全球2010～2014年白喉、破伤风和百日咳免疫预防和发病水平现况分析

Global Immunization Schedules,Vaccination Coverage Rates and Incidences of Diphtheria,Tetanus and Pertussis,2010-2014

目的分析世界卫生组织（World Health Organization,WHO）194个成员国白喉、破伤风和百日咳相关疫苗免疫程序、报告接种率与发病水平,为中国优化相关免疫策略提供参考。方法汇总分析WHO网站公开数据,包括疫苗种类、报告接种率和发病数据。结果报告儿童基础免疫、儿童加强免疫、青少年和孕妇/育龄期妇女免疫程序的成员国分别有194、144、122和94个;儿童基础免疫程序主要采用全细胞百白破（DTwP）-b型流感嗜血杆菌（Hib）-乙型肝炎（HepB）联合疫苗（DTwP-Hib-HepB）、无细胞百白破（DTaP）-Hib-灭活脊髓灰质炎（IPV）联合疫苗（DTaPHib-IPV）和DTaP-Hib-HepB-IPV,儿童加强免疫程序主要采用DTwP、DTaP-IPV和DTaP-Hib-IPV。青少年免疫主要采用减量白喉-破伤风联合疫苗（Td）和无细胞百日咳-减量白喉-破伤风联合疫苗（Tdap）。孕妇/育龄期妇女免疫程序主要采用破伤风类毒素（TT）和Td。WHO非洲区（AFR）的第1剂和第3剂DTP接种率中位数最低。2010~2014年美洲区（AMR）和欧洲区（EUR）的百日咳发病率较高,分别为2.9543/10万~7.4875/10万、3.1155/10万~6.3863/10万;AFR和东地中海区（EMR）较低,分别为0.5765/10万~1.8443/10万、0.3523/10万~2.2386/10万。东南亚区（SEAR）白喉发病率最高,为0.2124/10万~0.3786/10万;AMR最低,为0.0002/10万~0.0061/10万。AFR全人群破伤风发病率最高,为0.3010/10万~0.5490/10万;EUR最低,为0.0074/10万~0.0231/10万。AFR和EMR的新生儿破伤风发病率较高,分别为0.0867/10万~0.2266/10万、0.0247/10万~0.2069/10万;EUR最低,为0.0000/10万~0.0002/10万。结论国外DTP种类多,多用联合疫苗,免疫程序复杂;中国无针对青少年、孕妇/育龄妇女等特殊人群的DTP疫苗,百日咳发病低估,白喉和新生儿破伤风有较高的发病风险。有必要与疫苗研究、生产、监管、使用等多个部门联合,推动生产含DTaP和Tdap的联合疫苗,制定特殊人群免疫程序,降低相关疾病的发病水平。

Objective To analyze immunization schedules,vaccine coverage rates and disease incidences of diphtheria,tetanus and pertussis reported by all Member States（MS） of the World Health Organization（WHO）,and to provide evidence for optimizing the vaccination strategy in China.Methods Data on vaccine type,reported vaccine coverage and disease incidence were collected from the WHO website and were analyzed.Results Among the 194 WHO MSs,194,144,122 and 94 reported their primary immunization schedules for children,their booster dose schedules for children,their adolescent immunization schedules,and their schedules for pregnant / childbearing-age women,respectively.Diphtheria,tetanus and whole-cell pertussis（DTwP）-Haemophilus influenzae type b（Hib）-hepatitis B（HepB）combined vaccine（DTwP-Hib-HepB）,diphtheria,tetanus and acellular pertussis（DTaP）-Hib-inactivated poliovirus（IPV） combined vaccine（DTaPHib-IPV） and DTaP-Hib-HepB-IPV were widely introduced into primary immunization schedules for children;DTwP,DTaP-IPV and DTaP-HibIPV were widely introduced into booster dose schedules for children;tetanus toxoid and reduced diphtheria toxoid combined vaccine（Td）,and Td and acellular pertussis combined vaccine（Tdap） were widely introduced into schedules for adolescents;and tetanus toxoid（TT） and Td were widely introduced into schedules for pregnant / childbearing-age women.Coverage levels for DTP1 and DTP3 were lowest in the African Region（AFR）.During 2010-2014,the highest pertussis incidences were reported in the Region of the Americas（AMR） and the European Region（EUR）-2.9543-7.4875 and 3.1155-6.3863 per 100 000 population,respectively.Lower pertussis incidences were reported in AFR and the Eastern Mediterranean Region（EMR）-0.5765-1.8443 and 0.3523-2.2386 per 100 000 population,respectively.The highest and lowest diphtheria incidences,0.2124-0.3786 and 0.0002-0.0061 per100 000 population,respectively,were reported in the South-East Asia Region（SEAR） and AMR.The highest and lowest tetanus incidences-0.3010-0.5490 and 0.0074-0.0231 per 100 000 population,respectively,were reported in AFR and EUR.The highest newborn tetanus incidences were reported in AFR and EMR-0.0867-0.2266 and 0.0247-0.2069 per 100 000 population,respectively.The lowest newborn tetanus incidence,0.0000-0.0002 per 100 000 population,was reported in EUR.Conclusions DTP-based combined vaccines and immunization schedules have been introduced widely among MSs.There are no immunization schedules for special population,such as adolescents and pregnant /childbearing-age women,in China.The incidence of pertussis was underestimated in China,and the incidence of diphtheria or newborn tetanus was high.It is necessary to promote the development and use of DTaP or Tdap contained vaccines,through establishing an alliance in multiple sectors,including research institutions,manufacturers,regulatory authorities,and centers for disease control and prevention.Immunization schedules for special population should be developed in order to reduce disease incidence.