Impact of measles supplementary immunization activities on reaching children missed by routine programs

BackgroundMeasles supplementary immunization activities (SIAs) are vaccination campaigns that supplement routine vaccination programs with a recommended second dose opportunity to children of different ages regardless of their previous history of measles vaccination. They are conducted every 2–4 years and over a few weeks in many low- and middle-income countries. While SIAs have high vaccination coverage, it is unclear whether they reach the children who miss their routine measles vaccine dose. Determining who is reached by SIAs is vital to understanding their effectiveness, as well as measure progress towards measles control.MethodsWe examined SIAs in low- and middle-income countries from 2000 to 2014 using data from the Demographic and Health Surveys. Conditional on a child’s routine measles vaccination status, we examined whether children participated in the most recent measles SIA.ResultsThe average proportion of zero-dose children (no previous routine measles vaccination defined as no vaccination date before the SIA) reached by SIAs across 14 countries was 66%, ranging from 28% in São Tomé and Príncipe to 91% in Nigeria. However, when also including all children with routine measles vaccination data, this proportion decreased to 12% and to 58% when imputing data for children with vaccination reported by the mother and vaccination marks on the vaccination card across countries. Overall, the proportions of zero-dose children reached by SIAs declined with increasing household wealth.ConclusionsSome countries appeared to reach a higher proportion of zero-dose children using SIAs than others, with proportions reached varying according to the definition of measles vaccination (e.g., vaccination dates on the vaccination card, vaccination marks on the vaccination card, and/or self-reported data). This suggests that some countries could improve their targeting of SIAs to children who miss other measles vaccine opportunities. Across all countries, SIAs played an important role in reaching children from poor households.     

宁夏2010年麻疹疫苗强化免疫结果分析

目的 对宁夏2010年麻疹疫苗强化免疫结果进行分析.方法 利用全区统计局人口资料、各县上报强化免疫活动相关数据、疫情资料等,对其进行分析评价.结果 全区应种儿童数为409 950人,实种儿童数407 239人,报告接种率99.34％,不同县区、不同年龄、不同户籍儿童报告接种率差异有统计学意义,估算接种率和快速评估接种率均在95％以上,报告接种率真实、可信.全区共报告AEFI 95例,发生率为23.33/10万.麻疹疫苗强化免疫后,全区麻疹报告发病率有所下降.结论 2010年宁夏麻疹疫苗强化免疫达到方案预计目标.     

保山市2轮麻疹疫苗强化免疫情况及效果评价

目的对保山市2轮麻疹疫苗(MV)强化免疫情况及效果进行分析,为该市尽早消除麻疹提供科学的依据。方法利用保山市2008、2010年麻疹疫苗强化免疫报告、调查接种率,麻疹发病情况,2009、2010年麻疹IgG抗体水平调查和法定麻疹报告系统资料进行统计学描述,SPSS 11.5进行统计学分析,率之间的比较用卡方检验,并用趋势检验对麻疹发病率、抗体阳性率趋势变化进行分析,检验水准均为α=0.05,P<0.05为差异有统计学意义。结果保山市强化免疫报告、调查接种率均在98%以上;2轮强化免疫后,麻疹IgG抗体水平较第1轮强化免疫后得到明显提高(χ2=55.943,P<0.001),人群抗体阳性率达95.02%,且随着年龄段的增长,抗体阳性率无变化(rs=0.500,P>0.05);同时,麻疹发病率由2007、2008年的平均发病率5.99/10万下降至2009年的1.08/10万、2010年的0.12/10万,发病率分别下降了81.97%、98.00%,2010年8月至2011年9月无麻疹病例报告。结论 2轮强化免疫后,保山市麻疹疫情得到有效控制,为该市尽早消除麻疹奠定了坚实基础。     

2010年石家庄市麻疹疫苗强化免疫疑似预防接种异常反应监测分析

目的分析石家庄市麻疹疫苗强化免疫活动后,疑似预防接种异常反应(adverse events following immunization,AEFI)的发生状况,探讨麻疹疫苗强化免疫活动的安全性。方法采用描述分析方法对监测数据进行分析。结果石家庄市2010年麻疹强化免疫期间共报告AEFI 181例,发生率12.02/10万剂次。其中一般反应161例,异常反应16例,偶合症4例;绝大多数病例转归良好。结论 AEFI监测敏感性高,麻疹疫苗安全性好,未发现严重疑似预防接种异常反应。     

北京市通州区麻疹疫苗强化免疫前后麻疹流行病学特征

目的分析北京市通州区强化免疫前后2年麻疹的发病趋势及流行病学特征,评价强化免疫活动的效果,为制定麻疹防控措施提供科学依据。方法采用描述性流行病学方法分析通州区2010年10月麻疹疫苗强化免疫前后的麻疹发病情况。结果通州区2009、2010、2011和2012年麻疹发病数分别为77例、157例、9例和3例;2011~2012年麻疹平均发病率为0.43/10万,比2009~2010年下降了95.34%;麻疹发病仍有明显季节性,发病主要集中在3~5月份;地区分布以流动人口聚集地为主,强化免疫后各地区发病率下降均达到了88.02%以上;麻疹发病多为流动人口,主要由8月龄儿童病例和15岁的成人病例组成,强化免疫后,麻疹发病年龄双向移位现象更为明显。结论通州区麻疹疫苗强化免疫短期效果显著,麻疹疫苗强化免疫可以降低人群易感性,达到快速控制麻疹发病,降低麻疹发病率;根据强化免疫后麻疹流行特征的变化,成人、麻疹常规免疫前儿童和流动人口成为防控麻疹工作的重点和难点。     

2013年延安市部分县麻风疫苗补充免疫效果监测

目的评价延安市2013年部分县麻风疫苗补充免疫效果,为消除麻疹提供科学依据。方法对麻风疫苗补充免疫接种率,麻疹、风疹抗体水平免疫前及免疫后进行监测。结果2013年延安市部分县8月龄～4岁儿童43540名,麻风疫苗补充免疫接种率为97．47％。麻疹、风疹抗体阳性率分别由免疫前的90．70％、86．70％上升到免疫后的98．38％和99．35％。结论延安市2013年部分县麻风疫苗补充免疫效果显著,高质量的麻风疫苗补充免疫是提高抗体阳性率及控制麻疹的重要措施。     

北京市丰台区麻疹疫苗强化免疫前后流行病学特征

目的分析北京市丰台区麻疹疫苗强化免疫前后疫情特征变化,评价强化免疫效果,为实现消除麻疹行动计划提供对策依据。方法通过描述流行病学分析2010年强化免疫前后麻疹发病的三间分布特征。结果 2008—2010年共报告麻疹确珍病例1 086例,强化免疫后丰台区麻疹发病率明显下降,2008—2010年平均发病率为21.5/10万,2011年下降至0.6/10万;病例在城乡散在分布,多为流动人口,主要由1岁以内儿童病例(30.1%)和15岁以上成人病例(55.5%)组成。结论丰台区麻疹疫苗初始强化免疫效果非常显著,麻疹人群流行病学特征已发生重大变化,需对重点人群采取针对性措施巩固强化免疫成果,实现消除麻疹目标。     

Controlling measles using supplemental immunization activities: A mathematical model to inform optimal policy

BackgroundThe Measles & Rubella Initiative, a broad consortium of global health agencies, has provided support to measles-burdened countries, focusing on sustaining high coverage of routine immunization of children and supplementing it with a second dose opportunity for measles vaccine through supplemental immunization activities (SIAs). We estimate optimal scheduling of SIAs in countries with the highest measles burden.MethodsWe develop an age-stratified dynamic compartmental model of measles transmission. We explore the frequency of SIAs in order to achieve measles control in selected countries and two Indian states with high measles burden. Specifically, we compute the maximum allowable time period between two consecutive SIAs to achieve measles control.ResultsOur analysis indicates that a single SIA will not control measles transmission in any of the countries with high measles burden. However, regular SIAs at high coverage levels are a viable strategy to prevent measles outbreaks. The periodicity of SIAs differs between countries and even within a single country, and is determined by population demographics and existing routine immunization coverage.ConclusionsOur analysis can guide country policymakers deciding on the optimal scheduling of SIA campaigns and the best combination of routine and SIA vaccination to control measles.     

汕头市2004～2009年麻疹流行病学特征分析

目的 分析2004～2009年汕头市麻疹流行病学特征,为消除麻疹提供有针对性的防控策略.方法 采用描述流行病学方法对麻疹监测数据进行统计学分析.结果 2004～2009年汕头市报告麻疹2069例,年平均发病率为6.91/10万.1～6岁儿童发病率最高,其次是15～40岁成人;4～7月份为发病高峰,占病例总数的61.09％;潮南区、潮阳区、龙湖区发病数居全市前3位,累计发病分别占总发病的26.44％、25.13％、17.01％;对麻疹病例免疫史分析,有麻疹疫苗(MV)免疫史、无免疫史、免疫史不详的分别占13.8％、51.5％和34.7％.结论 做好麻疹常规免疫接种,适时开展高质量的麻疹强化免疫,扩大外来务工人员麻疹疫苗接种覆盖范围,加强麻疹监测,是控制消除麻疹的有效手段.     

2012年北京市大兴区庞各庄镇学龄前流动儿童强化查漏补种情况

目的分析评价2012年北京市大兴区庞各庄镇学龄前流动儿童强化查漏补种效果,了解流动儿童接种情况,为今后流动儿童免疫预防提供依据。方法采用描述流行病学方法,对2012年北京市大兴区庞各庄镇强化查漏补种数据进行分析。结果共调查流动儿童997名,强化查漏补种前流动儿童建卡率93．48％,建证率99．60％,脊髓灰质炎减毒活疫苗（OPV）零剂次免疫率为0．40％,漏种率2．61％,麻风减毒活疫苗（MR）、麻风腮减毒活疫苗（MMR）、脑膜炎球菌多糖疫苗（MPV）、百白破联合疫苗（DPT）、流行性乙型脑炎疫苗（JEV）和乙型肝炎疫苗（HepB）零剂次免疫率为0．20％～2．71％。强化查漏补种后的建卡、建证及疫苗补种／预约率达到100％。结论流动儿童主要集中在镇中心等繁华地区,居住〈2月儿童所占比例较高,儿童建卡率较低,OPV漏种率和其他疫苗零剂次免疫率随流动儿童年龄增长呈上升趋势,提示在当地居住时间较短的流动儿童是重点人群,大年龄组儿童易出现免疫空白,结合常规查漏补种工作及时提高流动儿童建卡、建证和各种疫苗接种率是关键措施。     

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。     

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。     

Utilization and impact of European immunization week to increase measles,mumps, rubella vaccine uptake in Austria in 2016

This paper describes engagement in European Immunization Week (EIW) in Tyrol, Austria in April 2016 and an assessment of its possible impact on demand for measles, mumps, rubella vaccination (MMR).It further describes the output of a knowledge, attitudes and practice (KAP) survey conducted during EIW, showing that 93% (188/202) of respondents were in favor of vaccination in general and 90% (192/214) perceived MMR vaccination to be important. MMR vaccination was perceived as important by more participants than other vaccinations.The number of MMR doses administered by public health services in the province of Tyrol during EIW was greater than in the previous week, and EIW activities thus potentially resulted in increased MMR vaccine uptake in Tyrol during the observed period. The annual EIW campaign provides important opportunities to address vaccine hesitancy by raising awareness about immunization, to identify barriers to immunization and test possible solutions.     

云南省保山市农村学生麻疹免疫现状分析及强化免疫效果评价

目的调查农村小学生麻疹免疫现状,同时进行麻疹强化免疫并对其效果进行评价,提高农村学生麻疹免疫水平,探讨控制和消除麻疹的可行性。方法多阶段随机抽样,抽取2个县的2所农村完小(1～6年级都有的小学),再按年级分层抽样抽取302名小学生,对其进行接种证、卡的查验;并在强化免疫前后采集302名学生静脉血5 ml,检测免疫前后麻疹IgG抗体水平。结果强化免疫前,302名学生麻疹疫苗第1针接种率为85.8%,第2针接种率为74.8%,2针均完成占74.8%;麻疹IgG抗体阳性率、抗体保护率分别为88.7%、51.0%,麻疹抗体几何平均滴度(GMT)为1∶551;此外免疫针次直接影响抗体的水平。通过强化免疫,302名学生抗体阳性率为100%,抗体保护率为76.9%,较强化免疫前的抗体阳性率88.7%、保护率51.0%分别上升了11.3个百分点(P<0.001)、25.9个百分点(P<0.001);GMT由强化前的1∶551升至1∶746(P<0.05)。结论强化免疫前,保山市农村学生中仍然存在一部分麻疹免疫空白人群,同时相当一部分学生的免疫水平较低,未达麻疹IgG抗体保护水平。因而在做好农村地区学生麻疹血清学监测的基础上,...     

Cost analysis of supplemental immunization activities to deliver measles immunization to children in Anambra state,south-east Nigeria

BackgroundMeasles immunization is critical for reducing the societal burden of the disease, especially among children. However, the costs of the measles supplemental immunization activities, which are the main vaccine deployment strategy, are usually high and financing such immunization activities is a serious challenge in Nigeria. In Nigeria, little or no information exists on the costs of measles supplemental immunization activity for planning and sustenance of immunization programmes. This study aimed to determine the cost per child immunized and cost structure of a follow-up supplemental immunization activity (SIA) for measles immunization to children.MethodData on costs and outputs of SIA were collected from six Local Government area (LGAs) immunization offices in Anambra state, southeast Nigeria. The ingredient approach was used for costing, based on the providers’ perspective. The sample results were extrapolated to state estimates using volume weighted mean method. The major indicator considered was cost per child immunized. Two-way sensitivity analysis was used to test the robustness of the results.ResultThe cost per child immunized through SIA was $1.37 and the cost per child for operational cost only was $0.81. The total cost of the SIA for the sample was $345,069.35 and the operational cost was $204,969.46. The cost of personnel (43.99%) and vaccine (36.22%) contributed the highest percentage to the total cost of SIA. The cost of personnel and transportation took the first (74.6%) and second (7.10%) highest percentages of the operational cost for the sample. The estimated total and operational costs of measles SIA for the state were $1,279,127.84 and $759,795.52 respectively.ConclusionThe cost per child immunized with measles containing vaccine through SIA is relatively high in Nigeria. There is a need to review the activities with SIA, so as to ensure that resources are efficiently allocated and used for different activities of the programme.     

2006-2012年淄博市淄川区入托入学儿童预防接种证查验及疫苗补种情况分析

目的 了解淄博市淄川区入托入学儿童预防接种证查验及疫苗补种情况,探讨有效的管理方法.方法 收集入托入学儿童预防接种证查验和疫苗补种资料,采用Excel和社会科学统计软件包14.0进行统计分析.结果 2006-2012年全区开展预防接种证查验的单位覆盖率分别为72.5 0％、86.96％、93.62％、94.68％、97.81％、98.96％、100％.调查入托入学儿童117 145名,有预防接种证的103 429名,持证率为88.29％;8种国家免疫规划疫苗合格接种率依次为卡介苗94.63％、乙型病毒性肝炎疫苗93.29％、百日咳-白喉-破伤风联合疫苗92.64％、脊髓灰质炎减毒活疫苗92.04％、乙型脑炎减毒活疫苗91.25％、麻疹减毒活疫苗90.68％、流行性脑脊髓膜炎疫苗89.89％、白喉-破伤风联合疫苗75.63％.入托儿童持证率、接种率均高于入学儿童.对漏种儿童补种,除卡介苗外,7种国家免疫规划疫苗补种率在26.34％～ 86.12％.结论 入托入学儿童预防接种证查验工作取得明显成效,呈逐年增高趋势,但持证率、补种率还有待于提高,教育、卫生部门应进一步加强沟通、协调和配合.     

合肥市适龄儿童麻疹疫苗强化免疫效果评价

目的了解合肥市适龄儿童麻疹疫苗(MV)强化免疫活动(SIA)效果及影响因素,为调整和实施消除麻疹策略提供参考。方法应用分层随机抽样法,选择合肥市社区疫苗接种门诊、幼儿园、小学、中学等作为研究点,分析8月龄～14岁儿童SIA前后麻疹抗体水平。SIA前后分别调查儿童340名和348名,应用描述统计方法,分析SIA前后麻疹流行状况。结果合肥市适龄儿童MV总体接种率为98.04%。SIA后麻疹抗体阳性率、几何平均滴度(GMT)均上升,麻疹抗体阳性率为91.38%。1～4岁组、≥3次免疫史者GMT分别为最高,Logistic多元回归分析显示,1次免疫史者抗体保护水平低。2010年麻疹发病率为0.81/10万,较2009年下降91.86%,发病年龄以婴儿为主,≥2次免疫史者病例构成比最低。结论在麻疹逐渐减弱流行阶段,需要规范适龄儿童首剂次、2剂次MV常规免疫,开展必要强化免疫,加强免疫规划和病例监测质量管理。     

Effect of several sociodemographic factors on measles immunization in children of Eastern Turkey

This study was performed to determine the status of measles immunization and the effect of several sociodemographic factors on immunization in children aged between 10 months and 6 years. Using cluster sampling, 663 healthy children were selected at random from three provinces in Eastern Turkey. The immunization histories of these children were obtained from their immunization cards. With respect to their vaccination status, children were categorized as vaccinated, unvaccinated or unknown. If the child had no immunization card, he or she was classified as unknown. Of these children, 81.6% were vaccinated and 15.1% were unvaccinated. The vaccination status was not known in 3.3% of the children. In children aged 10-12 months, the vaccination rate was 68.6%. For age groups of 1-2, 2-3, 3-4, 4-5 and 5-6 years, the vaccination rates were 84.2, 82.2, 85.3, 82.1 and 76.8%, respectively, but these differences were not significant. The vaccination rates increased in parallel with maternal education level (P = 0.009). Also, vaccination rates were significantly correlated with settlement area (P = 0.036), and were higher in urban regions than suburban and rural regions. There was no difference in vaccination rates with respect to gender, paternal education level, number of siblings and socio-economic status. The results of this study show that the level of immunization necessary for measles elimination has not yet been reached in Eastern Turkey. Priority should be given to increase the immunization levels to 90-95% among children.     

兰山区麻疹疫苗强化免疫效果分析

目的：进一步控制兰山区的麻疹疫情。方法：1999年度对该区149 016名8月龄—14岁儿童实施了麻疹疫苗(MV)强化免疫，接种率为97．38％。随后开展了麻疹免疫监测，应用酶联免疫吸附法(EHSA)检测麻疹和风疹IgM抗体，微量血凝抑制试验检测麻疹IgG抗体。结果：强化免疫后麻疹抗体阳转率达100％，GMT从1：5．56上升到1：52．68；经过流行病学观察，强化免疫后麻疹疫情被控制，2a后发病率下降到0．75／10万，麻疹发病数与1999年相比，下降了97．53％。检测79例麻疹疑似病例血清，其中麻疹IgM阳性16例，占20．25％；风疹IgM阳性12例，占15．19％。结论：开展麻疹强化免疫对控制麻疹效果非常显著。