深圳市2009—2012年预防接种后血小板减少性紫癜监测情况分析

Analysis of idiopathic thrombocytopaenic purpura after vaccination in Shenzhen,in 2009—2012

目的分析预防接种后特发性血小板减少性紫癜(Idiopathic thrombocytopaenic purpura,ITP)的发病特征,评价预防接种的安全性。方法通过深圳市疑似预防接种异常反应(Adverse events following immunization,AEFI)监测系统,收集2009—2012年15例预防接种后ITP病例,采用描述性方法对个案调查资料进行流行病学分析。结果接种疫苗后ITP好发于≤2岁儿童,其中<1岁占66.67%,1～2岁占33.33%;男女性别比为1.14∶1。接种后≤1 d发生2例,≥15 d发生3例,接种至发生的最短时间间隔为数小时,最长22 d。在报告预防接种后ITP病例中,涉及8种疫苗。其中乙型肝炎疫苗5例,占33.33%,发生率1.69/100万剂;其次是全细胞百日咳-白喉-破伤风联合疫苗3例,占20%,发生率为3.84/106;麻疹-风疹联合疫苗2例,占13.33%,发生率3.50/106。接种第1剂后发生的4例,占26.67%;接种第2剂后发生的5例,占33.33%。15例ITP中,最终判定为预防接种异常反应的10例,占66.67%;偶合症5例,占33.33%。2009—2012年各类疫苗预防接种后ITP报告发生率在0.25/106～3.84/106。结论深圳市2009—2012年各类疫苗预防接种后ITP报告发生率低于世界卫生组织估计的预期发生率,应加强监测,并且对严重AEFI须建立规范的救治方案和补偿机制。

Objective To analyze the characteristics of idiopathic thrombocytopaenic purpura （ ITP ） after vaccination and evaluate the safety for vaccination. Methods 15 ITP cases which occured in 2009--2012 were collected through Shenzhen Adverse Events Following Immunization （ AEFI ） surveillance system. The surveillance data was analyzed by descriptive sta- tistical analysis. Results ITP cases after vaccination were occured mainly in children less than 2 years old, the propor- tions of case age ≤ 1 year and 1 to 2 years were 66.67% and 33.33% , respectively. The ratio of male to female was 1. 43 ： 1. There were 2 cases whose onset interval was ≤ 1 d and 3 cases whose onset interval was ≥ 15 d. The shortest on- set interval was several hours and the longest onset interval was 22 d. There were 8 kinds of vaccine involved with ITP. There were 5 cases related to Human hepatitis B vaccine , which accounted for 33.33% and the reported rate was 1.69/ 106. There were 3 cases related to DTP combined vaccine （ Diphtheria,Tetanus and Pertussis Combined Vaccine ） , which accounted for 20.00% and the reported rate was 3.84/106. There were 2 cases related to Measles and Rubella Combined Vaccine,Live, which accounted for 13.33% and the reported rate was 3.50/106. 4 cases were occurred after first dose （26.67%） and 5 cases were after second dose（33.33%}. Among the 15 cases, 10 cases（66.67% ）were finally diag- nosed as rare adverse reaction and 5 cases（ 33.33% ）were coincidental event. The annually reported rate of ITP after vacci- nation was 0. 25/106-3. 84/106 in 2009-2012. Conclusions The annually reported rate of ITP after vaccination in 2009 -2012 in Shenzhen was lower than the expected rate of WHO, so we should strengthen monitoring. ITP after vaccination was a serious disease, it should be established a standard plan for medication and a standardized mechanism which is corn-pensation for severe cases from AEFI caused by vaccination.