用病例对照研究评价流行性腮腺炎疫苗保护效力及疾病暴发原因探析  

Evaluation of the protective effect of mumps vaccine with case-control study and analysis of the causes of the outbreak of disease

作　　者：胡伟军[1] 刘晓宇[1] 王新华 张少白[1] HU Weijun;LIU Xiaoyu;WANG Xinhua;ZHANG Shaobai(Shaanxi Provincial Center for Disease Control and Prevention,Xi'an 710054,China)

机构地区：[1]陕西省疾病预防控制中心,西安710054 [2]府谷县疾病预防控制中心,陕西府谷719400

出　　处：《实用医学杂志》2018年第22期3801-3804,共4页The Journal of Practical Medicine

基　　金：中华预防医学会疫苗和免疫青年人才托举项目(编号:Q2017A6119)

摘　　要：目的调查一起流行性腮腺炎暴发疫情并分析含腮腺炎成分疫苗保护效力,为完善流行性腮腺炎疫苗免疫策略提供理论依据。方法将报告疫情的陕西省某县作为现场,采用1∶2配对病例对照研究评估疫苗保护效力和估算疫苗接种率。结果共搜索病例85例,年龄范围1~38岁,病例集中在7~15岁(81.2%),其中≤9岁占55.3%;有明确免疫史的34例(39.1%),0剂次23例(26.4%),免疫史不详28例(32.1%);总体疫苗保护效力为76.6%(95%CI:52.0%~88.6%),1剂次含腮腺炎成分疫苗保护效力为75.8%(95%CI:75.8%~95%),2剂次为84.3%(95%CI:84.3%~95%),接种2剂次疫苗保护效力点估计值大于1剂次;接种1剂次流腮疫苗随年龄增大疫苗保护效力点估计值变小;接种1剂单腮疫苗保护效力点估计值(80.7%)高于1剂麻腮风疫苗(73.6%);暴发疫情的两校调查接种率分别为82.9%和76.4%,两校估算疫苗接种率74.0%。结论首发病例未及时就医和教室学生密集是引起流行性腮腺炎疾病流行的客观条件,接种率较低是疾病暴发的潜在因素,1剂次流腮疫苗难以达到有效保护,且随着时间推移有所衰减也是疾病暴发的重要因素。建议考虑2剂次免疫程序,同时做好密集人群病例管理是避免疫情暴发的关键。Objective To investigate the outbreak of mumps and the protective effect of mumps vaccine,and to provide the strategy basis for the epidemic prevention and control of mumps.Methods A 1∶2 matched case-control study was used to evaluate the efficacy of vaccine protection,and to estimate the vaccination rate and analyze the cause of the outbreak.Results There were 85 cases in total,ranging from 1 to 38 years old,mainly with 7~15 years old(69,81.2%),among which there were 47 cases(55.3%)under 9 years old.There were 34 cases(39.1%)with clear immune history,23 cases(26.4%)with 0 dose,and 28 cases(32.1%)with unknown immune history.Vaccine protective effect was 76.6%(95%CI:95%~52.0%),1 dose vaccine protecting effect estimated(75.8%,95%CI:75.8%~95%)was lower than 2 doses(84.3%,95%CI:84.3%~95%).The protective effect of single mumps vaccine(80.7%,95%CI:44.5%~93.3%)was higher than that of the combined measles mumps vaccine protection(73.6%,95%CI:42.8%~87.8%).Survey vaccination rate of the two schools outbreaking mumps was 82.9%and 76.4%,respectively,and the estimated vaccination rate was 74%.Conclusions The objective condition for the epidemic parotitis is that the first cases are not hospitalized in time.Low immunization rate and poor protection effect of mumps vaccine contribute to disease outbreaks.It is suggested that 2 doses of immunization should be considered and the key to avoid outbreak of the epidemic is to improve the vaccination rate and to strengthen the immunization and to manage the cases of densely populated cases.

关 键 词：流行性腮腺炎 暴发疫情 病例对照研究 

分 类 号：R512.1[医药卫生—内科学]