上海市1990-2006年风疹流行病学特征分析

目的了解1990—2006年上海市风疹流行病学特征。方法用描述流行病学方法分析1990—2006年上海市传染病报告疫情数据库，数据采用Excel整理与分析。结果1990—2006年上海市风疹报告发病率为0．15110万～451．57／10万；1993年上海市发生风疹大流行，是风疹发病最高的年份，共报告风疹病例58104例，1998年是风疹发病的最低年份，共报告19例；1990—1994年（疫苗使用前）年平均报告发病率为93．00/10万，在疫苗使用前，风疹发病有明显的季节性特征，每年发病高峰集中在3—6月；风疹病例主要集中在儿童和青少年人群，即以5～9岁和10～14岁年龄组为主。1995年开始在上海市大规模使用风疹联合疫苗（MMR）后，全市MMR接种率达85％以上。风疹发病率呈逐渐下降趋势，每年报告风疹发病数除1995年外均〈100例，风疹的发病得到有效控制。但疫苗使用后，风疹发病的年龄构成有所改变，0～4岁发病年龄构成增加，占总发病数的21．00％，且发病年龄有逐年后移趋势，20岁以上年龄组发病占总发病数的31．62％，1995—2006年25～29岁年龄组和30～34岁年龄组风疹发病率均高于疫苗使用前（除1993年）相同年龄组的发病率。结论上海市风疹发病年龄后移。     

安徽省农村地区风疹感染基线调查及风疹疫苗免疫效果观察

对安徽省农村地区115名≤2岁～≥23岁的健康人检测了风疹血凝抑制（HI）抗体,结果表明：风疹HI抗体平均阳性率为67．89％;≤5岁儿童为43.85％;育龄期妇女易感率为8．59％。对361名≤2岁～≥23对岁的健康人接种了BRDⅡ株风疹减毒活疫苗,免疫应答研究结果表明：各年龄组对风疹疫苗均有较好的免疫应答反应;免疫前HI抗体阳性者接种风疹疫苗后仍可获得良好的免疫应答．说明我国选育的BRDⅡ株风疹减毒活疫苗具有良好的免疫原性。作者建议：①在全省建立风疹的监测系统;②将风疹疫苗的接种纳入计划免疫管理,实行1岁儿童完成初种及对婚前育龄期妇女给予1剂风疹疫苗的接种方案;③在条件许可的情况下,对全省农村地区14岁以下儿童进行普种．     

BRDⅡ株风疹疫苗免疫应答研究

本文对安徽省４２６名健康人群血清检测结果分析表明：风疹ＨＩ抗体平均阳性率为５９．１５％；育龄期妇女易感率为１０．７７％。对３６１名健康人群ＢＲＤⅡ株风疹减毒活疫苗免疫应答研究结果分析表明：各年龄组对风疹疫苗均有较好的免疫应答反应；免前阳性人群接种风疹疫苗仍可获得良好的免疫应答反应。显示我国选育的ＢＲＤⅡ株风疹减毒活疫苗具有良好的免疫原性。推荐我省风疹免疫策略：１）在全省建立风疹的监测；将风疹疫苗的接种纳入ＥＰＩ管理规程。２）实行１岁儿童完成初种及对婚前育龄期妇女给予一针风疹疫苗的接种的方案。３）在条件许可的情况下，对全省农村地区１４岁以下的儿童进行一针普种。     

广东省1997—2006年风疹流行情况分析与控制策略探讨

目的 了解广东省风疹流行特征，进一步做好广东省风疹控制工作。方法 采用描述性流行病学方法对广东省1997—2006年风疹监测资料进行分析。结果 1997—2006年广东省共报告风疹病例13507例，报告年发病率为0．50／10万～5．60／10万，年平均报告发病率为1．68／10万。2000年风疹疫苗补种后风疹发病率明显下降；发病主要集中于10～14岁和5～9岁年龄组，占总发病数的43．1％（5822／13507）。与风疹疫苗补种前比较，2001—2006年0～4岁和生育高峰年龄的25～34岁发病构成比有所增加。职业分布主要以学生和散居儿童为主，分别为6632和2148例（分别占总数的49．1％和15．9％）；病例主要分布于广州、江门、清远、佛山和梅州市，共8585例，占总数的63．6％。发病高峰期以3—6月份为主，共发病7470，占总数的55．3％。调查2000年1～14岁儿童风疹疫苗补种的接种率和2001—2004年风疹疫苗抽查接种率，均未达到80％。结论 广东省风疹疫苗接种率不高，为加强广东省风疹控制，建议广东省可在实施扩大免疫规划后，对1～14岁儿童进行风疹疫苗补种工作，同时鼓励准备怀孕的妇女接种含风疹疫苗成分的疫苗。     

泉州市2004—2013年风疹流行特征分析

目的分析泉州市2004—2013年风疹流行趋势,为制定防控策略提供参考。方法对国家传染病报告信息系统中风疹疫情资料进行描述流行病学分析。结果泉州市此10年间报告风疹1 311例,年发病率1.68/10万,无死亡病例。2011年发病率最高。发病率居前3位是台商投资区（4.08/10万）、丰泽区（4.06/10万）和惠安县（3.83/10万）。城区发病率高于非城区;男性发病高于女性,性别比1.7∶1;发病有明显季节性,3-6月高发;病例主要集中在10-29岁（71.0%）;学生占57.7%,其次是散居儿童（12.3%）。发病年龄有向两头发展趋势,〈1岁组发病率从2.42/10万上升至8.22/10万,呈明显上升趋势;2009—2012年发病年龄高峰比2004―2008年后移5岁。12起暴发疫情均发生在学校。结论应加强疫情监测,开展健康教育,提高儿童风疹疫苗的接种率,鼓励大中专院校学生和育龄期妇女接种风疹疫苗。     

北京市顺义区1997～2007年风疹发病特征

目的了解北京市顺义区1997～2007年风疹流行病学特征,为控制风疹提供依据。方法对风疹发病资料进行描述流行病学分析。结果1997～2007年,顺义区风疹发病277例,年平均发病率3．77／10万,不同年份间发病率的差异有统计学意义（P〈0．01）;3～7月为发病高峰,占发病构成的77．85％;发病以学生为主,占发病构成的60．65％;有明确免疫史的40人,占14．44％;流动人口发病逐渐升高,出现发病年龄后移现象。结论学校和流动人口是风疹控制的重点,今后要加强学校疫情监测,提高学生和流动人口麻腮风疫苗免疫率。     

山东省风疹流行现状分析

为了解风疹发病现况 ,进一步做好控制风疹和先天性风疹综合征 (CRS)工作 ,对近年来山东省风疹流行现状进行了分析。结果显示 :自 1995年山东省推广风疹疫苗免疫接种以来 ,风疹发病得到了有效控制。但部分地区风疹疫苗免疫接种存在漏洞 ,风疹仍在局部地区以爆发形式呈小规模周期性流行。 1999年全省共报告风疹 114例 ,2 0 0 0年报告 2 13例 ,2 0 0 0年比 1999年上升 86 84 % ;高峰季节为春季 ,病例主要集中于学龄儿童 ,1999年 7岁发病最高 ,2 0 0 0年为 10～ 12岁。免疫史分析发现 ,山东省风疹发病主要与风疹疫苗实际接种率不高有关。因此 ,今后应加强风疹疫苗的常规免疫接种 ,以降低风疹和CRS的发生 ,提高麻疹监测工作的质量。     

珠海市1～30岁健康人群风疹抗体水平监测和风疹疫苗免疫的血清学效果

为给我省将风疹疫苗接种纳入计划免疫管理提供科学依据，１９９６年以珠海市为试点，在该市三个区选择９４４名１～３０岁健康人群，用微量血球凝集抑制（ＨＩ）试验检测风疹ＨＩ抗体，总阳性率为６８．２％，几何平均滴度倒数（ＧＭＲＴ）为３６．１，其中＜１６岁儿童的风疹抗体阳性率和ＧＭＲＴ均明显低于≥１６岁人群。从９４４人中随机抽取１６９人接种风疹疫苗，观察免疫后的血清效果，免疫成功率为４７．３％，其中免前抗体阴性者，免后阳转率为９６．５％，免前抗体≤１：６４者，免疫成功率为９５．６％，免后比免前ＧＭ－ＲＴ增长９．３倍。同时对珠海市１～７岁儿童普遍接种风疹功苗，接种率为６１．２％，其中１岁儿童接种率７１．１％。疫苗接后未发现严重副反应，显示风疹疫苗有良好的免疫原性，安全可靠，建议逐步将风疹疫苗接种纳入计划免疫管理。     

泉州市2008-2015年风疹流行病学特征分析

目的 了解泉州市2008年使用风疹疫苗以来风疹疫情流行特征,为进一步做好风疹防控工作提供基础数据.方法 采用Excel 2010和SPSS18.0软件包对泉州市2008-2015年风疹监测资料进行描述性流行病学分析.结果 2008-2015年泉州市共报告风疹病例1 343例,平均报告年发病率为2.04/10万.病例主要分布于惠安、晋江和南安,占总数的53.90％ (724/1 343).3～6月份为风疹发病高峰期,占总数的81.31％(1 092/1 343).发病率居前三的年龄组为l5～、l0～和0～岁组,职业分布主要以学生和散居儿童为主,占总数的65.97％ (886/1 343).育龄期妇女风疹抗体阳性率为74.80％ (365/488).含风疹疫苗接种率自2008年以来逐年增高,2012年以来麻风、麻腮风接种率95％以上.结论 泉州市风疹疫苗接种率提高,风疹疫情趋于低流行水平,但应加强对孕前风疹抗体阴性育龄期妇女进行含风疹疫苗接种.     

2006-2015年武汉市风疹疫情流行病学分析

目的 了解2006-2015年武汉市风疹疫情的流行病学特征,为制定风疹免疫预防策略提供参考.方法 收集中国疾病预防控制信息系统中2006-2015年武汉市风疹个案病例疫情信息,采用描述流行病学方法分析风疹的流行病学特征.结果 2006-2015年累计报告风疹5 353例,2006-2008年报告发病率逐年上升,2009-2015年发病逐年下降,发病高峰为3～7月,发病前3位的地区为青山区、洪山区、武昌区.病例中男性多于女性(x2=156.40,P＜0.05),以学生为风疹的高发人群,发病年龄以10～19岁人群最多,占发病总数的69.33％.风疹病例中有风疹免疫史的占0.43％,武汉市适龄儿童含风疹成分疫苗接种剂次数逐年上升.结论 2006-2015年武汉市风疹报告发病呈波动下降趋势,但存在发病年龄后移现象,应做好适龄儿童2剂次含风疹成分疫苗的常规免疫外,尽快制定15岁以上人群的免疫预防策略.     

Reasons for rubella susceptibility among pregnant women in west Lambeth.

One hundred and thirty-three pregnant women who delivered at St Thomas' Hospital, in 1990 were noted to require rubella vaccination post partum. Fifty-three (39%) had completed a telephone questionnaire in order to determine reasons for susceptibility to rubella. Laboratory reports confirmed that 92 women were rubella seronegative and 27 had low levels of antibody. Of the 53 women interviewed, 25 gave a history of one or more rubella immunizations, 20 had no history of immunization and vaccination history was unknown for eight. Eleven of the 20 unvaccinated women had not been at school in the UK between 11 and 14 years of age. Eighty-seven per cent of the patients' general practitioners had no knowledge of their patients' rubella antibody status. Ninety-four per cent of the 133 women received rubella vaccine post partum. The Department of Health guidelines should be more vigorously implemented in order to identify and immunize remaining rubella susceptible women of child-bearing age. Susceptibility among women with a history of rubella immunization suggests that the seroconversion rate following rubella immunization in clinical practice may be lower than in vaccine trials.     

Control of rubella and congenital rubella syndrome (CRS) in developing countries, Part 2: Vaccination against rubella.

In 1995-96 we conducted a review of rubella immunization strategies. Worldwide, 78 countries (more than one-third) reported a national policy of using rubella vaccine. This was closely related to country economic status. Based on the United Nations country classification, rubella vaccine is used in 92% of industrialized countries, 36% of those with economies-in-transition, and 28% of developing countries. Cases of congenital rubella syndrome (CRS) may be prevented as follows: by providing direct protection to women and/or schoolgirls (a selective vaccination strategy); by vaccinating boys and girls to provide indirect protection by reducing the transmission of rubella virus (a childhood vaccination strategy); or by a combination of these approaches (a combined strategy). A combined strategy was most commonly reported (60% of countries); seven countries (9%) reported a selective strategy; and 24 countries (31%) reported only childhood immunization. Experience has shown that it is essential to include vaccination of women of childbearing age in any rubella control strategy. Childhood vaccination alone may pose a risk of an increase in CRS cases. Although many countries have introduced rubella vaccine, few report any data on the impact of vaccination. Countries using rubella vaccine need to establish surveillance for rubella and CRS and monitor coverage in each of the target groups.     

Epidemiological profile and progress toward rubella elimination in China. 10 years after nationwide introduction of rubella vaccine

BackgroundRubella-containing vaccine (RCV) became available in China in 1993 and was introduced nationwide into the Expanded Immunization Program (EPI) in 2008. We evaluated implementation and impact of RCV from 2 years prior to nationwide introduction through the 10 years after nationwide introduction.MethodsWe analyzed RCV lot-release (doses distributed) data, 1- and 2-dose RCV coverage, and rubella data from China’s nationwide disease surveillance system to describe the current status and changes in rubella epidemiology between 2005 and 2017.ResultsWhile the vaccine was included into the routine immunization program in 2008, its full implementation required 4 years due to sporadic vaccine supply constraints. RCV1 and RCV2 coverage increased from 51.5% and 39.0% in 2008 to >95% during 2012 through 2016. From 2005 to 2017, the annual incidences (per million) of rubella ranged from 91.09 in 2008 down to 1.16 in 2017; reductions occurred in all age groups. The proportion of cases among individuals ≥20 years old increased from 0.97% in 2005 to 31.2% in 2017. In the better-developed eastern China, most cases were among adults; in central and western China, most cases were among children or adolescents.ConclusionsThe marked decrease rubella was a result of inclusion of RCVs into EPI targeting children less than 2 years of age and achieving high level of 2-dose coverage. Rubella was reduced in absolute terms, and its epidemiology was changed to older cases with substantial inter-province variation. Ensuring full vaccination of school children and identifying strategies to reach adults with measles and rubella combined vaccines will be important to hasten elimination of rubella and prevent CRS outbreaks.     

2004—2011年西安市风疹流行特征及应对策略

目的通过对2004—2011年西安市风疹的发病资料进行分析,了解其发病情况及其流行病学特征,为控制风疹和先天性风疹综合征(CRS)提供科学依据。方法导出中国疾病预防控制信息系统中2004—2011年西安市风疹报告病例,应用Excel软件对数据进行描述性统计分析。结果 2004—2011年间累计报告风疹4 704例,年平均发病率为7.40/10万,无死亡病例。风疹流行周期约为4 a,2007和2011年为流行高峰年。发病高峰月为3—7月。地区分布表现为城区发病率较高,郊县阎良区发病率最高(16.65/10万)。男性发病2 705例,女性1954例。男性发病人数明显高于女性。近年风疹发病呈现逐渐向大龄人群推移的趋势。年龄组发病率比较,10～25岁发病率较高,且以10～15岁年龄组最高,职业分布以学生为主,学生、幼托儿童和散居儿童总病例占全市病例总数的90.18%。结论西安市2004—2011年风疹呈周期性流行,建议制定针对性强的综合性预防措施,加强卫生宣传和健康教育工作,加强风疹疫苗的免疫接种工作;尽快制订育龄期人群风疹免疫策略,预防控制风疹暴发。     

Seroepidemiology study of rubella antibodies among pregnant women from seven Asian countries: evaluation of the rubella vaccination program in Taiwan

During 2003-2004, approximately 13% of birth in Taiwan was given by foreign-born females. The aims of this study were to compare the seroprevalence of rubella antibodies between Taiwan-born and foreign-born pregnant women and evaluate the effect of rubella vaccination program in Taiwan. We reviewed the rubella antibody test results of 5007 women during routine pregnancy check-ups at Fooyin University Hospital during 1999-2002. In Taiwan-born women, rubella antibody was undetectable in 29.2%, 7.3%, and 8.3% of the cohorts born before 1971, between 1971 and 1976, and after 1976, respectively. In the cohorts born between 1971 and 1976 and after 1976, pregnant women born in China, Vietnam, Indonesia, and Philippines had significant higher chances of being susceptible. Our results suggested that the voluntary adult vaccination program was not as effective as the school or wipe-out programs. Both Taiwanese women born before 1971 and foreign-born women were more likely to be susceptible to rubella. The introduction of 'catch-up' immunization program and enforcement of the checking of immunization record and/or blood test before pregnancy for these women are necessary in preventing CRS.     

Elimination of rubella and congenital rubella syndrome--United States, 1969-2004

In October 2004, CDC convened an independent panel of internationally recognized authorities on public health, infectious disease, and immunization to assess progress toward elimination of rubella and congenital rubella syndrome (CRS) in the United States, a national health objective for 2010. Since rubella vaccine licensure in 1969, substantial declines in rubella and CRS have occurred, and the absence of endemic transmission in the United States is supported by recent data: 1) fewer than 25 reported rubella cases each year since 2001, 2) at least 95% vaccination coverage among school-aged children, 3) estimated 91% population immunity, 4) adequate surveillance to detect rubella outbreaks, and 5) a pattern of virus genotypes consistent with virus originating in other parts of the world. Given the available data, panel members concluded unanimously that rubella is no longer endemic in the United States. This report summarizes the history and accomplishments of the rubella vaccination program in the United States and the Western Hemisphere and the challenges posed by rubella for the future.     

An epidemiological assessment towards elimination of rubella and congenital rubella syndrome in Singapore

ObjectiveIn line with regional and global goals for the elimination of rubella and congenital rubella syndrome (CRS), we reviewed the epidemiological situation in Singapore, based on surveillance reports on rubella and CRS, national immunization coverage and seroprevalence surveys. The aim of our review was to identify current gaps and steps taken to achieve the targets set by the World Health Organization (WHO) Western Pacific Regional Office (WPRO).MethodsEpidemiological data on clinical and laboratory-confirmed rubella cases, including CRS, notified to the Communicable Diseases Division, Ministry of Health, Singapore, from 2003 to 2013 were collated and analyzed. Vaccination coverage against rubella was obtained from the National Immunization Registry and School Health Services of the Health Promotion Board. The changing prevalence of rubella was determined from periodic serological surveys.FindingsThe incidence of indigenous rubella cases per million population decreased from 37.2 in 2008 to 7.6 in 2013 and there had been no indigenous case of CRS in 2012 and 2013. Therapeutic abortions performed due to rubella infections had become uncommon. The annual measles, mumps, and rubella (MMR) vaccination coverage in childhood population remained high ranging from 93% to 96%. The overall susceptibility to rubella in women aged 18–44 years had reduced significantly from 15.8% in 2004 to 11.0% in 2010. The prevalence of IgG antibody against rubella among Singapore children aged 1–17 years was maintained at 87.3% in 2008–2010.ConclusionAll available data indicated that Singapore has made good progress towards the elimination of rubella and CRS. It has attained the targets set by the WHO WPRO for 2015. In preparation for verification of rubella elimination, an enhanced surveillance system has been implemented to ensure that all reported cases are laboratory confirmed, and genotyping of rubella virus strains isolated is carried out to provide evidence for interruption of endemic transmission.     

2007—2013年黄山市风疹流行特征及免疫策略

目的了解2007—2013年黄山市风疹流行病学特征,探讨风疹免疫策略,为制定预防控制风疹和先天性风疹综合征（CRS）提供科学依据。方法对黄山市疾病监测信息管理系统及突发公共卫生事件信息报告管理系统报告的风疹发病资料,进行描述流行病学分析。结果 2007—2013年间累计报告风疹2 581例,年平均发病率为24.50/10万,无死亡病例。风疹流行周期约为3 a,2008和2011年为流行高峰年。发病高峰月为3—6月。地区分布表现为黄山区最高（74.19/10万）,徽州区最低（6.32/10万）。男性发病1 451例,女性1 130例。男女发病比为1.28∶1。近年风疹发病呈现逐渐向大龄人群推移的趋势,以10-20岁年龄组最高,占总病例数的73.23%。职业分布以学生为主,占病例总数的78.03%。风疹暴发疫情全部发生在中、小学校。结论黄山市2007—2013年风疹发病人群以学生为主,发病年龄呈向大龄人群推移的趋势。应加强对校医培训,规范疫情报告和学校疫情处置,预防控制风疹暴发,尽快制定对育龄期妇女接种风疹疫苗的免疫策略,减少CRS的发生。     

A resurgence of congenital rubella in Australia?

Two infants with congenital rubella defects (congenital rubella syndrome) have been reported from Queensland in 2003, after an increase in rubella in that State in 2001-2002. The national Measles Control Campaign in 1998 aimed to give measles-mumps-rubella (MMR) vaccine to all unvaccinated preschoolers and a second dose to primary schoolchildren. Following the Campaign no children with congenital rubella defects were born to Australian-born mothers during the five years 1998 to 2002, according to reports to the Australian Paediatric Surveillance Unit. However, three imported cases occurred. Broad immunisation coverage and detection and vaccination of susceptible women of child-bearing age before they become pregnant are necessary to prevent further cases.