郑州市麻疹疫苗强化免疫前后麻疹流行病学特征分析

目的了解郑州市麻疹疫苗强化免疫对疾病流行特征的影响,为消除麻疹采取针对性措施提供科学依据。方法对郑州市麻疹强化免疫活动前后的2010年和2011年麻疹发病情况进行描述性流行病学分析。结果郑州市强化免疫后麻疹病例大幅减少,2011年较2010年病例数减少90%;全年病例散发,无明显季节性高峰出现;病例构成仍以1岁以下儿童和无免疫史者为主;城区发病高于农村。结论此次麻疹强化免疫活动效果明显,致使麻疹发病率显著下降。     

Epidemiological situation of measles in Japan and measures for its control

In 2007, measles outbreak occurred mainly among teen/twenties in Japan, and many high-school, universities and colleges were closed to reduce spread of measles. Some high school students became measles when they were in foreign countries where measles has been eliminated, visited as school excursion. Since introducing measles vaccine as routine immunization, number of measles has been reduced remarkably in Japan. However, we had measles outbreak in 2001, and total annual patients number were estimated 200-300 thausands mainly among young infants. The main reason was low immunization coverage of measles at 1 year old, and operation to give measles vaccine as "the gift for 1 year old birthday" has been introduced widely. Then immunization coverage at this age was increased up from 50-60% (2001) to 80-90% (2006) and total measles number was estimated less than 10,000 at 2005 and 2006, however, measles outbreak occurred this time among teen/twenties in 2007. The total number of adult measles (more than 15 y.o.) were higher than the number of them at 2001 outbreak. To discontinue outbreak and to eliminate measles, enhancement of measles control activities has been introduced in Japan. Two doses policy with measles and rubella (MR) vaccine at 1 y.o. and before elementary school has been introduced since 2006 and further, supplementary immunization with MR at 1st grade in junior high school and 3rd grade in high school for 5 years from 2008 will start to eliminate measles by 2012. Reporting system will be also changed from sentinels system to notify to all measles cases system. In this paper, present epidemiological situation on measles in Japan, measles elimination strategy in WPRO, and plan for measles elimination in Japan are described.     

佛山市2004—2009年麻疹流行病学分析和防治措施探讨

通过分析近年来佛山市麻疹流行病学特征,为探讨麻疹控制措施提供理论依据。对2004—2009年麻疹发病情况进行描述性流行病学分析。结果显示,佛山市2004—2009年共报告麻疹病例3 599例,年平均发病率为10.19/10万;发病数前3位的区为顺德区、南海区、禅城区,占全市病例数的94.50%;4～8月为高发季节,占总病例数的66.60%;6岁以下儿童及15岁以上人群是麻疹发病主要人群,分别占总病例数的62.86%、31.54%;8月龄以下儿童发病数占14.48%;病例以流动人口为主,占总病例数的94.78%;有明确免疫史病例仅占总病例数10.22%。佛山市麻疹发病有回升趋势,疫情形势严峻。实施麻疹疫苗强化免疫和查漏补种是控制麻疹的有效措施;同时应采取加强流动人口管理,提高麻疹疫苗常规免疫接种率和及时率,加强麻疹监测和入学、入托查验证管理,控制医院内感染,强化疫区处理等综合防控措施。     

HLA class II-restricted presentation of cytoplasmic measles virus antigens to cytotoxic T cells

To analyze the nature of the HLA class II-restricted cytotoxic T-lymphocyte (CTL) response to measles virus, murine fibroblasts were transfected with expressible cDNA clones for human HLA-DR antigen and for measles virus matrix or nucleocapsid proteins. DR-positive murine fibroblasts transfected with measles virus matrix or nucleocapsid genes were lysed by class II-restricted measles virus-specific CTL lines. Lysis was as efficient as with infected autologous B-cell lines, even though the measles virus cytoplasmic proteins were undetectable by antibodies in the transfected target cells. These results demonstrate that cytoplasmic viral antigens can be presented to CTL in the context of HLA class II antigens and that measles virus matrix and nucleocapsid proteins contribute to class II-restricted measles virus-specific CTL responses. These results also show that endogenously synthesized measles virus proteins can be efficiently presented by class II antigens. The implications of these findings for measles virus pathogenesis and for antigen processing are discussed.     

深圳市南山区西丽人民医院辖区2005-2009年麻疹疫情分析

为了掌握深圳市南山区西丽人民医院辖区内麻疹病毒流行现状,评价该院辖区麻疹疫苗接种效果,为今后制订麻疹预防控制策略提供依据。采用回顾性调查方法,将2005-2009年间的麻疹发病情况作了分析。2005、2007两年发病人数最多,发病率较高,随着麻疹疫苗强化免疫活动的开展,使疫情有了较大的下降趋势。结果表明,接种麻疹疫苗是最有效地预防麻疹疫情的手段。     

克拉玛依市2008年麻疹监测与控制情况分析

分析克拉玛依市麻疹流行状况及预防控制措施,为消除麻疹提供依据。采用描述流行病学分析方法,对2008年克拉玛依市麻疹资料进行分析。结果显示,克拉玛依市2008年麻疹发病率为38.83/10万(138/355381),呈高度散发,较2007年有所上升。发病高峰在3～5月,发病数占全年的83.33%。年龄分布大年龄组高于小年龄组,>20岁年龄组病例占50.00%,<1岁病例占18.84%;流动人口发病占51.11%。应切实提高麻疹常规免疫接种率和做好入托、入学儿童查验预防接种证工作,加强麻疹监测,提高实验室确诊病例的比例。     

宁夏2004—2007年麻疹监测分析

为了客观评价宁夏麻疹监测系统现状,探讨控制和消除麻疹的策略。对宁夏2004—2007年麻疹流行病学和实验室监测工作进行分析。结果显示,宁夏麻疹监测系统的灵敏性较高,疑似麻疹病例标本采集率和血清学诊断率等主要监测指标已达较高水平。同时,对监测到的36株麻疹野病毒基因型进行了探讨,全部为H1基因型H1a亚型,未发现其它基因亚型。因此,宁夏亟需加速控制麻疹,应继续做好麻疹监测和麻疹疫苗免疫接种。     

甘肃省麻疹监测系统报告病例的流行病学分析

目的分析甘肃省近年来麻疹报告发病特点,为实现消除麻疹目标措施的制定提供参考依据。方法对甘肃省2009—2010年疾病监测信息报告系统和麻疹监测系统报告的疑似麻疹病例进行分析。结果 2009—2010年报告麻疹病例1 463例,主要集中在15岁以下年龄组,占病例总数的74.16%,≥15岁病例占病例总数的25.91%。4～7月为发病的高峰季节。对15岁以下进行流行病学调查的病例分析,20.86%的病例未接种过麻疹类疫苗,32.71%的病例免疫史不详。对病例的接触史分析,在发病前7～21d有5.82%的病例明确接触过发热出疹性病人,有12.43%的病例曾去过医院。分离出麻疹病毒H1a基因型,对麻疹疫苗免疫和疫情的防控有指导意义。结论根据麻疹发病年龄构成及免疫史分析,个别地区常规免疫接种不足是造成麻疹发病的主要原因,同时要注意控制院内感染的发生。需要在提高麻疹疫苗常规免疫覆盖率的基础上,进一步深入和规范监测工作,提高监测调查质量。     

日照市2005—2011年麻疹监测分析

目的分析日照市2005—2011年麻疹流行病学特征,为制定消除麻疹策略及措施提供依据。方法对日照市2005—2011年麻疹监测系统资料进行描述流行病学分析。结果日照市2005—2011年共报告麻疹病例193例,其中2011年无病例报告,年平均报告发病率0.97/100 000。麻疹病例分布各区县,但不同区县之间存在差异,发病高峰在3—6月,以15岁以上大年龄组发病为主;散发和暴发并存,散发以本土病例为主,共暴发疫情3起,均为输入性病例。结论日照市消除麻疹已取得显著进展,应继续保持和巩固高水平儿童基础免疫接种率,高质量地完成MV SIA,加强监测和风险评估,做好暴发疫情的预警与控制工作,实现消除麻疹。     

梅州市两次麻疹疫苗强化免疫效果分析

目的综合评估分析梅州市两次麻疹疫苗强化免疫效果,为消除麻疹提供科学依据。方法综合分析麻疹疫苗强化免疫现场调查资料、评估法定传染病报告系统中麻疹发病率的变化;随机对辖区内1～12岁健康儿童216名,采用酶联免疫吸附试验(ELISA)进行强化免疫前及完成二次强化免疫后麻疹lgG抗体水平监测。结果监测人群完成二次强化免疫后麻疹IgG抗体阳性率达100.00%(216/216),2009年强化组、2010年强化组麻疹IgG抗体保护率和几何平均滴度(GMT)分别为82.08%、87.62%和1958.83、2050.26,均显著高于强化免疫前;2009年强化免疫后麻疹年发病率由强化免疫前五年平均发病率1.71/10万下降至0.22/10万,下降率87.13%,2010年强化后麻疹年发病率再次下降(0.039/10万),下降率82.27%。结论梅州市两次麻疹疫苗强化免疫效果显著,均大幅度降低了麻疹发病率、提高了人群麻疹抗体水平。     

Case Based Measles Surveillance in Pune: Evidence to Guide Current and Future Measles Control and Elimination Efforts in India

Background

According to WHO estimates, 35% of global measles deaths in 2011 occurred in India. In 2013, India committed to a goal of measles elimination by 2020. Laboratory supported case based measles surveillance is an essential component of measles elimination strategies. Results from a case-based measles surveillance system in Pune district (November 2009 through December 2011) are reported here with wider implications for measles elimination efforts in India.

Methods

Standard protocols were followed for case identification, investigation and classification. Suspected measles cases were confirmed through serology (IgM) or epidemiological linkage or clinical presentation. Data regarding age, sex, vaccination status were collected and annualized incidence rates for measles and rubella cases calculated.

Results

Of the 1011 suspected measles cases reported to the surveillance system, 76% were confirmed measles, 6% were confirmed rubella, and 17% were non-measles, non-rubella cases. Of the confirmed measles cases, 95% were less than 15 years of age. Annual measles incidence rate was more than 250 per million persons and nearly half were associated with outbreaks. Thirty-nine per cent of the confirmed measles cases were vaccinated with one dose of measles vaccine (MCV1).

Conclusion

Surveillance demonstrated high measles incidence and frequent outbreaks in Pune where MCV1 coverage in infants was above 90%. Results indicate that even high coverage with a single dose of measles vaccine was insufficient to provide population protection and prevent measles outbreaks. An effective measles and rubella surveillance system provides essential information to plan, implement and evaluate measles immunization strategies and monitor progress towards measles elimination.     

The antimeasles immunity in infants in the 1st year of life

The serological survey of 138 infants aged 8 months and 138 mothers having had protective titers of specific antibodies to measles during pregnancy was made. The study revealed that passively transferred antibodies to measles circulated in infants for a longer time and were detected more frequently under the conditions of breast feeding by mothers having had measles (up to 93.7% of infants). In artificially fed infants, born of mothers having had no measles, but previously vaccinated against this infection, antibodies to measles were detected in rather rare cases (only in 7.3%). In infants, artificially fed, but born of mothers having had measles, the level of antibodies to measles was practically unchanged (81.6%).     

麻疹减毒活疫苗国家参考品的制备及标定

为了制备麻疹减毒活疫苗国家参考品,选用国内麻疹疫苗生产株沪191制备麻疹疫苗参考品。生产过程中严格控制精密性、水分含量,对候选参考品进行鉴别试验、水分含量、病毒滴度及无菌检查等检验。检验合格后组织进行候选参考品病毒滴度协作标定,共有5个实验室参加了协作标定。协作标定完成后,对实验室内变异、实验室间变异及国际参考品在不同实验室间的变异进行了分析。此外还对疫苗进行了热稳定性和实时稳定性分析。结果显示经5个实验室协作标定后,麻疹减毒活疫苗国家参考品的滴度为4.96±0.26 lgCC ID50/m l,实验室内部变异在1.09%～4.64%之间,实验室间变异为2.62%。国际参考品在不同实验室间的变异为4.19%。稳定性考核数据表明制备的参考品具有较好的稳定性,符合作为麻疹减毒活疫苗国家参考品的要求,滴度为4.96±0.26 lgCC ID50/m l。     

佛山市南海区2004—2010年麻疹流行病学特征分析及控制策略探讨

了解佛山市南海区2004—2010年麻疹流行病学特征,为进一步完善和制订消除麻疹策略与措施提供科学依据。采用流行病学方法对佛山市南海区2004—2010年麻疹发病资料进行分析。结果显示,佛山市南海区2004—2010年累计确诊麻疹病例1 376例,年平均发病率为9.24/10万;全年均有发病,3～8月是麻疹高发季节,但近年来随着麻疹防控措施的落实,季节性已不明显;麻疹发病以5岁以下儿童为主,占总发病数的55.7%,,近年来麻疹发病年龄趋势向<1岁人群组和≥15岁人群组发展,这两个年龄组发病数占总发病人数的62.8%;病例中无免疫史或免疫史不详者占92.2%。佛山市南海区麻疹发病年龄分布已逐步呈现"双向位移"现象,加强对重点人群、重点地区的免疫规划管理,提高麻疹疫苗接种率,是控制麻疹发病的有效措施。同时适时开展强化免疫接种是保护易感人群,进而实现消除麻疹的重要策略.     

Altered Reactivity to Measles Virus in Previously Vaccinated Children

In children vaccinated with killed measles vaccine, exposure to natural rubeola within two to four years can result in a clinical syndrome of altered measles reactivity.During a small epidemic of measles in Edmonton, Alberta, 51 children who had received their last killed measles vaccination 27 to 45 months before, were admitted to hospital with this syndrome.The syndrome consists of a prodromal cough and high fever followed by a maculopapular rash appearing on the extremities and progressing centrally. Pulmonary consolidations with or without pleural effusions were evident, but these cleared rapidly in four or five days. Initial WBC and ESR values suggested a bacterial etiology, but no pathogens could be isolated.Complement fixation titres for rubeola are present in acute and convalescent sera and indicate a definite measles infection.Previous killed measles vaccination excites a delayed hypersensitivity which is activated by the natural measles infection to account for this syndrome.It is recommended that killed measles vaccine be no longer used in routine vaccinations.     

Use of the leukocyte adherence inhibition reaction for assessing the effectiveness of vaccination against measles

The reaction of the inhibition of leukocyte adhesion to a glass slide under the action of measles antigen may be used for the evaluation of the activity of antigen-specific T-lymphocytes in the process of immunization against measles and recommended, along with serological studies, for finding out persons susceptible to measles among vaccinees. The immunological effect of booster immunizations against measles can be evaluated by the degree of the inhibition of leukocyte agglutination to a glass slide.     

许昌市2009—2013年麻疹流行病学特征和监测系统运转状况分析

目的分析许昌市2009—2013年麻疹流行特征和监测系统运转状况,为加速消除麻疹制定策略及措施提供科学依据。方法利用描述性流行病学方法对许昌市2009—2013年麻疹监测系统资料进行统计分析。结果许昌市2009—2013年累计报告麻疹病例675例,年均报告发病率为3.16/10万。全市8个县、市区均有病例报告,病例数主要集中在禹州市,占总病例数的55.56%;发病呈明显的季节性分布,主要集中在2—5月份,占总病例数的73.48%;病例主要集中于0~6岁儿童,占总病例数的85.63%,其中1岁以下婴幼儿占总病例数的50.22%;8月龄~14岁麻疹病例中有确切免疫史者仅占38.58%。随着监测系统及时性和特异性逐年提高,48 h完整调查率由2009年的88.32%上升至2012年的100%;血标本3 d内送达率由2009年的51.68%上升至2013年的100%;实验室结果 7 d内报告率由2009年的52.80%上升至2013年的100%;血标本采集率从2009年48.86%上升至2013年的100%;暴发血清学确诊率、病原学标本采集率均上升至100%。2009—2013年麻疹监测系统敏感性低,排除病例报告发病率为0.49/10万~1.43/10万。结论 2009—2013年许昌市麻疹发病率下降,小年龄组发病构成增加。监测系统运转综合质量逐年提升,但敏感性低。今后应进一步加强麻疹类疫苗接种与管理,提高人群免疫水平;加强医疗机构传染病报告与管理,提高监测系统敏感性,防止传染源扩散。     

河南省漯河市2005—2010年麻疹流行病学分析

目的掌握河南省漯河市麻疹流行特征与规律,探讨漯河市麻疹防治对策与措施。方法收集漯河市2005—2010年麻疹疫情及监测资料,用Excel统计软件进行分析。结果漯河市2005—2010年共报告麻疹病例683例,平均发病率为4.55/10万,2005—2007年发病率逐年上升,2008—2010年逐年下降,3—5月份为发病高峰,发病年龄以≤3岁散居儿童为主。结论提高麻疹疫苗常规免疫接种覆盖率及8月龄儿童麻疹疫苗及时接种率是控制和消除麻疹的关键。     

104例麻疹病例的流行病学分析

目的分析平顶山市麻疹病例发生的原因,为加速控制和消除麻疹提供科学依据。方法对平顶山市2013年法定传染病疫情报告资料和麻疹监测资料进行流行病学分析。结果平顶山市2013年共报告麻疹104例,年发病率为2.11/10万,2~4月为发病高峰;男女发病率差异有统计学意义,发病以3岁以下儿童居多,占发病总数的86.54%;其中8月龄~1岁者最多,占39.42%;14岁以上者9例,占8.65%,其他年龄组发病率随年龄增大而逐步下降。从病例就诊、住院时间上推断其感染方式可能以医院内感染为主。结论常规免疫接种率和首针及时接种率不高是麻疹高发的主要原因,医院内交叉感染是麻疹的传播因素,提高易感人群麻疹疫苗接种率,控制院内感染是控制、消除麻疹的有效手段。     

我们离麻疹消除还有多远?

中国麻疹发病率自2008年起出现大幅度下降,但2012年底以来麻疹发病疫情呈上升趋势,部分城市出现了以成人为主的疫情暴发。导致麻疹疫情再次上升的一个可能原因是中国的麻疹疫苗实际接种率低于报告接种率,常规免疫有不到位的情况。同时,中国存在部分麻疹免疫空缺人群,既未接种过麻疹常规疫苗,也没有参加过2004—2010年的补充免疫活动。这类人群积累到一定程度后,可引起聚集性的疫情暴发。中国在消除麻疹方面虽已取得显著进展,但近年来疫情再次抬头值得警惕。进一步增加常规麻疹两剂疫苗接种率,对重点地区和人群适当增加补充免疫活动,更好地落实麻疹应急预案等,将有助于控制并消除麻疹疫情。