应用中断时间序列设计评估石家庄市流行性乙型脑炎疫苗防控效果  

Impact of Japanese encephalitis vaccination in Shijiazhuang on the incidence of Japanese encephalitis:an interrupted time series analysis

作　　者：郭建花[1] 孙印旗[2] 阎香娟 张世勇[1] GUO Jian-hua;SUN Yin-qi;YAN Xiang-juan;ZHANG Shi-yong(Shijiazhuang Center for Disease Prevention and Control,Shijiazhuang 050011,China;Hebei Provincial Center for Disease Prevention and Control,Shijiazhuang 050021,China)

机构地区：[1]石家庄市疾病预防控制中心,石家庄050011 [2]河北省疾病预防控制中心,石家庄050021

出　　处：《中华疾病控制杂志》2021年第7期795-801,共7页Chinese Journal of Disease Control & Prevention

基　　金：河北省医学适用技术跟踪项目计划(G2018113)。

摘　　要：目的评估疫苗接种对流行性乙型脑炎(简称乙脑)发病趋势的影响。方法采用中断时间序列设计定量评估1949―2019年石家庄市乙脑年发病率变化趋势。结果1949―1968年,石家庄市乙脑发病率呈上升趋势(β_(1)=0.19,t=-2.01,P=0.048)。1969―2019年适龄人群疫苗接种,乙脑发病率当年下降(β_(2)=-7.83,t=-2.97,P=0.004);长期下降斜率均值(β_(1)+β_(3))为-0.04/10万(t=-3.24,P=0.002);疫情暴发流行致人群发病率上升(β_(4)=3.87,t=2.36,P=0.007)。其中免疫规划前阶段(1969―2007年),接种当年发病率下降(β_(2)=-7.22,t=-2.98,P=0.019);持续长期下降斜率为0.29(t=-2.73,P=0.008);疫情暴发流行对人群发病率的影响无统计学意义(β_(4)=4.65,t=0.72,P=0.476)。免疫规划期(2008―2019年)与免疫规划前期相比,当年发病率下降程度无统计学意义(β_(2)=-2.89,t=-1.56,P=0.169);免疫规划期,发病率趋势无统计学意义(β_(3)=-0.03,t=-1.16,P=0.252);暴发流行升高了人群发病率(β_(4)=3.62,t=4.21,P=0.001)。结论疫苗接种致石家庄市乙脑疫情明显下降,防控效果显著。但受发病人群年龄后移影响,免疫策略也需调整。Objective To analyze the impact of Japanese encephalitis(JE)vaccine administration on the trend of JE incidence.Methods An interrupted time series analysis(ITSA)and segmented regression analysis(SRA)using JE incidence data in Shi Jiazhuang from 1949 to 2019 were conducted to quantitatively assess short-term and long-term effect of JE vaccination.Results There was a statistical significant increasing trend of JE incidence from 1949 to 1968(β_(1)=0.19,t=-2.01,P=0.048).With the introduction of vaccine from 1969 to 2019,JE incidence decreased immediately(β_(2)=-7.83,t=-2.97,P=0.004)in 1969;And the average decreasing slope of JE incidence(β_(1)+β_(3))was-0.04/lakh with the significant difference(β_(3)=-0.23,t=-3.24,P=0.002).However,JE incidence increased due to the outbreak in 1969-2019(β_(4)=3.87,t=2.36,P=0.007).Further analysis using data on the period of pre-immunization program(1969-2007)showed that the JE incidence decreased(β_(2)=-7.22,t=-2.98,P=0.019)in 1969 and the continuous decreasing slope was 0.29(β_(3)=-0.29,t=-2.73,P=0.008);And JE incidence did not increase due to the outbreak(β_(4)=4.65,t=0.72,P=0.476)in this period.However,compared with the period of pre-immunization program,in the period of immunization program,no statistically significant decreasing of JE incidence was noted in 2008(β_(2)=-2.89,t=-1.56,P=0.169)and in this period(β_(3)=-0.03,t=-1.16,P=0.252);Meanwhile,JE incidence still increased due to the outbreak in this period(β_(4)=3.62,t=4.21,P=0.001).Conclusions The implementation of vaccine administration in Shi Jiazhuang has made remarkable effectiveness in the JE control.However,the immunization strategies need to be adjusted according to the change of the vulnerable population of cases moving from younger children to the older person.

关 键 词：流行性乙型脑炎 疫苗接种 中断时间序列设计 效果评估 

分 类 号：R512.32[医药卫生—内科学]