单剂水痘疫苗接种后人群中暴发水痘疫情的原因分析  

Reason for outbreak of varicella in population after immunization with a single dose of varicella vaccine

作　　者：钱晓华[1] 谭顺荣 杨彦基[1] 徐巍[1] 张格[1] 赵根明[2] 

机构地区：[1]上海市虹口区疾病预防控制中心,上海200082 [2]复旦大学公共卫生学院,上海200052

出　　处：《中国生物制品学杂志》2012年第11期1527-1529,1534,共4页Chinese Journal of Biologicals

摘　　要：目的通过对单剂水痘疫苗高接种率学校中暴发的水痘疫情分析,评估疫苗的免疫持久性。方法采用现场流行病学方法对2011年10月至2012年1月虹口区单剂水痘疫苗高接种率学校中水痘暴发疫情进行调查和分析。结果在2011年10月16日至2012年1月13日疫情暴发期间,累计发现36例水痘病例,罹患率为5.4%,症状以发热、皮疹为主,仅27.8%的病人呈轻度或中度发热,且均为轻型水痘病例。发病班级的水痘罹患率在2.2%～34.1%之间,其中,男性为21.21%,女性为19.23%,病例发病时间主要集中在11月9～13日,占总病例的36.1%,呈2、3、4代病例的传播特征;发病班级单剂水痘疫苗接种率为95.48%,未发现接种史与水痘发病有关(P>0.05),患病的相对危险度(Relative risk,RR)为0.8;接种年龄组间水痘发病率差异无统计学意义(P>0.05);36例病例中,接种疫苗与发病时间的间隔中位数为66月,进口与国产水痘疫苗接种后,水痘发病率差异无统计学意义(P>0.05);暴发疫情病例中有免疫史人群的比例显著高于散发病例(P<0.05),比值比(Odds ratio,OR)为11.3。结论单剂水痘疫苗接种,可预防重症病例,但不能完全预防水痘暴发。建议首剂水痘疫苗接种后5～6年加强接种,或在发生疫情时,对首剂接种≥5年的无水痘患病史的密切接触者进行应急接种。Objective To evaluate the immune-persistence of varicella vaccine by analyzing the outbreak of varicella in a school with high vaccination rate of a single dose of varicella vaccine.Methods A field epidemiological investigation was performed on the data on outbreak of varicella in a primary school with high vaccination rate of a single dose of varicella vaccine in Hongkou District,Shanghai City from October 2011 to January 2012.Results During an outbreak from October 16,2011 to January 13,2012,a total of 36 cases of varicella was observed,with an attack rate of 5.4%.All the cases were mild,of which the main symptoms were fever and rash.However,only 27.8% of patients had mild or moderate fever.The attack rates were 2.2% ～ 34.1% in various classes,21.21% in males and 19.23% in females.A portion of 36.1% of the cases appeared in November 9 ～ 13,2011,and the transmission characteristics of the second,third and forth generations of cases were observed.The vaccination rate of a single dose of varicella vaccine in the classes in which cases were observed was 95.48%.No relationship between vaccination history and attack was observed（P 0.05）.The relative risk（RR） of attack was 0.8.The attack rates of children vaccinated at various ages showed no significant difference（P 0.05）.The median interval between vaccination and attack of the 36 cases was 66 months.No significant difference was observed in the attack rates of children vaccinated with domestic and imported vaccines（P 0.05）.The percentage of population with history of vaccination was significantly higher in outbreak cases than in sporadic cases,with an odds ratio（OR） of 11.3.Conclusion Vaccination with a single dose of varicella vaccine may prevent the appearance of severe cases,but can not prevent the outbreak of varicella.A booster is recommended 5 ～ 6 years after primary vaccination,alternatively,in an outbreak,an emergent vaccination is recommended to the close contacts who has no history of varicella and vaccinated not less than 5 years

关 键 词：水痘 暴发 疫苗 

分 类 号：Q279[生物学—细胞生物学]