中國麻疹流行病學與消除麻疹免疫策略研究
發(fā)布時間：2018-07-16 19:50
【摘要】：背景中國從2006年開始實施消除麻疹策略,努力提高麻疹疫苗(MV)接種率,開展群體性MV補充免疫活動(MV SIA)。截至2010年9月,各省均完成覆蓋1995-2009年出生隊列的MV SIA。2011-2012年,全國麻疹發(fā)病率降至1/10萬,但所有省仍有病例報告。 目的了解不同時期麻疹發(fā)病人群分布變化趨勢,分析當前人群中不同出生隊列麻疹易感者比例以及感染麻疹的危險因素,為進一步完善消除麻疹免疫策略與措施提供參考。 方法(1)運用描述流行病學方法,分析不同時期全國麻疹病例人群分布特點與變化趨勢。(2)分析江蘇、浙江、山東、河南、云南、甘肅六省不同歷史時期人群年齡構成、MCV接種、麻疹病例年齡分布等數(shù)據(jù),采用催化數(shù)學模型方法并結合母傳麻疹抗體衰減和MCV接種效果,估算不同出生隊列的麻疹易感者數(shù)量。(3)在上述六省開展1：3配比的病例對照研究,在東部、中西部地區(qū),按照8月齡、8月齡～14歲和≥15歲分別估算最低樣本量。從2012年1月開始將發(fā)病的所有實驗室確診麻疹病例納入調查,選取3個年齡組匹配的鄰居對照,直至六個組調查病例數(shù)均達最低樣本量,采用條件Logistic回歸分析。(4)開展麻疹暴發(fā)疫情典型調查,了解2010-2012出生隊列MCV接種率,通過定性訪談了解常規(guī)免疫工作情況及存在的問題。 結果(1)1988～2013年,全國均以≤1歲兒童發(fā)病率最高,其次為2-4歲和5-9歲組,其他年齡組更低。2013年,全國≤1歲、2-4歲、5-9歲、10-14歲、15-34歲和≥35歲組發(fā)病率分別為50.0/10萬、5.6/10萬、1.4/10萬、0.3/10萬、1.2/10萬和0.3/10萬。2000年之前,2-14歲病例所占比例70%,至2013年則下降為13.7%；≤1歲組從12.3%上升至59.4%,≥15歲組從16.5%上升至26.9%。(2)1980年以來,六省人群中麻疹易感者感染麻疹速率(FOI)均大幅下降,FOI最高年齡組從以往3-10歲降至≤1歲。每省均以1歲兒童易感比例最高(52.9%),其次為1歲兒童(16.7%),3-19歲各出生隊列均5%。東部三個省部分成人出生隊列易感者比例在10%-20%之間,而云南、甘肅則在5%左右。(3)有醫(yī)院暴露史(8月齡組amOR=6.2,8月齡～14歲組amOR=7.5,≥15歲組amOR=13.0)和流動史(三個年齡組amOR分別為2.5、2.6和1.8)是每類地區(qū)、各個年齡組共同的危險因素。母親受教育程度低(amOR=2.3)、年齡≥5月(amOR=3.8)是8月齡組危險因素,無預防接種證、MCV接種率低(與無接種史相比,接種1劑amOR=0.046,接種≥2劑amOR=0.01)是8月齡-14歲兒童組主要危險因素。接種1劑MCV保護效果≥94%,接種≥2劑則98%。(4)暴發(fā)縣典型調查顯示,雖然報告MCV接種率均99%,但2010～2012年出生隊列MCV1和MCV2實際接種率僅為85%左右；定性訪談表明近年基層預防接種服務的提供能力遭到削弱,MCV接種率不升反降,使麻疹易感者快速積累。 結論全國2010年MV SIA后出生隊列和成人中存在大量麻疹免疫空白,以≤1歲易感者感染麻疹速率和麻疹發(fā)病率最高,是當前麻疹發(fā)病主要人群、消除麻疹的重點對象。接種MCV保護效果較好,兒童(尤其是流動兒童)8月齡、18月齡及時通過常規(guī)免疫接種MCV是消除麻疹的關鍵。同時,需要做好醫(yī)院內感染控制、制定針對成人易感者的免疫策略、適時研討針對6-7月齡的免疫措施。
[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.
【學位授予單位】：中國疾病預防控制中心
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R511.1;R181.3
本文編號：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.
【學位授予單位】：中國疾病預防控制中心
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R511.1;R181.3
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