上海市静安区2017—2019年集体机构学生水痘疫苗应急接种效果评估

张小娟; 敖建军; 余平; 权力; 卑伟慧; 华瑞珏; 黄瑾

doi:10.16835/j.cnki.1000-9817.2023.01.031

上海市静安区2017—2019年集体机构学生水痘疫苗应急接种效果评估

doi: 10.16835/j.cnki.1000-9817.2023.01.031

上海市静安区疾病预防控制中心免疫规划所, 200072

详细信息

作者简介:
张小娟(1980-), 女, 江苏省人, 硕士, 主管医师, 主要研究方向为流行病学和免疫规划管理

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R186 G478 R183
计量
- 文章访问数: 341
- HTML全文浏览量: 181
- PDF下载量: 39
- 被引次数: 0
出版历程
- 收稿日期: 2022-06-09
- 修回日期: 2022-07-10
- 网络出版日期: 2023-02-06
- 刊出日期: 2023-01-25

Epidemiological evaluation for vaccine effectiveness of varicella attenuated live vaccine among students in collective institutions in Jing'an District, Shanghai from 2017 to 2019

Immunization Planning Department, Center for Disease Control and Prevention, Jing'an District, Shanghai(200072), China

摘要

摘要: 目的了解集体机构学生水痘减毒活疫苗(varicella attenuated live vaccine, VarV)的接种情况, 为分析疫苗接种的保护效果提供依据。方法将2017—2019年静安区所有发生水痘疫情并开展应急接种的集体机构作为研究场所, 将其涉及到的发病班级内所有学生(6 473名)作为研究对象, 收集水痘发病信息、VarV接种情况, 分析VarV的保护效果(vaccine effectiveness, VE)及不同状态下应急接种的效果。结果学生无免疫史的比例逐年下降, 2017年为7.5%、2018年为7.2%、2019年为4.9%;病例中VarV既往免疫史的比例(90.0%)低于非病例(93.5%), 差异有统计学意义(χ²=6.53, P < 0.05);病例中VarV应急接种的比例(8.3%)低于非病例(44.1%), 差异有统计学意义(χ²=179.06, P < 0.01);续发病例中VarV应急接种的比例(28.6%)低于非病例(44.1%), 差异有统计学意义(χ²=9.44, P < 0.01);无既往免疫史且未开展应急接种的研究对象水痘罹患率最高(11.0%), 有既往免疫史且开展了应急接种的研究对象水痘罹患率最低(1.0%); 相对于无VarV免疫史的对象, 接种1剂VarV后2年内有明确的保护效果, VE为63.1%(95%CI=11.0%~84.7%)。结论接种1剂VarV保护效果不高; 尽早开展VarV应急接种可以有效降低续发率。
- 水痘疫苗 /
- 接种 /
- 患病率 /
- 学生
Abstract: Objective To understand the vaccination of varicella attenuated live vaccine (VarV) among students in collective institutions, to provide a basis for analying the protective effect of vaccination. Methods All collective institutions with chickenpox epidemic and post-exposure vaccination in Jing'an District from 2017 to 2019 were investigated. All students(n=6 473) in the affected class were included. Vaccination status and the incidence information of disease were collected to analyze vaccine effectiveness (VE). Results The proportion of study subjects without an immunization history decreased year by year, and 7.5% in 2017, 7.2% in 2018, and 4.9% in 2019. The proportion with a history of one dose prior to exposure in cases was 90.0%, it was lower than 93.5% in the non cases (χ²=6.53, P < 0.05). The proportion with one dose as post-exposure prophylaxis in cases was 8.3%, it was much lower than 44.1% in the non cases (χ²=179.06, P < 0.01). The proportion with one dose as post-exposure prophylaxis in secondary cases was 28.6%, much lower than 44.1% in the non cases (χ²=9.44, P < 0.01).Unvaccinated ones and the second dose as post-exposure prophylaxis ones in cases had the highest rate of varicella development (11.0%), a history of one dose prior to exposure and one dose as post-exposure prophylaxis in cases had the lowest varicella rate (1.0%).There was a clear protective effect within two years after one dose of VarV inoculation, VE was 63.1%(95%CI=11.0%-84.7%). Conclusion The vaccine effectiveness of one-dose VarV was limited. Post-exposure prophylaxis as early as possible was highly effective in decreasing secondary attack rate.
- Chickenpox vaccine /
- Vaccination /
- Prevalence /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 应急接种启动时间与疫情持续时间的关系

Table 1. Relationship between the start time of post-exposure prophylaxis and the duration of epidemic situation

应急接种启动时间/d	≤1周疫情起数	＞1周疫情起数	χ²值	P值
≤3	17(73.9)	6(26.1)	18.64	＜0.01
≥4	19(24.7)	58(75.3)
合计	36(36.0)	64(64.0)
注：()内数字为构成比/%。

下载: 导出CSV

表 2 应急接种启动时首发病例数量与疫情严重程度的关系

Table 2. Relationship between the number of first-episode cases and the severity of the epidemic

首发病例数	≤4例疫情起数	≥5例疫情起数	χ²值	P值
≤2	58(90.6)	6(9.4)	7.33	＜0.01
≥3	25(69.4)	11(30.6)
合计	83(83.0)	17(17.0)
注：()内数字为构成比/%。

下载: 导出CSV

表 3 接种1剂VarV的保护效果

Table 3. The VE of different vaccination status of VarV

接种情况		病例	非病例	χ²值	P值	OR值(OR值95%CI)	VE(VE 95%CI)/%
未接种		36	398	—	—	—	—
接种组(1剂)		297	4 307	2.19	0.14	0.76(0.53~1.09)	23.8(-9.4~46.9)
接种时间/年	0~ < 2	6	180	5.30	0.02	0.37(0.15~0.89)	63.1(11.0~84.7)
	2~＜3	14	268	2.92	0.09	0.58(0.31~1.09)	42.2(-9.1~69.4)
	3~＜4	26	390	1.31	0.25	0.74(0.44~1.24)	26.3(-24.4~56.3)

下载: 导出CSV

参考文献(17)

[1]	倪朝荣, 张晓铭, 潘琼娇, 等. 温州市一起小学水痘暴发疫情的疫苗保护效果评价[J]. 中国学校卫生, 2018, 39(8): 1268-1270. doi: 10.16835/j.cnki.1000-9817.2018.08.047 NI C R, ZHANG X M, PAN Q J, et al. Evaluation of vaccine protection effect on an outbreak of chickenpox in a primary school in Wenzhou[J]. Chin J Sch Health, 2018, 39(8): 1268-1270. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2018.08.047
[2]	孙烨祥, 李珊燕, 徐来荣, 等. 宁波市鄞州区幼托儿童水痘疫苗加强免疫接种状况[J]. 中国学校卫生, 2016, 37(10): 1585-1587. doi: 10.16835/j.cnki.1000-9817.2016.10.046 SUN Y X, LI S Y, XU L R, et al. Status of booster immunization of varicella vaccine for children in kindergartens in Yinzhou District, Ningbo[J]. Chin J Sch Health, 2016, 37(10): 1585-1587. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2016.10.046
[3]	上海市疾病预防控制中心. 关于下发《上海市水痘疫苗应急接种实施方案(2015年版)》的通知[Z]. 2015-01-06. Center for Disease Control and Prevention of Shanghai. Emergency vaccination implementation plan for varicella in Shanghai (version in 2015)[Z]. 2015-01-06. (in Chinese)
[4]	国家卫生健康委. 关于印发国际疾病分类第十一次修订本(ICD-11)中文版的通知[Z]. 2018-12-14. National Health Commission of the PRC. Notice on the issuance of the 11 th Revision of the International Classification of Diseases (ICD-11) Chinese version[Z]. 2018-12-14. (in Chinese)
[5]	上海市卫生和计划生育委员会, 上海市财政局. 关于将水痘疫苗纳入本市免疫规划的通知[Z]. 2018-06-21. Shanghai Municipal Health and Family Planning Commission, Shanghai Municipal Finance Bureau. Notice on incorporating chickenpox vaccine into the municipal immunization plan[Z]. 2018-06-21. (in Chinese)
[6]	蔡一飙, 李萍萍, 赵凤敏, 等. 宁波市学校水痘暴发疫情及疫苗接种效果调查[J]. 浙江预防医学, 2016, 28(2): 174-175. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX201602022.htm CAI Y B, LI P P, ZHAO F M, et al. Analysis of protective effect of vaccine of outbreaks of varicella in schools in Ningbo[J]. Zhejiang J Prev Med, 2016, 28(2): 174-175. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX201602022.htm
[7]	WHO. Varicella and herpes zoster vaccines: WHO position paper, June 2014[J]. Wkly Epidemiol Rec, 2014, 89(25): 265-287.
[8]	马蕊, 孙美平, 孙木, 等. 北京市小学生水痘疫苗应急接种效果及影响因素评价[J]. 中华流行病学杂志, 2009, 30(6): 559-563. doi: 10.3760/cma.j.issn.0254-6450.2009.06.006 MA R, SUN M P, SUN M, et al. Effectiveness on post-exposure vaccination of varicella and its influencing factors in elementary schools in Beijing[J]. Chin J Epidemiol, 2009, 30(6): 559-563. (in Chinese) doi: 10.3760/cma.j.issn.0254-6450.2009.06.006
[9]	LI T. Varicella emergency vaccination seemed instrumental in declining chickenpox incident in Guangzhou, Southern China[J]. Rev Inst Med Trop Sao Paul, 2013, 55(3): 217. doi: 10.1590/S0036-46652013000300016
[10]	上海市疾病预防控制中心. 关于下发《上海市水痘疫苗应急接种实施方案(2013—2014年试行版)》的通知[Z]. 2013-11-18. Shanghai Municipal Center for Disease Control and Prevention. Emergency vaccination implementation plan for varicella in Shanghai (trial version in 2013-2014)[Z]. 2013-11-18. (in Chinese)
[11]	杜艳, 余峰, 张莉萍, 等. 上海市闵行区4~17岁儿童水痘减毒活疫苗接种情况及其保护效果[J]. 中华预防医学杂志, 2014, 48(12): 1048-1052. doi: 10.3760/cma.j.issn.0253-9624.2014.12.006 DU Y, YU F, ZHANG L P, et al. Analysis of protective effect of using chickenpox live attenuated vaccine among 4-17 years old children in Minhang District, Shanghai[J]. Chin J Prev Med, 2014, 48(12): 1048-1052. (in Chinese) doi: 10.3760/cma.j.issn.0253-9624.2014.12.006
[12]	杨彦基. 上海市虹口区教学机构水痘疫苗应急接种的保护效果观察[J]. 中华预防医学杂志, 2016, 50(1): 91-93. YANG Y J. Effectiveness of vaccination following varicella outbreaks among schools in Hongkou District, Shanghai[J]. Chin J Prev Med, 2016, 50(1): 91-93. (in Chinese)
[13]	WU Q S, LIU J Y, WANG X, et al. Effectiveness of varicella vaccine as post-exposure prophylaxis during a varicella outbreak in Shanghai, China[J]. Int J Infect Dis, 2018(66): 51-55.
[14]	高洁, 卑伟慧, 沈冰, 等. 上海市静安区水痘聚集性疫情中1剂次水痘减毒活疫苗保护效果观察[J]. 中国疫苗和免疫, 2017, 23(5): 547-550. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJM201705014.htm GAO J, BEI W H, SHEN B, et al. Effectiveness of one dose of varicella attenuated live vaccine in varicella outbreaks in Jing'an District, Shanghai[J]. Chin J Vaccin Immun, 2017, 23(5): 547-550. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJM201705014.htm
[15]	姜大雷, 李智, 徐娜, 等. 上海市不同病例数时水痘疫苗应急接种效果评价[J]. 中国公共卫生, 2018, 34(6): 861-863. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201806021.htm JIANG D L, LI Z, XU N, et al. Efficiency of emergency vaccination of varicella vaccine under different epidemic condition in Shanghai City[J]. Chin J Public Health, 2018, 34(6): 861-863. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201806021.htm
[16]	张楠, 李智, 徐娜, 等. 不同时间间隔水痘疫苗应急接种有效性分析[J]. 中国生物制品学杂志, 2018, 31(4): 388-391. https://www.cnki.com.cn/Article/CJFDTOTAL-SWZP201804010.htm ZHANG N, LI Z, XU N, et al. Effectiveness of emergency vaccination with varicella vaccine at different time intervals after appearance of the first cases of varicella[J]. Chin J Biologic, 2018, 31(4): 388-391. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-SWZP201804010.htm
[17]	BREUER J, SCHMID D S. Vaccine Oka variants and sequence variability in vaccine-related lesions[J]. J Infect Dis, 2008, 197(Suppl 2): S54-S57.