上海市卢湾区人群麻疹免疫水平监测

[目的 ]　了解卢湾区近 10年人群麻疹免疫水平与麻疹发病情况的关系。 [方法 ]　对卢湾区 1989～1999年人群麻疹免疫水平和麻疹发病情况资料进行分析 ,并计算抗体阳转率、发病率。 [结果 ]　历年接种率维持在97%以上的较高水平。免后抗体阳性率为 99.42 %,几何平均滴度 (GMT)为 39.96。人群麻疹抗体总阳性率为99 .49%,近几年麻疹年均发病率在 0 .19/ 10万以下。 [结论 ]　在保持高接种率和免疫成功率的基础上 ,流动儿童和成人是当今控制麻疹的重点对象     

6月龄与8月龄婴儿接种麻疹疫苗后的血清学效果

[目的 ]　探索麻疹疫苗最佳初免月龄。 [方法 ]　分别选择卢湾、杨浦、南汇 3个区县 6、8月龄健康婴儿192名和 177名 ,给予麻疹疫苗接种 ,并对其免前、免后血清抗体水平进行观察。 [结果 ]　 6月龄婴儿麻疹疫苗免疫后IgG抗体阳转率 92 .6 1% ,GMT 1340 .15 ;8月龄婴儿IgG抗体阳转率 96 .0 0 % ,GMT 1138.11。[结论 ]　如果 8月龄初免前婴儿麻疹发病率高的地区 ,可考虑将初免时间提前至 6月龄     

上海市1950～1997年百日咳流行病学和免疫学效果分析

上海市的百日咳发病率曾经高达1150．16／10万,使用百白破混合制剂（DPT）免疫及全程免疫接种率提高至90％后,使发病得到了有效控制．DPT的免疫学效果观察显示．免疫后较免疫前抗体增长40倍以上,阳转率和达保护抗体水平率分别高至90％和85％,吸附DPT的保护率约为96％．由此可见,有效的疫苗和高质量的免疫接种是控制百日咳流行的关键措施。     

济南市1991～2001年百日咳监测资料分析

[目的 ]了解济南市百日咳发病状况与人群免疫水平。 [方法 ]对 1991～ 2 0 0 1年济南市百日咳发病和免疫监测资料进行分析。 [结果 ] 1991～ 2 0 0 1年百日咳年平均发病率为 0 3 2 / 10万 ,病例主要在郊县 ,呈散发状态 ,84 46%为 6岁以下儿童 ,人群百日咳抗体保护率平均为 14 3 3 % ,GMT为 1∶49 46。 [结论 ]通过本次近十年百咳监测资料调查分析 ,百日咳抗体水平低应使用副反应少、保护效果好的疫苗 ,进一步提高免疫接种率。     

两种百白破联合疫苗免疫后百日咳的血清学效果

为了解无细胞百白破联合疫苗(DPTa)和全细胞百白破联合疫苗(DPTw)的血清学免疫效果,在上海市卢湾区随机选取3月龄健康婴儿,分两组分别用DPTa和DPTw做基础免疫;又选取18月龄健康儿童也分两组,分别用两种联合疫苗做加强免疫,免疫前和免疫后1、6个月采血,用微量凝集试验检测百日咳凝集抗体,用酶联免疫吸附试验检测抗百日咳毒素抗体(抗-PT)和抗丝状血凝素抗体(抗-FHA)的水平.结果表明经DPTw基础免疫和加强免疫后,凝集抗体阳性、保护率和几何平均滴度(GMT)均明显高于DPTa;免疫后6个月,凝集抗体GMT仍维持在保护水平以上,证明DPTw是有效的.采用DPTa做基础免疫和为以DPTw做基础免疫者的加强免疫,免疫后抗-PT和抗-FHA抗体均明显高于DPTw;免疫后6个月抗-PT、抗-FHA抗体还显著高于保护水平,说明DPTa既可用于基础免疫,也可用于对以DPTw做基础免疫的婴儿的加强免疫.     

国产水痘减毒活疫苗接种的血清学免疫效果及成本效益分析

[目的 ]　观察不同代次、不同剂量的国产水痘减毒活疫苗的安全性和免疫效果 ,分析不同年龄组儿童水痘疫苗接种的经济效益。　 [方法 ]　随机分组 ,接种不同代次、不同剂量的国产水痘疫苗 ,对每组儿童进行人体反应性及免疫原性观察 ,用酶联免疫吸附法 (ELISA)测定水痘抗体 ,采用成本效益分析方法计算各年龄组效益费用比 (BCR)。　 [结果 ]　各组水痘疫苗免后副反应率及抗体水平差异均无显著性。免后 1～ 3月 ,抗体阳转率达到 96 %以上 ,几何平均滴度(GMT)达到 76 0以上。以后抗体逐渐下降 ,接种后 2年抗体阳转率为 81.40 %,GMT为 36 7.2 0。水痘疫苗接种后成本效益比值 ,2岁以下年龄组BCR值小于 1,3～ 7岁年龄组BCR值均大于 1,其中 6～ 7岁组经济效益最高。　 [结论 ]　不同代次、不同剂量的国产水痘疫苗副反应率较低 ,免疫效果好。 3～ 7岁组儿童接种水痘疫苗能获得正效益 ,应作为水痘疫苗免疫接种的首选对象。     

衢州市1954～2000年百日咳流行特征和免疫效果

衢州市是百日咳发病较高的地区 ,使用百日咳疫苗或含百日咳疫苗的混合制剂以来 ,尤其是计划免疫的实施和免疫覆盖率逐步提高 ,百日咳流行得到有效控制 ,发病率和死亡率显著下降。现将衢州市 195 4～ 2 0 0 0年百日咳流行特征和疫苗防制效果分析如下。材料与方法1　资料来源　 195 4～ 2 0 0 0年百日咳发病资料来源于省卫生防疫站疫情资料汇编和本站疫情档案资料。百白破疫苗免疫接种资料来源于本站计划免疫档案资料。2　百日咳抗体测定　按照卫生部下发的《计划免疫技术管理规程》所规定的方法进行 ,凝集试验阳性标准定为≥ 1∶2 0 ,保护水…     

贵州省麻疹疫苗后续强化免疫效果分析

目的分析贵州省麻疹减毒活疫苗(MV)后续强化免疫效果,探讨消除麻疹策略。方法综合分析后续强化免疫接种率、人群抗体水平和麻疹监测系统资料。结果本次强化免疫共接种目标儿童3279288人,报告接种率和快速评估接种率均95%,免疫后人群麻疹IgG抗体阳性率、保护率和几何平均滴度显著升高,麻疹发病率较后续强化免疫前下降79.1%。结论贵州省MV后续强化免疫效果显著,适时开展后续强化免疫是保持麻疹低发病率水平的重要措施。为实现消除麻疹目标,应加强常规免疫和麻疹监测,适时开展麻疹疫苗查漏补种或后续强化免疫,保证2剂次麻疹疫苗接种率≥95%。     

甲型肝炎疫苗接种流行病学效果和经济效益分析

[目的 ]　观察本市国产甲肝减毒活疫苗免疫和流行病学效果 ,分析不同年龄组甲肝疫苗接种的经济效益。　 [方法 ]　以整群随机分组方法观察接种组与对照组甲肝发病率 ,检测部分易感者的免后抗体水平 ,采用成本效益分析方法计算各年龄组效益费用比 (BCR)和净成本效益比 (NB)。　 [结果 ]　对照组发现甲型肝炎 2 2例 ,接种组未发现甲肝病人 ,保护率为 10 0 %。免后 3个月抗体阳转率为 94% ,抗体滴度随时间缓慢下降 ,至 6 0个月抗体阳转率为 41.74% ,但仍有很好保护效果。甲肝疫苗接种后成本效益比值 ,5岁以下年龄组BCR均小于 1,10～ 39岁年龄组BCR均大于 1,其中 2 0～ 2 9岁组经济效益最高。　 [结论 ]　本市预防接种甲肝疫苗能获得正效益 ,10～ 39岁组是首选接种人群 ,其中 2 0～ 2 9岁是重点接种对象     

义马市计划免疫效果评价

目的了解计划免疫工作效果。方法历年疫情报告及计划免疫资料进行整理、分析。结果基础免疫卡介苗、脊髓灰质炎、麻疹、百白破、乙肝疫苗接种率连续多年保持在95%以上,加强免疫脊髓灰质炎疫苗每年0～4岁儿童的强化免疫接种率达到98%,麻疹疫苗加强免疫率达96%。结论相应传染病发病率大幅度下降,部分达到消灭和控制的目标,收到了良好的社会效益,保护了儿童健康成长。     

Pertussis vaccination in infancy lowers the incidence of pertussis disease and the rate of hospitalisation after one and two doses: analyses of 10 years of pertussis surveillance

Objectives

Shortly after pertussis vaccination was reintroduced in Sweden in 1996, an intensified pertussis disease surveillance programme was set up. In this study, we report on in-depth analyses of age–dose–number-specific incidences and the rate of pertussis hospitalisation for children with no, 1 or 2 doses of an acellular pertussis vaccine before pertussis disease. Vaccine coverage, the timeliness of childhood vaccination and the effect of later than scheduled pertussis vaccination(s) are also examined.

Study design

Children with notified laboratory-confirmed (culture or PCR) pertussis disease were evaluated among the surveillance population of about 1 million infants, born between 1996 and 2007 and followed for pertussis disease from October 1997 to December 2007, for nearly 6 million person-years. Birth and vaccination dates of the diseased children are known from the surveillance programme. To estimate denominators of the age–dose–number-specific pertussis incidences, we used birth and vaccination dates from a vaccine trial with more than 72,000 infants combined with national pertussis vaccine coverage data for children in the surveillance population.

Results

For infants from 3 to <5 months of age, the incidence of pertussis disease with at least 14 days of cough decreased from 264/100,000 for unvaccinated infants to 155/100,000 for infants with one dose of a pertussis vaccine prior to onset of the disease. In the age range 5 to <12 months, the age–dose specific incidences were 526, 95, and 24/100,000 for infants with no, 1 and 2 doses, respectively. The rate of hospitalisation for infants with 1 dose of a pertussis vaccine prior to onset of the disease was significantly lower than for unvaccinated infants of the same age.For many infants, there is a delay in administration of the vaccine doses according to the regular 3–5–12 month schedule (which has been the case for many years). Hypothetically, if all infants had been vaccinated exactly on schedule, we would expect about 28% fewer pertussis cases with at least 14 days of cough and 38% fewer hospitalisations due to pertussis, of cases possible to influence by vaccinations on schedule.

Conclusion

Pertussis vaccination had a significant effect among infants already after the first dose. This is particularly important for premature infants and infants with severe respiratory and cardiac diseases. A moderate decrease in the incidence of pertussis disease in infants and rate of hospitalisation could be expected if primary vaccinations were carried out closer to the scheduled time than is currently the practice in Sweden.     

The initial coverage and impact of the pneumococcal and influenza vaccination program for at-risk indigenous adults in Far North Queensland

OBJECTIVES: To describe the initial coverage and impact of a pneumococcal and influenza vaccination program for at-risk Indigenous adults in Far North Queensland that formally commenced in 1996. DESIGN: Ascertainment of vaccine coverages, and prospective laboratory surveillance of invasive pneumococcal disease occurring in Indigenous adults in the region. MAIN OUTCOME MEASURES: Coverages of the first doses of both vaccines administered since 1995, and the incidence of invasive pneumococcal disease in Indigenous adults in the region between 1993-2000. RESULTS: Most (96% and 73%) of the Indigenous adults > or = 50 years of age received influenza and pneumococcal vaccines, respectively, for the first time between 1995-2000. Assuming that either 33% or 50% of Indigenous adults 15-49 years of age in Far North Queensland were eligible for vaccination, then either 109% or 72% of this population received influenza vaccine, and either 75% or 50% received pneumococcal vaccine, respectively, for the first time between 1995-2000. The incidence of vaccine-preventable invasive pneumococcal disease fell from 111 (95% confidence interval [CI] 77-154) cases per 100,000 per year in 1993/94 to 28 (95% CI 13-53) cases per 100,000 per year in 1999-2000 (p<0.05). CONCLUSION: Although there was a significant decline in the incidence of invasive pneumococcal disease, the vaccine coverages after five years of the program were suboptimal. Because of the difficulties in targeting the 15-49 years age group and because of unrecognised risk factors, we suggest that a universal Indigenous adult pneumococcal and influenza vaccination program should be considered.     

Pertussis in Poland in 2002

Reemergence of pertussis in a form of epidemic was observed in Poland in 1997/1998. It is rather sustained trend of increased incidence and shift in the age of infected. It may be due to the level of immunity decreasing with age, since according to the vaccination calendar in Poland, last pertussis vaccination is given before the age of two. 1788 cases were reported in 2002, a slight drop from the previous year (2411 in 2001) More cases occurred among females (1043 cases, 5.3/100,000) than among males (745 cases, 4.0/100,000) and in urban areas (5.7/100,000) than in the rural ones (3.0/100,000). Big differences in numbers of cases reported between different districts and between urban and rural areas bring strong possibility of insufficient sensitivity of the surveillance in many regions of Poland. It is concluded that increase of pertussis incidence in Poland, brings urgent need of additional vaccination in the age of 6 to secure protection for the older age groups. Additional dose of pertussis vaccine was included in vaccination calendar for 2003.     

Declining pertussis incidence in Sweden following the introduction of acellular pertussis vaccine

Acellular pertussis vaccines were introduced nation-wide in Sweden in 1996, 17 years after the withdrawal of whole-cell pertussis vaccine from the childhood immunisation schedule. We report national data on age specific incidence of culture-confirmed Bordetella pertussis for 1986-2000, and clinical follow-up for 3 years (October 1997-September 2000) in children born in 1996-2000 and from children born in 1993-1994 who had participated in a trial of pertussis vaccines. The annual incidence of culture-confirmed B. pertussis was 89-150 per 100,000 before introduction of acellular pertussis vaccines and has dropped to 17-26 per 100,000. The data suggest that unimmunised infants and children who have received only one dose of pertussis vaccine were provided some protection. The decline is most obvious from the second dose onwards and remained stable for 4-5 years after the third dose in the absence of any booster dose. The first signs of waning immunity were observed at 6-7 years of age in the trial cohort. The short-term benefits reflect high vaccination coverage and high initial efficacy. The full impact of the acellular pertussis vaccination programme in infants remains to be established.     

河北省2013—2017年疑似预防接种异常反应监测分析

目的 了解河北省2013—2017年疑似预防接种异常反应(adverse events following immunization,AEFI)的发生特征,评价所用疫苗的安全性和预防接种服务工作质量。方法 采用描述性流行病学方法分析河北省2013—2017年AEFI数据。结果 河北省2013—2017年报告AEFI病例57 028例,年均报告发生率为44.48/10万剂。男女性别比为1.33∶1,集中在1岁年龄组,报告时间集中在夏、秋两季;绝大多数AEFI报告已痊愈或好转,约85%的不良反应报告发生在接种后24 h内。一般反应、异常反应报告分别占97.56%、2.00%。AEFI报告发生率较高的疫苗是无细胞百白破联合疫苗(diphtheria,tetanus and acellular pertussis combined vaccine,DTaP)(189.91/10万剂)、23价肺炎球菌多糖疫苗(23-valent pneumococcal polysaccharide vaccine, PPV23)(182.45/10万剂)和无细胞百白破-灭活脊灰-b型流感嗜血杆菌联合疫苗(diphtheria,tetanus and acellular pertussis, inactivated poliomyelitis and Haemophilus influenza type b conjugate combined vaccine, DTaP-IPV-Hib)(150.67/10万剂)。过敏性皮疹(5.48/10万剂)是报告发生率最高的异常反应类型。结论 河北省2013—2017年AEFI监测工作质量逐年提高,所用疫苗安全性良好。     

Impact of universal vaccination on the epidemiology of varicella in Veneto, Italy

In 2005, universal varicella vaccination was introduced in the Veneto region, Italy. We examined trends in varicella incidence and hospitalization rates before and after vaccine introduction, and applied statistical models to assess vaccine effectiveness. Varicella incidence rates for 2000-2008 were calculated from the mandatory regional surveillance data and from a special surveillance system based on reports from a sample of family pediatricians that during the study period followed more than 40,000 children. To evaluate hospital admission rates, we analyzed the regional hospital discharge registry. The vaccine coverage rate was 6.8% in the 2004 birth-cohort and 78.6% in the 2008 cohort. Varicella incidence in 0-14 year-olds was 6136.8/100,000 person-years in 2000 and 4004.8 in 2008; hospitalization rates were 18.7 and 8.4. Incidence rates significantly decreased 2.5 years after beginning the universal vaccination, while hospitalization rates showed a significant decrease one year earlier. There was a remarkable decline of both varicella incidence and hospitalizations especially in 1-4 year-old children. This study confirms the positive impact of universal vaccination.     

Pertussis in year 2000

Reemergence of pertussis in a form of epidemic was observed in Poland in 1997/1998. After some decrease of incidence in 1999, year 2000 brought another increase in pertussis morbidity (2,269 cases; incidence 5.9/100,000), most of them in the older age group of 10-14. It indicates rather sustained trend of increased incidence and shift in the age of infected. It may be due to decrease of immunity with age. According to the vaccination calendar in Poland, last pertussis vaccination is given before the age of two. More cases occurred among females (6.3/100,000) than among males (5.4/100,000) and in urban areas (7.8/100,000) than in the rural ones (2.8/100,000). Big differences in numbers of cases reported between different districts and between urban and rural populations bring strong possibility of insufficient sensitivity of the surveillance in many regions of Poland. It is concluded that increase of pertussis incidence in Poland, causes urgent need of additional vaccination in the age of 5 to secure protection for the older age groups.     

1956～2012年临沂市人群百日咳抗体水平及流行动态分析

目的了解临沂市人群百日咳抗体水平及流行特征,为预测疫情趋势和制定免疫策略提供依据。方法对临沂市1956～2012年不同免疫阶段百日咳发病资料进行描述性分析;在不同年份随机抽取健康人群,分0～、2～、5～、8～、11～、15～、20～40岁7个年龄组进行百日咳抗体检测。结果 1956～2012年临沂市共报告百日咳578 487例,死亡426例。大致分为4个阶段：1956～1960年年均发病率为86.60/10万,死亡127例;1961～1981年年均发病率为283.82/10万,死亡296例;1982～2002年年均发病率为9.75/10万,死亡3例;2003～2012年年均发病率为0.16/10万,无死亡病例。1986～2012年共检测4 556人,达到抗体保护水平的3 587人,保护率为78.73%,几何平均滴度（GMT）为1∶197.24。结论已实施的免疫策略对控制百日咳发病效果显著,发病率大幅度降低;人群保护率和抗体水平有逐年增高趋势,说明疫苗接种工作质量较高;应警惕大年龄组儿童和成人百日咳的出现和传播。     

The seroepidemiology of Bordetella pertussis in Israel—Estimate of incidence of infection

This study was undertaken to estimate the magnitude of Bordetella pertussis infections in a highly vaccinated population in Israel in order to evaluate the relationship between clinical notification data and serology-based evidence of infection. A cross-sectional survey was conducted on a total of 1982 serum samples from the National Serum Bank, collected from January 2000 through December 2001, in order to monitor high levels of pertussis toxin (PT) IgG antibody indicative of recent B. pertussis infection, by standardized methods. The estimation yielded an infection incidence rate of 2448 per 100,000 population (≥3 years of age) for the year 2000 compared to an annual incidence of reported pertussis of 5.6 per 100,000 for the same period. The peaks of estimated incidence of infection were found in the groups of 15–19-year olds (5245 per 100,000) and older than 60 years (6469 per 100,000), whereas the majority of clinical pertussis cases were reported for the 10–14-year olds (20.5 per 100,000). The findings clearly show that despite a high vaccination coverage rate (>93%), there is still a considerable circulation of B. pertussis, particularly in adolescents and elderly. Population-based serosurveillance for pertussis offers the potential to assist interpretation of trends independent of notification and diagnostic bias.     

Enhanced safety surveillance study of ACAM2000 smallpox vaccine among US military service members

ObjectivesTo evaluate the rates of myopericarditis (primary objective) and rates of cardiovascular and neurological adverse events (secondary objectives) in temporal association with ACAM2000® smallpox vaccine.MethodsObservational cohort study conducted through monthly surveillance from 2009 to 2017 of electronic medical records of military service members (SM) for pre-specified cardiac and neurological International Classification of Diseases (ICD) codes reported in the 30 days following smallpox vaccination. ICD codes potentially predictive of myopericarditis and codes for encephalitis, Guillain-Barré syndrome, and sudden death were classified into Group 1. All other cardiovascular and neurological ICD codes were classified into Group 2. Medical records containing Group 1 codes were individually reviewed to confirm coding accuracy and to seek additional data in support of myopericarditis adjudication, which was performed by an independent clinical panel. Chart reviews were not performed for Group 2 codes, which were reported in aggregate only.Results897,227 SM who received ACAM2000 smallpox vaccine and 450,000 SM who received Dryvax smallpox vaccine were included in the surveillance population. The rate of adjudicated myopericarditis among ACAM2000 smallpox vaccine recipients was 20.06/100,000 and was significantly higher for males (21.8/100,000) than females (8.5/100,000) and for those < 40 years of age (21.1/100,000) than for those 40 years or older (6.3/100,000). Overall rates for any cardiovascular event (Group 1 plus Group 2) were 113.5/100,000 for ACAM2000 vaccine and 439.3/100,000 for Dryvax vaccine; rate ratio, 0.26 (95% CI, 0.24–0.28). The rates of subjects with one or more defined neurological events were 2.12/100,000 and 1.11/100,000 for ACAM2000 and Dryvax vaccines respectively; rate ratio, 1.91 (95% CI, 0.71–5.10).ConclusionsElectronic records surveillance of the entire vaccinated SM population over a ten-year period found rates of myopericarditis, of defined neurological events, and of overall cardiac events that were consistent with those of prior passive surveillance studies involving Dryvax or ACAM2000 smallpox vaccines.Clinical trials registration: ClinicalTrials.gov NCT00927719.