天津市2004—2017年首剂次含麻疹成分疫苗禁忌分析
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摘要
目的分析天津市2004—2017年首剂次含麻疹成分疫苗(MCV1)接种禁忌状况。方法利用天津市免疫规划信息管理系统收集2004—2017年出生队列儿童MCV1接种禁忌和不同地区接种医生情况;利用全国麻疹监测信息报告管理系统分析2009—2017年8月龄～14岁麻疹病例MCV1未免疫原因,综合评价儿童MCV1接种禁忌状况。结果天津市2004—2017年出生队列共有1 974 513名儿童,MCV1禁忌报告率为3.28%(64 670例),短期禁忌88.44%(57 191例),长期禁忌11.56%(7 479例)。不同禁忌种类中,急性疾病、严重慢性疾病、慢性疾病的急性发作期最多(59.27%)。不同地区间,滨海新区和市区禁忌报告率较高。禁忌报告率从2004年的0.14%逐渐升高到2013年的6.22%,然后迅速下降到2017年的2.76%。天津市288家接种门诊,接种医生1 401人,滨海新区和市区接种医生年龄和免疫规划工作年限较长。接种医生专业分布中,以护理专业为主(58.74%)。2009—2017年天津市报告8月龄～14岁麻疹病例749例,60.35%无MCV1免疫史,未免疫原因主要为短期禁忌(44.91%)和长期禁忌(18.14%)。结论禁忌的规定直接影响麻疹免疫策略的落实,目前禁忌掌握参差不齐,亟待制定科学可行的统一禁忌标准。
Objective To analyze the contraindications to first dose of measles-containing vaccine(MCV1) among children in Tianjin city between 2004 and 2017. Methods We collected data on reported cases of contraindication to MCV1 in a birth cohort of 1 974 513 children born between 2004 and 2017 and the information on medical personnel providing vaccination service to the children from the Information System for Planned Immunization of Tianjin city. The information on reasons not having MCV1 vaccination of the measles cases aged 8 months to 14 years reported in Tianjin city between2009 and 2017 were also extracted from National Information Management System for Measles Surveillance. Then we analyzed all the data collected to comprehensively evaluate contraindications to MCV1 among the children. Results Among all the children of the cohort, 64 670 cases of contraindication to MCV1 were reported and the prevalence rate of contraindication was 3.28%. Of the contraindications, 88.44%(57 191 cases) and 11.56%(7 479 cases) were short-and longterm contraindications. The majority(59.27%) of the contraindications were acute diseases, severe chronic diseases, and acute onset of chronic diseases and more contraindication cases were reported in Binhai New District and urban regions. The prevalence of contraindications increased from 0.14% in 2004 to 6.22% in 2013, and then decreased to 2.76% in 2017. There were totally 1 401 medical staff providing vaccination service at 288 immunization clinics in the city during the period;58.74% of the staff were majored in nursing and the staff in Binhai New District and urban regions were generally at elder age and with more work experience. There were 749 measles cases aged 8 months – 14 years reported in the city between2009 – 2017 and 60.35% of the cases were without MCV1 vaccination; main reasons for the cases not having MCV1 vaccination were due to short-term(44.91%) and long-term contraindications(18.14%). Conclusion The regulation on contraindications to MCV1 vaccination directly affects the implementation of immunization strategies and the discrimination of the contraindication is uneven among various vaccination providers, suggesting that standardized confirmation of contraindications to MCV1 vaccination needs to be implemented urgently in Tianjin city.
Objective To analyze the contraindications to first dose of measles-containing vaccine(MCV1) among children in Tianjin city between 2004 and 2017. Methods We collected data on reported cases of contraindication to MCV1 in a birth cohort of 1 974 513 children born between 2004 and 2017 and the information on medical personnel providing vaccination service to the children from the Information System for Planned Immunization of Tianjin city. The information on reasons not having MCV1 vaccination of the measles cases aged 8 months to 14 years reported in Tianjin city between2009 and 2017 were also extracted from National Information Management System for Measles Surveillance. Then we analyzed all the data collected to comprehensively evaluate contraindications to MCV1 among the children. Results Among all the children of the cohort, 64 670 cases of contraindication to MCV1 were reported and the prevalence rate of contraindication was 3.28%. Of the contraindications, 88.44%(57 191 cases) and 11.56%(7 479 cases) were short-and longterm contraindications. The majority(59.27%) of the contraindications were acute diseases, severe chronic diseases, and acute onset of chronic diseases and more contraindication cases were reported in Binhai New District and urban regions. The prevalence of contraindications increased from 0.14% in 2004 to 6.22% in 2013, and then decreased to 2.76% in 2017. There were totally 1 401 medical staff providing vaccination service at 288 immunization clinics in the city during the period;58.74% of the staff were majored in nursing and the staff in Binhai New District and urban regions were generally at elder age and with more work experience. There were 749 measles cases aged 8 months – 14 years reported in the city between2009 – 2017 and 60.35% of the cases were without MCV1 vaccination; main reasons for the cases not having MCV1 vaccination were due to short-term(44.91%) and long-term contraindications(18.14%). Conclusion The regulation on contraindications to MCV1 vaccination directly affects the implementation of immunization strategies and the discrimination of the contraindication is uneven among various vaccination providers, suggesting that standardized confirmation of contraindications to MCV1 vaccination needs to be implemented urgently in Tianjin city.
引文
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[9]武文娣,刘大卫,李克莉,等.全国2005-2009年麻疹减毒活疫苗疑似预防接种异常反应监测数据分析[J].中国疫苗和免疫,2010,16(4):310-316.
[10]National Center for Immunization and Respiratory Diseases.General recommendations on immunization-recommendations of the Advisory Committee on Immunization Practices(ACIP)[J].MMWR Recomm Rep,2011,60(2):1-64.
[11]Hill DA,Grundmeier RW,Ram G,et al.The epidemiologic characteristics of healthcare provider-diagnosed eczema,asthma,allergic rhinitis,and food allergy in children:a retrospective cohort study[J].BMC Pediatr,2016,16:133.
[12]李锋,韩同武,刘大卫,等.郑州市预防接种人员禁忌证知识现状调查[J].中国疫苗和免疫,2009,15(6):498-500.
[13]Dumortier B,Nosbaum A,Ponvert C,et al.Measles-mumpsrubella vaccination of an egg-allergic child sensitized to gelatin[J].Arch Pediatr,2013,20(8):867-870.
[14]韩柏慧,时念民,刘方,等.206例鸡蛋过敏儿童接种麻疹风疹联合减毒活疫苗后的安全性观察[J].中国生物制品学杂志,2015,28(2):151-154.
[15]启镕.全国实施麻疹疫苗强化免疫接种的重大意义[J].中华儿科杂志,2011,49(6):408-410.
[16]Pickering LK,Orenstein WA.FDA licensure of and ACIP recommendations for vaccines[J].Vaccine,2017,35(37):5027-5036.
[2]马超,郝利新,苏琪茹,等.中国2014年麻疹流行病学特征分析[J].疾病监测,2015,30(10):818-823.
[3]国家药典委员会.中华人民共和国药典[M].北京:中国医药科技出版社,2015.
[4]Fine P,Eames K,Heymann DL.“Herd immunity”:a rough guide[J].Clin Infect Dis,2011,52(7):911-916.
[5]Feldstein LR,Mariat S,Gacic-Dobo M,et al.Global routine vaccination coverage,2016[J].MMWR,2017,66(45):1252-1255.
[6]Atkinson W,Wolfe S,Hamborsky J.Epidemiology and prevention of vaccine preventable disease[M].12th ed,Washington D.C:Public Health Foundation,2011:6-15.
[7]Liu S,Wang J,Liu Y,et al.Survey of contraindications in children's routine vaccination in Hangzhou,China[J].Hum Vaccin Immunother,2017,13(7):1539-1543.
[8]武文娣,刘大卫,李克莉,等.中国2012年疑似预防接种异常反应监测数据分析[J].中国疫苗和免疫,2014,20(1):1-12.
[9]武文娣,刘大卫,李克莉,等.全国2005-2009年麻疹减毒活疫苗疑似预防接种异常反应监测数据分析[J].中国疫苗和免疫,2010,16(4):310-316.
[10]National Center for Immunization and Respiratory Diseases.General recommendations on immunization-recommendations of the Advisory Committee on Immunization Practices(ACIP)[J].MMWR Recomm Rep,2011,60(2):1-64.
[11]Hill DA,Grundmeier RW,Ram G,et al.The epidemiologic characteristics of healthcare provider-diagnosed eczema,asthma,allergic rhinitis,and food allergy in children:a retrospective cohort study[J].BMC Pediatr,2016,16:133.
[12]李锋,韩同武,刘大卫,等.郑州市预防接种人员禁忌证知识现状调查[J].中国疫苗和免疫,2009,15(6):498-500.
[13]Dumortier B,Nosbaum A,Ponvert C,et al.Measles-mumpsrubella vaccination of an egg-allergic child sensitized to gelatin[J].Arch Pediatr,2013,20(8):867-870.
[14]韩柏慧,时念民,刘方,等.206例鸡蛋过敏儿童接种麻疹风疹联合减毒活疫苗后的安全性观察[J].中国生物制品学杂志,2015,28(2):151-154.
[15]启镕.全国实施麻疹疫苗强化免疫接种的重大意义[J].中华儿科杂志,2011,49(6):408-410.
[16]Pickering LK,Orenstein WA.FDA licensure of and ACIP recommendations for vaccines[J].Vaccine,2017,35(37):5027-5036.