BRDⅡ株风疹疫苗免疫应答研究

本文对安徽省４２６名健康人群血清检测结果分析表明：风疹ＨＩ抗体平均阳性率为５９．１５％；育龄期妇女易感率为１０．７７％。对３６１名健康人群ＢＲＤⅡ株风疹减毒活疫苗免疫应答研究结果分析表明：各年龄组对风疹疫苗均有较好的免疫应答反应；免前阳性人群接种风疹疫苗仍可获得良好的免疫应答反应。显示我国选育的ＢＲＤⅡ株风疹减毒活疫苗具有良好的免疫原性。推荐我省风疹免疫策略：１）在全省建立风疹的监测；将风疹疫苗的接种纳入ＥＰＩ管理规程。２）实行１岁儿童完成初种及对婚前育龄期妇女给予一针风疹疫苗的接种的方案。３）在条件许可的情况下，对全省农村地区１４岁以下的儿童进行一针普种。     

Evaluation of measles–rubella vaccination for mothers in early puerperal phase

BackgroundThe postpartum period is an ideal opportunity to vaccinate mothers with inadequate immunity to vaccine-preventable diseases including measles and rubella.MethodsA prospective study of measles–rubella (MR) vaccination in the early puerperal phase was conducted in 171 mothers, who had insufficient antibody titers when screened for immunity to measles (≤1:4 on the neutralization test [NT]) or rubella (≤1:16 on the hemagglutination inhibition [HI] test) during pregnancy. To evaluate the efficacy of MR vaccination in the postpartum period, we determined their post-vaccination antibody titers and immune responses to vaccination, and investigated the association between these and their prolactin (PRL) levels and Th1/Th2 ratios at the time of vaccination. We also examined the passage of viral RNA and antigen into breast milk.ResultsOf the 169 participants who completed the study schedule, 117 and 101 had low antibody titers against measles and rubella, respectively. In the measles-seronegative group, the antibody-positive rate was 87% on the NT assay, and the NT geometric mean antibody titer was 11.4 (95% confidence interval [CI], 10.0–13.0). In the rubella-seronegative group, the antibody-positive rate was 88% on the HI test assay, and the HI geometric mean antibody titer was 64.0 (95% CI, 53.9–76.0). There was no association between the post-vaccination antibody titers and the PRL levels or Th1/Th2 ratios at the time of vaccination. In the rubella-seronegative group, subjects with higher Th1/Th2 ratios showed higher rates of responsiveness than those with lower ratios (P = 0.045). Although measles virus RNA was isolated from the breast milk of two vaccinated mothers, breastfeeding was not associated with clinical disease in any infants.ConclusionMR vaccination in the early puerperal phase is considered an effective way to prevent the diseases, regardless of the mother's immunological status and hormonal milieu.     

天津市麻疹风疹及流行性腮腺炎抗体水平分析

目的了解天津市健康人群麻疹、风疹、流行性腮腺炎抗体水平,评价疫苗接种需求。方法2007年3月采集0~57岁健康人群608人份血样品,用ELISA方法定量检测麻疹、风疹、流行性腮腺炎IgG抗体水平。运用直线相关分析抗体阳性率,保护率GMC与疾病发病率之间的关系,P0.05为差异有统计学意义。结果麻疹、风疹和流行性腮腺炎疫苗接种率分别为70.39%、16.78%和12.34%;抗体阳性率分别为91.78%,65.79%和73.52%;抗体几何平均浓度(GMC)分别为2 488.10 IU/L、200.4 IU/ml和759.91 U/ml。麻疹抗体阳性率,保护率与发病率存在明显相关关系(P0.01),而GMC与麻疹发病率没有显著性相关;风疹和流行性腮腺炎抗体阳性率、GMC与发病率无相关关系。结论本次调查显示2007年天津市麻疹人群抗体GMC总体保持在较高水平。风疹、流行性腮腺炎疫苗接种率和抗体水平较低,2剂次的麻腮风疫苗(MMR)纳入免疫规划既有助于消除麻疹,也有利于控制风疹和流行性腮腺炎。     

大规模含风疹成份疫苗接种后对人群风疹免疫水平的影响

目的　了解含风疹成份疫苗（Rubella Contained Vaccine,RCV）大规模接种后,对人群风疹免疫水平的影响。方法　对浙江省2009年全人群风疹免疫水平监测数据进行分析。结果　全人群风疹抗体阳性率为67.52％ ,几何平均浓度（Geometric Mean Concentration,GMC）为20.04国际单位/毫升（IU/ml）,以4～ 7月龄最低,2～ 4岁最高,15～ 39岁女性抗体阳性率为67.82％ 。有RCV免疫史者中,97.36％ 集中于8月龄～ 19岁。其中8～ 23月龄、2 ～ 4岁组有免疫史的比例明显高于其他年龄组。有RCV 免疫史及风疹患病史人群免疫水平明显升高。8 月龄～2 岁常规免疫覆盖人群中,有1 剂、2 剂次RCV 免疫史者风疹抗体GMC 均高于无免疫史者,但两者间的差异无统计学意义（P=0.085）。＜20 岁各年龄组风疹免疫水平与发病率基本上呈反比。结论　常规免疫覆盖人群风疹免疫水平较使用疫苗前明显提高,发病率明显下降。而青少年及成人风疹免疫水平却较使用疫苗前有不同程度下降。     

山东省实施儿童风疹疫苗免疫后风疹发病年龄变化趋势的分析

目的分析山东省自1995年开始实施儿童风疹疫苗免疫后风疹发病年龄的变化趋势。方法对1999—2004年通过麻疹疫情专报系统得到的风疹疫情资料以及风疹疫苗接种情况进行分析。结果1999—2004年山东省风疹年平均报告发病率为0．59／10万,多为暴发（占总病例数的81．17％）;发病主要集中在7～15岁学龄儿童（77．77％）,7岁以下发病较少（占7．93％）,发病年龄中位数分别为10．37岁、11．66岁、11．41岁、12．81岁、14．28岁和13．96岁,发病高峰年龄逐年后移,成人发病有所增加;学龄前儿童风疹疫苗基础免疫估算接种率约为60％,学龄儿童约为20％。结论风疹发病年龄后移,将威胁育龄期妇女,增加发生先天性风疹综合征的危险性;应在继续做好儿童风疹免疫的同时,积极开展育龄期妇女风疹抗体筛查及疫苗接种工作。     

Seroprevalence of rubella antibodies and determinants of susceptibility to rubella in a cohort of pregnant women in Canada, 2008–2011

Long term control of rubella and congenital rubella syndrome relies on high population-level immunity against rubella, particularly among women of childbearing age. In Canada, all pregnant women should be screened so that susceptible new mothers can be offered vaccination for rubella before discharge. This study was undertaken to estimate rubella susceptibility in a cohort of pregnant women in Canada and to identify associated socio-economic and demographic factors. Biobanked plasma samples were obtained from the Maternal-Infant Research on Environmental Chemicals (MIREC) study, in which pregnant women were recruited between 2008 and 2011. Socio-demographic characteristics and obstetric histories were collected. Second trimester plasma samples (n = 1,752) were tested for rubella-specific IgG using an in-house enzyme-linked immunosorbent assay. The percentage of women with IgG titers <5 IU/mL, 5–10 IU/mL, and ≥10 IU/mL were 2.3%, 10.1%, and 87.6%, respectively. Rates of seronegativity, defined as <5 IU/mL, were 3.1% in women who had no previous live birth and 1.6% in women who had given birth previously. Among the latter group, seronegativity was higher in women with high school education or less (adjusted OR (aOR) 5.93, 95% CI 2.08–16.96) or with a college or trade school diploma (aOR 3.82, 95% CI 1.45–10.12), compared to university graduates, and those born outside Canada (aOR 2.60, 95% CI 1.07–6.31). In conclusion, a large majority of pregnant women were found to be immune to rubella. Further research is needed to understand inequalities in vaccine uptake or access, and more effort is needed to promote catch-up measles-mumps-rubella vaccination among socioeconomically disadvantaged and immigrant women of childbearing age.     

Associations between race,sex and immune response variations to rubella vaccination in two independent cohorts

Introduction

Immune response variations after vaccination are influenced by host genetic factors and demographic variables, such as race, ethnicity and sex. The latter have not been systematically studied in regard to live rubella vaccine, but are of interest for developing next generation vaccines for diverse populations, for predicting immune responses after vaccination, and for better understanding the variables that impact immune response.

Methods

We assessed associations between demographic variables, including race, ethnicity and sex, and rubella-specific neutralizing antibody levels and secreted cytokines (IFNγ, IL-6) in two independent cohorts (1994 subjects), using linear and linear mixed models approaches, and genetically defined racial and ethnic categorizations.

Results

Our replicated findings in two independent, large, racially diverse cohorts indicate that individuals of African descent have significantly higher rubella-specific neutralizing antibody levels compared to individuals of European descent and/or Hispanic ethnicity (p < 0.001).

Conclusion

Our study provides consistent evidence for racial/ethnic differences in humoral immune response following rubella vaccination.     

The incidence of rubella virus infections in Switzerland after the introduction of the MMR mass vaccination programme

We have collected data on the incidence of rubella in Switzerland from 1987 to 1992 to help evaluating the impact of the measles, mumps and rubella (MMR) mass vaccination programme which started in 1985 in this country. We used detailed informations on samples submitted for diagnostic testing in conjunction with anonymous laboratory notifications to the Swiss Federal Office for Public Health, and data from the Swiss sentinel network of general practitioners to find trends in the incidence of rubella after the introduction of mass vaccination. We observed an unabated seasonal oscillation without decreasing trend during the observation period and were unable to detect a shift in the age distribution of cases. An important proportion of laboratory-confirmed rubella occurred in women of childbearing age. Immigrants from regions with low endemicity of rubella were at increased risk of contracting rubella and transmitting it to their offspring. We conclude, that MMR mass vaccination has not interrupted the circulation of rubella virus in Switzerland, and that improvements in the implementation and surveillance of the MMR vaccination campaign are necessary in order to avoid untoward effects of it.     

天津市流行性腮腺炎疫苗纳入免疫规划效果评价

目的 麻疹、流行性腮腺炎和风疹联合疫苗纳入天津市免疫规划后,对流行性腮腺炎的控制效果进行评价。 方法 利用全国传染病报告管理系统和天津市流行性腮腺炎专报平台数据分析疾病流行特征和免疫状况,开展血清学监测评价人群抗体水平。 结果 2007-2014年天津市流行性腮腺炎发病率从40.34/10万下降到11.14/10万,0~4岁组病例比例从9.50%增加到32.50%,10~14岁组从33.20%降低到12.93%,5~9岁和10-14岁组发病率降幅分别为70.41%和81.05%。2013-2014年共调查<10岁组流行性腮腺炎病例2 195例,个案调查率分别是83.45%和96.78%,病例中87.19%有至少1剂次免疫史。其中18月龄~2岁85.85%有1剂次疫苗免疫史,在3~4岁组中达到91.33%,5-9岁组有73.81%的病例有≥2剂次免疫史。2007-2014年天津市开展了4次健康人群流行性腮腺炎IgG抗体监测,抗体阳性率分别是2007年73.52%、2011年74.09%、2013年74.04%和2014年79.85%,经χ2检验,各年份抗体阳性率无统计学差异(χ2=6.51,P=0.09)。不同年龄组中,18月龄~2岁、3~4岁和5~9岁组抗体阳性率近年来逐渐升高,其中2014年3~4岁和5~9岁组抗体阳性率分别达到91.53%和98.33%。 结论 加强流行性腮腺炎监测和实现消除目标,应提高病例实验室检测率和开展2剂次MMR疫苗接种。     

Predicting parents' decisions on MMR immunisation: a mixed method investigation

BACKGROUND: Increasing uptake rates for MMR vaccination requires an understanding of factors leading parents to decide for and against vaccination, particularly in the light of recent developments. OBJECTIVE: We investigated factors relevant to immunising and non-immunising parents and the extent to which these factors predicted their decisions. METHODS: The study was conducted in Edinburgh, UK. A two-stage mixed method design was used. Delphi technique elicited parents' views of factors relevant to MMR immunisation. Twenty-six factors identified as relevant were incorporated into a final questionnaire. Using cluster sampling, the final questionnaire was distributed to parents recruited through a group of local nurseries. 110 parents participated: eighty (72.7%) had had their child MMR vaccinated, thirty (27.3%) had refused the vaccine. The factors in the final questionnaire were analysed against vaccination status using a direct binary logistic regression model. RESULTS: Four factors significantly predicted vaccination status, (prediction toward 'yes vaccination'). These were the influence of current research (OR=0.18, 95% CI=0.07-0.51), the helpfulness of leaflets and information packs (OR=3.27, 95% CI=1.38-7.75), the importance of eradication of rubella (OR=2.42, 95% CI=1.01-5.78), and the importance attached to the risk of adverse reactions (OR=0.65, 95% CI=0.48-0.87). CONCLUSIONS: Differences between immunising and non-immunising parents lie in the importance attached to four relevant factors. Excluding risk of adverse reactions, these factors have not been previously identified as salient and require to be explored further. Health advice to parents should highlight the identified importance attached to eradicating rubella and explicitly reflect research findings.     

2005年山东省部分孕期妇女风疹易感性调查

[目的]了解山东省孕期妇女风疹易感性水平,为调整风疹疫苗免疫策略提供依据。[方法]2005年,采集不同地区到医院准备分娩的20~40岁孕妇血清,采用间接酶联免疫吸附定量法检测风疹IgG抗体。[结果]检测标本3 788份,风疹抗体阳性(>20 IU/ml)的2 942人,阴性(<10 IU/ml)的314人,临界值(10~20 IU/ml)的532人,易感(临界值和阴性者)合计846人,易感率为22.33%。几何平均抗体含量(CMT)为34.93 IU/ml。不同地区风疹易感率和CMT的差异均有统计学意义(P<0.01);风疹易感率有随年龄增长而增高的趋势(P<0.01)。[结论]山东省近1/4的孕妇为风疹的易感者,有必要对育龄期妇女开展风疹疫苗接种。     

2007—2010年天津市和平区风疹流行病学分析

目的了解天津市和平区风疹发病概况,为有效预防控制风疹流行提供科学依据。方法利用中国疾病预防控制信息系统的数据分析天津市和平区2007—2010年风疹的流行病学特征。结果 2007—2010年全区共报告377例风疹,年平均发病率25.56/10万,无死亡病例。高发时间每年4—6月份,70%的病例集中在人口密度较大的南营门街、劝业场街和新兴街,60.21%的病例为在校学生,年龄集中在10～19岁的病例占全部病例的53.31%,全部病例中有免疫史的仅10%。结论对高发地区应加强疾病监测,对学龄儿童及青少年可考虑接种风疹疫苗,准备妊娠的妇女可考虑接种麻腮风疫苗,有利于减少风疹及先天性风疹综合征的发生。     

2006-2015年武汉市风疹疫情流行病学分析

目的 了解2006-2015年武汉市风疹疫情的流行病学特征,为制定风疹免疫预防策略提供参考.方法 收集中国疾病预防控制信息系统中2006-2015年武汉市风疹个案病例疫情信息,采用描述流行病学方法分析风疹的流行病学特征.结果 2006-2015年累计报告风疹5 353例,2006-2008年报告发病率逐年上升,2009-2015年发病逐年下降,发病高峰为3～7月,发病前3位的地区为青山区、洪山区、武昌区.病例中男性多于女性(x2=156.40,P＜0.05),以学生为风疹的高发人群,发病年龄以10～19岁人群最多,占发病总数的69.33％.风疹病例中有风疹免疫史的占0.43％,武汉市适龄儿童含风疹成分疫苗接种剂次数逐年上升.结论 2006-2015年武汉市风疹报告发病呈波动下降趋势,但存在发病年龄后移现象,应做好适龄儿童2剂次含风疹成分疫苗的常规免疫外,尽快制定15岁以上人群的免疫预防策略.