麻疹实验室确诊病例原发性和继发性免疫失败的回顾性研究  

A retrospective study of primary and secondary vaccine failure among laboratory-confirmed measles cases

作　　者：丁亚兴[1] 毛乃颖[2] 雷玥[1] 曲江文[1] 郭玉婷 刘莹 Ding Yaxing;Mao Naiying;Lei Yue;Qu Jiangwen;Guo Yuting;Liu Ying(Tianjin Center for Diseases Control and Prevention,Tianjin 300011,China;National Institute for Viral Disease Control and Prevention,Chinese Center for Diseases Control and Prevention,Beijing 102206,China)

机构地区：[1]天津市疾病预防控制中心,天津300011 [2]中国疾病预防控制中心病毒病预防控制所,北京102206

出　　处：《中国疫苗和免疫》2021年第5期514-518,共5页Chinese Journal of Vaccines and Immunization

基　　金：天津市卫生健康科技项目(ZC20200)。

摘　　要：目的探讨麻疹实验室确诊病例含麻疹成分疫苗(Measles containing vaccine MCV)原发性免疫失败(Primary vaccine failure,PVF)和继发性免疫失败(Secondary vaccine failure SVF)。方法收集天津市2013-2019年麻疹实验室确诊病例的剩余急性期血清标本,采用麻疹IgG抗体亲和力试验和酶联免疫吸附试验分别检测IgG抗体亲和力和IgM/IgG抗体,分析高/低亲和力病例构成、免疫失败比例和IgM/IgG抗体阳性率。结果共纳入麻疹实验室确诊病例367例,其中麻疹IgG抗体高、低亲和力病例分别占65.39%、23.71%;高亲和力病例比例从<1岁病例的26.32%升高至30-34岁的77.01%和≥40岁的63.41%(趋势χ^(2)=12.79,P<0.001)。在91例有MCV免疫史病例中,高、低亲和力病例(SVF、PVF病例)分别占75.82%、15.38%;在1剂次、≥2剂次MCV免疫史病例中高亲和力病例比例分别为74.24%、80.00%(χ^(2)=0.33,P=0.567),低亲和力病例比例分别为19.70%、4.00%(χ^(2)=4.24,P=0.039)。高、低亲和力病例的IgM阳性率分别为58.85%、90.24%(χ^(2)=26.54,P<0.001),IgG阳性率分别为98.09%、63.41%(χ^(2)=68.61,P<0.001)。结论SVF是MCV接种后麻疹发病的主要原因;≥30岁人群SVF风险较高,推荐增加1剂次MCV补充免疫。Objective To explore primary vaccine failure(PVF)and secondary vaccine failure(SVF)of measles containing vaccine(MCV)among laboratory-confirmed measles cases.Methods We obtained residual acute-phase serum specimens from laboratory-confirmed measles cases reported in 2013-2019 in Tianjin.We used a measles virus IgG avidity assay and an enzyme-linked immunosorbent assay to measure IgG avidity and assess IgM/IgG antibodies;we determined proportions of cases with high and low avidity,proportions of cases with PVF and SVF,and IgM and IgG antibody positivity rates.Results A total of 367 laboratory-confirmed measles cases were studied;65.39%were high-avidity cases and 23.71%were low-avidity cases.The percentage of high-avidity cases increased from 26.32%among<1-year-olds to 77.01%among 30-34-year-olds and 63.41%among≥40-year-olds(χ^(2)=12.79,P<0.001).Of 91 measles cases with history of MCV vaccination,75.82%were high-avidity cases(i.e.,SVF)and 15.38%were low-avidity cases(i.e.,PVF).Among 1-MCV-dose cases,74.24%were high-avidity cases,and among cases with history of≥2 MCV doses,80.00%were high-avidity cases(χ^(2)=0.33,P=0.567);19.70%of 1-MCV-dose cases were low-avidity cases and 4.00%of cases with history of≥2 MCV doses were low-avidity cases(χ^(2)=4.24,P=0.039).Among high-and low-avidity cases,58.85%and 90.24%,respectively,were IgM positive(χ^(2)=26.54,P<0.001),and 98.09%and 63.41%were IgG positive(χ^(2)=68.61,P<0.001).Conclusions SVF was the main cause of measles in MCV-vaccinated measles cases,implying a high risk of SVF among≥30 year-old adults.We recommend administration of a dose of measles vaccine for people 30 years and older.

关 键 词：麻疹 含麻疹成分疫苗 原发性免疫失败 继发性免疫失败 实验室确诊病例 

分 类 号：R181.1[医药卫生—流行病学] R511.1[医药卫生—公共卫生与预防医学]