2012—2017年福建省疑似与预防接种有关的死亡病例特征分析

Analysis on the characteristics of suspected vaccine-related deaths in Fujian Province, 2012-2017

目的分析2012—2017年福建省疑似与预防接种有关的死亡病例特征。方法收集中国疑似预防接种异常反应(AEFI)监测信息管理系统中,福建省2012—2017年疑似与预防接种有关的死亡病例个案、尸检报告以及AEFI调查诊断专家组的结论,共33例。通过福建省免疫规划信息系统收集福建省其间不同疫苗的预防接种数据,计算AEFI、异常反应发生率及死亡率,并分析福建省疑似与预防接种有关的死亡病例特征。结果年龄范围为26 d至52月龄,其中8例为预防接种异常反应,25例为偶合症;2012—2017年分别报告2、3、6、8、7和7例;男性为23例(70%)。接种麻疹-风疹联合减毒活(MR)疫苗病例AEFI发生率最高,为38.88/10万剂(95%CI:36.85/10万剂~40.91/10万剂),三价口服脊髓灰质炎减毒活疫苗(tOPV)最低,为2.01/10万剂(95%CI:1.73/10万剂~2.30/10万剂);接种MR疫苗病例异常反应报告发生率最高,为15.04/10万剂(95%CI:13.78/10万剂~16.30/10万剂),tOPV最低,为0.38/10万剂(95%CI:0.25/10万剂~0.50/10万剂);接种灭活脊髓灰质炎疫苗(IPV)病例死亡率最高,为0.26/10万剂(95%CI:0.04/10万剂~0.54/10万剂),麻疹-流腮-风疹联合减毒活疫苗最低,为0.01/10万剂(95%CI:0.00/10万剂~0.08/10万剂)。Spearman秩相关分析显示,AEFI与异常反应具有相关性(r=0.64,P=0.048),与死亡无相关性(r=-0.34,P=0.329),异常反应与死亡也无相关性(r=-0.25,P=0.484)。结论 AEFI、异常反应与疑似预防接种有关的死亡均无相关性,偶合症为疑似预防接种有关死亡的主要原因。

Objective To analyze the characterisitics of the death cases suspected to be related to vaccination in Fujian Province from 2012 to 2017. Methods A total of 33 death cases information which was suspected to be related to the vaccinations from 2012 to 2017 were extracted from Chinese Adverse Events Following Immunization Information System (AEFI). The autopsy reports and the conclusions made by AEFI investigation diagnosis expert committee were collected at the same time. The inoculation data were obtained through the Fujian province Immunization Program Information System. The AEFI incidence, rare vaccine reaction incidences and mortality rates following immunization were figured out to analyze the characterisitics of the death cases associated with vaccination. Results The age of deuths cases was from 26 days to 52 months. Among 33 cases, 23 were males, and 8 were due to vaccine-related reaction, and the others were due to coincidental events. The number of rare vaccine reaction cases from 2012 to 2017 were 2,3,6,8,7 and 7, respectively. The highest AEFI incidence was measles and rubella combined attenuated live vaccine [38.88 (95%CI: 36.85-40.91)/100 000 dose], and the lowest was trivalent oral poliomyelitis attenuated live vaccine [2.01 (95%CI: 1.73-2.30)/100 000 dose]. The highest rare vaccine reaction incidence was measles and rubella combined attenuated live vaccine [15.04 (95%CI: 13.78-16.30)/100 000 dose], and the lowest was trivalent oral poliomyelitis attenuated live vaccine [0.38 (95%CI: 0.25-0.50)/100 000]. The highest mortality rate was inactivated poliomyelitis vaccine [0.26 (95%CI: 0.04-0.54)/100 000 doses], and the lowest mortality rate was measles, mumps and rubella combined attenuated live vaccine [0.01 (95%CI: 0.00-0.08)/100 000 doses]. The Spearman correlation analysis showed that there were correlations between AEFI incidence and rare vaccine reaction incidence (r=0.64, P=0.048), there were no correlations between AEFI incidence and mortality rate (r=-0.34, P=0.329), and there were no correlations between rare vaccine reaction incidence and mortality rate (r=-0.25, P=0.484). Conclusion Neither AEFI incidence nor rare vaccine reaction incidence was correlation with mortality rate. The main causes of death following vaccination were coincidental events.