高水痘疫苗覆盖率幼儿园中的水痘暴发调查  

OUTBREAK OF VARICELLA IN HIGHLY VACCINATED KINDERGARTENS

作　　者：蔡军芳[1] 罗凤基[1] 李书明[1] 陈天京[1] 李坤[1] 

机构地区：[1]北京市朝阳区疾病预防控制中心,北京100021

出　　处：《现代预防医学》2010年第19期3634-3636,共3页Modern Preventive Medicine

摘　　要：[目的]调查分析北京市城区高水痘疫苗覆盖率幼儿园发生的水痘暴发疫情。[方法]对2007年北京市朝阳区100%水痘疫苗覆盖率幼儿园水痘暴发疫情进行流行病学分析。[结果]①9例病例中3例皮损为中度,其余都是轻度,分布在两个班、两个楼层,班级罹患率存在统计学上的差异。②暴露群体的疫苗覆盖率为100%,接种时年龄的中位数为15个月,接种后免疫间隔的中位数为49个月。9名患儿的免疫间隔集中在3～4年,免疫间隔≥4年者发生水痘的概率是免疫间隔﹤4年者的2倍。③暴露班级的抗体检测结果:4名学生水痘IgM抗体阳性,46名学生水痘IgG抗体阳性。病例的IgG抗体全部为阳性,抗体含量均值为(2000.00±509.09)mIU/ml,IgM抗体有4人为阳性,抗体含量均值(13.28±24.31)U/ml。[结论]①虽然突破性水痘的临床症状轻微,但仍具有传染性。②100%的疫苗覆盖率,未能预防水痘的暴发。③在高疫苗接种率群体,除预防接种外,隔离和排查也是疫情控制中非常有效的防控措施。④单剂接种国产减毒水痘活疫苗的免疫保护期到底有多长、是否应该开展2剂接种是需要继续研究的问题。[Objective] To investigate an outbreak of varicella in highly vaccinated kindergartens in Beijing. [Methods] Epidemiological analysis was made on the data from outbreak of varicella among 100% vaccinated kindergartens in Chaoyang District in 2007. [Results] ① 9 clinical cases were reported. 3 of these were moderate,the others were mild,and distributed in 2 classes on 2 floors,and significant differences were observed between the attack rates in the 2 classes. ② Varicella vaccination coverage rate of the exposure population was 100%. The median age at vaccination of vaccinated students was 15 months,and the median time since vaccination was 49 months. The vaccination interval time of 9 cases was among 3 to 4 years. The probability that varicella happening of people with vaccination interval ≥4 years was 2 times as those vaccinated ﹤4 years. ③ We detected antibody of varicella and found there were 4 cases with positive IgM antibody,and 46 cases with positive IgG antibody. Mean concentration of IgG antibody of cases was（2 000.00 ± 509.09） mIU /ml,and mean concentration of IgM antibody was（13.28 ± 24.31） U /ml. [Conclusion] ① Although breakthrough disease is mostly mild,varicella in vaccinated persons is contagious. ② 100% varicella vaccination coverage is not sufficient to prevent the outbreak. ③ In response to increasing reports of varicella outbreaks among highly vaccinated populations,we propose that,besides vaccination,isolation and exclusion are effective in preventing and controlling the epidemic situation of varicella,too. ④ There are two problems which we should keep on investigating on. The first one is how long the immunoprotection time of homemade live attenuated vaccine is. The second one is if we should launch two doses of preventive inoculation of varicella vaccine.

关 键 词：水痘暴发 水痘疫苗免疫 水痘疫苗免疫程序 疫苗有效性 疫苗覆盖率 

分 类 号：R511.5[医药卫生—内科学]