临沂市健康人群白喉和破伤风抗体水平调查

目的 为有计划地进行人群抗体水平监测,了解人群免疫状况,为制定免疫对策、评价免疫效果提供依据。方法 采用分层随机抽样的方法,2001、2003、2004年调查了临沂市10个县（区）0-39岁847人的白喉和破伤风抗体水平。结果 白喉和破伤风抗体总阳性率分别为77.80%和74.03%,阳性率均是0-4岁组最高,20-39岁组最低;山区县低于平原县和市区。白喉和破伤风抗体几何平均浓度分别为0.0997U/ml和0.0674U/ml,均是8-10岁组最高,20-39岁组最低。结论 临沂市白喉和破伤风疫苗基础免疫的效果可靠,但随着年龄的增长,免疫力衰退而重新成为易感者,故应及时对成人加强百日咳、白喉的免疫,并在新生儿破伤风高危县区对育龄期妇女开展破伤风疫苗免疫。     

河南省健康人群白喉和破伤风抗体水平调查

目的为有计划地进行人群抗体水平监测,了解人群免疫状况,为制定免疫对策、评价免疫效果提供依据。方法采用分层整群随机抽样的方法,1998~2002年调查了河南省21个县(区、市)2~39岁3 510人的白喉和破伤风抗体水平。结果白喉和破伤风抗体总阳性率分别为80.5%和77.9%,阳性率均是2~3岁最高,25~39岁最低;山区县低于平原县和市区。白喉和破伤风抗体几何平均浓度分别为0.101IU/ml和0.073IU/ml,均是8~9岁最高,25~39岁最低。结论河南省白喉和破伤风疫苗基础免疫的效果可靠,但随着年龄的增长,免疫力衰退而重新成为易感者,故应及时对成人加强白喉疫苗的免疫,并在新生儿破伤风高危县对育龄期妇女开展破伤风疫苗免疫。     

曲靖市健康人群白喉破伤风抗体水平调查

[目的]了解人群免疫状况,为制定免疫策略、评价免疫效果提供依据。[方法]对曲靖市1035人健康人群进行白喉破伤风疫苗免疫史、抗体水平调查。[结果]白喉和破伤风抗体总阳性率分别为59.18%和70.54%,抗体阳性率以1～2岁组最高,16～20岁组最低;白喉和破伤风抗体几何平均浓度(GMT)分别为1︰17.92和1︰23.2;不同年龄组、不同地区之间人群白喉和破伤风抗体阳性率和GMT差异均有统计学意义。曲靖市健康人群小年龄组白喉和破伤风抗体阳性率、GMT较高,但随着年龄增大,抗体水平呈下降趋势。[结论]不同地区免疫规划工作发展不平衡;今后应重视大年龄组人群的白破二联疫苗的加强免疫工作,提高人群免疫水平,做好白侯、破伤风的防控工作。     

2006年青州、寿光市部分健康人群百日咳、白喉、破伤风抗体水平监测

[目的]了解潍坊市健康人群百日咳、白喉、破伤风免疫状况,评价无细胞百白破三联疫苗的免疫效果。[方法]2006年对青州、寿光2市采取划片轮转的方式,每个市抽取2个乡镇,每个乡镇抽取3月龄至60岁人群80人,全市共抽取319人,进行百日咳、白喉、破伤风免疫水平检测。[结果]百日咳抗体保护率为68.57%,几何平均滴度(GMT)为1∶326.14,免疫成功率为79.66%;白喉抗体保护率为83.70%,抗毒素含量为0.1326 IU/ml,免疫成功率为90.00%;破伤风抗体保护率为86.52%,抗毒素含量为0.1472 IU/ml,免疫成功率为90.00%;3种抗体保护率均以2~4岁和15~19岁人群较高,20岁以上人群较低,不同年龄组间的差异有统计学意义(P<0.01),不同性别间差异无统计学意义(P>0.05),百日咳抗体保护率和免疫成功率较白喉和破伤风低,2市间的差异有统计学意义(P<0.01)。[结论]3种抗体中百日咳抗体保护率最低为68.57%,抗体水平较低,平均为1∶326.14;20岁以上人群白喉和破伤风抗体保护率较低,为68.18%~75.00%,抗体水平较低,抗毒素平均值分别为0.0398 IU/ml~0.1606 IU/ml。应加强疫苗在保存、运输、接种等各个环节的冷链管理,确保疫苗效价;开展成人白破二联疫苗的接种工作,提高人群免疫水平。     

广州市健康人群麻疹、白喉、百日咳和破伤风抗体监测分析

目的　了解广州市健康人群麻疹、白喉、百日咳和破伤风免疫水平。方法　 1 999年在广州市 5个区 (市 )随机抽取 2～ 4岁 ,6～ 8岁 ,1 3～ 1 5岁 ,2 5～ 39岁 4个年龄组健康人群 975份血液标本 ,分别采用酶联免疫 (ELISA)、间接血凝 (IHA)、凝集反应等免疫方法检测麻疹、白喉和破伤风、百日咳的抗体。结果　受检人群中的麻疹、白喉、破伤风平均抗体阳性率分别为 94 8%、89 1 %和 87 1 % ,前者的抗体GMRT为 1 388 2 8,后二者平均抗毒素分别为 0 1 3IU/ml、0 2 0IU/ml;百白咳抗体阳性率高达 97 6 % ,但抗体保护率 ( 44 2 % )及GMRT( 1 86 50 )较低 ;白喉、破伤风和百日咳的抗体水平随年龄增长呈下降趋势。结论　广州市 2～ 39岁人群对麻疹、白喉和破伤风形成较好的群体免疫屏障 ;百日咳抗体水平低 ,需规范接种 ,确保有效免疫 ;为消除白喉流行的隐患和防止新生儿破伤风的发生应加强成人白喉和孕妇破伤风的免疫接种。     

2017年北京市昌平区健康人群百日咳、白喉、破伤风抗体水平监测

目的 了解北京市昌平区健康人群百日咳、白喉、破伤风抗体水平,为制定免疫策略提供依据。方法 2017年采取多层抽样方法对360名健康人群采集血标本,采用酶联免疫吸附试验(ELISA)对血清进行百日咳、白喉、破伤风IgG抗体检测,分析不同年龄组、性别、户籍等之间抗体水平情况。结果 昌平区健康人群百日咳、白喉、破伤风抗体阳性率分别为5.00%、59.44%、68.33%,抗体几何平均滴度(geometric mean concentration,GMC)分别为9.18、0.55、0.86 IU/ml。不同年龄组白喉、破伤风抗体水平差异有统计学意义(P<0.001)。不同性别、户籍和免疫剂次人群间百日咳、白喉、破伤风抗体水平差异均无统计学意义(P>0.05)。接种末剂DTaP和/或DT和/或DTaP-IPV/Hib≤1年、2~5年、6~14年后的百日咳、白喉、破伤风抗体水平差异均有统计学意义(P<0.001)。结论 昌平区15岁以上人群白喉、破伤风抗体阳性率较低,随着免疫后时间延长,百日咳、白喉、破伤风抗体水平均明显降低。应加强小月龄婴儿、青少年及成人百日咳、白喉、破伤风的监测,推荐15岁以上人群、与1岁以下儿童有密切接触的成人及医务人员接种1剂Tdap疫苗。     

济宁市2—39岁健康人群百日咳、白喉、破伤风抗体水平监测

目的：为摸清济宁市健康人群百日咳、白喉、破伤风抗体水平。方法：随机选取济宁市2－39岁健康人群中的540人作为本次调查对象。结果：百日咳抗体阳性率为60．2％,37．0％达到保护水平,抗体几何平均滴度例数（GMRT）为120;白喉抗毒素阳性率为82．0％,GMRT为109,抗毒素平均含量（ATC）0．107IU／ml;破伤风抗毒素阳性率为77．2％,GMRT为18,ATC为0．066IU／ml。25－39岁人群白喉、破伤风ATC低于其他年龄组,但均在保护水平以上。结论：本市的白喉、破伤风免疫水平较高,提示本市近期不会有白喉、破伤风流行;但百日咳免疫水平较低,提醒我们应做好其监测工作。     

2008年费县部分健康人群百日咳、白喉、破伤风抗体水平调查

[目的]了解费县健康人群百日咳、白喉、破伤风抗体水平,评价百白破三联制剂免疫效果,为制定免疫策略提供科学依据。[方法]2008年随机抽取费县446名健康人群进行血清百日咳、白喉、破伤风抗体水平检测。[结果]检测446人,百日咳抗体保护率为68．39％,抗体几何平均滴度为1：306．56;白喉抗毒索均值为0．11IU／ml,保护率为77．13％;破伤风抗毒素均值为0．12IU／ml,保护率为76．01％。百日咳、白喉、破伤风抗体保护率,〈15岁组分别为76．53％、84．24％、83．42％。[结论]费县15岁以下健康人群对百日咳、白喉、破伤风均有较高的免疫水平,但15岁以上人群的抗体水平明显降低。     

2013年内蒙古自治区健康人群风疹抗体水平调查

目的了解内蒙古自治区健康人群风疹抗体水平,掌握易感人群的分布特点,为制定预防控制措施提供科学依据。方法将健康人群分为8个年龄组,每组随机抽取不少于30人,应用酶联免疫吸附试验（ELISA）检测风疹IgG抗体。结果采集血清标本754人份,风疹抗体IgG阳性536人份,阳性率71.09%。赤峰市松山区的抗体阳性率和平均抗体浓度（GMC）均最高,分别为80%和28.66 m U/ml;锡林郭勒盟西乌珠穆沁旗为最低,分别为63.16%和17.89 m U/ml。≥20岁组人群抗体阳性率和GMC最高,分别为93.26%和48.16 m U/ml;5～7岁组最低,分别为56.52%和12.78 m U/ml。结论内蒙古自治区不同地区人群风疹免疫水平不同,GMC较低,尤其应加强〈1岁和5～7岁组人群的免疫接种。     

温州市健康人群百日咳和白喉抗体水平调查

目的了解2014年温州市健康人群百日咳和白喉抗体水平,为百日咳和白喉防制提供依据。方法采用分层抽样方法,抽取温州市1 350名健康居民进行人口学特征及免疫史调查,采用酶联免疫吸附试验(ELISA)检测百日咳Ig G抗体和白喉Ig G抗体。根据检测结果对≥3岁且百日咳抗体浓度≥100 IU/m L的对象进行疾病史回顾性调查并估算百日咳感染率。对百日咳、白喉抗体水平在接种疫苗后衰减趋势进行对比分析。结果百日咳抗体阳性率为36.52%(标化后47.87%),抗体浓度中位数为19.45 IU/m L,随着年龄增长而增高,36岁~组最高(56.35%,36.39 IU/m L)。3剂次以上百白破疫苗(DPT)接种率为95.80%,其对应人群抗体阳性率为24.36%。接种疫苗0~3月后抗体阳性率为28.57%,10~12月后为10.71%,其浓度水平随时间推移在0~12月内呈线性相关(r=-0.22,P0.05)。由≥3岁且抗体浓度≥100 IU/m L对象所占的比例7.91%,估算温州市≥3岁健康人群百日咳感染率为49.30%;白喉抗体阳性率96.00%(标化后95.03%),抗体浓度中位数为0.13 IU/m L。新生儿抗体阳性率最低(82.50%),1岁~组婴幼儿最高(100.00%)。有含白喉成分疫苗免疫史者其抗体阳性率(或抗体安全保护率)、抗体浓度均高于无免疫史者(P均0.05)。接种DPT后白喉抗体持久性高于百日咳。结论温州市健康人群对百日咳易感性高,百日咳自然感染应是影响地区抗体水平的重要因素。健康人群白喉抗体水平较高,儿童含白喉成分疫苗接种效果良好,成人含白喉成份疫苗的预防接种不容忽视。     

北京市西城区健康人群白喉抗体水平监测

目的了解北京市西城区健康人群白喉抗体水平,为传染病预防控制工作提供科学依据。方法采集西城区10个居委会本市及外省健康人群血标本共220份,采用酶联免疫吸附试验(ELISA)测定白喉抗体,同时调查患病史、免疫史及人口学特征。结果白喉抗体阳性率为78.64%,抗体几何平均浓度(GMC)为0.421 IU/ml,不同性别、不同户籍白喉抗体阳性率和GMC比较,差异无统计学意义(χ2=0.244,P=0.622;t=0.841,P=0.401)。≥20岁人群白喉抗体阳性率和GMC随年龄增长和免疫后时间延长而逐渐下降。结论预测西城区近期不会发生白喉暴发流行;当出现白喉流行迹象时,建议对成人开展白破疫苗加强免疫。     

Immunity against diphtheria among children and adults in Izmir, Turkey

The aim of this study was to evaluate diphtheria immunity in a sample of the Turkish population having high childhood immunization coverage, including a booster dose of diphtheria toxoid at 12-15 years of age. A total of 599 persons aged 1-70 years were selected with cluster sampling. The information on socio-demographic characteristics, vaccination status and diphtheria history was gathered for each participant. Diphtheria antitoxin levels were measured qualitatively by using micro-enzyme immune assay. Of studied population, 72.3% had fully protective antitoxin levels (≥0.1 IU/ml). The rate of protection was 92.5% in the children aged 0-2 years, 93.2% in the primary school children aged 7-9 years, and 86.0% in the adolescents aged 15-19 years. After 20 years of age, diphtheria protection rates showed a significant age-related decrease, reaching minimum in the 30-39 age group, in which 47.3% of these subjects had fully protective antitoxin levels. The diphtheria antitoxin geometric mean titer (GMT) was highest in the 0-2 year age group (1.18 IU/ml). In the adolescents aged 15-19 years, diphtheria antitoxin GMT was 0.71 IU/ml. Then, geometric mean titer decreased with increasing age, and reached the minimum level in the 40-59 years age group (0.18 IU/ml). The protection rate among females was significantly lower than males (67.1% vs. 80.9%). The difference was apparent in the 20-29 and the 30-39 years age group: 80% of the males and 46.2% of the females in the 20-29 years age group, and 60% of males and 44.1% of females in the 30-39 years age group were fully protected against diphtheria (p < 0.0001). These results suggest that in Izmir, Turkey, full serological protection against diphtheria is only detectable in <50% of the young adult population, even though childhood immunization coverage is relatively high. Potentially, there is still risk of diphtheria outbreaks among the adults in our country. Therefore, a revaccination of adults with reduced doses of diphtheria toxoid should be considered to sustain diphtheria immunity.     

Immunity to diphtheria and tetanus in England and Wales

The immunity profile of the English and Welsh population to diphtheria and tetanus has been determined by measuring diphtheria and tetanus antitoxin levels for 3088 and 3142 sera, respectively. Time-resolved fluorimetric immunoassay - DELFIA was used to measure diphtheria antitoxin levels and an in-house, indirect ELISA to measure tetanus antitoxin levels. More than 80% of those aged between 2 and 20-24 years had protective diphtheria antitoxin levels of 0.01 IU/ml, or greater, and more than 80% of those aged between 4 and 35-39 years had protective tetanus antitoxin levels of 0.1 IU/ml, or greater. Only 29% and 53% of those aged 60 and over were protected against diphtheria and tetanus. Two increases of diphtheria antitoxin levels greater than 0.1 IU/ml and tetanus antitoxin levels greater than 1.0 IU/ml were apparent, starting at 4 and 14 years of age, which correspond with the policy of giving a diphtheria and tetanus toxoid booster on school entry and a tetanus plus low-dose diphtheria toxoid (recently introduced) booster to school leavers. This is the first comprehensive study of diphtheria and tetanus immunity in the English and Welsh population and shows that the accelerated schedule of immunisation, introduced in 1990, has effectively primed immunological memory against both these antigens and that boosting at school entry and at school leaving is effective in increasing levels of immunity.     

Notes from the field : use of tetanus, diphtheria, and pertussis vaccine (Tdap) in an Emergency Department - Arizona, 2009-2010

Because of an increasing incidence of reported pertussis cases attributed to waning immunity among adults and adolescents, the Advisory Committee on Immunization Practices (ACIP) in 2005 recommended administration of a new, combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) for adolescents and adults aged 11-64 years. ACIP recommended that they receive a single dose of Tdap to replace tetanus and diphtheria toxoid vaccine (Td) for booster immunization against tetanus and diphtheria if they had not previously received Tdap. Adults aged ≥65 years were to receive Td according to ACIP recommendations. To learn whether these age-specific recommendations were being followed in an emergency department (ED), the charts of a sample of patients receiving tetanus vaccines at a large ED were reviewed.     

Seroepidemiology of diphtheria and tetanus among children and young adults in Tajikistan: Nationwide population-based survey, 2010

Background

Tajikistan had a major diphtheria outbreak (∼10,000 cases) in the 1990s, which was controlled after nationwide immunization campaigns with diphtheria-tetanus toxoid in 1995 and 1996. Since 2000, only 52 diphtheria cases have been reported. However, in coverage surveys conducted in 2000 and 2005, diphtheria-tetanus-pertussis vaccine coverage was lower than administratively reported estimates raising concerns about potential immunity gaps. To further assess population immunity to diphtheria in Tajikistan, diphtheria antibody testing was included in a large-scale nationwide serosurvey for vaccine-preventable diseases conducted in connection with a poliomyelitis outbreak in 2010. In addition, the serosurvey provided an opportunity to assess population immunity to tetanus.

Methods

Residents of all regions of Tajikistan aged 1–24 years were included in the serosurvey implemented during September–October 2010. Participants were selected through stratified cluster sampling. Specimens were tested for diphtheria antibodies using a Vero cell neutralization assay and for tetanus antibodies using an anti-tetanus IgG ELISA. Antibody concentrations ≥0.1 IU/mL were considered seropositive.

Results

Overall, 51.4% (95% CI, 47.1%–55.6%) of participants were seropositive for diphtheria and 78.9% (95% CI, 74.7%–82.5%) were seropositive for tetanus. The lowest percentages of seropositivity for both diseases were observed among persons aged 10–19 years: diphtheria seropositivity was 37.1% (95% CI, 31.0%–43.7%) among 10–14 year-olds, and 35.3% (95% CI, 29.9%–41.1%) among 15–19 year-olds; tetanus seropositivity in respective age groups was 65.3% (95% CI, 58.4%–71.6%) and 70.1% (95% CI, 64.5%–75.2%).

Conclusions

Population immunity for diphtheria in Tajikistan is low, particularly among 10–19 year-olds. Population immunity to tetanus is generally higher than for diphtheria, but is suboptimal among 10–19 year-olds. These findings highlight the need to improve routine immunization service delivery, and support a one-time supplementary immunization campaign with diphtheria-tetanus toxoid among birth cohorts aged 1–19 years in 2010 (3–21 years in 2012) to close immunity gaps and prevent diphtheria outbreaks.     

Immunity against diphtheria and tetanus in various age groups after 40 years since implementation of the mass vaccination program

The aim of this study was to determine immunity against diphtheria and tetanus in various age groups and to compare it with the results of seroepidemiological studies conducted during previous 40 years. The level of diphtheria and tetanus antibody was determined by means of ELISA tests in 1534 sera obtained from persons aged 1-81 years. As elsewhere in Europe, the present study confirms the insufficiency of humoral immunity to diphtheria among Polish adults. Groups with the lowest levels of diphtheria antibody include persons aged 30-60 years (62% protected). Tetanus immunity was highest during the first three decades of life (above 90% protected), and then declined with increasing age. The comparison with results of several serologic surveys performed earlier showed gradually increasing immunity level against tetanus in all age groups.     

Diphtheria in the United States, 1971-81.

After a decade-long resurgence, including a large cutaneous diphtheria outbreak in Washington State, the diphtheria incidence rate in the United States reached its lowest recorded level ever in 1980--two patients (0.01 case per million). Mortality paralleled the decline in incidence rate. Only 143 of the 3,141 US counties reported noncutaneous diphtheria patients during 1971-81; most were located in the West. The highest attack rates were experienced by children less than 15 years old (0.8 case per million) and by American Indians (22.6 cases per million). Persons immunized with three or more doses of diphtheria toxoid had a lower death-to-case ratio (1.3 per cent) than totally unimmunized persons (13.4 per cent). The reasons for the dramatic decline in diphtheria incidence rates are unclear, although it has been postulated that the gene for producing diphtheria toxin may be lost from organisms in highly immunized populations. Significant proportions of the adult and elderly populations are susceptible to diphtheria. Continuation of primary immunization with increased emphasis on the routine use of tetanus and diphtheria toxoids (Td) boosters in adults should ensure that diphtheria will remain largely a scourge of the past.     

2010年白山市健康人群百日咳、白喉及破伤风IgG抗体水平监测

目的了解白山市健康人群百日咳、白喉、破伤风血清抗体水平。方法在全市6个县(市、区)采取随机抽样的方法抽取八道江区,对0～1岁、1～2岁、3～4岁、5～6岁、7～14岁、15～19岁、﹥20岁7个年龄组的健康人群进行抗体水平监测。结果百日咳IgG抗体阳性率为80.0%,白喉IgG抗体阳性率为68.10%,新生儿破伤风IgG抗体阳性率为49.52%。不同年龄组人群百日咳、白喉、破伤风抗体阳性率比较,差异有统计学意义(P﹤0.05)。结论在进一步提高常规免疫接种率的基础上,加强人群免疫水平监测,考虑对成人进行加强免疫[1]。