人类免疫缺陷病毒感染儿童疫苗接种情况调查
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摘要
目的了解人类免疫缺陷病毒(HIV)感染患儿这一特殊群体疫苗接种情况。方法对截至2016年12月31日,在国家艾滋病综合防治信息系统中,现住址为湖南省、确诊HIV感染时年龄在15岁以下、可随访到的HIV感染患儿148例进行问卷调查,了解其疫苗接种、HIV感染诊断及相关疾病诊断治疗情况。结果 148例HIV感染患儿中,男70例(47.3%),女78例(52.7%);140例(8例拒答)知晓确诊感染HIV时的年龄为3.8(0.2～14.8)岁;感染来源为母婴传播133例(91.7%),血液传播1例(0.7%),不详14例(9.5%);129例(87.2%)接受抗病毒治疗,未治疗19例(12.8%)。乙肝疫苗、卡介苗、脊灰减毒活疫苗、百白破三联疫苗接种率相对较高(70.9%～77.7%),但远低于全国水平(≥97%),后续疫苗的接种率随患儿年龄增长逐步降低。患儿接种疫苗后无严重不良反应。结论国内儿童HIV感染途径主要是母婴传播,HIV感染儿童诊断延迟明显,疫苗接种率低,需要加强HIV感染患儿的早诊断、早治疗及疫苗接种,提高患儿生存质量。
Objective To investigate the status of vaccination in children with human immunodeficiency virus(HIV) infection. Methods A questionnaire survey was performed in 148 children in Hunan province, China who were registered in China's Acquired Immune Deficiency Syndrome Comprehensive Response Information Management System up to December 31, 2016 and were aged <15 years at the time of confirmed diagnosis of HIV infection. The information on vaccination, diagnosis of HIV infection, and diagnosis and treatment of related diseases was collected.Results Of the 148 children with HIV infection, there were 70 boys(47.3%) and 78 girls(52.7%); 140 children had an age of 3.8(0.2-14.8) years at the time of confirmed diagnosis, and 8 children refused to answer this question. Mother-tochild transmission was found in 133 children(91.7%), blood transmission in 1 child(0.7%), and unknown in 14 children(9.5%). Of the 148 children, 129(87.2%) received antiviral therapy and 19(12.8%) did not receive such treatment.The vaccination rates of hepatitis B vaccine, bacille Calmette-Guérin vaccine, poliomyelitis live attenuated vaccine and diphtheria-pertussis-tetanus vaccine ranged from 70.9% to 77.7%, which was significantly lower than the national level(≥97%); the vaccination rates of the other vaccines in the National Immunization Program gradually decreased with age.No severe adverse effects were reported after vaccination. Conclusions Mother-to-child transmission is the main route of HIV infection in Chinese children. The diagnosis of children with HIV infection is significantly delayed, with low vaccination rates. Efforts should be made to strengthen early diagnosis, early treatment and vaccination in children with HIV infection, in order to improve their quality of life.
Objective To investigate the status of vaccination in children with human immunodeficiency virus(HIV) infection. Methods A questionnaire survey was performed in 148 children in Hunan province, China who were registered in China's Acquired Immune Deficiency Syndrome Comprehensive Response Information Management System up to December 31, 2016 and were aged <15 years at the time of confirmed diagnosis of HIV infection. The information on vaccination, diagnosis of HIV infection, and diagnosis and treatment of related diseases was collected.Results Of the 148 children with HIV infection, there were 70 boys(47.3%) and 78 girls(52.7%); 140 children had an age of 3.8(0.2-14.8) years at the time of confirmed diagnosis, and 8 children refused to answer this question. Mother-tochild transmission was found in 133 children(91.7%), blood transmission in 1 child(0.7%), and unknown in 14 children(9.5%). Of the 148 children, 129(87.2%) received antiviral therapy and 19(12.8%) did not receive such treatment.The vaccination rates of hepatitis B vaccine, bacille Calmette-Guérin vaccine, poliomyelitis live attenuated vaccine and diphtheria-pertussis-tetanus vaccine ranged from 70.9% to 77.7%, which was significantly lower than the national level(≥97%); the vaccination rates of the other vaccines in the National Immunization Program gradually decreased with age.No severe adverse effects were reported after vaccination. Conclusions Mother-to-child transmission is the main route of HIV infection in Chinese children. The diagnosis of children with HIV infection is significantly delayed, with low vaccination rates. Efforts should be made to strengthen early diagnosis, early treatment and vaccination in children with HIV infection, in order to improve their quality of life.
引文
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[2]王丽艳,秦倩倩,丁正伟,等.中国报告15岁以下儿童艾滋病病例流行特征分析[J].疾病监测,2017,32(3):227-231.
[3]Scott P,Moss WJ,Gilani Z,et al.Measles vaccination in HIV-Infected children:systematic review and meta-analysis of safety and immunogenicity[J].J Infect Dis,2011,204 Suppl 1:S164-S178.
[4]Chandwani S,Beeler J,Li H,et al.Safety and immunogenicity of early measles vaccination in children born to HIV-infected mothers in the United States:results of Pediatric AIDS Clinical Trials Group(PACTG)protocol 225[J].J Infect Dis,2011,204Suppl 1:S179-S189.
[5]Mofenson LM,Brady MT,Danner SP,et al.Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children:recommendations from CDC,the National Institutes of Health,the HIV Medicine Association of the Infectious Diseases Society of America,the Pediatric Infectious Diseases Society,and the American Academy of Pediatrics[J].MMWR Recomm Rep,2009,58(RR-11):1-166.
[6]Bamford A,Manno EC,Mellado MJ,et al.Immunisation practices in centres caring for children with perinatally acquired HIV:a call for harmonisation[J].Vaccine,2016,34(46):5587-5594.
[7]崔健,曹雷,郑景山,等.中国2015年国家免疫规划疫苗报告接种率分析[J].中国疫苗和免疫,2017,23(6):601-607.
[8]中华人民共和国国家卫生和计划生育委员会.国家免疫规划疫苗儿童免疫程序及说明(2016年版)[J].中国病毒病杂志,2017,7(2):81-86.
[9]Asturias EJ,Wharton M,Pless R,et al.Contributions and challenges for worldwide vaccine safety:The Global Advisory Committee on Vaccine Safety at 15 years[J].Vaccine,2016,34(29):3342-3349.
[10]World Health Organization.Measles vaccines:grading of scientific evidence in support of key recommendations[DB/OL].(2017-04-28)[2018-11-24].http://www.who.int/immunization/measles_grad_HIV.pdf?ua=1&ua=1.
[11]World Health Organization.Safety update of BCG vaccine[DB/OL].(2017-7-14)[2018-11-24].https://apps.who.int/iris/bitstream/handle/10665/255870/WER9228.pdf;jsessionid=4A3BD4C7893ADF9BA2579B80A4BE5BDB?sequence=1.
[12]Frota ACC,Harrison LH,Ferreira B,et al.Antibody persistence following meningococcal C conjugate vaccination in children and adolescents infected with human immunodeficiency virus[J].J Pediatr(Rio J),2017,93(5):532-537.
[13]Warshaw MG,Siberry GK,Williams P,et al.Immunogenicity of a booster dose of quadrivalent meningococcal conjugate vaccine in previously immunized HIV-infected children and youth[J].JPediatric Infect Dis Soc,2017,6(3):e69-e74.