中国麻疹流行病学与消除麻疹免疫策略研究
发布时间：2018-07-16 19:50
【摘要】：背景中国从2006年开始实施消除麻疹策略,努力提高麻疹疫苗(MV)接种率,开展群体性MV补充免疫活动(MV SIA)。截至2010年9月,各省均完成覆盖1995-2009年出生队列的MV SIA。2011-2012年,全国麻疹发病率降至1/10万,但所有省仍有病例报告。 目的了解不同时期麻疹发病人群分布变化趋势,分析当前人群中不同出生队列麻疹易感者比例以及感染麻疹的危险因素,为进一步完善消除麻疹免疫策略与措施提供参考。 方法(1)运用描述流行病学方法,分析不同时期全国麻疹病例人群分布特点与变化趋势。(2)分析江苏、浙江、山东、河南、云南、甘肃六省不同历史时期人群年龄构成、MCV接种、麻疹病例年龄分布等数据,采用催化数学模型方法并结合母传麻疹抗体衰减和MCV接种效果,估算不同出生队列的麻疹易感者数量。(3)在上述六省开展1：3配比的病例对照研究,在东部、中西部地区,按照8月龄、8月龄～14岁和≥15岁分别估算最低样本量。从2012年1月开始将发病的所有实验室确诊麻疹病例纳入调查,选取3个年龄组匹配的邻居对照,直至六个组调查病例数均达最低样本量,采用条件Logistic回归分析。(4)开展麻疹暴发疫情典型调查,了解2010-2012出生队列MCV接种率,通过定性访谈了解常规免疫工作情况及存在的问题。 结果(1)1988～2013年,全国均以≤1岁儿童发病率最高,其次为2-4岁和5-9岁组,其他年龄组更低。2013年,全国≤1岁、2-4岁、5-9岁、10-14岁、15-34岁和≥35岁组发病率分别为50.0/10万、5.6/10万、1.4/10万、0.3/10万、1.2/10万和0.3/10万。2000年之前,2-14岁病例所占比例70%,至2013年则下降为13.7%；≤1岁组从12.3%上升至59.4%,≥15岁组从16.5%上升至26.9%。(2)1980年以来,六省人群中麻疹易感者感染麻疹速率(FOI)均大幅下降,FOI最高年龄组从以往3-10岁降至≤1岁。每省均以1岁儿童易感比例最高(52.9%),其次为1岁儿童(16.7%),3-19岁各出生队列均5%。东部三个省部分成人出生队列易感者比例在10%-20%之间,而云南、甘肃则在5%左右。(3)有医院暴露史(8月龄组amOR=6.2,8月龄～14岁组amOR=7.5,≥15岁组amOR=13.0)和流动史(三个年龄组amOR分别为2.5、2.6和1.8)是每类地区、各个年龄组共同的危险因素。母亲受教育程度低(amOR=2.3)、年龄≥5月(amOR=3.8)是8月龄组危险因素,无预防接种证、MCV接种率低(与无接种史相比,接种1剂amOR=0.046,接种≥2剂amOR=0.01)是8月龄-14岁儿童组主要危险因素。接种1剂MCV保护效果≥94%,接种≥2剂则98%。(4)暴发县典型调查显示,虽然报告MCV接种率均99%,但2010～2012年出生队列MCV1和MCV2实际接种率仅为85%左右；定性访谈表明近年基层预防接种服务的提供能力遭到削弱,MCV接种率不升反降,使麻疹易感者快速积累。 结论全国2010年MV SIA后出生队列和成人中存在大量麻疹免疫空白,以≤1岁易感者感染麻疹速率和麻疹发病率最高,是当前麻疹发病主要人群、消除麻疹的重点对象。接种MCV保护效果较好,儿童(尤其是流动儿童)8月龄、18月龄及时通过常规免疫接种MCV是消除麻疹的关键。同时,需要做好医院内感染控制、制定针对成人易感者的免疫策略、适时研讨针对6-7月龄的免疫措施。
[Abstract]:Background China began to implement the measles elimination strategy in 2006, efforts to improve the vaccination rate of measles (MV) and group MV supplemental immunization (MV SIA). As of September 2010, all provinces completed MV SIA.2011-2012 covering 1995-2009 years of birth cohort, and the incidence of measles fell to 1/10 million in the country, but there were still cases reported in all provinces.
Objective to understand the trend of distribution of measles in different periods, analyze the proportion of susceptible people in different birth cohort and the risk factors of measles, and to provide reference for further improvement of measles immunity strategies and measures.
Methods (1) using descriptive epidemiological methods, the distribution characteristics and trends of measles population in different periods were analyzed. (2) analysis of age composition, MCV inoculation and age distribution of measles cases in six provinces of Jiangsu, Zhejiang, Shandong, Henan, Yunnan, Gansu, and measles case age distribution, using the catalytic mathematical model method and combined with mother measles. The effect of antibody attenuation and MCV inoculation was used to estimate the number of susceptible people with different birth queues. (3) a case-control study of the 1:3 ratio in the above six provinces was carried out in the eastern and western regions. The minimum sample size was estimated at 8 month old, 8 month old to 14 years and more than 15 years old. All the laboratory confirmed measles cases were diagnosed from January 2012. In the survey, 3 age groups were selected to match the neighbor control, until the number of cases in six groups reached the lowest sample size, and the conditional Logistic regression analysis was used. (4) a typical survey of the outbreak of measles was carried out to understand the MCV inoculation rate in the 2010-2012 birth cohort and to understand the routine immune work and the existing problems through qualitative interview.
Results (1) 1988~2013 years, the incidence of children under the age of 1 was the highest, followed by 2-4 years and 5-9 years of age, the other age group was lower.2013 years, the country was less than 1, 2-4, 5-9, 10-14, 15-34 years and 35 years old, respectively, the incidence of 5.6/10 million, 1.4/10 million, 0.3/10 million, 1.2/10 Vanward 0.3/10 million.2000 years ago, 2-14 years cases accounted for the ratio. For 70%, to 2013, the decrease was 13.7%, the group in the 1 year old group rose from 12.3% to 59.4%, and the rate of measles susceptibility to measles (FOI) decreased significantly in the six provinces from 16.5% to 26.9%. (2) in 1980, and the highest age group of FOI decreased from 3-10 years old to less than 1 years. Children (16.7%), 3-19 year old birth queue in three provinces of 5%. eastern part of the adult birth cohort is between 10%-20%, and Yunnan, Gansu is around 5%. (3) there is a history of hospital exposure (8 month old groups of amOR=6.2,8 months to 14 years of age amOR=7.5, > 15 years of age amOR=13.0) and flow history (three age groups amOR 2.5,2.6 and 1.8 respectively) are each category. The common risk factors of the age group, the low education level (amOR=2.3) and the age of May (amOR=3.8) were 8 month old groups of risk factors, no vaccination certificate, the low rate of MCV inoculation (compared with no inoculation history, 1 doses of amOR=0.046, 2 doses of amOR=0.01) were the main risk factors for 8 month old -14 years old children group. 1 doses of MCV protection effect was inoculated. The typical investigation of 98%. (4) outbreaks in the county of 98%. (4) showed that the inoculation rate of MCV was 99%, but the actual inoculation rate of MCV1 and MCV2 in the 2010~2012 year birth queue was only 85%. Qualitative interview showed that the ability of providing the primary vaccination service was weakened in recent years, the rate of MCV inoculation was not rising, and the susceptible people of measles were accumulated quickly.
Conclusion there is a large number of measles immune gaps in the birth cohort and adults of MV SIA in 2010. The rate of measles and the incidence of measles are highest for those who are less than 1 years old. It is the main target of measles and the key object of measles elimination. The effect of MCV protection is better, children (especially the mobile children) are 8 month old, and 18 month old are in time to pass the routine. Immunization with MCV is the key to eliminating measles. At the same time, it is necessary to do a good job in hospital infection control, to formulate immune strategies for adult susceptible people, and to discuss the 6-7 month old immunization measures in a timely manner.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R511.1;R181.3
本文编号：2127494
[Abstract]:Background China began to implement the measles elimination strategy in 2006, efforts to improve the vaccination rate of measles (MV) and group MV supplemental immunization (MV SIA). As of September 2010, all provinces completed MV SIA.2011-2012 covering 1995-2009 years of birth cohort, and the incidence of measles fell to 1/10 million in the country, but there were still cases reported in all provinces.
Objective to understand the trend of distribution of measles in different periods, analyze the proportion of susceptible people in different birth cohort and the risk factors of measles, and to provide reference for further improvement of measles immunity strategies and measures.
Methods (1) using descriptive epidemiological methods, the distribution characteristics and trends of measles population in different periods were analyzed. (2) analysis of age composition, MCV inoculation and age distribution of measles cases in six provinces of Jiangsu, Zhejiang, Shandong, Henan, Yunnan, Gansu, and measles case age distribution, using the catalytic mathematical model method and combined with mother measles. The effect of antibody attenuation and MCV inoculation was used to estimate the number of susceptible people with different birth queues. (3) a case-control study of the 1:3 ratio in the above six provinces was carried out in the eastern and western regions. The minimum sample size was estimated at 8 month old, 8 month old to 14 years and more than 15 years old. All the laboratory confirmed measles cases were diagnosed from January 2012. In the survey, 3 age groups were selected to match the neighbor control, until the number of cases in six groups reached the lowest sample size, and the conditional Logistic regression analysis was used. (4) a typical survey of the outbreak of measles was carried out to understand the MCV inoculation rate in the 2010-2012 birth cohort and to understand the routine immune work and the existing problems through qualitative interview.
Results (1) 1988~2013 years, the incidence of children under the age of 1 was the highest, followed by 2-4 years and 5-9 years of age, the other age group was lower.2013 years, the country was less than 1, 2-4, 5-9, 10-14, 15-34 years and 35 years old, respectively, the incidence of 5.6/10 million, 1.4/10 million, 0.3/10 million, 1.2/10 Vanward 0.3/10 million.2000 years ago, 2-14 years cases accounted for the ratio. For 70%, to 2013, the decrease was 13.7%, the group in the 1 year old group rose from 12.3% to 59.4%, and the rate of measles susceptibility to measles (FOI) decreased significantly in the six provinces from 16.5% to 26.9%. (2) in 1980, and the highest age group of FOI decreased from 3-10 years old to less than 1 years. Children (16.7%), 3-19 year old birth queue in three provinces of 5%. eastern part of the adult birth cohort is between 10%-20%, and Yunnan, Gansu is around 5%. (3) there is a history of hospital exposure (8 month old groups of amOR=6.2,8 months to 14 years of age amOR=7.5, > 15 years of age amOR=13.0) and flow history (three age groups amOR 2.5,2.6 and 1.8 respectively) are each category. The common risk factors of the age group, the low education level (amOR=2.3) and the age of May (amOR=3.8) were 8 month old groups of risk factors, no vaccination certificate, the low rate of MCV inoculation (compared with no inoculation history, 1 doses of amOR=0.046, 2 doses of amOR=0.01) were the main risk factors for 8 month old -14 years old children group. 1 doses of MCV protection effect was inoculated. The typical investigation of 98%. (4) outbreaks in the county of 98%. (4) showed that the inoculation rate of MCV was 99%, but the actual inoculation rate of MCV1 and MCV2 in the 2010~2012 year birth queue was only 85%. Qualitative interview showed that the ability of providing the primary vaccination service was weakened in recent years, the rate of MCV inoculation was not rising, and the susceptible people of measles were accumulated quickly.
Conclusion there is a large number of measles immune gaps in the birth cohort and adults of MV SIA in 2010. The rate of measles and the incidence of measles are highest for those who are less than 1 years old. It is the main target of measles and the key object of measles elimination. The effect of MCV protection is better, children (especially the mobile children) are 8 month old, and 18 month old are in time to pass the routine. Immunization with MCV is the key to eliminating measles. At the same time, it is necessary to do a good job in hospital infection control, to formulate immune strategies for adult susceptible people, and to discuss the 6-7 month old immunization measures in a timely manner.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R511.1;R181.3
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