肠道病毒71型灭活疫苗使用技术指南

  目的  了解肠道病毒71 型（EV71）疫苗对中国大陆地区儿童手足口病发病率的影响，为手足口病的预防控制提供参考依据。  方法  收集2015年1月 — 2017年12月中国疾病预防控制中心公共卫生科学数据中心手足口病数据库中中国大陆地区 < 5岁儿童手足口病发病率的月度数据，按年龄组（0岁～、1岁～、2岁～、3岁～、4岁～）整理，应用Stata/SE 15.0统计软件进行间断时间序列分析。  结果  干预前和干预后0岁～、1岁～、2岁～、3岁～、4岁～儿童手足口病发病率分别为122.54/10万和117.96/10万、350.03/10万和290.64/10万、239.99/10万和192.61/10万、213.53/10万和179.21/10万、119.49/10万和104.37/10万，干预前后儿童手足口病发病率差异均无统计学意义（均P > 0.05）。除0岁～组外，1岁～、2岁～、3岁～和4岁～组儿童手足口病发病率在干预前均呈上升趋势（均P < 0.05），以3岁～组斜率最高。干预后手足口病月发病率瞬间水平下降最为明显的为1岁～组，瞬间水平下降了118.107/10万（P = 0.044）；其次为3岁～组，瞬间水平下降了101.135/10万（P = 0.045）；其他3组瞬间水平变化差异均无统计学意义（均P > 0.05）。干预后2岁～、3岁～和4岁～组儿童手足口病发病率均由干预前的增长趋势改变为下降趋势（均P < 0.05），0岁～和1岁～组儿童手足口病发病率变化差异均无统计学意义（均P > 0.05）。  结论  EV71疫苗接种可有效降低2～5岁儿童的手足口病发病率，但需要结合其他非疫苗防控措施进一步加强疫苗对 < 2岁低龄儿童的防控效果。

Testing the autocorrelation structure of disturbances in ordinary least squares and instrumental variables regressions

  Objective  To analyze the impact of enterovirus 71(EV71) vaccine vaccination on the incidence of hand, foot and mouth disease (HFMD) among children under five years old in China mainland and to provide evidences for the prevention and control of HFMD.   Methods  The data on monthly incidence of HFMD among children under five years in China mainland from January 2015 through December 2017 were extracted from the Public Health Database established by Chinese Center for Disease Control and Prevention. The data were categorized into five one-year age groups and analyzed using interrupted time series analysis with Stata/SE 15 software.   Results   The age-group specific HFMD incidence rate (1/100 000) during the two periods (January 2015 – July 2016 and August 2016 – December 2017) before and after the implementation of EV71 vaccine vaccination were not significantly different for each of the five one-year age groups (122.54 vs. 117.96, 350.03 vs. 290.64, 239.99 vs.192.61, 213.53 vs. 179.21, and 119.49 vs. 104.37 for the age groups of 0, 1, 2, 3, and 5 years, respectively; all P > 0.05). During the period before EV71 vaccine vaccination, an significantly increasing trend in monthly age-group specific HFMD incidence rate was observed among the children (P < 0.05 for all), except for among those of aged 0 year; the slope for the incidence rate increment was the highest among the children aged 3 years. After the vaccination, the most significantly notable immediate drop by 118.107/100 000 in monthly HFMD incidence rate was observed in the children aged 0 year (P = 0.044), followed by that by 101.135/100 000 in the children aged 3 years (P = 0.045); whereas, there was no significant change in the immediate monthly age-group specific HFMD incidence rate among the children of other ages (all P > 0.05). The analysis revealed a significantly declining trend in the monthly HFMD incidence rate after the vaccination only for the children aged 2, 3, and 5 years (P < 0.05).  Conclusion  EV71 vaccine vaccination could decrease HFMD incidence significantly among the children aged two to five years. Preventive strategies other than vaccine vaccination should be promoted among the children under two years old.