贵州省流行性乙型脑炎疫苗强化免疫成本效益评价

目的 探讨贵州省实施流行性乙型脑炎(乙脑)疫苗强化免疫的成本效益.方法 抽样调查乙脑病例住院和非住院治疗费用、陪护费用、康复费用以及乙脑疫苗强化免疫工作中需投入的经费.计算因乙脑患病陪护人员人均减少的产值,用伤残调整寿命年指标(DALY)计算因乙脑发病造成的死亡和伤残损失,采用成本-效益分析方法,计算乙脑强化免疫的成本效益比值和产生的净效益.结果 1例乙脑病例患病后社会减少产值84.36万元.贵州省2007年开展乙脑疫苗强化免疫后发病率较1990～2006年强化前平均下降了65.30％,因采取强化免疫措施而减少发病、伤残和死亡损失的净效益为1亿2千5百余万元,成本效益比值为1∶4.88.结论 开展大规模的强化免疫,对降低乙脑发病水平效果显著,可产生较好的社会效益和经济效益.     

江苏省乙型脑炎疫苗计划免疫成本效益分析

目的探讨江苏省乙型脑炎疫苗接种的效益成本比,为在全国范围内将乙型脑炎疫苗接种纳入儿童计划免疫提供依据。方法以江苏省疾病预防控制中心1965年至今的乙型脑炎疫苗接种、乙型脑炎发病及死亡资料为基础,以2005年的乙型脑炎疫苗计划免疫成本及2005年乙型脑炎患者费用调查资料为依据,对江苏省乙型脑炎疫苗计划免疫项目进行成本效益分析。结果自1978年起将乙型脑炎疫苗接种纳入儿童计划免疫后,江苏省乙型脑炎发病率逐年下降,由1965~1977年的20.88/10万降至2005年的0.09/10万。2005年人群避免发病所产生的效益为14458.64万元,当年乙型脑炎疫苗免疫总成本为1154.96万元,效益成本比为12.52∶1,效益远大于成本。结论接种乙型脑炎疫苗预防乙型脑炎的效果和效益非常显著。建议将乙型脑炎疫苗纳入儿童计划免疫管理。     

江苏省2008年乙型脑炎疾病经济负担调查研究

流行性乙型脑炎(乙脑)是由乙脑病毒引起的一种急性中枢神经系统传染病,病死率高,后遗症重.东南亚及我国(除西北三省为非流行区)均存在不同程度流行.在人群中有计划、大规模预防接种疫苗是预防乙脑最有效的方法,乙脑疫苗的预防效果已得到广泛认同[1,2].目前有关乙脑疫苗接种所需投入与乙脑病人花费支出即乙脑疫苗成本-效益研究较少.为配合卫生部将乙脑疫苗纳入儿童计划免疫管理,并提供理论依据,给下一步进行乙脑疫苗计划免疫成本-效益研究打下基础.2008年江苏省开展了乙型脑炎疾病经济负担研究,现将结果报告如下.     

麻疹疫苗强化免疫策略的成本效益分析

目的分析麻疹疫苗强化免疫的经济效益,为2012年实施麻疹消除策略提供科学依据。方法采用成本-效益分析方法分析麻疹疫苗强化免疫的经济和社会效益。结果 2009年麻疹疫苗强化免疫后与2007和2008年相比,每投入成本1万元可减少3.3个和1.7个麻疹病例,可产出2.57万元和1.35万元的效益。结论麻疹疫苗强化免疫可产生巨大的经济效益和社会效益。     

河北省流行性乙型脑炎纳入免疫规划前后流行病学特征北大核心

目的分析河北省流行性乙型脑炎(乙脑)在乙脑疫苗纳入免疫规划(Expanded Program on Immunization,EPI)前后的流行特征变化。方法通过中国传染病信息报告管理系统和乙脑监测信息报告管理系统收集河北省乙脑疫苗纳入EPI前后(2004-2007年和2008-2019年)乙脑报告病例,比较乙脑发病特征。结果河北省2004-2007年、2008-2019年乙脑年均报告发病率分别为0.075/10万(204例)、0.053/10万(453例)。<15岁儿童病例构成、发病率从2004-2007年的62.25%(127/204)、0.240/10万下降到2008-2019年的24.06%(109/453)、0.070/10万;≥40岁病例构成、发病率从2004-2007年的19.61%(40/204)、0.040/10万上升到2008-2019年的50.77%(230/453)、0.060/10万。结论河北省乙脑疫苗纳入EPI后儿童乙脑发病率下降,≥40岁人群成为高风险人群。需探索实施成人乙脑免疫策略和健康教育措施。     

河北省流行性乙型脑炎纳入免疫规划前后流行病学特征

目的分析河北省流行性乙型脑炎(乙脑)在乙脑疫苗纳入免疫规划(Expanded Program on Immunization, EPI)前后的流行特征变化。方法通过中国传染病信息报告管理系统和乙脑监测信息报告管理系统收集河北省乙脑疫苗纳入EPI前后(2004-2007年和2008-2019年)乙脑报告病例,比较乙脑发病特征。结果河北省2004-2007年、2008-2019年乙脑年均报告发病率分别为0.075/10万(204例)、0.053/10万(453例)。15岁儿童病例构成、发病率从2004-2007年的62.25%(127/204)、0.240/10万下降到2008-2019年的24.06%(109/453)、0.070/10万;≥40岁病例构成、发病率从2004-2007年的19.61%(40/204)、0.040/10万上升到2008-2019年的50.77%(230/453)、0.060/10万。结论河北省乙脑疫苗纳入EPI后儿童乙脑发病率下降,≥40岁人群成为高风险人群。需探索实施成人乙脑免疫策略和健康教育措施。     

基于中断时间序列评价乙型脑炎疫苗纳入扩大免疫规划对甘肃省乙型脑炎报告发病率的影响

目的评价乙型脑炎(乙脑)疫苗纳入扩大免疫规划对甘肃省乙脑报告发病率的影响。方法通过国家人口健康科学数据中心和中国疾病预防控制信息系统收集1987-2019年甘肃省乙脑报告发病率资料, 并利用中断时间序列设计分析乙脑疫苗纳入扩大免疫规划前后甘肃省乙脑报告发病率的变化趋势。结果 1987-2019年甘肃省乙脑年报告发病率平均为0.448/10万, 甘肃省将乙脑疫苗纳入扩大免疫规划后, 乙脑报告发病率的水平变化量为-2.223/10万(t=-2.90, P=0.007), 乙脑报告发病率的斜率变化量为0.082(t=2.87, P=0.008), 乙脑报告发病率的斜率为0.071(β1+β3=0.071)。结论乙脑疫苗在甘肃省纳入扩大免疫规划后短期内取得了较好的防控效果, 但仍出现了乙脑暴发。甘肃省应及时调整乙脑疫苗的免疫策略, 继续重视儿童青少年疫苗接种, 加强成年人群特别是甘肃省东南部农村地区成年人群的疫苗接种工作。     

海南省流行性乙型脑炎减毒活疫苗有效性与安全性评价

摘要:目的　评价海南省免疫规划使用流行性乙型脑炎（以下简称“乙脑”）减毒活疫苗预防接种的有效性和安全性,为乙脑预防接种实施和控制提供策略依据。方法　收集1980年以来乙脑疫情资料及2008-2012年乙脑减毒活疫苗接种后疑似预防接种异常反应（Adverse Events Following Immunization;AEFI）监测资料,从乙脑发病率、疫苗保护率、异常反应发生率等流行病学指标评价有效性和安全性。结果　2008-2012年海南省乙脑年均发病率为0.17/10万,疫苗平均保护率为97.52%。AEFI报告203例,总发生率为14.03/10万,以一般反应（发热/红肿/硬结）;异常反应发生率为3.53/10万,主要表现为过敏性皮疹,严重异常反应如血小板减少性紫癜、Arthus反应、脑炎和脑膜炎发生率为0.07/10万。结论　海南省将乙脑减毒活疫苗纳入儿童计划免疫推广应用效果显著,疫苗安全性高,可继续推广应用乙脑减毒活疫苗。     

使用乙脑减毒活疫苗成本——效益分析

目的:了解乙脑疫苗接种在防控乙脑工作中产生的社会效益和经济效益,合理分配和有效利用免疫经费资源,为制定卫生决策提供重要依据.方法:采用成本-效益分析模型,通过抽样调查乙脑病例住院和非住院治疗费用、陪护费用、康复费用、丧葬费用、家庭和社会补贴生活费及残疾人应创造的经济价值和社会效益,控制乙脑工作中需投入的经费,用目前国际通用的伤残调整寿命年指标(DALY),定量的计算因乙脑发病造成的死亡和伤残损失.计算成本效益比值和产生的净效益.结果:海南省自使用乙脑减毒活疫苗后,年均发病率较使用前下降了96.04%;因使用乙脑减毒活疫苗而减少发病、伤残和死亡损失合.成本效益比值为1:56.19.结论:使用乙脑减毒活疫苗预防乙脑的措施,可产生巨大的社会效益和经济效益.     

2007-2013年汉中市流行性乙型脑炎流行病学特征分析

目的了解陕西省汉中市2007-2013年流行性乙型脑炎的流行特征,为制定乙型脑炎预防控制措施提供科学依据。方法按照《陕西省流行性乙型脑炎监测方案》病例定义开展监测,采用描述性流行病学方法对汉中市2007-2013年乙型脑炎监测病例进行统计分析。结果汉中市2007-2013年共报告乙型脑炎58例,报告年发病率波动在0.34/10万~0.03/10万之间,平均发病率为0.21/10万,病死率3.4%,2009年出现流行高峰,发病率达0.49/10万,2010年后下降。病例散发在全市的10个县区农村,以洋县、宁强居多,各占总病例的24.14%。发病季节集中在7~9月,发病年龄以学龄儿童和学生为主,其中,1~6岁占56.9%,7~15岁占20.7%。病例中无免疫史或免疫史不详者占79.3%,其中≤15岁以下儿童无免疫史或免疫史不详者占56.9%。病例临床分型极重型占10.4%,中、重型各占36.2%,轻型和未分型病例各占8.6%,这些病例中有2例死亡,其余经治疗大部分恢复正常。结论 2007-2013年汉中市乙脑发病趋势呈波动性下降,地区分布广,病例多散发于农村15岁以下年龄组儿童,与未接种疫苗或疫苗接种不全有关,因此切实提高乙脑疫苗接种率,扎实开展乙脑病例监测,在高发地区及农村进行重点控制,是降低汉中市乙型脑炎发病的重要措施。     

Cost-effectiveness of routine immunization to control Japanese encephalitis in Shanghai,China

OBJECTIVE: To assess the cost-effectiveness of inactivated and live attenuated Japanese encephalitis (JE) vaccines given to infants and children in Shanghai. METHODS: A decision-analytical model was constructed in order to compare costs and outcomes for three hypothetical cohorts of 100,000 children followed from birth in 1997 to the age of 30 years who received either no JE vaccine, inactivated JE vaccine (P3), or live attenuated JE vaccine (SA 14-14-2). Cumulative incidences of JE from birth to 30 years of age in the pre-immunization era, i.e. before 1968, were used to estimate expected rates of JE in the absence of vaccination. The economic consequences were measured as cost per case, per death, and per disability-adjusted life year (DALY) averted for the two JE immunization programmes. FINDINGS: In comparison with no JE immunization, a programme using the P3 vaccine would prevent 420 JE cases and 105 JE deaths and would save 6456 DALYs per 100,000 persons; the use of the SA 14-14-2 vaccine would prevent 427 cases and 107 deaths and would save 6556 DALYs per 100,000 persons. Both kinds of immunization were cost saving but the SA 14-14-2 vaccine strategy resulted in a saving that was 47% greater (512,456 US dollars) than that obtained with the P3 vaccine strategy (348,246 US dollars). CONCLUSION: Both JE immunization strategies resulted in cost savings in comparison with no JE immunization. This provides a strong economic rationale for vaccinating against JE in Shanghai and suggests that vaccination against JE might be economically justifiable in other parts of China and in certain other developing countries of Asia where the disease is endemic.     

Epidemiology and control of Japanese encephalitis.

Japanese encephalitis (JE) remains endemo-epidemic in several countries in East, South-East and South Asia. The disease has been under control in Japan since the 1970s owing to mass immunization using mouse-brain-derived inactivated vaccine and to reduced vector mosquito populations. The vector density which was once reduced by wide spraying of insecticides in rice fields showed an increasing trend after the 1980s as a result of mosquito resistance. In the Republic of Korea, the number of JE cases showed a significant decrease after 1983 also because of mass immunization using mouse-brain-derived vaccine. On the other hand, large outbreaks of JE continued to occur in China, Viet Nam, Thailand, India, Nepal and Sri Lanka. In China, a hamster-kidney cell-derived vaccine was developed and used for human immunization. Besides human JE, the fatal outcome of equine JE is an economic problem in China. Current JE vaccine derived from mouse brain is highly purified and its safety and efficacy have been proved by field-tests as well as laboratory experiments. In spite of slight antigenic differences among JE virus isolates, JE vaccine produced by a classical Nakayama strain was effective in preventing overt JE in a field study in Thailand. The technology of mouse-brain-derived inactivated JE vaccine production was transferred from Japan to India, Thailand and Viet Nam. The production of JE vaccine in these countries is still on a pilot scale and insufficient for mass-immunization of susceptible target populations.(ABSTRACT TRUNCATED AT 250 WORDS)     

开江县乙脑疫苗接种及影响因素调查

目的了解开江县乙脑疫苗接种情况及其影响因素,为乙脑防治工作提供科学依据。方法以2006年发生的31名乙脑病例分布地区作为调查点,每个点抽取1～7岁儿童7名进行乙脑疫苗接种情况及其未接种原因调查。结果共抽查26个点1～7岁儿童169名,有预防接种证的107名,有证率为63.31%,有乙脑疫苗接种的79名,接种率为46.75%。90名儿童未接种乙脑疫苗的原因:不知道要接种占10.00%,怕接种反应占5.56%,对接种缺乏科学信任占6.67%,不知道接种地点、时间占10.00%,儿童患病未去接种占3.33%,疫苗收费太贵占37.78%,计划外生育占15.56%,随父母外地流动占11.11%。结论开江县发生的乙脑病例,可能与当地乙脑疫苗接种率低(46.75%),难以达到保护易感儿童的作用有关,疫苗收费太贵、计划外生育儿童、流动儿童等是导致未接种的主要原因。     

江苏省2008-2017年流行性乙型脑炎流行特征及防控效果

目的 分析2008-2017年江苏省乙型脑炎（Japanese encephalitis,JE）流行特征,为JE的防控工作提供科学依据。方法 采用描述流行病学方法对2008-2017年江苏省JE数据进行统计分析,资料来源于《中国疾病预防控制信息系统》,采用酶联免疫吸附法进行JE IgM抗体的检测。结果 江苏省2008-2017年共报告269例JE病例,年均发病率为0.034/10万,JE发病率总体呈下降趋势（χ_趋势²=104.47,P<0.001）;病例主要发生在7~9月份,8月为发病高峰;病例主要分布于宿迁市、连云港市、苏州市、淮安市和徐州市5市（占72.86%）;男女发病比为1：0.72,发病年龄集中在﹤10岁（占80.67%）,职业为散居儿童。JE患者血清/脑脊液标本有462份,阳性率为78.35%（362/462）;病例以无免疫史和免疫史不详为主,有接种史的病例占42.75%。经过一系列的防治措施,近几年JE发病数下降明显。结论 江苏省JE发病率低于全国平均水平,本省JE疫苗的接种人群效果显著,今后应继续做好JE的防控工作,加强宣传教育,同时做好防蚊灭蚊等防控措施。     

Cost-effectiveness of Japanese encephalitis (JE) immunization in Bali, Indonesia

Two hypothetical birth cohorts in Bali, each consisting of 100,000 newborns, one immunized with live, attenuated JE vaccine and the other un-immunized, were modeled for JE risk over 11 years. Cumulative JE incidence before JE vaccine introduction was used to represent JE risk in the unvaccinated cohort. Data on vaccine efficacy, vaccination and treatment costs were taken from published papers and surveys. The potential immunization program averted 54 cases, 5 deaths and saved 1,224 disability adjusted life years (DALYs) at a net cost of USD 700 per JE case averted and USD 31 per DALY saved and thus was highly cost-effective.     

Non-clinical and phase I clinical trials of a Vero cell-derived inactivated Japanese encephalitis vaccine

The safety and effectiveness of a Vero cell-derived inactivated Japanese encephalitis (JE) vaccine were compared with those of a current JE vaccine in non-clinical studies and a phase I clinical trial. The single-dose toxicity study showed no toxicity of either the current JE vaccine or the investigational Vero cell-derived JE vaccine. In a local irritation study, the degree of irritation caused by both vaccines was determined to be the same as that induced by normal saline. To investigate genotoxicity, a chromosomal aberration test was conducted and the results were negative. Both JE vaccines were administered to a group of 30 subjects who were seronegative (neutralizing antibody titer <10(1)) for JEV virus (Beijing-1 Strain). Each subject was subcutaneously inoculated twice at an interval of 1-4 weeks, followed by an additional booster inoculation 4-8 weeks later, and clinical reactions and serological responses were subsequently investigated. Adverse drug reactions of local reaction, headache and malaise were mild, occurring at a rate of 6.7 and 20.0% after administration of the Vero cell-derived JE vaccine and the current JE vaccine, respectively. The seroconversion rate after three doses of both JE vaccines was 100%, while the geometric mean titer for the Vero cell-derived and current JE vaccines was 10(2.35) and 10(2.03), respectively. These results suggest that the safety and effectiveness of the Vero cell-derived inactivated JE vaccine are equal to those of the currently available conventional vaccine in humans, and that the Vero cell-derived vaccine could be a useful second-generation JE vaccine.     

流行性乙型脑炎减毒活疫苗效果的病例对照研究

为了解流行性乙型脑炎 (乙脑 )减毒活疫苗在乙脑流行时的保护效果 ,对 2 0 0 0年发生乙脑流行的重庆市万州区 1～ 6岁临床诊断病例 4 7例 ,按照 1∶2配对进行乙脑减毒活疫苗免疫接种史调查。结果显示 :乙脑病例和对照中 ,有免疫接种史的分别占 2 13% (1/47)和 35 11% (33/94 )。乙脑减毒活疫苗对 1～ 6岁儿童的保护率为95 98% ,95 %可信限为 72 0 3%～ 99 4 2 % ,即最低的保护率为 72 0 3%。接种乙脑减毒活疫苗可提高人群免疫力 ,在乙脑流行时有较好的保护效果。     

宝鸡市预防接种工作人员对流行性乙型脑炎疫苗可接受性调查

目的了解宝鸡市预防接种工作人员对流行性乙型脑炎(乙脑)疫苗的可接受性,探讨提高乙脑疫苗接种率的有效策略。方法选取宝鸡市6个县的192名预防接种工作人员做问卷调查。结果认为乙脑发生十分危险及发病十分严重的分别占24.0%和15.1%;认为家长拒绝为儿童接种乙脑疫苗的原因中经济困难和接种费用高占50.0%;91.7%的预防接种工作人员认为多对家长宣传动员,71.7%的预防接种工作人员认为接种完全免费可以提高乙脑疫苗的接种率。结论预防接种工作人员对乙脑及其危害了解较少;对疫苗临床反应的认识程度较高;应加强对预防接种工作人员、儿童家长的宣传工作。乙脑疫苗纳入免疫规划后,将会很大程度上提高免疫覆盖率。     

Single dose of inactivated Japanese encephalitis vaccine with poly(gamma-glutamic acid) nanoparticles provides effective protection from Japanese encephalitis virus

Japanese encephalitis (JE) is a serious disease caused by the JE virus (JEV), and vaccination is the only way to prevent the diseases. In Japan, the only JE vaccine currently available is an inactivated vaccine that requires multiple doses for effective protection; therefore, an effective single-dose vaccine is needed. However, no report of an effective protocol for a single dose of JE vaccine in animals has been published. Here, we evaluated the efficacy of a single-dose vaccination in mice to which the JE vaccine was given with or without adjuvant. Biodegradable poly(gamma-glutamic acid) nanoparticles (gamma-PGA-NPs) were used as a test adjuvant. Remarkably, a single dose of JE vaccine with gamma-PGA-NPs enhanced the neutralizing antibody titer, and all of the immunized mice survived a normally lethal JEV infection, while only 50% of the mice that received a single dose of JE vaccine without gamma-PGA-NPs survived. The use of aluminum as the adjuvant showed similar levels of enhanced efficacy. These results show that gamma-PGA-NPs are a novel and safe adjuvant for JE vaccine, and that a single dose of JE vaccine with gamma-PGA-NPs provides effective protection from lethal JEV in mice. A similar protocol, in which a single dose of JE vaccine is mixed with gamma-PGA-NPs, may be useful for the immunization of humans.