cerebral palsy,115 cases(12. 18%)of congenital foolishness,74 cases(7. 83%)of epilepsy,54 cases(5. 72%)of congenital heart disease and 30 cases(3. 18%)of Down syndrome. There were 519 males(54. 98%)and 425 females(45. 02%). Among the healthy special children,918 cases(97. 25%)were recommended to get vaccinated normally,8 cases(0. 85%)were recommended to be vaccinated with inactivated vaccine but avoid to be vaccinated with attenuated live vaccine,and 18 cases(1. 91%)were recommended to suspend all vaccination. Among the special healthy children recommended for vaccination,926(98. 09%)had been vaccinated,842(89. 19%)had been vaccinated with inactivated vaccine,and 612(64. 83%)had been vaccinated with live attenuated vaccine. A total of 8 480 doses of vaccines were administered to 926 children,including 6 770 doses of inactivated vaccines and 1 770 doses of attenuated live vaccines. Adverse reactions occurred in 62 children after 68 doses of vaccination(including 15 cases of local reactions and 53 cases of systemic reactions),with a total incidence of 8. 02 ‰(68/8480). The incidences of inactivated vaccine and attenuated live vaccine were 6. 79 ‰(46/6 770)and 1. 29%(22/1710),respectively. All cases of adverse reactions were treated and basically cured,with a cure rate of 98. 53%(67/68),except for the case of dry mouth. Conclusions Most of the healthy special children can be vaccinated after medical evaluation,and the risk of adverse reactions after vaccination is controllable.

目的 总结预防接种认知干预对儿童预防接种效果的影响。方法 对2018年5—9月在东莞企石镇接种百白破疫苗的儿童家属按接种时间顺序分为对照组254名、实验组248名,对照组家属按常规方法进行预防接种,实验组在常规接种基础上,结合不按时接种、延迟接种等问题对幼儿家属开展多种多样的百白破疫苗预防知识、不良反应观察处理、接种注意事项等知识宣教和培训干预,总结两组儿童在按时接种、延迟接种、疫苗接种知识、不良反应表现与处理、接种注意事项知识的掌握、服务满意度等情况。结果 实验组幼儿按时接种率比对照组高,延迟接种率比对照组低,结果有差异(P＜0.05);家属对疫苗接种知识、不良反应表现和处理、接种注意事项等知识的掌握比对照组高,结果有差异(P＜0.05)。结论 实施家属预防接种认知干预管理能提高家属掌握预防接种知识和不良反应护理知识;提高儿童疫苗接种率和及时接种率,提高预防接种服务管理效果。

Objective To summarize the effect of cognitive intervention on children's vaccination. Methods The family members of children vaccinated with DPT vaccine in Qishi Town of Dongguan City from May to September 2018 were divided into control group 254 and experimental group 248 according to the sequence of vaccination time. The family members of control group were vaccinated by routine methods. On the basis of routine vaccination, the experimental group carried out a variety of preventive knowledge and adverse reactions observation of DPT vaccine to the family members of children in combination with the problems of untimely vaccination and delayed vaccination. The knowledge propaganda and training intervention of treatment and vaccination precautions were summarized. The situation of two groups of children in timely vaccination, delayed vaccination, vaccination knowledge, adverse reaction performance and treatment, knowledge of vaccination precautions and service satisfaction were summarized. Results The vaccination rate of children in the experimental group was higher than that in the control group, and the delayed vaccination rate was lower than that in the control group. The results showed statistical difference (P＜0.05). The knowledge of vaccination, adverse reactions, treatment and matters needing attention of family members were higher than that in the control group, and the results showed statistical difference (P＜0.05). Conclusion Implementing cognitive intervention management of family vaccination may improve family members'knowledge of vaccination and nursing of adverse reactions, improve children's vaccination rates and timely vaccination rates, and improve the management effect of vaccination service.