深圳市儿童手足口病既往感染和接种EV 71疫苗对二次感染的保护效果分析  

Analysis on effectiveness of protection against hand-foot-mouth disease reinfection after previous infection and EV 71 vaccination of children in Shenzhen

作　　者：李雪梅[1] 林凯[1] 刘雅文 古丽斯 徐震东 张陈欢 黄仁湛 于海航 LI Xuemei;LIN Kai;LIU Yawen;GU Lisi;XU Zhendong;ZHANG Chenhuan;HUANG Renzhan;YU Haihang(Yantian District Center for Disease Control and Prevention,Shenzhen 518000,Guangdong Provicne,China.)

机构地区：[1]深圳市盐田区疾病预防控制中心,广东深圳518000

出　　处：《预防医学情报杂志》2024年第11期1371-1375,1402,共6页Journal of Preventive Medicine Information

摘　　要：目的分析儿童手足口病(hand-foot-mouth disease,HFMD)既往感染和接种EV 71灭活疫苗产生的混合免疫对二次感染的保护作用和免疫持久性,为预防HFMD二次感染提供参考。方法从中国疾病预防控制信息系统、深圳市免疫规划信息管理系统中获取2010—2022年深圳市盐田区HFMD个案及EV 71疫苗接种史,按照回顾性队列研究方法,使用R 4.2.1软件,运用Kaplan-Meier和Cox回归分析既往感染和接种EV 71疫苗对HFMD二次感染的免疫持久性和保护作用。结果共纳入HFMD个案7026人次,二次感染率4.83%(324/6702)。二次感染个案中,男女性别比为1.84∶1;首次发病时年龄中位数1岁,再次发病时为3岁;首次发病时散居儿童、幼托儿童和其他人群分别占81.79%、17.28%、0.93%,再次发病时分别占42.59%、50.31%、7.10%,不同人群二次感染发生率差异有统计学意义(P<0.001)。总体而言首次发病至再次发病的时间间隔为1.33至124.97个月,中位时间16.67个月,接种2针次疫苗者时间间隔为26.8个月,较未接种疫苗者的15.8个月、接种1针次者的22.7个月长,差异有统计学意义(P=0.011)。接种2剂次疫苗者二次感染发生率为2.34%,低于未接种疫苗者的5.10%、接种1针次者的3.61%,差异有统计意义(P=0.010)。Kaplan-Meier生存分析发现,未接种疫苗者,首次发病3年内发生二次感染风险快速上升,12个月、24个月和36个月累计发病风险为1.7%、3.4%和4.2%,接种2剂次EV 71灭活疫苗者发生二次感染的累计风险为0.3%、1.4%和2.2%,差异有统计学意义(P=0.016)。Cox回归分析显示,在校正年龄、人群分类、首次感染年份流行株等因素后,接种2剂次EV71灭活疫苗者发生二次感染风险明显低于未接种者(HR=0.401,95%CI:0.234~0.688),免疫保护效果59.9%。结论在既往感染的基础上,接种2剂次EV 71灭活疫苗可有效预防HFMD二次感染,建议HFMD恢复期儿童在3年内接种EV 71灭活疫苗。Objective This study investigated the effectiveness and durability of hybrid immunity resulting from previous infection and EV 71 vaccination against HFMD reinfection,to provide reference for the preventive strategy of HFMD reinfection.Methods HFMD cases reported in the Chinese Disease Prevention and Control Information System in Yantian District of Shenzhen from 2010 to 2002,and vaccination data were obtained from the Shenzhen Immunization Program Information Management System.We estimated Kaplan-Meier risks and performed a Cox regression model by using R4.2.1 to investigate the level and durability of protection against reinfection after previous infection and EV 71 vaccination.Results Of 7026 participants,4.83%(324/6702)of them were reinfection,with a male-to-female ratio of 1.84∶1.The median age of first infection was 1 year old,while the median age of reinfection was 3 years old.At the time of the first incidence,81.79%,17.28%and0.93%were found in scattered children,preschool children and other populations,respectively.And at the time of the second onset,42.59%,50.31%and 7.10%were found in them,respectively.The differences among differenct populations was considerded statistically significant(P<0.001).The time interval between first infection and reinfection was 1.33 to 124.97 months,with a median time interval of 16.67 months.The time interval of those who received 2 doses of vaccine was26.8 months,which was longer than 15.8 months for those who did not receive the vaccine and22.7 months for those who received 1 dose,and the difference was considerded statistically significant(P=0.11).The incidence of reinfection was 2.34%in those who received 2 doses of vaccine,which was lower than 5.10%in those who did not receive the vaccine and 3.61%in those who received 1 dose,the difference was statistically significant(P=0.010).Kaplan-Meier estimates showed that the risk of reinfection rose rapidly three years after the first infection among children who did not receive EV 71 vaccination.The cumulative risk in the

关 键 词：手足口病 EV 71灭活疫苗 二次感染 COX回归分析 疫苗保护效果 

分 类 号：R512.5[医药卫生—内科学]