初次免疫月龄对麻疹减毒活疫苗免疫成功率影响的Meta分析

Meta-analysis on Associations of Primary Immune Age and Immunization Success Rate of Measles Vaccination

目的研究初次免疫月龄对麻疹减毒活疫苗（MV）免疫成功率的影响,为国家免疫规划程序调整提供科学依据。方法采用Review Manager5.0软件,对2003-2013年公开报道的开展MV6月龄和8月龄初次免疫效果的文献资料进行Meta分析。结果纳入到本研究的文献共9篇,累计调查1 192人,其中6月龄婴儿525人,8月龄婴儿667人。6月龄和8月龄婴儿平均免疫成功率分别为87.89%和93.03%。2个年龄组接种MV后Ig G抗体几何平均滴度（Geometric Mean Titer,GMT）平均数分别为1∶1 178.66和1∶1 727.37。8月龄和6月龄初次免疫成功率差值d=0.05,其95%CI为0.02~0.08。发表偏倚和敏感性分析结果显示,本次Meta分析无发表偏倚,结果基本稳定可靠。结论 8月龄接种MV免疫成功率超过6月龄,目前可继续以8月龄为MV初次免疫月龄。宜采取维持高水平MV常规免疫接种率、控制院内感染及适时启动麻疹强化免疫和考虑育龄期妇女接种MMR等策略控制和消除麻疹。

Objective To study the associations of primary immune age and immunization success rate of measles vaccination（ MV）,as well as to provide references for process adjustments in national immunization planning. Methods Studies on immune effect of measles vaccine in 6 months 8 months old children and published between 2003-2013 were included for meta-analysis by using Review Manager5. 0 software. Results A total of 9 articles were included,including 1192 individuals,of which 525 were 6 months old infants and 667 were8 months old infants. The immunization success rate of 6 months and 8 months infants were 87. 89% and93. 03%,respectively. The average number of Geometric mean titer（ GMT） on measles Ig G antibody of the two groups were 1： 1178. 66 and 1： 1727. 37,respectively. The difference value（ d） between the success rate of vaccination in 8 month and that of 6 old infants was 0. 05（ 95% CI： 0. 02-0. 08）. There was no publication bias in this study,and the results were stable with publication and sensitivity analyses. Conclusion The immunization success rate of primary measles vaccination is higher in 8 month old infants than that in 6month old infants. In order to control and eliminate measles,strategies are recommended as following： maintaining high levels of MV routine immunization coverage,control the nosocomial infection, launch of measles supplementary immunization with timeliness and conduct MMR in childbearing age women.