高疫苗覆盖率下扬州市百日咳病例激增的影响因素分析  

Analysis of influencing factors of pertussis cases surge in Yangzhou cityunder high vaccine coverage

作　　者：唐诗静 梁杰 董玉颖 徐娅雯 TANG Shi-jing;LIANG Jie;DONG Yu-ying;XU Ya-wen(Yangzhou Center for Disease Control and Prevention,Yangzhou,Jiangsu 225000,China)

机构地区：[1]扬州市疾病预防控制中心,江苏扬州225000

出　　处：《现代预防医学》2024年第3期542-546,共5页Modern Preventive Medicine

基　　金：扬州市科技局2022年市级计划——政策引导计划(软科学研究)(YZ2022259)。

摘　　要：目的 分析2022年扬州市百日咳疫情流行特征和无细胞百日咳类疫苗(acellular pertussis vaccine, a PV)预防百日咳的保护效果(vaccine effectiveness),探讨在高疫苗覆盖率形势下病例激增的影响因素及应对策略。方法 对发病病例的临床数据进行统计分析,采用1:2匹配病例对照研究,分析a PV预防百日咳的保护效果。结果 发病率-年龄曲线呈“U”形,0~3月龄婴幼儿发病率较高,为127.8/10万,第2个发病高峰发生在5~7岁儿童,发病率超过60/10万。发病病例中突破病例占86.0%,突破病例在并发症等临床症状的情况好于未免疫病例。a PV预防百日咳的总体保护效果为86.10%(95%CI:34.70%~97.04%),1~3剂次a PV预防百日咳的保护效果为85.35%(95%CI:31.10%~96.89%),4剂次a PV的保护效果达98.20%(95%CI:74.28%~99.88%),发病-接种间隔时间<1年的保护效果为85.72%(95%CI:32.08%~97.00%),提示接种后时间增长为百日咳发病的危险因素。结论 目前百日咳免疫策略与流行特征不相匹配,0~3月龄婴幼儿以及学龄儿童的百日咳风险颇高。a PV的保护效果的时效性不佳,需进一步调整和完善百日咳免疫策略,尤其需要考虑百日咳加强免疫在学龄期儿童的应用。Objective To analyze the epidemic characteristics of pertussis in Yangzhou City in 2022 and the vaccine effectiveness(VE)of acellular pertussis vaccine(aPV)against pertussis,and to explore the influencing factors of the case surge under the high vaccine coverage,as well as the responding strategies.Methods The clinical data of pertussis patients were analyzed using a matched case-control study with the ratio of 1:2 to investigate the vaccine effectiveness of aPV in preventing pertussis.Results The incidence-age curve showed the“U-shape”.The incidence of infants at the age of 3 months was higher,which was 127.8/100000.The second peak occurred in children aged 5 to 7 years,with the incidence exceeding 60/100000.Among the cases,the breakthrough cases accounted for 86.0%,and the clinical symptoms such as complications of the breakthrough cases were better than those of the unimmunized cases.The total VE of aPV in preventing pertussis was 86.10%(95%CI:34.70%-97.04%),the VE of 1 dose of aPV in preventing pertussis was 85.35%(95%CI:31.10%-96.89%),the VE of 4 doses of aPV was 98.20%(95%CI:74.28%-99.88%),and the VE of onset-vaccination interval less than 1 year was 85.72%(95%CI:32.8%-99.00%),indicating that the increased duration of time after vaccination was a risk factor for pertussis.Conclusion Currently,the immunization strategy of pertussis does not match the epidemic characteristics,and the risk of pertussis is high in infants at the age of 3 months and school-age children.The protective effect of aPV is not timely,so it is necessary to further modify and improve the pertussis immunization strategy,especially to consider the application of pertussis immunization in school-age children.

关 键 词：百日咳 无细胞百日咳类疫苗 保护效果 流行特征 免疫策略 

分 类 号：R516.6[医药卫生—内科学] R186[医药卫生—临床医学]