慢性儿童的流感疫苗|Overview
neurodevel儿童患有慢性疾病opmental disorders, asthma or respiratory conditions, just to name a few—are among患有严重流感并发症的高风险的人，例如呼吸衰竭甚至死亡。鉴于这一点，总有强有力的建议，即这样的孩子每个季节接受流感疫苗，此外还要求接种6个月及以上的所有儿童。
Unfortunately,波士顿儿童医院调查员的最新研究欧宝彩票平台发现只有25％的慢性病儿童接受了与流感相关的危害疾病接受重症监护的疫苗。该速率甚至低于美国一般儿科人口，每年有50-58％的疫苗接种。
那么，为什么长期患病的孩子不尽可能多地接受流感疫苗呢？差距在哪里？
或者，换句话说，机会在哪里？
找到合适的家
Adrienne Randolph，医学博士，MSC- 波士顿儿童的强化主义者和该流感疫苗研究的主要作者 - 信心护理协调和沟通是解决问题的关键。她说：“许多慢性病儿童缺乏'医疗之家'（一种协调和跟踪护理各个方面的单一医疗资源），因为有很多专科医生参与他们的护理。”
That lack of home can fuel a lack of clarity as to who should vaccinate and under what circumstances, leading to missed opportunities. For instance, if a child is an inpatient, her provider may prefer to wait to vaccinate until she is healthy, but the vaccine may not be offered as part of her discharge process. She may have an appointment with a specialty clinic, but that clinic may not offer seasonal vaccination to its patients. And her primary care provider (PCP) may think that vaccination is too risky, given her chronic condition.
Gregory Young, MD，波士顿儿童儿科医师组织的总裁兼首席执行官，波士顿的Longwood Pediatrics的初级保健提供者，虽然最终应流感疫苗应成为医疗家庭功能，但长期病人的医疗家庭不一定必须生活与她的PCP。
"For patients on kidney dialysis, those actively being treated for cancer or those with cystic fibrosis, the medical home is often based in the specialty setting," he explains. "But for children with high complexity and vulnerability that doesn't necessarily boil down to a single condition, it should be the primary care setting."
这是每个人的工作
Instead of only asking why these children don't get the vaccine in the medical home, Young says, we should instead ask what needs to be done to ensure that no opportunity is ever missed. In his mind, all of the providers involved in a child's care should feel accountable for vaccinating.
“如果一个孩子是我的病人，我每年见到她一次或两次，但她每年看到四次心脏病专家，那么我相信应该发生的事情是，如果孩子在9月拜访心脏病专家，而她尚未收到疫苗还应接种疫苗。心脏病专家办公室应该告诉家人让我的实践知道，并在其心脏病学访问中包括射击文档。”
伦道夫同意，在流感季节之前的每一次医疗互动都应该被视为接种疫苗的机会。她列举了波士顿儿童心脏中心，重症监护病房（ICU）和急诊科为秋季所有患者提供季节性流感疫苗接种的最新努力。她补充说：“应该鼓励专业诊所在拜访期间免疫儿童。”
两者都表明需要支持医疗家庭角色的系统，如果已经提供了疫苗并指出孩子是否是否提供了疫苗接种的患者，并与患者的整个护理团队（专业人士和PCP）进行通讯应该接受第二剂（对于最初的疫苗接种季节，最高8岁的儿童所必需的）。
Young强调了对诊所和实践的需求，以开始测量其长期患者的流感疫苗覆盖率。“您无法管理自己不衡量的事情。大多数实践不知道弱势儿童的免疫率是多少。
"It's only when you start measuring these things that people can start thinking critically about the systems that are in place," he continues. "We all want to do the right thing, but we need to have the information available."
Randolph points out that there are larger systematic benefits beyond the clear health benefits to solving this problem and making sure chronically ill patients get the flu vaccine, but that the system needs to change to make sure vaccination happens. "The cost and effort of vaccinating are very low compared to those of an ICU admission for flu-related critical illness. The time it takes to prevent that outcome is worth it."