天津市含麻疹成分疫苗接种率和抗体水平评价

目的 对天津市含麻疹成分疫苗（measles containing vaccine,MCV）接种率和健康人群抗体水平进行评价。方法 2012-2014年采用多阶段随机抽样法抽取天津市0～44岁健康人群开展MCV接种率调查和麻疹血清学抗体监测。结果 2006-2013年8个出生队列993名儿童中,含麻疹成分疫苗首剂次（MCV1）接种年龄中位数从2006年8.42月龄提高到2013年的8.15月龄。8月龄及时接种率从2006年50.67%上升到2013年的90.90%。2006-2012年7个出生队列720名儿童中,含麻疹成分疫苗第2剂次MCV2接种年龄中位数从2006年21.99月龄提高到2012年的18.16月龄。18月龄及时接种率从2006年2.67%上升到2012年的71.11%。血清学监测共调查3 147人,年龄为0～44岁,麻疹抗体阳性率90.28%,几何平均浓度（geometric mean concentration,GMC）为912.83 mIU/ml。Logistic回归分析结果显示,<8月龄麻疹易感性最高,其次30～34岁组,OR（95% CI）分别为7.27（3.93～13.46）和3.30（1.67～6.51）。对麻疹抗体阳性率和发病率进行秩相关分析,两者之间存在负相关（r=-0.73,P=0.007）。结论 儿童高免疫覆盖率下,难以阻止成人间的麻疹传播,成人免疫亟待考虑。     

临沂市部分人群麻疹抗体水平及麻疹疫苗强化免疫血清学效果监测

目的了解临沂市麻疹疫苗强化免疫的效果和人群麻疹抗体水平.方法随机抽取2个县区1 534名0～39岁健康人,应用酶联免疫吸附试验检测麻疹IgG抗体.结果1 534人中抗体阳性1190人,阳性率77.57%,几何平均滴度(GMT)1:783.1～12岁儿童抗体阳性率最高(85.71%～98.44%),GMT则从6岁开始下降至中低等水平,抗体阳性率有随年龄增长而下降的趋势.观察麻疹疫苗初种8～12月龄儿童188人,免疫成功率为96.81%;麻疹疫苗复种5～7岁儿童186人,免疫成功率61.29%;免疫后抗体GMT初、复种疫苗分别比免疫前提高28.4倍和3.1倍.结论大年龄儿童及成人的麻疹抗体水平仅达到中低水平;不论是初种或复种,免疫前抗体处于中低等水平者其免疫成功率显著高于免疫苗高抗体水平者.     

Vaccination against rubella and measles: quantitative investigations of different policies

This paper uses relatively simple and deterministic mathematical models to examine the impact that different immunization policies have on the age-specific incidence of rubella and measles. Following earlier work by Knox (1980) and others, we show that immunization programmes can, under some circumstances, increase the total number of cases among older age groups; the implications for the overall incidence of measles encephalitis and of congenital rubella syndrome are examined, paying attention both to the eventual equilibrium and to the short-term effect in the first few decades after immunization is initiated. Throughout, we use data (from the U.K., and U.S.A. and other countries) both in the estimation of the epidemiological parameters in our models, and in comparison between theoretical predictions and observed facts. The conclusions defy brief summary and are set out at the end of the paper.     

Vaccination against rubella and measles: quantitative investigations of different policies.

This paper uses relatively simple and deterministic mathematical models to examine the impact that different immunization policies have on the age-specific incidence of rubella and measles. Following earlier work by Knox (1980) and others, we show that immunization programmes can, under some circumstances, increase the total number of cases among older age groups; the implications for the overall incidence of measles encephalitis and of congenital rubella syndrome are examined, paying attention both to the eventual equilibrium and to the short-term effect in the first few decades after immunization is initiated. Throughout, we use data (from the U.K., and U.S.A. and other countries) both in the estimation of the epidemiological parameters in our models, and in comparison between theoretical predictions and observed facts. The conclusions defy brief summary and are set out at the end of the paper.     

Prevention of measles in Israel: implications of a long-term partial immunization program

Following the introduction of routine measles immunization in Israel in 1967, rapid and persistent modifications in the pattern of the disease were observed, including much more limited and more widely spaced epidemics, a change in the age distribution of measles cases, and a progressively increasing herd immunity that was estimated, following the 1982 epidemic, at 91.6 percent for the first 26 generations. This pattern supports the expectation that measles can be eliminated in Israel provided a herd immunity greater than or equal to 94 percent can be achieved before the next epidemic, which is predicted for 1988-89. A logistic approach to the elimination of measles in Israel requires (a) maintenance of an immunization rate of at least 90 percent in each newborn generation; (b) identification and immunization of still susceptible children in the 1-5 year and 6-9 year age groups, to attain vaccination coverage for at least 97 percent of this population (which should result in immunity among at least 94 percent); (c) provision of similar coverage for older, susceptible individuals in selected groups of children, adolescents, and young adults at high risk; (d) disease surveillance based on an early identification of the main sources of infection and monitoring of the active foci of disease in the neighbouring territories, which are an important potential source of the introduction of infection.     

免疫预防不同时期北京市通州区麻疹流行病学特征动态分析

目的随着麻疹疫苗的广泛应用,麻疹发病年龄出现“双相”趋势,在目前麻疹发病年龄结构和流行病学动态形势下,提供现阶段制定麻疹防治策略的参考依据。方法针对免疫预防30年后麻疹流行特征动态变化,结合各人群血清学监测结果,对现阶段麻疹的流行规律进行描述性流行病学分析预测。结果从麻疹疫苗广泛应用到计划免疫再到免疫规划的30年间,虽然发病年龄构成改变,北京市通州区麻疹整体发病率持续下降,维持3／10万的低发病率水平,并且临床并发症减少,轻型、不典型以及不可预防性病例增多。但2005年后发病率显著回升,表现出〈8月龄婴儿和≥20岁人群发病升高的“双相”趋势,流动人口以多发、爆发为主要流行类型,成为影响该地区麻疹发病率升高的主要原因。血清学监测结果显示,1982—1991年和1992～2006年两时期婴儿麻疹疫苗初免成功率均较高（x^2=0．189,P=0．921）,抗体GMT均达到较高水平;1982～1991年和2007年两时期健康人群抗体阳性率差异有统计学意义（x^2=12．784,P〈0．01）;相同时期的育龄妇女抗体阳性率分别为95．94％和92．51％（x^2=1．524,P=0．900）,健康人群及育龄妇女抗体GMT均偏低。结论随着麻疹流行特征的改变,血清流行病学随之改变,形成了不同时期麻疹流行规律特征的免疫学基础,制定大年龄及育龄妇女的免疫策略,是降低“双相”趋势升高的有效手段。     

太原市初免儿童麻疹、白喉、破伤风抗体水平监测

目的为了解太原市初免儿童麻疹、白喉、破伤风免疫状况及评价麻疹疫苗（MV）、百白破联合疫苗（DPT）接种质量,同时为控制麻疹、白喉、破伤风的发病率提供依据。方法按照随机抽样方法抽取太原市10个区县2004年1月1日至2005年12月31日出生儿童。取静脉血2～3毫升,测定其麻疹、白喉、破伤风的抗体水平。结果调查显示,太原市麻疹抗体阳性率较高,白喉抗毒素达到保护水平的占95.74%,可基本控制白喉的发生,破伤风抗毒素阳性率为95.70%。结论在太原市初免儿童中,只要按免疫程序接种疫苗,就能达到保护水平。     

奉化市中学生麻疹疫苗强化免疫后麻疹IgG抗体水平的观察

目的:通过对奉化市中学生麻疹疫苗强化免疫后的不同时段麻疹IgG抗体的监测,了解不同时段麻疹IgG抗体的水平。方法:采用酶联免疫吸附试验(ELISA)。结果:2009年-2011年总共检测了559人份血清,其中接种后半年组的217份,接种后一年半组的240份,接种后两年半组的102份;麻疹IgG抗体GMC分别为1668.38 IU/ml、1119.22 IU/ml、1200.72 IU/ml;麻疹IgG保护性抗体阳性率分别为86.64%(188/217)、53.75%(129/240)、54.9%(56/102)。结论:经过麻疹疫苗接种后效果良好,麻疹IgG抗体水平都较高,但经过一定时间后麻疹IgG抗体水平有所下降,接种后两年半跟接种后半年组相比麻疹IgG抗体水平有显著下降,同样保护性抗体阳性率也有显著下降。     

Identification of an association between HLA class II alleles and low antibody levels after measles immunization.

This is the first large cohort study to report a genetic association between humoral antibody level after measles vaccine and the HLA class II genes. The WHO goal to eradicate measles world-wide magnifies the importance of data relating to the influence of immunogenetics on measles vaccine-induced antibody responses. We present here the analysis of 242 individuals who received one dose of measles-mumps-rubella-II (MMR-II) vaccine at the age of 15 months and were genotyped for HLA class II alleles. These subjects fit into one of three categories; 72 were classified as seronegative, 93 were seropositive and 77 were serohyperpositive. HLA-DRB1*03 (odds ratio (OR), 2.22) and HLA-DPA1*0201 (OR, 1.71) were significantly associated with measles vaccine seronegativity, while additional alleles provided suggestive evidence of association with seronegativity: DQA1*0201, DQB1*0201, and DQA1*0501. The alleles DRB1*03 and DQA1*0201 remained statistically significant after accounting for the effects of other alleles. These findings are crucial in designing both measles eradication by the use of vaccine, and future vaccines to be used in genetically heterozygous populations.     

Measles immunization with further attenuated heat-stable measles vaccine using five different methods of administration

Further attenuated heat-stable measles vaccine Attenuvax was administered randomly to 109 children using five different methods and a control group (24). Vaccine administration by syringe and needle (0.5 ml) and by jet-injector (0.1 ml) resulted in a high percentage of significant HAI measles antibody titres (greater than or equal to 1:24). Vaccine administration by nose drops (0.5 ml), bifurcated needle or needle planted cylinder did not yield satisfactory levels of serum antibody. Morbidity measured over a period of four weeks after administration showed a moderate increase of respiratory symptoms over the controls. Children who showed a positive tuberculin PPD reaction after BCG immunization did not differ from children with a negative tuberculin reaction in regard to their ability to produce a Kenya. The aim was to find a simpler method of administration of this improved vaccine, suitable for community health workers. The vaccine was shown to be less stable under field conditions than suggested by previous reports.     

麻疹抗体血清学研究现状

麻疹是最常见的呼吸道传染病,也是目前世界上最危险的儿科疾病之一,即使已广泛使用麻疹减毒活疫苗(MV),全球每年仍发病4 300万,死亡100万,是发展中国家儿童的主要死因[1].随着全球消灭脊髓灰质炎的进程加快,消灭麻疹的目标又被提上议事日程;世界卫生组织(WHO)美洲区,以提高常规免疫辅以初始强化免疫和后续强化免疫,使麻疹发病大幅减少,阻断了麻疹病毒传播[2],为消灭麻疹提供了例证.     

Predicting and comparing patient satisfaction in four different modes of health care across a nation

This study aims to inform strategic policy makers and managers about the value of general population surveys by determining and comparing dimensions of satisfaction in four different health services in Scotland: general practice, domiciliary care, outpatients and inpatients (including day cases). The research design involved secondary data analysis of a national telephone survey conducted to inform the development of a national health plan. The database was created using a stratified quota sample of 3052 people of 16 years and above resident in Scotland in 2000. The main outcome measures investigated were overall measures of patient satisfaction with each type of service. Principal components analysis was used to determine the dimensions. Interest was in the extent to which patients, many of whom were the same (having used more than one service), evaluated different services in similar ways, as well as those factors specific to each service. Using logistic regression, the results demonstrate that interpersonal care and information, and desired improvements in service were universal and key explanatory dimensions in all services, followed by a combination of access, physical facilities, time and quality of food, depending on relevance to the service. These factors, particularly interpersonal care and information, distinguished well the highly satisfied from the others, with age providing further discrimination between non-hospital patients, while gender added to discrimination between inpatients. In conclusion, despite the limitations of telephone interviews, it is feasible to ask about several services at the same time and for the answers to reflect common underlying dimensions of evaluation found in more exhaustive research within each service. These factors offer a set of summary measures by which services can be easily evaluated at a strategic level and point to where efforts to increase patient satisfaction can be maximised.     

Cost analysis of post-polio certification immunization policies

OBJECTIVE: An analysis was conducted to estimate the costs of different potential post-polio certification immunization policies currently under consideration, with the objective of providing this information to policy-makers. METHODS: We analyzed three global policy options: continued use of oral poliovirus vaccine (OPV); OPV cessation with optional inactivated poliovirus vaccine (IPV); and OPV cessation with universal IPV. Assumptions were made on future immunization policy decisions taken by low-, middle-, and high-income countries. We estimated the financial costs of each immunization policy, the number of vaccine-associated paralytic poliomyelitis (VAPP) cases, and the global costs of maintaining an outbreak response capacity. The financial costs of each immunization policy were based on estimates of the cost of polio vaccine, its administration, and coverage projections. The costs of maintaining outbreak response capacity include those associated with developing and maintaining a vaccine stockpile in addition to laboratory and epidemiological surveillance. We used the period 2005-20 as the time frame for the analysis. FINDINGS: OPV cessation with optional IPV, at an estimated cost of US$ 20,412 million, was the least costly option. The global cost of outbreak response capacity was estimated to be US$ 1320 million during 2005-20. The policy option continued use of OPV resulted in the highest number of VAPP cases. OPV cessation with universal IPV had the highest financial costs, but it also had the least number of VAPP cases. Sensitivity analyses showed that global costs were sensitive to assumptions on the cost of the vaccine. Analysis also showed that if the price per dose of IPV was reduced to US$ 0.50 for low-income countries, the cost of OPV cessation with universal IPV would be the same as the costs of continued use of OPV. CONCLUSION: Projections on the vaccine price per dose and future coverage rates were major drivers of the global costs of post-certification polio immunization. The break-even price of switching to IPV compared with continuing with OPV immunizations is US$ 0.50 per dose of IPV. However, this doses not account for the cost of vaccine-derived poliovirus cases resulting from the continued use of OPV. In addition to financial costs, risk assessments related to the re-emergence of polio will be major determinants of policy decisions.     

麻疹疫苗强化免疫在消除麻疹中的作用

目的研究麻疹减毒活疫苗强化免疫效果,探讨预防控制措施,为消除麻疹提供依据。方法用描述性流行病学方法,分析2009年麻疹疫苗强化免疫活动开展情况,收集2009与2010年麻疹发病资料并对强化免疫接种效果进行分析。结果 2009年麻疹疫苗强化免疫活动适龄儿童接种报告接种率98.66%,调查接种率99.21%,各年龄组儿童接种率均在97%以上;2009年与2010年麻疹报告发病率分别为8.45/10万和0.53/10万,麻疹疫苗强化免疫前后麻疹发病率下降了93.73%;发病人群麻疹IgM抗体阳性率2009年80.00%,2010年28.57%。结论2009年麻疹强化免疫活动效果显著,应进一步研究麻疹免疫策略,以适应消除麻疹的需要。     

Evaluation of immunization policies for peacekeeping missions

This article first examines data bases available to assess the risk of vaccine-preventable diseases (VPD). In the second part, immunization recommendations and practices are briefly evaluated in view of the risk of exposure to VPD and of the efficacy and safety of available vaccines.     

Evaluating the benefits of increasing measles immunization rates

OBJECTIVE: To calculate the cost-effectiveness, expressed in dollars per quality-adjusted life years (QALY), of increasing measles immunization rates. DATA SOURCES/STUDY DESIGN: Published data were supplemented by expert opinion. We determined the cost savings and value of the health benefits from averting a single case of measles. Next we examined the U. S. data regarding the relationship between pre-school measles immunization and incidence rates. Finally, we calculated the cost-effectiveness of a program that would increase a locality's immunization rate to the point of disease elimination. PRINCIPAL FINDINGS: Averting a single case of measles, using "base case" assumptions, yields societal cost savings of $2,089 and an increase of 0.086 QALYs. Using a very low discount rate increases the total benefits to $2,251 in societal cost savings and 0.150 QALYs in health benefits. In general, programs to raise measles immunization rates are not cost-effective, except possibly during an outbreak of the disease or in areas with very low immunization rates. The extremely low measles incidence rates in the mid-1990s result in such programs having extremely high costs per QALY gained. CONCLUSIONS: Programs that are narrowly designed to increase immunization rates alone are not likely to be cost-effective. Yet these programs do have the potential to be cost-effective if the program design and evaluation also recognize the benefits associated with the primary and preventive care that can accompany immunizations. Such programs may also be cost-effective if they are components of a global eradication of measles.     

孕妇麻疹抗体水平及婴儿麻疹疫苗免疫效果分析

目的　了解孕妇麻疹免疫状况和婴儿麻疹疫苗免疫效果。方法　对 1 1 2名孕妇产前和5 0名 6月龄婴儿及 72名 8月龄婴儿免前免后采用酶联免疫吸附试验 (ELISA)检测麻疹抗体IgG。结果　 1 1 2名孕妇麻疹抗体阳性 1 0 7例 ,阳性率 95 5 % ,抗体滴度 (GMRT)为 84 9 9;未达到保护水平有 30例 ,占 2 6 8% ;6月龄和 8月龄婴儿免疫成功率分别为 88 0 %、97 2 % ,免前麻疹抗体GMRT分别为4 1、1 1 ,差异均有显著性 (均P <0 0 5 ) ,而免后麻疹抗体GMRT分别为 782 0、976 5 ,差异无显著性(P >0 0 5 )。结论　 8月龄婴儿免疫效果稍好于 6月龄婴儿 ,主要表现在免疫成功率方面 ,而免后抗体水平差异无显著性。