疫苗时代麻疹母传抗体追踪观察及北京市麻疹控制策略的分析

针对北京市近年麻疹发病率上升，发病年龄向 ２～７月龄婴儿和２０岁以上成人转移等新情况，本文对麻疹的流行病学、流行因素、人群免疫状况进行了分析研究，采用配对与追踪观察方法对婴儿母传麻疹抗体进行了调查研究。根据调研结果，着重对近年麻疹发病年龄变化原因、疫苗时代的初免月龄以及有争议的再免问题进行了深入探讨，进而提出适当调整本市麻疹疫苗免疫程序，提前初免，婚前再免，坚持原有再免方案的高水平控制或消除麻疹的新策略。     

合理使用麻疹疫苗对控制、消灭麻疹作用的研究

本文报道了江苏省近年来麻疹疫苗的使用情况及其对麻疹发病的控制情况，对广泛使用麻疹疫苗后麻疹发病的流行、大年龄组及成人发病日趋增多以及苗接种率与发病率不呈直线关系是我们在当前控制、消灭麻疹中出现的新问题，并给该项工作的进展带来了困难。本文针对这些问题，就如何进一步合理使用麻疹疫苗，提高免疫接种质量及免疫成功率，从而达到控制消灭麻疹的目标，提出了建议。     

麻疹的维生素A治疗

麻疹仍然是全球性的公共卫生问题，有资料表明，发展中国家维生素Ａ的应用，与麻疹发病率和病死率降低有关。本文简要综述维生素Ａ在麻疹中的应用、作用机理、安全性、适应症及剂量。     

十堰市1996～2000年麻疹疫情分析

目的：探讨十堰市麻疹流行现状，以采取有效的控制措施。方法：使用EPInfo分析处理十堰市1996-2000年麻疹病例个案调查表。结果：5年共发病1901例，年平均发病率为11.20/10万，与前5年相比发病率下降了99.83％，各县（区）均有病例报告，部分县有爆发、流行；全年各月份均有病例发生，2-5月发病较多，占71.96％；发病年龄以10岁以下儿童为主，占81.69％；流行主要原因是部分儿童漏种，易感人群积累所致。结论：我市仍需进一步加强麻疹疫苗的常规免疫，提高接种质量；落实对高危人群及时进行麻疹疫苗强化免疫；提高麻疹监测系统质量，开展人群抗体水平监测，完善疑似病例血清学检测。     

柳州市儿童麻疹疫苗免疫效果观察

柳州市儿童麻疹疫苗免疫效果观察吴昕翁毓秋１９９６年３月５～２０日我们对接种过麻疹疫苗一针及两针的儿童１６４名进行免疫效果观察。１材料与方法在我市城区、郊县抽取１９９４年出生并明确记录８月龄接种一针麻疹疫苗儿童７３名，８月龄接种一针麻疹疫苗，１１２岁再...     

浙江省2000年麻疹监测结果分析

根据卫生部《加速麻疹控制规划指南》和《全国麻疹监测方案（试行）》，从１９９９年１月ｌ日起建立麻疹监测系统并实施运转。为了掌握麻疹发病动态，及时发现问题，现将２０００年全省的麻疹监测结果报告如下。 材料与方法１　资料来源　全省麻疹监测系统的疑似麻疹病例个案调查表、旬报表、麻疹暴发情况汇总表、麻疹主动监测月报表；省、市卫生防疫站（疾控中心）麻疹实验室的血清学检测结果。疫情来自省疾控中心卫生信息所。２　方法　麻疹血清学检测采用酶联免疫吸附试验（ＥＬＩＳＡ）捕捉法检测ＩｇＭ抗体。病例诊断与分类标准按卫生…     

浅谈控制与消除麻疹存在的问题与对策

根据世界其他国家和地区的经验,在消灭脊髓灰质炎后,麻疹将最有可能成为下一个要消除的疾病。我国在“九五”规划中规定了麻疹控制的目标,即“九五”期间麻疹年平均发病率在“八五”基础上再降低50％,为消除麻疹奠定基础。1 控制和消除麻疹存在的问题要控制和消除麻疹,首先要认清控制麻疹中所存在的问题。我国从60年代开始,应用麻疹疫苗,80年代把麻疹疫苗列入计划免疫,在“八五”期间,我国麻疹的发病率和死亡率与计划免疫前相比分别下降了90％和95％,麻疹疾病得到了有效的控制。但是,与根本控制和消除麻疹疾病的目标,还有一定的差距,主要存在以下问题:     

某高校一起麻疹暴发调查报告

某高校一起麻疹暴发调查报告江苏省徐州市泉山区卫生防疫站吴融宝近几年，各地陆续有麻病发病＂双相移位＂现象报道，尤其大年龄组发病比例增加，早期常被误诊。现将１９９２年春季某高校一起麻疹暴发的调查结果报告如下。一、流行特征１９９３年３月２８日，区、市卫生防...     

当前麻疹流行和免疫的若干问题

当前麻疹流行和免疫的若干问题刘正英１综述麻疹是一种传染性极强、传播机制极易实现的急性呼吸道传染病。ＷＨＯ估计全球每年因麻疹死亡的儿童约１４０万例〔１〕。因此，预防麻疹是当前及今后一个时期不容人们忽视的问题。１麻疹的流行病学特征１．１发病率的变化我国在...     

2003年～2005年商洛市麻疹IgM抗体检测及流行分析

麻疹是由麻疹病毒引起的一种以发热、呼吸道卡他和遍及全身斑丘疹为特征的急性病毒性传染病。人类是麻疹病毒的自然宿主。它的传播途径主要是呼吸道和直接接触传染，是危害儿童生命健康极其严重的传染病之一，我国在1965年开始应用麻疹疫苗，特别是1984年开展强化计划免疫工作之后，麻疹发病率急剧下降，年发病率在10／10万左右，但是，麻疹具有高度的传染性，较高的常规覆盖率能降低麻疹的发病率，但不能阻止易感者的积累。如果人群中易感者积累到一定数量并有病毒输入时将会发生麻疹爆发。世界卫生组织估计全球每年仍有4500万例麻疹，其中100万婴儿和儿童死于麻疹，主要集中在发展中国家，特别是非洲国家。     

中国消除麻疹的关键技术问题：专家解读共识

中国卫生部发布《2006—2012年全国消除麻疹行动计划》以来,全国采取了一系列消除麻疹策略与措施并取得明显进展,但中国处于消除麻疹的关键时期,面临着新的挑战,麻疹流行病学特征也发生了变化,尤其需要统一和澄清对一些技术问题的认识。中国疾病预防控制中心（Center for Disease Control and Prevention,CDC）免疫规划中心收集、汇总各级CDC专业人员近年来关注的问题,并会同世界卫生组织驻华代表处,组织国内外专家深人研讨了主要的技术问题,包括消除麻疹与接种疫苗、麻疹病例的传染来源、保护〈8月龄婴儿、爆发疫情的应急免疫活动、医院传播的作用和控制意义、特殊人群及场所等,形成专家解读共识,供相关部门和专业人员在消除麻疹中参考。     

Accelerating measles and rubella elimination through research and innovation – Findings from the Measles & Rubella Initiative research prioritization process, 2016

The Measles & Rubella Initiative (M&RI) identified five key strategies to achieve measles and rubella elimination, including research and innovation to support cost-effective operations and improve vaccination and diagnostic tools. In 2016, the M&RI Research and Innovation Working Group (R&IWG) completed a research prioritization process to identify key research questions and update the global research agenda. The R&IWG reviewed meeting reports and strategic planning documents and solicited programmatic inputs from vaccination experts at the program operational level through a web survey, to identify previous research priorities and new research questions. The R&IWG then convened a meeting of experts to prioritize the identified research questions in four strategic areas: (1) epidemiology and economics, (2) surveillance and laboratory, (3) immunization strategies, and (4) demand creation and communications. The experts identified 19 priority research questions in the four strategic areas to address key areas of work necessary to further progress toward elimination. Future commitments from partners will be needed to develop a platform for improved coordination with adequate and predictable resources for research implementation and innovation to address these identified priorities.     

北京市顺义区外来农民工麻疹知识及危险因素调查

目的了解外来农民工对麻疹相关知识的掌握情况,为下一步制定麻疹控制策略以及采取合适的干预措施提供依据。方法采用分阶段整群抽样的方法,对资料进行描述性流行病学分析。结果共调查4个类型24家集中用工单位921名外来农民工,男,445人,女,476人。学历主要是中学、中专或职高,占80.9%,年龄主要是21～30岁,占56.8%,67.4%的调查对象人均居住面积是0～5m2,如果工作环境密闭,仅64.1%的单位提供或要求戴口罩,44.2%调查对象所在单位会定期更换宣传栏。对麻疹某一项知识的知晓率平均在75%以上,对政策的知晓率在60%以下,预防麻疹知识均回答正确的知晓率仅为6.3%,对麻疹政策均了解的知晓率仅为5.9%。结论今后应重点提高外来农民工麻疹预防控制知识和政策知晓率,特别是政策利用方面的宣传,强调所在单位宣传培训的多样性和可及性。     

The Immunisation Beliefs and Intentions Measure (IBIM): Predicting parents’ intentions to immunise preschool children

In England, uptake of the second dose of MMR (against measles, mumps, rubella), and dTaP/IPV or DTaP/IPV booster (against diphtheria, tetanus, pertussis, polio), is lower than that of the primary course. The Immunisation Beliefs and Intentions Measure (IBIM), based on the theory of planned behaviour (TPB) and qualitative interviews, was used to predict parents’ intentions to take preschoolers for these recommended vaccinations. Parents from 43 child groups in southern England were randomised to receiving questions about either MMR (N = 193) or dTaP/IPV (N = 159). Overall, 255 parents fully completed TPB-based items. Regression analyses revealed that parental attitudes about the protective benefits of immunising and perceived behavioural control were strong, reliable predictors of intention to immunise with MMR. For dTaP/IPV, perceived protective benefits and number of children reliably predicted intention to immunise. Differences between parents with ‘maximum immunisation intentions’ and those with ‘less than maximum intentions’ are described. The IBIM appears to be a useful measure for predicting parents’ intentions to immunise preschoolers. Implications for improving uptake are discussed.     

Research priorities for accelerating progress toward measles and rubella elimination identified by a cross-sectional web-based survey

BackgroundIn 2012, the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP) that set a target to eliminate measles and rubella in five of the six World Health Organization (WHO) regions by 2020. Significant progress has been made toward achieving this goal through intensive efforts by countries and Measles & Rubella Initiative (M&RI) partners. Accelerating progress will require evidence-based approaches to improve implementation of the core strategies in the Global Measles and Rubella Strategic Plan. The M&RI Research and Innovation Working Group (R&IWG) conducted a web-based survey as part of a process to identify measles and rubella research priorities. Survey findings were used to inform discussions during a meeting of experts convened by the M&RI at the Pan American Health Organization in November 2016.MethodsThe cross-sectional web-based survey of scientific and programmatic experts included questions in four main topic areas: (1) epidemiology and economics (epidemiology); (2) new tools for surveillance, vaccine delivery, and laboratory testing (new tools); (3) immunization strategies and outbreak response (strategies); and (4) vaccine demand and communications (demand). Analyses were stratified by the six WHO regions and by global, regional, or national/sub-national level of respondents.ResultsThe six highest priority research questions selected by survey respondents from the four topic areas were the following: (1) What are the causes of outbreaks in settings with high reported vaccination coverage? (epidemiology); (2) Can affordable diagnostic tests be developed to confirm measles and rubella cases rapidly and accurately at the point of care? (new tools); (3) What are effective strategies for increasing coverage of the routine first dose of measles vaccine administered at 9 or 12 months? (strategies); (4) What are effective strategies for increasing coverage of the second dose given after the first year of life? (strategies); (5) How can communities best be engaged in planning, implementing and monitoring health services including vaccinations? (demand); (6) What capacity building is needed for health workers to be able to identify and work more effectively with community leaders? (demand). Research priorities varied by region and by global/regional/national levels for all topic areas.ConclusionsResearch and innovation will be critical to make further progress toward achieving the GVAP measles and rubella elimination goals. The results of this survey can be used to inform decision-making for investments in research activities at the global, regional, and national levels.     

2012-2015年湖北省麻疹病毒基因测定分析

目的：通过对2012—2015年湖北省麻疹病毒流行株的基因型别和特征进行分析,了解湖北省麻疹病毒流行株基因特点,为制定消除麻疹策略提供依据。方法选取2012—2015年湖北省麻疹病例咽拭子标本126份,提取病毒核酸,对其中86份核酸阳性标本通过RT－PCR扩增麻疹病毒N基因并进行序列测定,对病毒基因型别进行分析。结果通过基因测序定型发现2012—2015年湖北省麻疹病毒基因型主要为 H1a亚型,仅发现一例 D8亚型,2例麻疹病毒疫苗株 A 基因。结论2012—2015年湖北省麻疹病毒主要为H1a基因亚型,首次发现一例麻疹D8基因亚型,存在少数疫苗相关病例。建议进一步加强麻疹病毒基因型别监测,实时了解全省麻疹病毒基因型别变化特征,为中国消除麻疹行动计划提供科学依据。     

Research priorities for global measles and rubella control and eradication

In 2010, an expert advisory panel convened by the World Health Organization to assess the feasibility of measles eradication concluded that (1) measles can and should be eradicated, (2) eradication by 2020 is feasible if measurable progress is made toward existing 2015 measles mortality reduction targets, (3) measles eradication activities should occur in the context of strengthening routine immunization services, and (4) measles eradication activities should be used to accelerate control and elimination of rubella and congenital rubella syndrome (CRS). The expert advisory panel also emphasized the critical role of research and innovation in any disease control or eradication program. In May 2011, a meeting was held to identify and prioritize research priorities to support measles and rubella/CRS control and potential eradication activities. This summary presents the questions identified by the meeting participants and their relative priority within the following categories: (1) measles epidemiology, (2) vaccine development and alternative vaccine delivery, (3) surveillance and laboratory methods, (4) immunization strategies, (5) mathematical modeling and economic analyses, and (6) rubella/CRS control and elimination.     

2009 - 2015年呼和浩特市麻疹流行病学分析

目的 了解呼和浩特市2009 - 2015年麻疹流行特征,为今后制定科学合理的预防控制麻疹策略和措施提供依据。方法 对呼和浩特市2009 - 2015年麻疹疫情资料进行描述流行病学分析。结果 呼和浩特市近年来麻疹发病一直控制在较低水平,发病形式主要为散发。流动人口麻疹发病率高于本地人口,城区麻疹发病率（3.36／10万）高于农区（1.33／10万）,且差异有统计学意义。发病高峰在4 - 6月份(占77.80％)。在518例确诊病例中,＜8月龄和＞20岁麻疹病例所占比例较大,占 55.79%。在确诊病例中,有免疫史者仅占17.95％,无免疫史者占44.02％,免疫史不详者占38.03%。结论 近几年该市麻疹发病年龄特征发生较大变化,＜8月龄和＞20岁麻疹发病增多。应提高2剂次麻疹减毒活疫苗(MV)接种率和满8月龄婴儿MV及时接种率,同时加强流动人群和成人麻疹防控工作,应适时开展成人麻疹疫苗的强化免疫和查漏补种。     

Development of measles vaccines in Japan

Studies on measles vaccine development started in 1950s in Japan. After 3-year studies on development of further attenuated live measles vaccines by Japan Measles Vaccine Research Commission, two kinds of vaccines of different strains were licensed for optional use in 1971. In 1978, periodical immunization against measles was started using BIKEN CAM-70 vaccine, Takeda Schwarz-FF8 vaccine and Kitasato AIK-C vaccine. Combined measles and rubella vaccines (MR vaccine) were licensed in 2005. Periodical immunization with MR vaccines of BIKEN and Takeda Pharmaceutical Co. Ltd. to eliminate measles together with rubella from Japan by 2012 was started for children 1- and 6 (5–7)-year of age in 2006.     

麻疹可疑病例IgM抗体结果分析

采用酶联免疫吸附试验（ELIEA），对1998年麻疹可疑病例的血清标本进行麻疹特异性IgM测定．结果麻疹IgM抗体阳性的患者构成比在1-6岁和7-14岁的比率高（31．6％、53．9％），麻疹IgM抗体阳性的患者中有免疫史的仅占28．9％．说明目前我省麻疹的计划免疫工作应加强基础免疫和复种工作，提高接种质量，同时重视病例的流行病学、免疫学监测，才能有效、全面地控制麻疹病例的发生，最终达到消除麻疹的目标．