水痘疫苗接种对学校暴发疫情的保护效果及影响因素分析

麦炜桢; 李佳玲; 谢莘; 梁文佳; 李伟南; 林丹儿; 吴娴波; 朱琦; 马文军

doi:10.16835/j.cnki.1000-9817.2023.02.027

水痘疫苗接种对学校暴发疫情的保护效果及影响因素分析

doi: 10.16835/j.cnki.1000-9817.2023.02.027

麦炜桢^{1, 2},
李佳玲³,
谢莘³,
梁文佳³,
李伟南⁴,
林丹儿⁵,
吴娴波¹,
朱琦^3, ,,
马文军^{1, 2, ,}

1.
南方医科大学公共卫生学院，广东广州 510515
2.
广东省疾病预防控制中心广东省公共卫生研究院
3.
广东省疾病预防控制中心免疫所
4.
汕头市疾病预防控制中心疾病控制科
5.
广州市白云区疾病预防控制中心免疫规划科

基金项目:

广东省重点领域研发计划资助 2020B0101130019

广东省重点领域研发计划资助 2019B111103001

详细信息

作者简介:
麦炜桢(1996-)，女，广东江门人，在读硕士，主要研究方向为疫苗可预防控制传染病

通讯作者:
朱琦，E-mail：zqraul7@163.com

马文军，E-mail：mawj@gdiph.org.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R186 G478 R193
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- 被引次数: 0
出版历程
- 收稿日期: 2022-09-20
- 修回日期: 2022-11-30
- 网络出版日期: 2023-03-02
- 刊出日期: 2023-02-25

Effectiveness and associated factors of varicella vaccination on school outbreaks

MAI Weizhen^{1, 2},
LI Jialing³,
XIE Xin³,
LIANG Wenjia³,
LI Weinan⁴,
LIN Daner⁵,
WU Xianbo¹,
ZHU Qi^{3
, ,},
MA Wenjun^{1, 2
, ,}

1.
School of Public Health, Southern Medical University, Guangzhou(510515), China

摘要

摘要: 目的评价学校水痘暴发疫情中，水痘疫苗免疫史对发病以及疾病严重程度的影响，并探索其影响因素，为制定相应预防控制措施提供参考。方法选择广东省2021年发生水痘疫情的2所中小学校中既往没有水痘患病史的3 888名学生。采用回顾性队列研究方法进行问卷调查，计算相对危险度(RR)和保护效果(VE)，并分析水痘疫苗保护效果的影响因素。结果研究对象中水痘确诊病例138例。不同性别学生的疫苗接种率差异无统计学意义(χ²=1.36，P=0.51)，不同年龄组学生的疫苗接种率差异有统计学意义(χ²=555.82，P < 0.01)。水痘疫苗总体保护效果为66.94%(95%CI=56.17%~77.71%)，2剂次疫苗保护效果(VE=90.02%，95%CI=83.13%~96.90%)高于1剂次(VE=49.40%，95%CI=32.36%~66.44%)，差异有统计学意义(χ²=24.93，P < 0.01)。疫苗接种组与未接种组高热率分别为7.69%和25.81%，中重度皮损率分别为20.00%和50.00%，差异均有统计学意义(χ²值分别为6.29，11.32，P值均 < 0.05)。水痘疫苗对高热和中重度皮疹的保护效果分别为70.19%(95%CI=42.11%~98.27%)和60.00%(95%CI=38.15%~81.85%)。分层分析发现，不同接种年限间水痘疫苗保护效果差异有统计学意义(χ²=37.87，P < 0.05)，而接种年龄与疫苗厂家间差异均无统计学意义(P值均>0.05)。结论接种水痘疫苗可以预防水痘感染和降低疾病严重程度，疫苗保护效果受到接种年限的影响。建议提高水痘疫苗的接种覆盖率预防疫情的暴发。
- 水痘疫苗 /
- 接种 /
- 疾病暴发流行 /
- 因素分析，统计学 /
- 学生
Abstract: Objective To evaluate the effectiveness of varicella vaccine in varicella outbreaks and to analyze the influencing factors, and to provide a reference for making the targeted prevention and controlling measures. Methods A total of 3 888 students with no history of varicella were selected from 2 schools with varicella outbreak in Guangdong Province in 2021, a retrospective cohort study was conducted by using questionnaire survey, rate ratio (RR) and vaccine effectiveness (VE) values were calculated and Logistic regression was uses to analyze the factors influencing the protective effect of varicella. Results There were 138 confirmed cases of varicella among the participants. There was no significant sex difference in the vaccination rate(χ²=1.36, P=0.51), but there was significant difference in the vaccinattion rate of different age groups(χ²=555.82, P < 0.01). The overall protective effect of VarV was 66.94%(95%CI=56.17%-77.71%), and the protective effect of 2 doses of vaccine(VE=90.02%, 95%CI=83.13%-96.90%) was higher than that of 1 dose(VE=49.40%, 95%CI=32.36%-66.44%)(χ²=24.93, P < 0.01). The high fever rates in the vaccinated and unvaccinated groups were 7.69% and 25.81%, with significant difference(χ²=6.29, P < 0.05). The rates of moderate and severe skin lesions of vaccinated and unvaccinated groups was 20.00% and 50.00%, respectively, and the difference was statistically significant(χ²=11.32, P < 0.01). The protective effects of varicella vaccine against high fever and moderate to severe rash were 70.19%(95%CI=42.11%-98.27%) and 60.00%(95%CI=38.15%-81.85%). Stratified analysis showed that there were significant differences in different years of vaccination(χ²=37.87, P < 0.05), while there were no significant differences in age of vaccination and vaccine manufacturer (P>0.05). Conclusion Varicella vaccination can prevent chickenpox infection and reduce the severity of the disease. However, the efficacy of varicella vaccine was affected by vaccination years. It is recommended to improve the vaccination coverage of varicella vaccine to prevent the outbreak of the epidemic.
- Chickenpox vaccine /
- Vaccination /
- Disease outbreaks /
- Factor analysis, statistical /
- Students
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1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 不同组别研究对象疫苗接种率比较

Table 1. Comparison of vaccination among different groups of subjects

组别	选项	人数	1剂次	2剂次	χ²值	P值
性别	男	2 242	975(43.49)	718(32.02)	1.36	0.51
	女	1 646	685(41.62)	544(33.05)
年龄/岁	6~8	1 515	455(30.03)	777(51.29)	555.82	< 0.01
	9~11	1 912	1 009(52.74)	454(23.74)
	12~16	461	196(42.52)	31(6.72)
注： ()内数字为接种率/%。

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表 2 水痘疫苗对儿童高热和中重度皮损的保护效果

Table 2. Protective effect of varicella vaccine on high fever and moderate to severe skin lesions

水痘疫苗接种情况	人数	发热症状				疱疹症状
水痘疫苗接种情况	人数	高热人数	高热率/%	RR值(RR值95%CI)	VE值(VE值95%CI)/%	中重度皮损人数	中重度皮损率/%	RR值(RR值95%CI)	VE值(VE值95%CI)/%
未接种	62	16	25.81	1.00		31	50.00	1.00
接种	65	5	7.69	0.30(0.10~0.87)	70.19(42.11~98.27)	13	20.00	0.40(0.18~0.88)	60.00(38.15~81.85)
1剂次	57	5	8.77	0.34(0.12~1.00)	66.01(34.14~97.88)	10	17.54	0.35(0.15~0.82)	64.91(43.32~86.51)
2剂次	8	0	0	—	100.00	3	37.50	0.75(0.16~3.41)	25.00(-44.64~94.64)

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表 3 水痘疫苗保护效果影响因素分析

Table 3. Analysis of factors affecting the protective effect of varicella vaccine

变量	组别	人数	发病人数	发病率/%	VE值(VE值95%CI)/%
接种年限/年	< 3	832	4	0.48	90.41(80.50~100.00)
	3~5	696	9	1.29	74.22(55.36~93.08)
	6~8	756	24	3.17	36.71(3.88~69.53)
	≥9	638	32	5.02	1.00
接种年龄/月	< 15	1 342	35	2.61	1.00
	≥15	1 580	34	2.15	17.49(-20.96~55.97)
疫苗厂家	A	507	19	3.75	1.00
	B	676	21	3.11	17.11(-33.44~67.65)
	C	143	2	1.40	62.68(8.74~116.61)
	D	123	2	1.63	56.61(-6.03~119.25)
	E	279	4	1.43	61.74(20.87~102.61)
	F	1 194	21	1.76	53.07(24.35~81.78)
注：英文字母A至F分别代表国内疫苗生产的6个品牌。

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