合理使用菌苗控制我国80年代流脑周期流行效益分析及最佳免疫方案的研究

Proper Use of Group A Polysaccharide Vaccination to Control Cerebro-spinal Meningitis (CSM) Epidemicsin China (1980s)-with Cost/benifit Analysis and Suggestion of Best Immunization Program

自８０年代初开始在全国７个有代表性的省市进行了Ａ群脑膜炎菌苗不同免疫方案的研究。根据菌苗对不同年龄组人群的免疫反应性及持久性制订的免疫方案，经过８～１０年的观察，各省市均有效的控制了８０年代的流脑流行，使发病率下降至有史以来最低水平。经监测证明，８０年代流行的Ａ群脑膜炎菌与６０年代相同，均为ＣｌｏｎｅⅢ－Ｉ型，它曾引起世界性流行。接种菌苗的最适免疫剂量证实为３０μｇ，比国际通用剂量少２０μｇ。对不同免疫方案的评价指出：方案的制订主要依靠本地区的监测及预测工作，综合预测分析法和Ｂａｙｅｓ概率法早期预测具有较高的实用价值。人群抗体水平及Ａ群带菌率是流脑动力学及预测流行的重要指标。最佳免疫方案是在预测流行到来之前对易感人群进行一次性普种，要求复盖率达８５％～９０％以上。其后对６月～２岁的婴幼儿每年基础免疫１针，共２针，间隔１年，有利于降低低年龄组的发病专率，且能提高人群的免疫反应性，起到延长流行间歇期的作用。这种免疫方案经济效益最高。

A national research project had been organized from 1980～1989 to evaluate the different methods of selective vaccination to control CSM and to find out the best immuniting program. Selective vaccination was designed according to the immunue response of different ages and implemented in predicted areas. All the epidemics were control in all the F. province after vaccination and the morbidity rates were decreased to the historical lowermost levels, but with different cost /benifit.In the use of multi-locus enzyme electrophoresis to study the clone types showed clone Ⅲ were the predominate type contributing to the epidemic in 1980s and just the same as in 1960s.The best immuniting programs were including: 1. The proper dose of vaccination was 30μg; 2.It should be work about through surveillance, early prediction and selective vaccinafion: 3, The best program included once vsccinaton for the susceptible person (6rnos～15yrs) at the time just before the epidemic. The coverage rate should be oVer 85～90%,and then followed by immuniting the infants once each year fol 2 years. It could give the high cost/benifit and finally to control the epidemic for longest time.