苏州市吴中区小学2017-2018年水痘暴发应急处置效果比较

观察现行水痘疫苗接种策略下小学水痘疫情暴发情况,评价应急接种对暴发疫情控制的效果.方法 收集2017—2018年冬春季苏州市吴中区小学水痘暴发病例的流行病学资料,利用传染病报告信息管理系统、学校因病缺课信息系统比较应急接种法和传统应急停课法开展后水痘病例的续发感染情况.结果 应急接种实验组(187 人) 既往水痘疫苗接种率为78.5%,平均应急接种率为75.0%,续发罹患率为5.0%; 停课对照组(95 人) 既往水痘疫苗接种率为 53.2%,续发罹患率为13.6%.在控制了既往疫苗接种史后,停课对照组的水痘病例续发危险度为应急实验组的5.20 倍 (95%CI = 1.30~ 20.20,P= 0.02).结论 接种一针剂水痘疫苗未在儿童中形成有效免疫屏障.较传统的应急停课方案相比,应急接种能够提高暴发疫情控制效果,降低间接疾病负担.     

实施2剂水痘疫苗免疫程序对水痘发病的影响

目的 分析北京市海淀区实施2剂水痘疫苗免疫程序前后水痘发病情况的变化,为制定科学合理的水痘疫苗接种程序,推进水痘疫情防控工作提供依据.方法 收集海淀区2008-2019年"中国疾病预防控制信息系统"中报告的水痘发病资料及北京市免疫规划信息管理系统中适龄儿童第1剂和第2剂水痘疫苗的接种情况,对比分析实施2剂疫苗免疫程序前...     

小学生水痘突破病例资料分析

目的了解北京康复中心所辖地区小学生水痘突破病例发病特点及规律。方法对2009年1月～2013年1月管辖地区1 681名小学生水痘疫苗接种资料及70例水痘突破病例进行分析。结果 1 681人中共发生70例水痘突破病例,发生率为4.16%;1～3岁开始接种水痘疫苗者突破病例居多;突破病例发病年龄9岁组最多;与疫苗接种间隔4年开始突破病例逐渐增多;冬春季发病为主。结论接种水痘疫苗后小学生中仍有一定程度水痘突破病例发生,提示应做好学生及学生家长疫苗接种告知及解释工作;加强冬季和春末、夏初小学生水痘疫情的预防与控制工作。     

泰州市1—7岁儿童水痘疫苗接种情况分析

目的了解泰州市1—7岁人群水痘疫苗接种情况,为进一步提高水痘疫苗接种率和控制水痘疫情提供依据。方法通过免疫规划信息系统对泰州市1—7岁儿童的水痘疫苗接种史进行描述性分析。结果共调查2331Y7名儿童,水痘疫苗接种率59．80％（47．85％-66．50％）,各年龄组之间儿童水痘疫苗接种率经卡方检验,差异具有统计学意义（x^2=5616．681,P〈O．001）,4岁组儿童接种率最高,为66．50％。本地与流动接儿童种率分别为58．65％、64．09％,流动儿童接种率高于本地儿童,差异具有统计学意义（x^2=506．500,P〈0．001）。结论泰州市水痘疫苗接种率水平较低,需加强7岁以下儿童水痘疫苗接种宣传,提高接种率,控制托幼机构和学校水痘疲情。     

北京市丰台区2008－2010年717例水痘突破病例流行病学特征分析

水痘是由水痘-带状疱疹病毒感染引起的发热出疹性疾病,严重影响儿童的身体健康.北京市于2006年将水痘纳入免疫规划管理,随着水痘管理的逐渐规范化,突破病例越来越受到关注.为了解水痘疫苗接种后突破病例发病特点及规律,本研究对2008-2010年北京市丰台区水痘疫苗接种后发生的突破病例资料进行了分析.     

一起初中水痘突发公共卫生事件的疫苗保护效果评价

目的评价上海市徐汇区2013年某初中水痘突发公共卫生事件中既往水痘疫苗以及应急接种水痘疫苗的免疫效果,为有效控制学校水痘暴发疫情提供依据。方法采用现场流行病学方法收集徐汇区某初中水痘疫情相关资料和该校学生既往水痘疫苗接种史及应急接种情况,计算水痘疫苗保护效果。结果在2013-10-03/12-19该校累计报告27例临床诊断水痘病例,罹患率为3.82%,发病学生主要集中在初二年级,年级水痘罹患率为14.14%。该校707名学生中有558名曾接种水痘疫苗,疫苗接种率为78.93%。经趋势检验,随着年级提升学生水痘疫苗接种率呈下降趋势(χ2=6.56,P0.05)。以水痘疫苗接种史为暴露因素,初二年级病例组接种率为66.67%,对照组接种率为76.74%,病例组与对照组暴露比值比(Odds ratio,OR值)为0.50(95%CI:0.21~1.22),总保护效率为49.62%(95%CI为-22.26%~79.24%)。该校分别于首发病例发病后第13天和第19天对首发班级和全校易感学生进行水痘疫苗的应急免疫,全校应急免疫率为41.38%,应急接种有效率VE应急为53.66%(95%CI为-42.22%~84.90%)。结论该校水痘突发公共卫生事件中,首发病例未及时隔离和疫情期间学校运动会的召开是导致水痘在该校初二年级蔓延的主要原因。水痘疫苗接种距疫情时间间隔过长可能是水痘疫苗未能在本次疫情中起到保护作用的原因之一。在首发病例发病后尽早对易感学生进行水痘疫苗应急接种,可更迅速地形成人群免疫屏障,有效控制暴发疫情。     

一起小学水痘暴发疫情的调查分析

目的 通过分析某小学水痘暴发的流行病学特征和引起暴发的原因,探索预防控制水痘暴发疫情的对策.方法 采用描述流行病学方法对武汉市硚口区某小学水痘暴发疫情个案资料进行分析.结果 2011年4月8日—7月5日,共发生水痘病例137例,罹患率5.41％.相邻的3个低年级罹患率非常显著高于3个高年级(x2=76.35,P＜0.01),43.07％的病例有水痘疫苗接种史,63.50％的病例有发热症状,35.04％的病例为中重度出疹.有免疫史的病例,其发热率、中重度出疹率与无免疫史和不详组比较,差异有统计学意义(分别为x2=5.37,P＜0.05和x2=8.28,P＜0.01),医疗机构网络直报报告率仅18.98％.结论 加强医疗机构和学校传染病报告、提高水痘疫苗接种率、开展水痘疫苗加强接种,是预防控制水痘暴发的重要措施.     

幼托儿童水痘免疫水平及国产水痘疫苗免疫效果观察

目的为了解嘉善县幼托儿童的水痘抗体水平和国产水痘疫苗的免疫原性、反应原性。方法采用FAMA法测定2~6岁人群和水痘疫苗接种者的VZV抗体GMT水平,并观察疫苗接种的安全性。结果该人群水痘抗体阳性率为68.12%,水痘感染率随年龄增长而升高,与性别无关。国产水痘疫苗接种后血清抗体阳转率为88.33%,几何平均滴度为1∶23.98,全身和局部反应轻微。结论该疫苗有良好的有效性和安全性,可用于预防水痘—带状疱疹病毒,接种年龄以18月龄前为宜。     

北京市小学生水痘疫苗应急接种效果及影响因素评价

目的 评价北京市小学生水痘疫苗应急接种效果及其影响因素.方法 对2007年5-7月北京市4个区(县)49起小学水痘疫情应急接种进行前瞻性观察.将应急接种前发生水痘病例的班级和同楼层或同排平房无病例班级的全体7882名学生作为观察对象;收集水痘病史、疫苗接种史、病例个案等资料,采用描述流行病学方法评价水痘疫苗应急接种保护效果.结果 水痘疫苗应急接种总体保护率为85.26%.首例水痘病例既往有疫苗接种史、疫情发现及时、病例数少、距首例病例发病时间短的水痘疫苗应急接种保护效果较好;分别对水痘疫苗应急接种前已发生病例班级和同楼层或同排平房无病例班级的应急接种效果进行分析,疫苗保护率分别为84.26%和87.06%.首例病例既往有水痘疫苗接种史的应急接种保护率分别为92.09%和93.06%,均高于首例病例既往无疫苗接种史的学校.应急接种前仅发生1例病例的疫曲接种保护率分别为83.09%和93.02%,均高于应急接种前已发生2～3例病例的学校.首例病例发病后<5 d完成消毒、隔离和应急接种等综合措施的疫苗保护率分别为86.60%和92.73%,均高于首例病例发病后<5 d完成消毒、隔离、但≥5 d完成应急接种的学校.此外,学校教室为平房、无校车或食堂、无住宿、学生间无搭伴包车或就餐的学校应急接种后疫苗保护率较高.结论 北京市小学生水痘疫苗应急接种具有较高的保护率,有利于控制水痘疫情.     

无锡市学校水痘病例流行特征分析

目的了解无锡市学校水痘发病情况及流行病学特点。方法收集2006—2016年无锡市学校水痘报告病例资料,采用描述性流行病学方法对水痘流行强度、病例三间分布及预防接种情况进行分析。结果 2006—2016年无锡市学校共报告水痘病例20 649例,年均报告发病率为303.27/10万,无死亡病例报告;共报告水痘突发公共卫生事件66起。水痘病例男女性别比为1.37∶1;发病主要集中在3—6月和11月—次年1月,共报告15 803例,占76.53%;无锡市各地区学校均有报告,惠山区学校水痘报告发病率最高,为764.43/10万。81.32%水痘病例无水痘疫苗接种史。结论学生是水痘发病的易感人群,应加强冬季和春末夏初学生水痘疫情的预防与控制,加强水痘疫苗接种宣传。     

Influenza vaccination and risk of stroke: Self-controlled case-series study

BackgroundStroke may be triggered by respiratory infections, including influenza. Influenza vaccination could therefore reduce risk of stroke. Previous studies of this association have shown conflicting results. We aimed to investigate whether influenza vaccination was associated with reduced risk of stroke.MethodsWe used a self-controlled case series design. The General Practice Research Database (GPRD) was used to extract records of patients aged 18 years or over recorded with stroke (fatal or non-fatal) from September 2001 to May 2009. Statistical modelling with conditional Poisson regression was employed to compute incidence rate ratios (IRR). The incidence rate of stroke in fixed time periods after influenza vaccination was compared with the incidence rate during a baseline period.ResultsThere were 17,853 eligible individuals who received one or more influenza vaccinations and experienced a stroke during the observation period. The incidence of stroke was significantly reduced in the first 59 days following influenza vaccination compared with the baseline period. We found reductions of 55% (IRR 0.45; 95% CI 0.36–0.57) in the first 1–3 days after vaccination, 36% (0.64; 0.53–0.76) at 4–7 days, 30% (0.70; 0.61–0.79) at 8–14 days, 24% (0.76; 0.70–0.84) at 15–28 days and 17% (0.83; 0.77–0.89) at 29–59 days after vaccination. Early vaccination between 1 September and 15 November showed a greater reduction in IRR compared to later vaccination given after mid-November.ConclusionsInfluenza vaccination is associated with a reduction in incidence of stroke. This study supports previous studies which have shown a beneficial association of influenza vaccination for stroke prevention.     

Effectiveness of 2 + 1 PCV7 vaccination schedules in children under 2 years: A meta-analysis of impact studies

Although a case control study suggested high effectiveness of the 2 + 1 PCV-7 vaccination, schedule against invasive pneumococcal disease (IPD) in children the results of impact studies in, different countries yield considerable differences in the magnitude of the effects. A systematic, literature review was conducted to identify all relevant studies on IPD incidence reduction after onset, of PCV7 vaccination programmes in children younger than 2 years of age given in the 2 + 1 schedule. The incidence rate ratio between IPI incidences for vaccine serotypes before and after beginning of the, vaccination programme was calculated for each study. Heterogeneity was assessed and attempts to, identify causes for heterogeneity were made. In the literature search 4 studies which fulfilled inclusion, criteria were identified. The summary estimates yielded an IRR 0.10 [0.04; 0.30] suggesting a 90%, incidence reduction. Heterogeneity was high with I² = 93%. Heterogeneity might be explained by, differences in vaccination rates, the way vaccination rates were assessed, matching of the periods of, vaccination and case ascertainment, time between onset of the vaccination programme and onset of, case ascertainment during the vaccination period and the length of the observation period after onset, of the vaccination programme. A study which started 3 years after onset of the vaccination programme, with vaccination rates ≥80% throughout the ascertainment period of the incidence rates reported a, 98% reduction in the incidence rates. A meta-analysis on IRR studies on reductions of the IPD, incidence in children <2 years of age suggested high effectiveness of the 2 + 1 vaccination schedule for PCV 7.     

Universal measles-mumps-rubella vaccination to new recruits and the incidence of mumps in the military

In response to the resurgence of mumps, the Korean Armed Forces started the measles-mumps-rubella (MMR) vaccination to all new recruits regardless of prior vaccination history. We evaluated the effectiveness of the vaccination by comparing the incidence between the military and civilian populations before and after implementation of the new policy. The standardized incidence ratio of mumps in the military was 7.06 in the prevaccine period, which declined to 0.96 in the postvaccine period. Vaccine effectiveness was estimated at 86.4%. Incidence rate ratio was lower in the 1996–1998 birth cohort (BC) compared with 1989–1995 BC (0.10 vs. 0.55), suggesting higher effectiveness of vaccination in the 1996–1998 BC. Our data provide evidence for the use of the MMR vaccination in the prevention of mumps in high-risk adults.     

Indications for,and the significance of,the tuberculin test in the Netherlands

The almost 100-year-old tuberculin skin test still is the gold standard for diagnosing Mycobacterium tuberculosis infection. The sensitivity of this test with the usual cut-off values is high, but may be decreased with impaired cellular immunity and at older age. The specificity is primarily determined by cross-reactivity to atypical mycobacterial infections and vaccination with Bacillus Calmette-Guérin (BCG). Positivity of the skin test after BCG vaccination decreases with time after vaccination and depends on the age when vaccinated. The tuberculin reaction can be boosted by repeated tuberculin skin tests over a short time period, whereby the anamnestic immune response is stimulated. This boosting phenomenon occurs mostly with atypical mycobacterial infections, after BCG vaccination and at older age. Interpretation of the tuberculin skin test depends on the indication for the test, the expected risk of latent tuberculosis infection, higher prevalence of 'old' tuberculosis in elderly Dutch people and immigrants, BCG vaccination status and, if a baseline value is available, the boosting phenomenon. Its role in the diagnosis of tuberculosis is limited.     

Intussusception risk after RotaTeq vaccination: Evaluation from worldwide spontaneous reporting data using a self-controlled case series approach

The increased risk of intussusception after vaccination with the rhesus-human reassortant rotavirus vaccine Rotashield led to its withdrawal in 2005. We assess the risk of intussusception following the pentavalent rotavirus vaccine (RV5) on the basis of worldwide reports to the manufacturer up to May 2014, using a self-controlled case series. The method had to be modified to account for the under-reporting, a specific feature of pharmacovigilance spontaneous reports. The risk of intussusception occurring in either of the 0- to 2-day, 3- to 7-day or 8- to 14-day risk periods, was compared to the risk in the 15- to 30-day period. A total of 502 cases occurring 0–30 days after a vaccine dose were studied, including 188 cases after the first dose, 190 cases after the second dose, and 124 cases after the third dose. The incidence risk ratio relative to the control period was highest for the 3- to 7-day period and equal to 3.45 (95% CI 1.84–6.55), 1.63 (0.86–3.13) and 1.73 (0.86–3.51) after the first, second and third dose, respectively. Rotavirus vaccination with RV5 increases the risk of intussusception 3–7 days following vaccination, mainly after the first dose and marginally after the second and third doses. The risk is small and restricted to a short time window. It does not outweigh the benefit of the vaccination, but parents of vaccinated infants should be informed in order to react appropriately to the first symptoms. With appropriate assumptions about the reporting rate, spontaneous reports of adverse events after vaccination can be studied to evaluate vaccine safety.     

Evaluation of the stability and immunogenicity of autoclaved and nonautoclaved preparations of a vaccine against American tegumentary leishmaniasis

This study was designed to evaluate the immunogenicity of autoclaved and nonautoclaved preparations of a vaccine composed of whole antigens from killed promastigotes of Leishmania amazonensis. Leishmanin skin-test (LST)-negative volunteers were immunized with either autoclaved or nonautoclaved vaccine preparations (32 and 36 subjects, respectively) that had been maintained at 4 degrees C for one year before the onset of this trial. Immunological tests were performed two days before and 40 days after vaccination. The LST conversion rates induced by the autoclaved and nonautoclaved vaccines were significantly different: 59% and 83%, respectively. Leishmania antigen-stimulated proliferative responses of peripheral blood mononuclear cells (PBMC) were significantly higher after vaccination than before vaccination in both groups. The CD8+ subset was predominant over the CD4+ subset among the leishmania-reactive cells after vaccination in both groups. The production of IFN-gamma by the leishmania antigen-stimulated PBMC was significantly higher after vaccination than before vaccination in the group receiving the nonautoclaved vaccine but not in the autoclaved vaccine group. IL-2 was found both before and after vaccination with no differences between its levels in these time points in either group. IL-4 was not detected for either group during the study period.     

Costs and benefits of measles vaccination in Finland.

Measles vaccination is fairly beneficial. During the third year after launching of the vaccination programme, cumulative benefits accuring from vaccination outweigh the cumulative costs of vaccination. This conclusion is based on a study of the vaccination programme in Finland. According to the vaccination programme, all 1-year-old infants in Finland are vaccinated. The duration of the period under survey has been set at 25 years, the measuring unit is the Finnish mark and the price level is that of the year 1975. When comparing costs and benefits, these are converted to present day monetary values. Vaccination costs per vaccinated infant amount to 32 marks, and in total during the period 1975--1999 they will amount to about 34 million marks according to an interest rate of 9% and to about 41 million marks according to an interest rate of 6% in current monetary value. Benefits gained by vaccination, compared with costs, are manifold. The benefits of one vaccination have been estimated at 230 marks. In total, benefits during the period 1975--99 constitute ca 117 million marks at an interest rate of 9%, and ca 159 million marks at an interest rate of 6% in current monetary value, without any deduction for vaccination costs. The net gain of vaccination--with a deduction of vaccination costs--is ca 84 million marks at an interest rate of 9%, and ca 118 million marks at an interest rate of 6% in current monetary value.     

海拉尔铁路工务系统职工接种森林脑炎疫苗免疫效果观察

目的为了解海拉尔铁路工务系统的线路工人接种森林脑炎疫苗后的免疫效果。方法随机抽取工务系统在林业区段作业的402名职工,于预防接种前和接种后三周进行静脉采血,采用酶联免疫法进行抗体检测。结果免疫接种后抗体阳性率为98.76%;免疫前连续接种5年者抗体阳性率高于连续接种3年者、未连续接种者和从未接种者;吸烟、饮酒等不良生活习惯并不影响注射疫苗后抗体的产生。结论长春生物制品研究所研制的这种新型地鼠肾纯化灭活疫苗（森泰保）具有较高的抗体阳转率,但接种疫苗后的抗体水平维持时间较短,需每年进行加强注射才能维持身体内的抗体水平。接种年限越长血清抗体水平越高。吸烟、饮酒不良生活习惯不影响抗体的产生。     

接种甲型H1N1流感疫苗1年后免疫持久性评价

目的 评价成都市甲型H1N1流感疫苗接种1年后疫苗免疫持久性.方法 以2010年免后1个月HI抗体≥1∶40的398人作为观察对象,用微量血凝抑制试验方法测定抗体,计算人群抗体几何平均滴度(GMT)和疫苗保护率.结果 免疫后1年人群GMT下降62.03％,抗体保护率达92.71％,老年组保护率为83.12％;免后1个月低抗体水平个体(1∶40、1∶80),1年后有40.21％的人抗体滴度上升.结论 甲流疫苗具有一定的免疫持久性,老人免疫持久性相对较差.     

Interpreting the epidemiology of postexposure vaccination against smallpox

Six historical studies were investigated to clarify the obtainable information on postexposure vaccination against smallpox. Using the distribution of incubation period, the frequency of cases by time from exposure to vaccination was obtained. More than half of all failures happened within 7 d after exposure in all six records investigated. Based on two studies (n=36 and 28), the probability of escaping severe smallpox was further analyzed using logistic regression, showing an inverse association between severe smallpox and time from vaccination to onset (p<0.01 and p=0.04, respectively). Whereas the relationship between the probability of developing severe disease and the time from vaccination to onset could be analyzed with the available information, our findings indicate that previous epidemiologic records showing cases alone, rather than also showing individuals probably protected, are not useful for clarifying the effectiveness of postexposure vaccination by time after exposure.