山东省两剂含腮腺炎成分疫苗纳入免疫规划后流行性腮腺炎短期预防效果评价

Evaluation on the short term effectiveness of two doses mumps-containing vaccine policy in Shandong, China

目的分析山东省实施2剂次含腮腺炎成分疫苗（MuCV）免疫策略后，流行性腮腺炎（腮腺炎）流行病学特征和健康人群腮腺炎抗体水平，评价腮腺炎预防控制效果。方法山东省2004--2015年腮腺炎疫情网络直报的病例资料来自于中国疾病预防控制信息系统。山东省2005-2015年MuCV接种信息来自山东省预防接种信息管理系统。健康人群资料通过分层随机抽样获得，于2015年10月，选取山东省2个东部市（青岛、日照）、2个西部市（聊城、枣庄）和3个中部市（济南、淄博、莱芜）中0-60岁当地居民为调查对象，共1785名；按照统一的调查问卷对所有调查对象或其监护人询问和登记年龄、性别、家庭住址、接种史、患病史等基本信息；采用ELISA检测腮腺炎IgG。结果山东省2004--2015年腮腺炎平均报告发病率为11．43／10万，中部地区发病率（14．64／10万）高于东、西部地区（分别为11．14／10万、11．33／10万）；2009-2013年腮腺炎发病率较高（16．07／10万），其中2012和2013年发病率高达25．33／10万和24．45／10万，高发年龄组为6-9岁（172．67／10万）；2014-2015年腮腺炎发病率下降（7．81／10万），尤以接种过2剂次MuCV的6～8岁儿童下降明显，从2009-2013年的114．02／10万下降到45．66／10万，且低于接种过1剂次MuCV的3～5岁儿童（66．85／10万）。1785名健康人群的腮腺炎抗体阳性率为80．62％（1439名），抗体几何平均浓度（GMC）为38．11IU／ml（95％CI：37．03～39．19IU／m1）；中部地区GMC为42．21IU／ml，高于东部和西部地区（分别为35．17和35．36IU／m1）（P=0．047）；19月龄至2岁、3～5岁儿童I剂次MuCV估算接种率分别为97．53％和93．48％，抗体阳性率分别为83．12％（192／231）和77．82％（214／275），抗体GMC分别为36．75和31．71IU／rnl，抗体阳性率和GMC均高于〈19月龄儿童[分别为41．81％（74／177）、11．88IU／m1]（P值均〈O．001）；6～9岁儿童的抗体阳性率为83．63％（189／226），GMC为46．88IU／ml，高于3～5岁组（P值均〈0．001）。结论山东省适龄儿童1剂次MuCV接种率、腮腺炎发病率处于较高水平；2剂次MuCV覆盖儿童的抗体水平高于1剂次覆盖的儿童，且发病率较低。

Objective To evaluate the effectiveness of mumps prevention and control after implementation of two doses mumps-containing combined vaccine （MuCV） policy by analyzing epidemiological characteristics of mumps and mumps antibody levels in general population. Methods We obtained data on cases of mumps reported during 2004-2015 from National Notifiable Diseases Reporting System （NNDRS）. Descriptive analysis methods were used to describe the epidcmiologieal characteristics of mumps during 2004-2015. MuCV immunization information from 2005 to 2015 was obtained from the immunization information management system in Shandong Province. Antibody data of mumps in healthy people were from a cross-sectional survey according to the principle of stratified random sampling from 0 to 60 years old healthy people in 2015. Commercial ELISA kits were used to detect and quantify human IgG antibodies against mumps virus in sera, and the results were analyzed statistically. Results The average incidence of mumps from 2004 to 2015 was 11.43/100000 in Shandong. The incidence of mumps in the central region （14.64/100000） was higher than that in the eastern and western regions （11.14/100000, 11.33/100 000）. The incidence of mumps was still high in 2009-2013 （stage of one-dose MuCV free, 16.07/ 100 000）with the highest incidence of 25.33/100 000 and 24.45/100 000 occurred in 2012 and 2013 and the eases were mainly 6 to 9 years old group （172.67/100 000）. Since the second dose MuCV was introduced into NIP for 6 years old children in May 2013 in Shandong, the incidence of mump decreased significantly in 2014-2015 （7.81/100 000）, especially in children of 6-8 years old who were vaccinated with two doses of MuCV （2009-2013 was 114.02/100 000; 2014-2015 was 45.66/100 000） and lower than 3-5 years old vaccinated one doses of MuCV. A total of 1 785 serum samples were collected from the healthy population, the average seroprevalence was 80.62% and Geometric Mean Concentration （GMC） was 38.11 IU/ml （95 % CI： 37.03-39.19 IU/ml）. There was no significant difference about seroprevalenee in different regions, while the GMC in middle region was significantly higher compared to east and west region. The prevalence and GMC in children aged 19 months-2 years and 3-5 years old who received one dose of MuCV were significantly higher than those of 〈19 months old children. The GMC （46.88 IU/ml, 95%CI： 39.43-55.74 IU/ml） in children aged 6-9 years old who received the two doses MuCV was significantly higher than that of aged 3-5 years old children （31.71 IU/nd, 95%CI： 27.23-36.93 IU/ml）. Conclusion The incidence of mumps in Shandong was still at a high level in spite of coverage one doses MuCV to children. Compared with the period of the 1 dose MuCV immunization strategy, the incidence the groups coverage two doses MuCV was significantly reduced and lower the groups coverage one dose MuCV, but the prevalence and GMC were higher than that of the grouos coverage one dose MuCV.