2004-2011年广西阳朔县流行性腮腺炎流行病学特征与控制策略分析

目的 通过分析流行性腮腺炎(流腮)流行特征,掌握流行规律,制定控制策略。 方法 采用平均增长速度、动态数列、样本率比较的2检验、相对危险度、圆形分布法进行分析。 结果 2004-2011年阳朔县共发生流腮659例,平均发病率为29.26/10万,2004-2008年发病率呈上升趋势,至 2008年达高峰,发病率为92.25/10万。该病的发病特征为流行有周期性;季节分布全年均有发病,有明显的季节性,每年夏季和冬季为发病高峰,夏季发病高峰日6月24日,流行高峰期4月3日至9月14日,冬季发病高峰日11月12日,流行高峰期9月11日至次年1月11日;人群分布4~14岁儿童为高危人群;农村发病高于城区,农村小学时有多发、暴发疫情;随着疫苗使用量的上升,流腮发病率呈下降趋势。 结论 按照目前的国家免疫策略不能达到控制或大幅度降低流腮发病的目标,应调整流腮免疫程序,同时通过严格预防接种证查验制度,以提高儿童疫苗免疫接种率。     

2005-2011年山西省古交市流行性腮腺炎流行特征分析

目的 了解山西省古交市流行性腮腺炎的流行趋势,为制定预防控制策略提供参考依据。 方法 在中国疾病预防控制信息系统中对古交市2005-2011年腮腺炎疫情资料进行数据统计,运用描述流行病学方法进行分析。 结果 2005-2011年古交市共报告流行性腮腺炎病例720例,年均发病率48.30/10万。2006-2007年和2010-2011年出现两个流行高峰。季节性高峰出现在每年的4-6月和12月至次年1月。人口密集的中心城市街道和矿区街道、乡镇高于农村乡镇。2~14岁儿童占总病例数的93.06%,男女病例性别比1.70∶1。学生、托幼儿童和散居儿童分别占病例总数的59.31%、26.94%和10.00%。 结论 流行性腮腺炎是古交市发病率较高的前10位传染病之一,必须采取以2~14岁儿童流行性腮腺炎减毒活疫苗强化免疫为主的控制措施,同时做好小学、托幼机构流行性腮腺炎的防控工作。     

MMR vaccine effectiveness in an outbreak that involved day-care and primary schools

Objective

In 2006, a large measles outbreak occurred in Catalonia (Spain), where the immunization schedule included two doses of MMR vaccine at 15 months and 4 years. The aim of this study was to investigate the vaccine effectiveness (VE) of MMR in children attending day-care and pre-school centres and to estimate the number of cases that would have been avoided by administering the first dose of MMR at 12 months.

Methods

A retrospective cohort study was carried out between October 2006 and January 2007 in day-care and pre-school centres with confirmed measles cases. VE was calculated in children aged ≥15 months without previous measles infection. Cases avoided by advancing the first dose of MMR to 12 months were estimated by calculating the basic and effective reproduction number in centres where transmission outside the class was observed.

Results

Fifteen centres and 1394 children were included. There were 77 confirmed cases (attack rate = 5.5%). Vaccination coverage of the 1121 children aged ≥15 months was 91.6% and VE was 96% (95%CI 89-98%).There were 33 (41%) cases in the 81 children aged 12-14 months. Advancing the first dose to 12 months would have prevented 74 cases (91.5%) and lowered the attack rate from 41% to 8.6%.

Conclusions

Over 90% of cases in children aged 12-14 months would have been avoided by MMR administration at 12 rather than 15 months. We strongly recommend advancing the first dose of MMR to 12 months in order to reduce the risk of measles outbreaks.     

Mumps outbreaks in four universities in the North West of England: prevention, detection and response

Evidence suggests that primary and secondary vaccine failure have contributed to recent university-based mumps outbreaks. We describe the epidemiology and public health management of two such outbreaks that occurred simultaneously in two areas of the North West of England, affecting four universities, using data from routine surveillance, serology testing, and telephone interviews and electronic questionnaires. Vaccination status was obtained from GP records. Cases were predominantly first year students living in university halls of residence. Public health response involved active surveillance, isolation advice and targeted vaccination clinics. Many students lack natural immunity and mumps vaccination. Factors hindering the public health response include delayed notifications, inability to readily define the ‘at risk’ population, low vaccine uptake, and lack of an evidence-based, cost effective strategy.     

2000-2009年天津市汉沽区流行性腮腺炎发病流行特征分析

目的 了解天津市汉沽区2000-2009年近10年的流行性腮腺炎(流腮)流行病学特征.方法 采用描述流行病学方法对2000-2009年汉沽区疾病监测信息报告的流腮疫情资料进行分析.结果 汉沽区2000-2009年共报告流腮病例1074例,年平均发病率为61.79/10万,2003年为发病流行年.发病有明显的季节性,4-...     

蒲地蓝口服液治疗儿童流行性腮腺炎30例临床分析

目的:探讨分析蒲地蓝口服液对儿童流行性腮腺炎的疗效。方法:60例流行性腮腺炎患儿被随机分为治疗组(30例)与对照组(30例);对照组抗病毒常规治疗,治疗组在常规治疗的基础上每天给蒲地蓝口服液口服,两组持续治疗5～7 d,进行临床观察。结果:治疗组总有效率为100%,对照组总有效率为77%,两组比较差异有统计学意义(P<0.01)。结论:蒲地蓝口服液治疗流行性腮腺炎起效快、安全、疗效好,值得推广。     

一起小学流行性腮腺炎爆发的调查分析

目的核实疫情,确定某小学流行性腮腺炎(简称流腮)暴发的存在并描述疫情三间分布特征和流行强度,探讨发病危险因素。结论按照病例定义,开展病例搜索,描述其三间分布后,结合现场流行病学调查情况,形成假设,再采用病例对照研究方法验证假设。结果某小学2009年5月1日至6月18日搜索到符合病例定义的病例共33例。首例病例5月21日发病,6月14-17日出现发病高峰。二(3)班罹患率最高,为28%。男生罹患率为12%,女生罹患率为9%。病例对照研究表明,在校就餐是危险因素;吃午饭前洗手、平时洗手时使用肥皂是保护因素。结论根据病例临床表现、三间分布特征,确定某小学存在流行性腮腺炎暴发;建议校方减少学生在教室就餐的机会,加强宣传教育,提高学生自我保护意识,养成良好的洗手习惯。     

Seeking the optimal schedule for chickenpox vaccination in Canada: Using an agent-based model to explore the impact of dose timing,coverage and waning of immunity on disease outcomes

Many countries continue to consider implementing a universal chickenpox vaccine program; however, there is no consensus on the most appropriate and effective timing between vaccine doses. The chickenpox vaccine schedule debate is highlighted in Canada, where there are currently eight different vaccine schedules across the country. The objective of this study was to test the overall effectiveness of chickenpox vaccination, as well as the specific impact of two different vaccine schedules, on chickenpox disease outcomes in Alberta over 75 years. Using an agent-based model of chickenpox disease, we tested the impact of three vaccination scenarios including: baseline (no vaccination), a long dosing interval-Schedule LDI (1^st dose – 12 months; 2^nd dose –  4-6 years) and a short dosing interval-Schedule SDI (1^st dose – 12 months; 2^nd dose – 18 months) on chickenpox and shingles disease outcomes. Chickenpox vaccination led to a substantial decrease in chickenpox incidence over 75 years post-vaccine implementation. Compared to Schedule LDI, Schedule SDI resulted in a significantly lower chickenpox incidence, a higher age of chickenpox infection, a lower chickenpox breakthrough rate and a higher shingles incidence rate. Our model findings suggest that the chickenpox vaccine is effective over a long period of time and the dose timing of the vaccine may impact disease outcomes and vaccine effectiveness. However, the effectiveness of the vaccine dose timing is only one consideration for policy-makers who are implementing a chickenpox vaccine program, with others including risk of adverse events, the impact of the schedule on other antigens in a combination vaccine, parental acceptance and the cost associated with different schedules.     

Healthcare workers’ knowledge,beliefs, and coverage regarding vaccinations in critical care units in Italy

BackgroundLow rates of vaccine coverage have resulted in a resurgence of several vaccine-preventable diseases in many European countries. Routine vaccination of healthcare workers (HCWs) is important to reduce disease transmission, and to promote vaccine awareness and acceptance in the population. The objectives of this cross-sectional study were to investigate knowledge and beliefs about vaccines and to evaluate self-reported immunization coverage with vaccines recommended for HCWs. Additionally, the effects of several factors on these outcomes have been evaluated.MethodsA survey was conducted between September and November 2018 among a random sample of HCWs in cardiac, adult, and neonatal critical care units of 8 randomly selected hospitals across the Campania and Calabria Regions in Italy. Multivariate logistic and linear regression analysis has been performed.ResultsA total 531 HCWs returned the questionnaire for a response rate of 54.9%. Based on a vaccination knowledge score ranging from 0 to 9, more than half of the participants (55.4%) knew few of the vaccines recommended for HCWs (≤3 correct answers), 16.2% knew some vaccines (4–6 correct answers), and 28.4% knew most vaccines (≥7 correct answers), and only 13.2% knew all the vaccines recommended for HCWs. However, two-thirds (62.2%) knew that hepatitis B and influenza vaccines were recommended, and this knowledge was significantly higher among females (p < 0.001), among HCWs aged between 50 and 59 years (p = 0.01) compared with those aged < 30 years, and in those who search for information about recommended vaccines for HCWs (p = 0.012). The vaccine knowledge was significantly lower among nurses and nursing supporting staff compared with physicians (p = 0.032). Approximately two-thirds (62.7%) of HCWs considered themselves at risk of contracting vaccine-preventable infectious diseases during their professional practice. High rates of coverage were self-reported for hepatitis B (96.3%), tetanus and pertussis (93.7%), whereas they were lower for measles/mumps/rubella (80.5%), chickenpox (65.3%), and influenza (35.8%). Only 9.2% of HCWs reported prior receipt of all recommended vaccines. Male HCWs were less likely to report prior receipt of all recommended vaccines (p = 0.011). HCWs aged between 30 and 39 years compared with those aged < 30 years (p = 0.001) and those who knew some (p < 0.001) and most (p = 0.007) of all vaccines recommended for HCWs were more likely to self-report to be immunized.ConclusionsAdditional training about the vaccinations is needed to improve HCWs knowledge and to address specific concerns which may lead to better uptake among this group.     

Vaccine administration error rates at a large academic medical center and its affiliated clinics – Familiarity matters

ObjectiveThe purpose of this study was to track and describe the absolute number of vaccine administration errors and corresponding error rates over time and by patient age and vaccine type.MethodsTotal vaccines administered to patients aged 0 through 19 years 364 days from 1/1/2006 through 12/31/2017 at a large academic health system in the Midwest United States with primary, specialty and school-based clinics, and a pediatric hospital were obtained from an electronic medical record. Vaccine administration errors over the same time period for the same patient criteria were analyzed from the health system’s incident reporting system and further compared to the frequency of all incidents reported. Vaccine administration error rates were calculated. Data were analyzed by patient age, vaccine type and year administered.ResultsOf the 1,431,206 vaccine doses given, 552 vaccine administration errors were identified (0.04%). The highest error rates occurred in children aged 2, 3, and 19 years. Vaccine types with the highest error rate were Td, rabies and pneumococcal polysaccharide vaccines. Overall vaccine doses given and errors reported increased over the study period. However, the increase was disproportionate, resulting in an increase in the error rate initially followed by a stabilization at the end of the study period.ConclusionsVaccine administration errors are uncommon. The error rate appears to be stabilizing. Errors are more likely at ages when vaccines are not commonly given, with vaccines that have age-specific dosing and with vaccines that are given less often. This suggests more safety checks are needed for vaccines that are rarely used or given off-schedule, and manufacturers should avoid vaccines with age-specific dosing.