儿童接种不同免疫程序国产麻疹-流行性腮腺炎-风疹联合减毒活疫苗后3年抗体持久性分析

Antibody persistence following on different vaccination strategies of domestic measles, mumps and rubella combined attenuated live vaccine： a 3-year follow-up study

目的 分析儿童接种不同免疫程序国产麻疹-流行性腮腺炎-风疹联合减毒活疫苗（MMR）后3年时的抗体阳性率及抗体水平.方法 于2015年7月,选择浙江省衢州市的开化县和常山县为研究现场,采用单纯随机抽样方法,通过免疫规划信息系统选择最后1剂次接种国产MMR满3年（36-38个月）的儿童,共170名,作为常规免疫接种组（8月MR组）;选取浙江省疾病预防控制中心2011年建立的2针MMR队列中171和173名儿童为研究对象,分别作为8、18月龄时接种MMR（8月MMR组）和12、22月龄时接种MMR组（12月MMR组）,并在其完成初免MMR后以及最后1剂次MMR满3年后,分别采集静脉血2-3 ml,用ELISA法检测麻疹、流行性腮腺炎和风疹的IgG抗体.采用χ^2检验或Fisher确切概率法比较各组抗体阳性率差异,采用Kruskal-Wallis H检验比较抗体几何平均浓度（GMC）差异.结果 514名调查对象中,男性为248名（48.25%）,女性为266名（51.75%）;接种国产MMR后3年麻疹、流行性腮腺炎和风疹病毒的抗体阳性率分别为98.1%（504例）、93.4%（480例）和88.1%（453例）,抗体GMC分别为1012.33 mU/ml、502.87 U/ml和50.53 U/ml.3组麻疹病毒抗体阳性率均在97%及以上;3组中12月MMR组流行性腮腺炎病毒的抗体阳性率最高,为98.8%（171/173）,8月MR组和8月MMR组分别为88.2%（150/170）和93.0%（159/171）（Fisher确切概率法,P〈0.001）;风疹病毒的抗体阳性率也是12月MMR组最高,为94.8%（164/173）,8月MR组和8月MMR组分别为82.9%（141/170）和86.6%（148/171）（Fisher确切概率法,P=0.002）.麻疹、流行性腮腺炎和风疹病毒抗体GMC最高的均是12月MMR组,分别为1217.30（1119.35-1323.82）mU/ml、717.07（643.83-798.65）U/ml和62.54（56.21-69.58）U/ml;麻疹和流行性腮腺炎病毒抗体GMC最低为8月龄MR组,分别为812.01（734.52-897.67）mU/ml和363.28（305.42-432.11）U/ml;风疹最低为8月MMR组,为44.10（39.08-49.76）U/ml;以上差异均有统计学意义（P〈0.05）.结论 不同程序接种国产MMR后3年时麻疹、风疹均维持较高的抗体阳性率和抗体水平,接种2剂次MMR的流行性腮腺炎抗体水平较高.

Objective To assess the 3-year antibody persistence after vaccination of domestic measles, mumps and rubella combined attenuated live vaccine （MMR） with different program. Methods Children from three different vaccination strategies （Group 8 m MR： 8 months and 18 months vaccinated with measles-rubella combined attenuated live vaccine and domestic MMR,respectively; Group 8 m MMR： 8 months and 18 months both vaccinated with domestic MMR; Group 12 m MMR： 12 months and 22 months both vaccinated with domestic MMR ） were followed up in Zhejiang province in July 2015. There were 170 participants in Group 8 m MR, 171 participants in Group 8 m MMR and 173 participants in Group 12 m MMR selected by simple random sampling method .Blood samples （venous blood 2-3 ml） were collected 1 month after the first dose vaccination of MMR （only in Group 8 m MMR and Group 12 m MMR） and 3 years （36-38 months） after the last dose vaccination of MMR and tested for antibody IgG against Measles, Mumps and Rubella using ELISA. Seropostive rate and Geometric mean concentration （GMC） were calculated and compared among different groups by Chi-square test or Fisher exact test and Kruskal-Wallis H test. Results A total of 514 participants （8 m MR：170;8 m MMR：171;12 m MMR：173） were enrolled. The overall seropositivity rate of measles, mumps and rubella was 98.1%（504）, 93.4%（480） and 88.1%（453）, respectively, with corresponding GMC was 1012.33 mU/ml, 502.87 U/ml and 50.53 U/ml respectively. There was no significant difference of seropositivity rate for measles among three groups （all groups were＆gt;97%）. The highest seropositivity rate for mumps was found in the Group 12 m MMR with the rate of 98.8% （171/173）, followed by Group 8 m MMR and Group 8 m MR with 93.0%（159/171）and 88.2%（150/170）respectively（Fisher exact test,P〈0.001）. The highest seropositivity rate for rubella was also found in the Group 12 m MMR with the rate of 94.8%（164/173）, followed by Group 8 m MMR and Group 8 m MR with 86.6%（148/171）and 82.9%（141/170）respectively（Fisher exact test,P=0.002）. The highest GMC of antibody against measles, mumps and rubella were all found in Group 12 m MMR, with 1217.30 （1119.35- 1323.82） mU/ml, 717.07 （643.83- 798.65） U/ml and 62.54（56.21- 69.58） U/ml respectively. The lowest GMC of antibody against measles and mumps were both in Group 12 m MR with 812.01 （734.52-897.67） mU/ml and 363.28 （305.42-432.11） U/ml respectively. The lowest GMC of antibody against rubella was in Group 8 m MMR with 44.10 （39.08-49.76） U/ml. These differences of GMCs among three groups were all reach significant means（P〈0.05）. Conclusion High level seropostive rates and GMCs were exist against measles and rubella after 3-year vaccination of domestic MMR among different program. Higher antibody level against mumps were found in those children with two doses vaccination of MMR.