国产冻干麻疹-流行性腮腺炎-风疹联合减毒活疫苗免疫原性及安全性观察

目的观察国产冻干麻疹-流行性腮腺炎(腮腺炎)-风疹联合减毒活疫苗(MMR)的安全性及免疫原性。方法选取18~24月龄儿童210名,每名儿童接种1剂MMR,在接种后30min、6h、24h、48h、72h、7d、9d分别观察接种后临床反应,并于接种前、后6周各采集血清标本1份,用血凝抑制(HI)试验定量检测麻疹、腮腺炎、风疹IgG抗体。结果接种MMR后中、弱发热反应发生率4.29%,在1~2d内消退,无异常反应发生。免疫前麻疹HI抗体阴性儿童,免疫后抗体阳转率100%;免疫前麻疹HI抗体阳性儿童,免疫后抗体≥4倍增长率61.53%;抗体几何平均滴度(GMT)免疫后比免疫前增长3.8倍。免疫前腮腺炎HI抗体阴性儿童,免疫后抗体阳转率83.50%;免疫前腮腺炎HI抗体阳性儿童,免疫后抗体≥4倍增长率53.97%;抗体GMT免疫前1∶1.57,免疫后1∶3.52。免疫前风疹HI抗体均为阴性,免疫后抗体阳转率100%;抗体GMT 1∶487.2。免疫前、后麻疹、腮腺炎、风疹的抗体阳转率及GMT差异均有显著的统计学意义。结论国产冻干MMR具有良好的安全性和免疫原性。     

儿童流行性腮腺炎血清流行病学及疫苗免疫效果研究

为了解儿童中流行性腮腺炎(腮腺炎)的免疫情况,观察腮腺炎减毒活疫苗的安全性和免疫原性,选取516名2～9岁儿童进行血清流行病学调查,采用血凝抑制(HI)试验检测血清HI抗体.抗体阴性者进行接种疫苗,接种后48h内观察人体副反应,并分别在免疫后1个月、12个月、36个月采血测定HI抗体.516名2～9岁儿童中,腮腺炎HI抗体阳性者171人,总阳性率为33.1%,2～3岁、4～6岁和7～9岁3组的抗体阳性率分别为17.1%、28.2%和45.9%.345名抗体阴性儿童接种了腮腺炎减毒活疫苗,1个月后抗体阳转率分别为81.61%、76.55%和81.42%(总阳转率为79.42%),抗体几何平均滴度(GMT)则分别达到1∶13.42、1∶14.39和1∶12.29(平均为1∶13.40),无一例出现严重的副反应.免疫后12个月、36个月抗体阳性率及抗体GMT均有所降低,但仍维持在保护水平.     

国产麻疹流行性腮腺炎风疹联合疫苗初免效果及免疫程序探讨

目的为观察麻疹、流行性腮腺炎(腮腺炎)、风疹联合疫苗(MMR疫苗)的安全性和免疫原性,并探讨其免疫程序.方法选择91名8月龄儿童,接种MMR疫苗,观察接种后局部反应和全身反应,并检测接种后6周血清麻疹、腮腺炎、风疹抗体阳转率和几何平均滴度(GMT).结果91名8月龄儿童接种MMR疫苗后,有8名儿童发生一过性发热,2名儿童发生皮疹,2名儿童发生局部弱反应.麻疹、风疹、腮腺炎血凝抑制(HI)抗体阳转率分别为98.61%、100.00%、74.07%,GMT分别为145.25、1248.71、14.29.结论MMR疫苗对8月龄儿童接种具有较好的安全性和免疫原性,将其初免月龄定为8月龄儿童是可行的.     

母婴配对及不同月龄婴儿麻疹减毒活疫苗免疫后抗体水平分析

目的为研究母婴麻疹抗体水平的关系及6月龄和8月龄儿童接种麻疹减毒活疫苗(MV)的血清学免疫效果。方法开展母婴配对及不同月龄婴儿MV免疫后麻疹抗体水平研究。2003~2005年在徐州市和盐城市,采集到174对母亲、出生婴儿和3月龄婴儿的配对齐全者血清,及97名6月龄、62名8月龄婴儿的免疫前、后的血清,用微量血凝抑制(HI)试验检测麻疹HI抗体。结果①母亲与出生婴儿、出生婴儿与3月龄婴儿、3月龄婴儿与6月龄婴儿抗体滴度之间均有相关性,随着母亲抗体水平变化,婴儿抗体水平相应变化。②婴儿母传麻疹抗体随着月龄增加而下降,到6月龄时大部分婴儿抗体已降到低滴度,达不到保护抗体水平;8月龄时抗体水平基本消失。③97名6月龄婴儿免疫前麻疹抗体阳性率为11.34%,免疫后为97.94%;HI抗体总几何平均滴度(GMT)为1∶24.22。62名8月龄婴儿免疫前麻疹抗体阳性率为1.61%,免疫后为100.00%;HI抗体总GMT为1∶54.12。两组婴儿免疫前HI抗体总GMT差异无显著的统计学意义(t=0.521,P>0.05);免疫后1个月的抗体GMT差异有非常显著的统计学意义(t=8.348,P<0.001)。结论婴儿在8月龄时的免疫效果要明显好于6月龄,但在必要时对6月龄婴儿实行初免以提高保护率,同时开展6月龄和8月龄婴儿免疫前麻疹中和抗体水平的研究,以探讨最佳初免月龄。     

宜兴市麻疹免疫效果及健康人群免疫水平

目的了解麻疹免疫效果,掌握宜兴市未接种过麻疹疫苗的健康人群的麻疹抗体水平。方法单纯随机抽样选取未患过麻疹、无麻疹免疫史及接种禁忌症的65名儿童(I1组)及25名成人(I2组),分别接种麻疹疫苗、麻风疫苗,并于免疫前后1个月采集血清;选取未患过麻疹、无含麻制剂疫苗免疫史的健康人群(Ⅱ组),采集血清,应用酶联免疫吸附法测定抗体浓度。结果儿童及成人组接种后血清抗体阳转率为87.88%和100.00%;健康人群抗体阳性率为85.04%,抗体平均浓度为(3 229.85±439.04)IU/L,各年龄组间抗体阳性率、抗体平均浓度差异均有统计学意义(P值均0.01);0岁组抗体阳性率和平均浓度最低,且随月龄增加而降低。结论宜兴市麻疹疫苗免疫效果较好,健康人群抗体水平达到保护要求。     

西安市婴儿麻疹发病原因及防治策略的探讨

近年来,西安市未及接种麻疹疫苗（MV）的周岁内婴儿麻疹发病有增高趋势,为查明原因,在2000年春季对西安市儿童医院收治的436例≤7岁麻疹患儿进行了分析。结果＜8月龄未接种MV的病例占34.40％,发病最多的是6、7、8月龄,分别占周岁内病例数的18.18％、15.91％和21.82％。同时随机抽取51名5～8月龄未接种MV未患过麻疹的健康婴儿和63名育龄期妇女,用酶联免疫吸附试验（ELISA）间接法检测麻疹IgG抗体,结果7名5月龄儿童麻疹抗体阳性率为57.14％,GMT为1∶148.4,随月龄增长抗体阳性率逐渐下降,12名8月龄婴儿均为阴性。63名育龄期妇女抗体阴性占15.87％,抗体处于低水平占58.73％,中等水平19.05％,高水平只占6.35％。此结果表明,婴儿发生麻疹主要是母亲麻疹抗体水平低,导致婴儿母传抗体水平低、维持时间短,不能保护婴儿至8月龄MV初种时。因此建议对育龄期妇女进行婚前MV接种,并将MV初种月龄调整至6月龄。     

冻干麻疹减毒活疫苗安全性及免疫原性观察

目的评价接种冻干麻疹减毒活疫苗(MV,病毒滴度≥3.3lgCCID50/ml,0.5ml/剂次)的安全性和免疫原性。方法以209名8~12月龄未接种过MV的健康儿童作为试验组,63名1~2岁在观察期间不接种任何疫苗的健康儿童作为对照组,进行MV安全性观察,采用血凝抑制(HI)试验检测试验组儿童血清抗体。结果接种MV后无即时反应和局部反应发生。全身反应主要为发热反应,发热率为29.19%,以低、中热为主;皮疹发生率为4.78%。接种MV后HI抗体阳转率为98.46%,几何平均滴度为1∶29.38。结论MV具有良好的安全性和免疫原性。     

洞头县流动儿童麻疹抗体水平及接种率调查

目的了解洞头县流动儿童麻疹减毒活疫苗(MV)接种情况,为流动儿童预防接种的管理提供依据。方法采用分层随机抽样方法,在25个村(居委会),对2004—2009年出生的流动儿童进行麻疹疫苗接种率调查并采集血清检测麻疹抗体。结果 450名流动儿童中,麻疹疫苗接种率92.00%,麻疹抗体阳性率84.67%。1岁~组的抗体阳性率最低为73.08%。城区流动儿童麻疹抗体阳性率90.68%高于农村62.50%(P0.01)。结论洞头县流动儿童麻疹疫苗接种率较低,是麻疹暴发的重大隐患。应加强农村地区1岁~组儿童麻疹疫苗接种率。     

麻疹-风疹联合疫苗的安全性和免疫原性观察

目的探讨麻疹-风疹(MR)联合疫苗的安全性和免疫原性。方法选择8~12月龄未接种过麻疹疫苗(MV)和风疹疫苗(RV)、且免疫前麻疹和风疹血凝抑制(HI)抗体均为阴性的健康儿童238人,分为3组,分别接种MR联合疫苗、MV、RV,观察免疫后局部和全身反应,并于免疫后1个月检测麻疹和风疹HI抗体阳转率和几何平均滴度(GMT)。结果受种者未见严重不良反应,免疫后1个月麻疹和风疹HI抗体阳转率均为100%,MR联合疫苗麻疹HI抗体GMT为1∶50.6,风疹HI抗体GMT为1∶512;MV的HI抗体GMT为1∶35.8,RV的HI抗体GMT为1∶289.2。结论MR联合疫苗在适龄儿童中使用具有良好的安全性和免疫原性。     

健康人群麻疹抗体水平调查及分析

为杜绝外来传染病的入侵 ,有效控制和消除麻疹 ,S市 1999年对 6 73名健康人群 (其中 35 5名 0～ 2 9岁当地健康人群及 318名外来民工 )进行麻疹血凝抑制 (HI)抗体测定。结果显示当地健康人群HI抗体阳性率为 86 .2 0 % ,GMT为 1∶4 .6 2 ,各年龄组之间阳性率及GMT经统计学处理差异有显著性。外来民工HI抗体阳性率为 72 .96 % ,GMT为 1∶2 .14 ,各年龄组之间 ,抗体阳性率及GMT经统计学处理差异无显著性。调查结果提示 ,有必要对较大年龄组人群进行麻疹再免 ,同时建议对外来民工进行麻疹强化免疫 ,并提高流动人口儿童免疫接种率。     

Measles immunity in the first year after birth and the optimum age for vaccination in Kenyan children: Collaborative study by the Ministry of Health of Kenya and the World Health Organization*

There is still controversy about the optimum age for measles vaccination in developing countries, where the incidence of measles infection is higher in the first few months of life than it is in developed countries. This study was undertaken to collect reliable data in order to determine the optimum age for mass vaccination programmes. Haemagglutination inhibition (HI) antibodies were titrated periodically from birth to one year of age in children who were given the vaccine at different ages, between 5 and 9 months. It was found that 90% of children no longer have their maternal antibodies at 7-8 months of age, precisely at the period that the incidence of measles begins to rise sharply. Almost all children showed HI seroconversion when vaccinated at 71/2 months (or later, but not before), even if a low level of maternal antibody still persisted when the vaccine was given. These data show that there is an advantage in carrying out measles vaccination at 71/2 months of age in countries with conditions similar to that of Kenya. The duration of post-vaccinal immunity beyond one year of age has not been studied, but it can reasonably be expected that immunity after one vaccination can last for at least 3-5 years, thus exceeding the period when African children are most exposed to malnutrition.     

Evaluation of a measles-smallpox vaccination campaign by a sero-epidemiologic method.

An assessment technique has been devised whereby children from 30 randomly chosen sampling sites are visited within three days of measles-smallpox vaccination and one month later. Vaccination coverage is measured at house visits and immunologic status is determined by collection of early and late blood samples on filter papers from substratified children in priority age-groups, and by looking at vaccination scars. The methodology was employed in a rural area of the Ivory Coast during the maintenance phase of a measles-smallpox vaccination program; 1762 children from 0--72 months old were inspected. Children in the target age groups, 6--24 months, had a vaccination coverage of 53.6% whereas children outside of the target group had a 10.5% coverage. Of 571 target age children, 94.6% had a measles hemagglutination-inhibition antibody titer of less than 1:10 dilution at the first visit, and were presumed susceptible to measles or vaccine. Of 247 substratified children 6--8 months, 98.3% were susceptible to measles before vaccination; 84.3% of 127 vaccinated children in this age-group sero-converted when re-tested. Of 324 children 9--24 months, 91.7% were susceptible before the campaign; 94.7% of 170 vaccinated children in this age-group converted. A positive history of prior measles or prior measles-vaccination was not a good indicator of measles serologic status. The smallpox vaccination major reaction rate was 93.2%; 91.4% of children with a recent vaccination scar sero-converted to measles vaccine. Thus, the smallpox scar read at the second visit proved the best clinical marker for determining both coverage and immunologic effectiveness of the campaign.     

上海市中小学生麻疹疫苗强化免疫的效果评价

为进一步降低上海市麻疹疫情，1994～1996年完成了中小学学生（5～19岁）一次麻疹疫苗强化免疫，共计接种1 621 454人，接种率98.19％。流行病学效果评价强化免疫前后3年平均发病率比较，5～19岁发病率由0.97／10万下降至0.15／10万,全市发病率由0.42／10万下降至0.16／10万；麻疹血凝抑制（HI）抗体，强化免疫前阴性率8％，几何平均滴度（GMT）15.53，强化免疫后阳性率100％，GMT 152.56，抗体≥4倍增长率94.4％，效果均极显著。     

Immunogenicity and efficacy of one dose measles-mumps-rubella (MMR) vaccine at twelve months of age as compared to monovalent measles vaccination at nine months followed by MMR revaccination at fifteen months of age

BACKGROUND AND METHODS: measles is a common cause of morbidity and mortality in developing countries. Although the measles-mumps-rubella vaccine (MMR) is currently in use in developed countries, monovalent measles vaccine (MV) is routinely recommended by World Health Organization (WHO) at 9 months of age in Turkey, as in many other developing countries. In this study, 442 Turkish children received MV at 9 months of age and were revaccinated with MMR vaccine at 15 months of age. In the second group 495 children received MMR at 12 months of age with no earlier measles vaccination. Antibodies were measured before the first vaccination and 6 weeks after the MMR. All children had been followed for occurrence of measles infection for 60 months. Two vaccination schedules were compared for immunogenicity and protection rates. CONCLUSIONS: seroconversion and clinical protection rates were significantly higher in children who received only MMR at 12 months of age than in children revaccinated at 15 months of age. Seroconversion rate for measles was 69.9% in children who received MMR at 12 months of age and 90.3% in children revaccinated at 15 months of age (P=0.0003). While there was no measles case in children who were revaccinated, 12 (2.7%) children in the first group acquired measles during the follow-up period. Vaccination at 12 months of age appeared to be better than the current national standard. The late elimination of maternal antibodies and the inhibitory effect of a weak antibody response after the first dose of vaccine at 9 months may explain the better immunogenicity and efficacy of the MMR vaccine given at 12 months of age.     

2010年玉溪市儿童麻疹强化免疫接种率快速评估

目的评估玉溪市2010年麻疹减毒活疫苗(MV)后续强化免疫效果,总结经验,为控制并加快消除麻疹工作进程制定针对性的免疫策略提供依据。方法每县抽取城区和2个乡镇各30名目标儿童进行现场接种率快速评估。结果全市麻疹疫苗强化免疫接种率为99.66%,不同年龄段麻疹疫苗强化免疫接种率均在99.36%以上;不同居住形式麻疹疫苗强化免疫接种率均在97.78%以上,0剂次免疫史该县及外地的儿童均集中分布于8月龄～2岁年龄组。结论玉溪市2010年麻疹疫苗强化免疫达到了预期的目标。加强流动儿童管理,发现并适时消除免疫空白人群是实现2012年消除麻疹目标的工作重点。     

移民城市农民房居民区儿童麻疹疫苗漏种情况与发病的关系

目的了解移民城市农民房居民区儿童麻疹疫苗（麻苗）漏种特征与发病的关系,为制定麻疹预防控制措施提供科学依据。方法采用现场抽样调查和对麻疹病例电话调查的方法,对深圳市19个社康中心辖区内的553名儿童的调查资料进行描述流行病学分析。结果553名儿童中麻苗漏种率高达22．78％。1针漏种率为20．61％,2针漏种率为2．17％。在深圳居住时间〈3个月外来儿童的漏种率高达30．99％,而深圳户籍的常居儿童麻苗漏种率仅为6．67％,艘为4．65,P〈0．01。全部漏种儿童中的无证率为19．84％。其中,在深圳居住〈3个月儿童的无证率为50．00％。麻苗漏种率最高的大浪街道,其儿童麻疹发病率也显著地高于其他漏种率低的街道。〈8月龄未到麻苗初种年龄儿童,麻疹发病数占全部儿童病例数的36．36％。结论移民城市农民房居民区外来儿童是麻苗漏种的高危险人群;其漏种原因与其移居深圳时间短,未能及时获得预防接种证有关。因此认为,提高农民房居民区儿童,尤其是提高来深圳居住时间〈3个月外来儿童的预防接种证及时办证率和加大麻苗查漏补种的频率,同时对妊娠前妇女进行一针麻苗强化免疫是有效降低这一高危险人群麻疹发病率的关键措施。     

2011年深圳市南山区麻疹疫苗基础免疫的成功率

目的监测和评价深圳市南山区2001年麻疹疫苗的初次免疫效果。方法随机选择预防接种门诊接种麻疹疫苗的8月龄儿童86名,分别于免疫前、免疫后1个月采集静脉血,用酶联免疫吸附试验测定麻疹IgG抗体。结果 86名初免儿童免前抗体阳性率22.09%,免后抗体阳性率81.40%,差异有统计学意义(χ2=60.56,P0.01)。86名初免儿童免前抗体GMT为1∶138,免后为1∶2 864,差异有统计学意义(t=19.52,P0.01)。免疫成功率为80.23%。对麻疹疫苗免疫后不同性别、不同户籍的抗体阳性率及GMT进行统计分析,差异无统计学意义(P0.05)。结论南山区麻疹疫苗的基础免疫成功率未达到85%的指标要求,建议麻疹疫苗初免时间提前到6月龄。     

Evaluation of the effectiveness of routine measles vaccination: case-control study

A retrospective case-control study was conducted in two primary schools located in eastern region of Cairo to evaluate the protective value of routine measles vaccination. A total of 230 children who had a previous measles illness were identified over 3 months period. Each case was matched to two controls based on age and sex. Vaccination status of the study children was ascertained through reviewing vaccination certificates The overall measles vaccine effectiveness was estimated at 53% (95% CI 71%-26%) There was an association between age of measles vaccination and vaccine effectiveness (VE) Primary vaccination failure due to young age of measles vaccination is the likely explanation of the low measles vaccine effectiveness. Adoption of two-dose measles vaccination policy with the second dose being given at older age needs to be considered to correct the problem of vaccine failure.     

奉化市人群麻疹抗体水平监测及初中学生麻疹疫苗加强接种效果观察

目的分析奉化市1957-2006年麻疹流行病学特征,了解奉化市人群麻疹免疫水平及对初中学生加强接种麻疹疫苗后的免疫效果,为修定麻疹疫苗加强免疫方案提供客观依据。方法按照麻疹疫苗使用和计划免疫冷链装备情况将奉化市1957-2006年麻疹疫情划分为4个阶段进行比较;随机选取该市孕妇、婴幼儿、小学、初中、高中学生和育龄妇女共1500余人次进行麻疹IgG抗体监测,对2005年暴发过麻疹并进行过麻疹疫苗应急接种的西坞初中学生和2006年加强接种麻疹疫苗的莼湖初中学生进行免疫效果分析。麻疹IgG抗体检测采用ELISA定量法。结果4阶段麻疹年均发病率和年龄构成差异有统计学意义,发病年龄由幼儿和学龄前儿童为主,向8月龄以下小婴儿和15岁以上大年龄组人群转移;2005年该市本地人口8月龄以下小婴儿和15岁以上人群发病分别占25.86%和72.41%。6～8月龄婴儿麻疹IgG抗体GMC为51IU/L,8月龄婴儿麻疹疫苗初免成功率为100%,保护性抗体阳性率为94.12%,GMC为1352IU/L;18月复种后保护性抗体阳性率达100%,GMC为2333IU/L,小学高年级、初高中学生、育龄妇女及孕妇保护性抗体阳性率在46%～68%之间,GMC在783IU/L～901IU/L之间;西坞初中学生应急接种麻疹疫苗1年后保护性抗体阳性率为80.10%,GMC为1889IU/L,莼湖初中学生加强接种麻疹疫苗1月后保护性抗体阳性率为97.64%,GMC为2354IU/L。结论8月龄和18月龄麻疹疫苗初免和复种免疫效果良好,10岁以上人群麻疹IgG抗体水平下降,对初中学生进行麻疹疫苗加强接种免疫效果明显。建议调整现行麻疹的免疫策略,对初中学生进行麻疹疫苗加强接种,以削平大小两端年龄麻疹发病高峰,实现WHO西太区提出的到2012年消除麻疹的目标。     

麻疹母传抗体水平及6～8月龄接种麻疹疫苗的免疫效果监测

[目的]了解8月龄以下婴儿麻疹母传抗体水平及6～8月龄婴儿接种麻疹疫苗的免疫效果和安全性,探讨控制小月龄婴儿麻疹的免疫策略。[方法]在南昌市的12个县(区)随机抽取0～8月龄婴儿各70余名,监测麻疹母传抗体;对6～8月婴儿初免麻疹疫苗后免疫效果及安全性观察,采用酶联免疫吸附试验检测免前和免后1个月的麻疹IgG抗体滴度。[结果]8月龄以下婴儿母传抗体几何平均滴度为1︰209,各月龄组抗体几何平均滴度均未达保护水平;6月龄、7月龄、8月龄初免后GMT分别为1︰1407、1︰1897、1︰2410,初免前后GMT差异有统计学意义(P﹤0.05),初免后3组的阳性率均≥90%,免疫成功率﹥85%,接种MV未出现异常反应,提示6月龄的MV初免程序是可行的;但6、7、8月龄3组间免疫成功率差异有统计学意义(P﹤0.05),免前母传抗体阴性和阳性的免疫成功率差异有统计学意义(P﹤0.05),提示婴儿母传抗体的存在对MV的免疫成功率有干扰作用。[结论]婴儿麻疹母传抗体滴度均较低,无有效保护作用;6足月后接种麻疹疫苗安全有效。建议进行育龄妇女孕前接种MV和提前婴儿MV初免时间的成本效益研究,制定安全有效的免疫策略,减少小月龄婴儿麻疹发病率。