Vaccine effectiveness estimates, 2004-2005 mumps outbreak, England

The United Kingdom and United States have recently experienced large outbreaks of mumps, which raises concerns about vaccine effectiveness. The effectiveness of the mumps component of the measles, mumps, rubella (MMR) vaccine was estimated using the screening method. In England from January 2004 through March 2005, 312 cases of mumps were reported in children eligible to have received 2 doses of MMR vaccine. Of these children, 52 (16.7%) had received 1 dose of MMR vaccine, and 97 (31.1%) had received 2 doses. Vaccine effectiveness was 88% (95% confidence interval [CI] 83%-91%) for 1 dose and 95% (95% CI 93%-96%) for 2 doses. The effectiveness of 1 dose declined from 96% (95% CI 81%-99%) in 2-year-olds to 66% (95% CI 30%-83%) in 11- to 12-year-olds, and the effectiveness of 2 doses declined from 99% (95% CI 97%-99.5%) in 5- to 6-year-olds to 86% (95% CI 74%-93%) in 11- to 12-year-olds (p<0.001 for 1 or 2 doses). Waning immunity may contribute to mumps outbreaks in older vaccinated populations.     

Adverse events following a third dose of measles,mumps, and rubella vaccine in a mumps outbreak

During a 2009–2010 mumps outbreak in a New York State village, a third dose of measles, mumps, and rubella (MMR) vaccine was administered to children in three schools as a control measure. Information on local and systemic adverse events (AE) was collected by a self-report survey distributed to all children in grades 6–12. A comprehensive search for AE following MMR vaccination was conducted using physician records and the Vaccine Adverse Events Reporting System (VAERS). A literature search was performed for published reports pertaining to AE associated with mumps-containing vaccine, using the Jeryl-Lynn strain, from 1969 to 2011. A total of 1755 individuals received the third dose; 1597 (91.0%) returned the survey. Of those, 115 (7.2%) reported at least one local or systemic AE in the 2 weeks following vaccination. The most commonly reported AE were “pain, redness, or swelling at the injection site” (3.6%) and “joint or muscle aches” (1.8%). No serious AE were reported in the survey, physician records or through VAERS. The proportions of AE found in the present study were lower than or within the range of those reported in prior studies of first- and second-dose MMR vaccine studies. The results of this study suggest that a third dose of MMR vaccine administered in an outbreak setting is safe, with injection site reactions reported more frequently than systemic reactions. However, to assess risk for rare or serious AE after a third dose of MMR vaccine, longer term studies would be required.     

应急接种等措施在一起流行性腮腺炎暴发疫情防控中的效果评价

目的 评价应急接种等措施在一起流行性腮腺炎暴发疫情防控中的效果。方法 根据病例定义收集该起暴发疫情中的所有病例发病、隔离日期,疫情中采取的应急接种、病例隔离、停课、洗手宣传教育等防控措施信息,计算应急接种的疫苗保护效率(vaccine efficiency,VE),采用离散时间模型对拟合实际暴发疫情数据计算传播能力,计算应急接种、病例隔离、停课和洗手的效果指数。结果 该起暴发疫情共调查共1 471人,发生4代病例,三代间距均为15 d;暴发期间共339人接种了麻腮风疫苗,应急接种率为73.38%,发病3人,罹患率0.88%。未应急接种的人数为123人,发病25人,罹患率20.33%。应急接种的疫苗保护效率为95.6%。隔离在第二至第四代的效果系数分别为0.43、0.46和0.47;停课和洗手联合措施在第二、三代病例发生时产生了作用,效果系数分别为0.279和0.078。模型模拟结果显示,接种率达到90%~100%,罹患率、疫情持续时间、疫情高峰出现周才能产生明显防控效果。结论 在流腮暴发疫情中,应急接种率达到90%~100%才能起到好的防控效果;停课和洗手等健康教育能起到一定作用,但主要防控措施应为高接种率和及时病例隔离。     

深圳市一起幼儿园流行性腮腺炎暴发疫情的调查

目的了解深圳市一起幼儿园流行性腮腺炎暴发原因和流行特征,为制定和落实防控措施提供科学依据。方法采用现场流行病学调查方法对疫情的流行强度、三间分布、流行原因进行调查。结果全园流行性腮腺炎总罹患率为7.48%（44/588）,男女罹患率有差别（χ²=4.67,P=0.031）,中位发病年龄为5岁,首发病例2014年2月27日发病,疫情持续3个月半,传播4代,波及6个班级。早期病例有33.33%（6/18）未及时隔离。出现病例的6个班级合计接种率为59.41%（120/202）,与未出现病例班级合计接种率（81.61%,213/261）差别有统计学意义（χ²=27.80,P<0.001）,大班和大大班合计接种率为62.08%（167/269）,与中班和小班合计接种率（85.57%,166/194）差别有统计学意义（χ²=35.79,P<0.001）,疫苗效果指数（VE）为59.81%。结论该起事件为儿童病例引入幼儿园后引发的流行性腮腺炎暴发疫情,传播方式为人传人增殖模式。环境条件差和疫苗接种率不高是造成本次疫情传播的影响因素。落实麻疹-腮腺炎-风疹联合疫苗（MMR）接种率,加强幼儿园软硬件管理,是预防和控制流行性腮腺炎暴发的重要措施。     

Enhanced surveillance of primary measles mumps and rubella (MMR) immunisation in Wales

In England and Wales routinely available data measure uptake of the measles mumps and rubella (MMR) vaccine at 2 years. This results in a delay in detecting change in uptake of the vaccine, which is scheduled at 12 months of age. The predictive value of uptake at 15–17 months is limited by the greater variability in uptake between quarters at the younger age. This can be overcome by presenting the data as a four-quarter annual rolling average. Uptake of the MMR vaccine at 2 years of age in Wales is predicted to stabilise at around 84% in the first three quarters of 2002.     

襄阳市某学校流行性腮腺炎暴发疫情调查

目的 分析裹阳市某学校流行性腮腺炎暴发的流行病学资料,评价防治措施,为防控该病提供科学依据.方法 采用描述流行病学方法,对该学校流行性腮腺炎暴发疫情进行分析和评价.结果 该学校1180名学生,累计发病220例,罹患率为18.64％,年龄最小的6岁,最大的15岁,发病时间持续98天.结论 建立学校传染病预警机制,落实早发现、早隔离和早治疗,及时控制传染源、预防接种等措施,是控制流行性腮腺炎暴发的有效办法.     

沈河区2005-2011年流行性腮腺炎流行特征分析

目的掌握辽宁省沈阳市沈河区流行性腮腺炎流行特点和趋势,为制定和调整流行性腮腺炎预防控制策略提供依据。方法采用描述流行病学分析方法对中国疾病预防控制信息系统中沈阳市沈河区2005-2011年流行性腮腺炎监测资料进行统计分析。结果沈河区2005-2011年流行性腮腺炎共报告病例2 269例,年平均发病率为50.56/10万;发病有明显季节性,全年出现2个发病高峰,5月份报告病例最多;五里河街道办事处发病数最高,占总发病人数的12.56%;流行性腮腺炎发病主要集中在5~14岁年龄组,占总发病例数的68.40%;男性发病率高于女性,男女性别比为1.51:1;流行性腮腺炎病例中学生发病最多,占发病总数的66.37%。结论人群密集场所和机构是防治流行性腮腺炎的重点单位,应适时开展强化免疫活动,预防和控制流行性腮腺炎流行。     

宿州市2006-2009年流行性腮腺炎流行病学分析

目的：了解宿州市流行性腮腺炎疫情特征,探讨预防控制措施,为控制其流行提供依据。方法：通过流行病学描述性研究方法,对宿州市2006-2009年网络直报的流行性腮腺炎个案信息进行分析。结果：2006-2009年,宿州市共报告流行性腮腺炎2 648例,年均发病率11.51/10万,2007年埇桥区流行性腮腺炎发病率明显上升（499.40%）,2008年全市高发,达20.43/10万,出现多起局部暴发疫情。5岁~和10岁~儿童分别占41.65%和40.63%,主要为在校中、小学生,男女性别比例2.02∶1,P〈0.01,有统计学差异。结论：认真实施免疫规划工作,在做好适龄儿童麻疹-腮腺炎二联疫苗和麻疹-腮腺炎-风疹三联疫苗常规免疫的基础上,对15岁以下的儿童免费普种一剂次腮腺炎疫苗。     

广西昭平县2004-2012年流行性腮腺炎流行病学特征分析

目的了解昭平县近9年流行性腮腺炎流行病学特征,为今后制定防治措施提供科学依据。方法收集该县2004-2012年报告的流行性腮腺炎病例及儿童麻疹-腮腺炎-风疹疫苗(MMR)的接种资料,采用Excel软件进行统计分析。结果在过去的9年中该县报告流行性腮腺炎病例共1141例,人群年发病率在3.10～107.84/10万之间,年均发病率为30.32/10万,健康人群年均MMR疫苗接种率为1.38%。该县全年均有病例报告,全年6月份出现一个高峰。0～6岁幼儿占总病例数的23.84%,7～14岁占56.79%。全县12个乡镇均有病例出现,病例较多的昭平镇年发病率为56.27/10万,属县城所在地。结论该县需提高适龄儿童MMR疫苗的接种率,加强入托和入学前后儿童MMR接种及补种工作来提高疫苗接种质量。     

RT-PCR快速检测腮腺炎病毒

目的：建立腮腺炎病毒的核酸快速诊断技术。方法：在腮腺炎病毒核蛋白基因（NP）的保守区域设计一对半引物，采用逆转录聚合酶链（RT-PCR）和半巢式PCR方法扩增腮腺炎病毒特异性核酸片段。结果：该方法能特异性地扩增腮腺炎病毒357bp和232bp的核酸片段，而对麻疹、风疹和流感病毒无交叉反应。检测腮腺炎病毒的灵敏度，1次PCR可检测出10CCID50，2次PCR反应可达0.1CCID50。采用该方法从流行性腮腺炎患含漱液标本中能直接检出腮腺炎病毒核酸条带。结论：该方法能特异、敏感地检测临床标本中腮腺炎病毒，是快速诊断腮腺炎病毒感染的理想方法。     

河南省2007-2011年流行性腮腺炎流行病学特征分析

目的 了解河南省2007-2011年流行性腮腺炎流行病学特征,为进一步防控流行性腮腺炎提供参考依据。 方法 对2007年1月1日-2011年12月31日河南省疾病监测系统报告的流行性腮腺炎病例资料进行回顾描述性流行病学分析。 结果 5年间共报告流行性腮腺炎81 235例,死亡1例,年平均发病率为17.26/10⁵,男女发病率性别比为1.93∶1;平均每年4-6月及11月-次年1月是流行性腮腺炎的高发时间,病例主要集中在2~15岁儿童(93.58%),病例数最多的职业为学生 (57.27%)。 结论 河南省流行性腮腺炎发病率仍处较高水平,应进一步完善儿童免疫规划,提高疫苗接种率,加强流行性腮腺炎的监测工作。     

Genomic characterization of mumps viruses from a large-scale mumps outbreak in Arkansas, 2016

In 2016, a year-long large-scale mumps outbreak occurred in Arkansas among a highly-vaccinated population. A total of 2954 mumps cases were identified during this outbreak. The majority of cases (1676 (57%)) were school-aged children (5–17 years), 1536 (92%) of these children had completed the mumps vaccination schedule. To weigh the possibility that the mumps virus evaded vaccine-induced immunity in the affected Arkansas population, we established a pipeline for genomic characterization of the outbreak strains. Our pipeline produces whole-genome sequences along with phylogenetic analysis of the outbreak mumps virus strains. We collected buccal swab samples of patients who tested positive for the mumps virus during the 2016 Arkansas outbreak, and used the portable Oxford Nanopore Technology to sequence the extracted strains. Our pipeline identified the genotype of the Arkansas mumps strains as genotype G and presented a genome-based phylogenetic tree with superior resolution to a standard small hydrophobic (SH) gene-based tree. We phylogenetically compared the Arkansas whole-genome sequences to all publicly available mumps strains. While these analyses show that the Arkansas mumps strains are evolutionarily distinct from the vaccine strains, we observed no correlation between vaccination history and phylogenetic grouping. Furthermore, we predicted potential B-cell epitopes encoded by the Arkansas mumps strains using a random forest prediction model trained on antibody-antigen protein structures. Over half of the predicted epitopes of the Jeryl-Lynn vaccine strains in the Hemagglutinin-Neuraminidase (HN) surface glycoprotein (a major target of neutralizing antibodies) region are missing in the Arkansas mumps strains. In-silico analyses of potential epitopes may indicate that the Arkansas mumps strains display antigens with reduced immunogenicity, which may contribute to reduced vaccine effectiveness. However, our in-silico findings should be assessed by robust experiments such as cross neutralization assays. Metadata analysis showed that vaccination history had no effect on the evolution of the Arkansas mumps strains during this outbreak. We conclude that the driving force behind the spread of the mumps virus in the 2016 Arkansas outbreak remains undetermined.     

2011—2020年呼和浩特市流行性腮腺炎流行特征分析

目的 分析呼和浩特市2011—2020年流行性腮腺炎(流腮)流行病学特征,为制定有针对性防控措施提供参考依据。方法 对呼和浩特市2011—2020年流行性腮腺炎的发病数据进行监测分析,描述其分布及趋势。 呼和浩特市2011—2020年共报告流腮病例6 176例,年均发病率20.60/10万,其中2012年发病率最高为40.17/10万,2020年发病率最低为7.08/10万,2012年和2020年发病率差异有统计学意义(χ2=717.641,P<0.001),10年间流腮发病呈波动下降趋势。流腮发病具有明显季节性,11月至次年1月和4—7月出现2个发病高峰。年龄分布以儿童和青少年为主,占总病例数60.83%。流腮病例最多人群是学生,占总病例数的61.08%。 流腮暴发疫情主要发生在中小学校,应加强儿童入托、入学预防接种证查验和流腮疫苗查漏补种工作,必要时开展6～15岁学生为目标人群的应急接种。     

余姚市2008-2018年流行性腮腺炎流行病学分析

目的了解余姚市流行性腮腺炎发病情况,为流行性腮腺炎预防和控制提供科学依据。方法采用描述性流行病学方法,对中国传染病报告信息管理系统中2008-2018年余姚市的流行性腮腺炎病例进行分析,并建立SARIMA模型对2019年余姚市流行性腮腺炎发病趋势进行预测。结果 2008-2018年共报告流行性腮腺炎3 983例,年均发病率35. 96/10万,从2008年开始,每年发病率呈下降趋势(χ~2趋势=986. 762,P <0. 05)。发病数每年从2月份开始增加,4月份达到发病高峰,再逐渐下降,10-11月又有一小高峰,次年2月降到发病最低点。山区乡镇(鹿亭乡、大岚镇、四明山镇)年均发病率(7. 15/10万)低于平原乡镇(37. 17/10万),差异有统计学意义(χ~2=108. 072,P <0. 05)。发病主要集中在1~4岁、5~9岁、≥10岁三个年龄段,分别占总病例的21. 89%、49. 69%、17. 93%。以学生、幼托儿童、散居儿童为主,分别占总病例的48. 88%、32. 04%、11. 08%。男性年均发病率(45. 26/10万)高于女性(26. 46/10万),差异有统计学意义(χ~2=272. 288,P <0. 05)。预测2019年1月-12月余姚市流行性腮腺炎月发病数分别为10例、6例、16例、27例、26例、25例、26例、16例、17例、16例、15例、13例。发病数3月份开始上升,4-7月份维持在一个发病高峰,再平稳下降,总体略高于2018年发病数。结论 2008-2018年余姚市流行性腮腺炎年均发病率为35. 96/10万,每年发病率呈下降趋势,2014-2018年余姚市流行性腮腺炎一直处于较低的发病水平,但预测显示2019年发病数略高于2018年,应采取有效防控措施,避免疫情反弹。     

Children's health and the social theory of risk: insights from the British measles, mumps and rubella (MMR) controversy

Recent debates in the United Kingdom about the measles, mumps and rubella (MMR) vaccine and its alleged link with autism have centred on contested notions of risk. This paper presents findings from 87 parents' focus group and interview discussions of their decision-making about the vaccine in light of three streams of theoretical literature on risk (cultural theory, risk society, psychometric models of risk perception) and models of vaccination acceptance and resistance. In addition to the risks of infectious disease and autism, parents balanced other risk concerns-both biological and social-in making their decisions. Such decisions, made on behalf of children unable to choose for themselves, and in the midst of contradictory information and uncertainty, symbolised what it means to be a 'good parent'. To cope with uncertainty, parents sought explanations for why some children seem to be more vulnerable to adverse outcomes than others. Debates about children's risks may need special theoretical consideration beyond that offered by the current risk literature. Specific aspects of the MMR debate, namely, selecting between potentially competing risks, making risk judgements on behalf of dependent others, and tensions between private and public good, provide a platform for exploring how social theories of risk might be adapted for children's health controversies.     

2015-2019年北京市石景山区流行性腮腺炎流行病学特征分析

目的 分析2015-2019年北京市石景山区流行性腮腺炎的流行特征,为有效控制流行性腮腺炎提供科学依据.方法 采用描述流行病学方法对2015-2019年北京市石景山区流行性腮腺炎发病情况进行分析.结果 2015-2019年石景山区累计报告流行性腮腺炎病例352例,年平均发病率为11.09/10万.发病高峰在5-9月.病...     

Transmission of mumps virus from mumps-vaccinated individuals to close contacts

During a recent mumps epidemic in the Netherlands caused by a genotype D mumps virus strain, we investigated the potential of vaccinated people to spread mumps disease to close contacts. We compared mumps viral titers of oral fluid specimens obtained by quantitative PCR from vaccinated (n = 60) and unvaccinated (n = 111) mumps patients. We also investigated the occurrence of mumps infection among the household contacts of vaccinated mumps patients. We found that viral titers are higher for unvaccinated patients than for vaccinated patients during the 1st 3 days after onset of disease. While no symptomatic cases were reported among the household contacts (n = 164) of vaccinated mumps patients (n = 36), there were cases with serological evidence of asymptomatic infection among vaccinated household contacts (9 of 66 vaccinated siblings). For two of these siblings, the vaccinated index patient was the most probable source of infection. We conclude that, in this particular outbreak, the risk of a close contact becoming infected by vaccinated patients was small, but present.     

2017—2021年苏州市流行性腮腺炎流行病学分析

目的 分析苏州市2017—2021年流行性腮腺炎流行病学特征,为进一步制定流行性腮腺炎防治措施提供科学依据。方法 从中国疾病预防控制信息系统收集2017—2021年苏州市报告的流行性腮腺炎临床确诊病例,采用描述性流行病学方法进行分析。结果 2017—2021年苏州市共报告流行性腮腺炎病例6 690例,年平均发病率为8.55/10万。2017—2019年流行性腮腺炎年平均发病率为9.09/10万,2020 —2021年平均发病率较之有所降低,为7.87/10万(χ2=14.07,P＜0.05)。4 —6月以及10 —12月为发病高峰。2017—2021年发病率最高的地区为太仓市,其次为常熟市、吴中区。男性年平均发病率为9.98/10万,高于女性的6.90/10万(χ2=44.08,P＜0.05)。发病人群以学生、幼托儿童、散居儿童为主,分别占报告病例总数的46.08%、35.00%、8.89%。结论 自2020年以后,苏州市流行性腮腺炎发病率有所下降,接种2剂次麻腮风疫苗可有效减少并推迟流腮的发生。     

2011—2014年重庆万州区流行性腮腺炎流行病学特征

目的分析重庆万州区流行性腮腺炎的流行病学特点,为采取有效防控措施提供依据。方法采用回顾性调查方法,对万州区2011年1月—2014年12月流行性腮腺炎疫情资料进行流行病学统计分析。结果共报告流行性腮腺炎2 785例,无死亡病例,流行性腮腺炎发病率为44.02/10万。发病人群年龄段主要为15岁,占总发病人数的84.45%(2 352/2 785)。病例的职业分布主要为学生(1 674例,60.11%)。4—7月和10—12月为发病高峰期,2013年10—12月病例数有明显升高。2011—2014年各年度发病率比较,差异有统计学意义(χ2=40.52,P0.01)。城区街道流行性腮腺炎发病率为63.99/10万,乡镇为32.13/10万,两者比较,差异有统计学意义(χ2=20.168,P0.01);2011—2014年各年度城区街道与乡镇流行性腮腺炎发病率比较,差异均有统计学意义(均P0.05),且除2012年外,其余各年度城区街道发病率均高于乡镇。结论应做好传染病防治的"五早",加强免疫接种麻疹-腮腺炎-风疹三联疫苗(MMR)或流行性腮腺炎疫苗,特别是学生和幼托儿童,普及流行性腮腺炎防控知识,提高诊疗水平并加强疫情监测。     

Report of a nutritional screening audit

Background: Malnutrition in hospitals has been widely documented and nutritional screening forms part of the National Professional Standards for Dietitians. As a result of this concern, a nutrition screening tool has been incorporated into the nursing care plan documentation. Aims: To audit the use of the screening tool in nursing care plans for elderly patients and examine the communication methods concerning the need for individual nutritional care. Methods: A standard chart was used to audit patient notes. In addition, a short informal interview was conducted with nursing staff. Results: Use of the screening tool was variable and fewer than half of those identified by this tool as in need of nutritional care were referred to the dietitian. Conclusion: Ward staff are prioritizing patients referred for dietetic care, even when they have been identified by the screening tool, but this is not always done systematically. Improvements could be made in the relevant documentation. Further training of ward staff and a follow-up audit should be undertaken.