一起流行性腮腺炎暴发的流行病学调查分析

目的 通过对流行性腮腺炎暴发的流行病学调查,指导流行性腮腺炎的防治工作.方法 对暴发调查的疫情资料进行描述流行病学分析.结果 首例患者有明确的流行病学接触史,暴发时间为2011年4月20日至7月12日,男女性别比例为1.14:1,最小4岁,最大40岁,5～10岁病例占71.11%;病例分布在紧密相连的两个自然村;患者均无相关疫苗免疫史;实施应急接种和相关治疗后后,疫情得到有效控制.结论 疫苗接种率低、易感人群积累是造成流行性腮腺炎暴发的主要原因.提高人群免疫接种率是防止暴发的主要措施.     

2015—2019年西双版纳傣族自治州流行性腮腺炎流行特征分析

目的 分析2015－2019年西双版纳傣族自治州（西双版纳）流行性腮腺炎的流行特征,为进一步预防控制流行性腮腺炎提供参考依据。方法 对2015－2019年中国疾病预防控制信息系统报告的流行性腮腺炎病例和暴发疫情资料进行描述性分析。结果 西双版纳2015－2019年共报告2 452例流行性腮腺炎,年平均报告发病率为41.87/10万;男、女性报告发病率比为1.16:1.00;夏冬季为高发季节;0~14岁人群发病率最高（154.39/10万）;总病例的64.23%为学生,7次暴发疫情均发生于学校。2015－2019年共接种136 433剂次含腮腺炎成分疫苗,其中104 133剂次麻疹-腮腺炎-风疹联合疫苗,其余为腮腺炎疫苗。结论 2015－2019年西双版纳流行性腮腺炎发病率呈上升趋势,建议完善麻疹-腮腺炎-风疹联合疫苗儿童免疫规划,提高疫苗接种覆盖率,做好学校晨检工作,加强预防接种证查验工作和流行性腮腺炎的主动监测。     

流行性腮腺炎的流行现状及疫苗免疫策略

流行性腮腺炎(腮腺炎)是由腮腺炎病毒(mumps virus,MuV)导致的急性全身性传染病,接种疫苗是预防MuV感染最有效的手段.腮腺炎疫苗广泛应用后,全球腮腺炎发病率大幅下降,但近些年却多次发生小规模腮腺炎暴发,可能的原因主要包括:疫苗接种覆盖率不够高、疫苗效果不理想、人群免疫力下降和流行株基因型改变.针对这些情况,应调整免疫接种策略,并需研发新疫苗.     

一起小学流行性腮腺炎突发公共卫生事件的流行特征及暴发原因分析

目的：分析流行性腮腺炎的流行病学特征和暴发的原因,为更好防控流行性腮腺炎提供科学依据。方法对庐江县某小学86例流行性腮腺炎患者的流行病学特征和相关资料进行描述,并对这些特征进行统计学分析。结果此次流行性腮腺炎疫情持续时间长,覆盖面广,发病班级占班级总数的76.19%,学生总罹患率为6.94%,其中男生罹患率为7.32%,女生罹患率为6.46%,男女生罹患率无明显差异。病例多未接种腮腺炎疫苗,接种率仅为5.81%。发病年龄以6-11岁为主,占发病总数的94.19%。结论腮腺炎疫苗接种率低、未采取严格的隔离、消毒以及应急接种措施是流行性腮腺炎流行的主要原因。疫情处理中,应全面落实各项防控措施,应急接种疫苗和严格隔离是预防、控制疫情扩大、蔓延的有效措施。     

腮腺炎疫苗免疫效果研究进展

目前广泛使用的腮腺炎减毒活疫苗株有Jeryl Lynn株、Leningrad-3株以及它们的衍生株.疫苗的免疫效果为80%-100%,差异较其他同类疫苗大,可能的原因首先是这些病毒株是几个亚株形成的混合物.在某些疫苗生产用细胞上连续传代,亚株的比例会出现变化;但最近发现,人类HLA和免疫调节相关细胞因子及其受体基因多样性对腮腺炎疫苗接种效果有重要影响;有可能是以上两者结合导致了现阶段腮腺炎免疫效果的较大差异,而后者也许是更主要的原因.2004年以来,英国、美国和西班牙均发生了疫苗接种人群中的腮腺炎流行,疫苗的保护效果随时间而减弱是其主要原因.目前仍应遵照WHO的建议,提供及时的追加免疫机会以维持人群的免疫水平.     

腮腺炎疫苗免疫效果研究进展

目前广泛使用的腮腺炎减毒活疫苗株有Jeryl Lynn株、Leningrad-3株以及它们的衍生株.疫苗的免疫效果为80%-100%,差异较其他同类疫苗大,可能的原因首先是这些病毒株是几个亚株形成的混合物.在某些疫苗生产用细胞上连续传代,亚株的比例会出现变化;但最近发现,人类HLA和免疫调节相关细胞因子及其受体基因多样性对腮腺炎疫苗接种效果有重要影响;有可能是以上两者结合导致了现阶段腮腺炎免疫效果的较大差异,而后者也许是更主要的原因.2004年以来,英国、美国和西班牙均发生了疫苗接种人群中的腮腺炎流行,疫苗的保护效果随时间而减弱是其主要原因.目前仍应遵照WHO的建议,提供及时的追加免疫机会以维持人群的免疫水平.     

腮腺炎疫苗免疫效果研究进展

目前广泛使用的腮腺炎减毒活疫苗株有Jeryl Lynn株、Leningrad-3株以及它们的衍生株.疫苗的免疫效果为80%-100%,差异较其他同类疫苗大,可能的原因首先是这些病毒株是几个亚株形成的混合物.在某些疫苗生产用细胞上连续传代,亚株的比例会出现变化;但最近发现,人类HLA和免疫调节相关细胞因子及其受体基因多样性对腮腺炎疫苗接种效果有重要影响;有可能是以上两者结合导致了现阶段腮腺炎免疫效果的较大差异,而后者也许是更主要的原因.2004年以来,英国、美国和西班牙均发生了疫苗接种人群中的腮腺炎流行,疫苗的保护效果随时间而减弱是其主要原因.目前仍应遵照WHO的建议,提供及时的追加免疫机会以维持人群的免疫水平.     

History of Meningococcal Outbreaks in the United States: Implications for Vaccination and Disease Prevention

Invasive meningococcal disease caused by Neisseria meningitidis presents a significant public health concern. Meningococcal disease is rare but potentially fatal within 24 hours of onset of illness, and survivors may experience permanent sequelae. This review presents the epidemiology, incidence, and outbreak data for invasive meningococcal disease in the United States since 1970, and it highlights recent changes in vaccine recommendations to prevent meningococcal disease. Relevant publications were obtained by database searches for articles published between January 1970 and July 2015. The incidence of meningococcal disease has decreased in the United States since 1970, but serogroup B meningococcal disease is responsible for an increasing proportion of disease burden in young adults. Recent serogroup B outbreaks on college campuses warrant broader age‐based recommendations for meningococcal group B vaccines, similar to the currently recommended quadrivalent vaccine that protects against serogroups A, C, W, and Y. After the recent approval of two serogroup B vaccines, the Advisory Committee on Immunization Practices first updated its recommendations for routine meningococcal vaccination to cover at‐risk populations, including those at risk during serogroup B outbreaks, and later it issued a recommendation for those aged 16–23 years. Meningococcal disease outbreaks remain challenging to predict, making the optimal disease management strategy one of prevention through vaccination rather than containment. How the epidemiology of serogroup B disease and prevention of outbreaks will be affected by the new category B recommendation for serogroup B vaccines remains to be seen.     

东莞市横沥镇流行性腮腺炎流行特征和防控策略

目的对东莞市横沥镇流行性腮腺炎的流行特征进行分析，判定高危人群，预测流行趋势，为制定有效防控措施提供科学依据。方法采用描述流行病学方法对2005至2013年东莞市横沥镇流行性腮腺炎发病资料进行分析。结果2005至2013年该镇共报告流腮病例314例，年平均报告发病率为17．56／10万，发病率在年份间的波动呈现双峰的特征；全年发病高峰为4—7月；男女性别比为2．05：1，发病年龄以0～14岁为主，发病人群主要是学生、幼托儿童和散居儿童；流动人口发病率显著高于户籍人口。结论应提高疫苗免疫覆盖率，加强流动人口儿童免疫管理，进一步落实人学查验预防接种证制度。     

Review of the cost effectiveness of immunisation strategies for the control of epidemic meningococcal meningitis

Outbreaks of meningococcal disease have caused devastation worldwide. Effective vaccines have not been used routinely, due to perceived limitations of the duration of effectiveness as well as immunogenicity when administered during infancy. Given the sporadic nature of outbreaks, the optimal use of these vaccines to control both short-term epidemic and endemic meningococcal disease has been the subject of much debate. Seven economic studies on the use of polysaccharide vaccination strategies help to highlight the relevant epidemiological and economic issues surrounding the decisions for their use. Five of these studies were based in Africa, the region where annual incidence rates can be several orders of magnitude greater than the rest of the world. These studies demonstrated that vaccination against meningococcal disease during outbreak situations is suboptimal given the inability to rapidly immunise populations in a timely fashion in resource-poor areas. However, depending on the disease incidence and the ability to deliver vaccines, the polysaccharide vaccine can be cost effective for preventive strategies when given prior to the start of outbreaks, either through presumptive vaccination or through a modified routine delivery strategy. Economic analyses of mass immunisation campaigns and modelled routine vaccination suggest that routine use of meningococcal vaccines for preventive strategies could be within the range of cost-effective public health interventions in those regions of the world where meningococcal disease is endemic. This includes the meningococcal belt of Africa, the Sahelian region.     

某地区2011年流行性腮腺炎暴发的调查分析

目的了解某地2011年流行性腮腺炎暴发的流行原因和流行趋势,为当地预防流行性腮腺炎提供科学依据。方法根据该地区2011年流行性腮腺炎暴发的疫情数据,对该地区流行性腮腺炎进行流行病学分析。结果该地区2011年中有三所小学暴发流行性腮腺炎,共涉及107名学生。患者多集中在低年级,一年级尤其明显,共37例,占总发病人数的34.58%。结论该地区对流行性腮腺炎的危害的认识程度很低,调查的三所小学中只有极少数学生接种了腮腺炎疫苗。政府部门应高度重视,并加强对学校和青少年儿童关于流行性腮腺炎危害的宣传力度。     

麻江县12起麻疹暴发疫情分析

目的探讨麻疹暴发原因,制定防治对策。方法对麻江县2000-2004年12起麻疹暴发资料进行分析。结果麻江县麻疹暴发强度大,平均每起暴发有42.33例患者,暴发疫情多发生在3月和9月,主要为小学低年级学生,以4～9岁为主,暴发疫情74.5%的病例无免疫史或免疫史不详。结论暴发的主要原因是麻疹疫苗（简称麻苗）接种率低、疫情迟报等。     

Swedish experience of two dose vaccination programme aiming at eliminating measles, mumps, and rubella.

In 1982 a two dose regimen was introduced in Sweden for the combined vaccination against measles, mumps, and rubella of children aged 18 months and 12 years. Since 1977 about half of the preschool children were vaccinated against measles annually, and since 1974 about 80% of 12 year old girls were vaccinated against rubella. During the period 1982 to 1985 90-93% of the eligible age cohorts of 18 month old children and 88-91% of the 12 year old children were immunised with the new combined vaccine. A study in 1982 of about 140 18 month old children who were nearly all seronegative before vaccination showed that 96%, 92%, and 99% seroconverted against measles, mumps, and rubella, respectively. A second study was carried out in 1983 of 247 12 year old children, of whom 11% lacked antibodies to measles, 27% to mumps, and 45% to rubella. This showed seroconversion in 82% and 80% against measles and mumps, respectively, and all children seroconverted against rubella. In the latest study in 1985 of 496 12 year olds 9% and 13% were seronegative against measles and mumps before vaccination, and 41% against rubella. Of these, 88% seroconverted to measles and 80% to mumps, and all converted to rubella when sera were tested by the haemolysis in gel method. After a neutralisation test against measles as well all children showed immunity to the disease. A low incidence of measles and declining figures for mumps and rubella were reported in 1984 to 1986. An outbreak of rubella during 1985 affected mainly boys in age cohorts in which only the girls had been vaccinated during the 1970s.     

Influenza vaccination and antiviral therapy: is there a role for concurrent administration in the institutionalised elderly?

Influenza vaccination is estimated to be 50-68% efficacious in preventing pneumonia, hospitalisation or death in nursing home residents. Large culture-proven outbreaks may occur despite high resident vaccination rates. There is, therefore, a significant role for concurrent administration of influenza vaccination and antiviral therapy. The use of antiviral treatment and chemoprophylaxis requires community reporting of viral isolates, and contingency plans for rapid case identification and application of antiviral therapy. Clinicians must react quickly to control a highly infectious seasonal pathogen that may strike as an explosive outbreak. This situation is unique in geriatric practice. Current antiviral treatment should be administered within 48 hours of symptom onset, and is more efficacious if administered within 12 hours. In the case of an explosive institutional outbreak, a 1-day delay in prophylaxis may allow infection of many residents with a potentially fatal illness. Influenza must be differentiated from other respiratory viruses or syndromes. Grouped rapid diagnostic tests can aid laboratory confirmation. Antiviral agents include the M(2) inhibitors, amantadine and rimantadine, active against influenza A, and the neuraminidase inhibitors, zanamivir and oseltamivir, active against influenza A and B. In our experience, influenza B illness is as severe as influenza A. All agents have similar efficacy as treatment and prophylaxis against sensitive strains. When M(2) inhibitors are used simultaneously within an enclosed space (i.e. household or nursing home) as both treatment and prophylaxis, resistant strains may emerge that limit prophylactic efficacy. When M(2) inhibitors are administered to suspected cases (residents or staff) in institutions, precautions against secretion are especially important to diminish the risk of transmission of resistant virus. Rimantadine has been shown to have significantly fewer CNS adverse events compared with amantadine. Amantadine and oseltamivir require dosage adjustment in those with renal impairment. Oseltamivir, rimantadine and amantadine are administered by mouth, while zanamivir is administered by oral inhalation in a lactose powder. The labelling advises caution in the use of zanamivir in those with underlying airway disease. Pooled analysis of studies in patients given zanamivir indicate that individuals over the age of 50 years (at high risk for complications) and those severely symptomatic at presentation, tend to benefit most from early treatment. Neuraminidase inhibitors also diminish the need for antibacterials to treat secondary complications. An institutional programme to control influenza should include vaccination, and contingency plans for clinical surveillance, specimen processing and the rapid application of antiviral treatment and prophylaxis.     

Economic aspects of food-borne outbreaks and their control

This paper begins with a discussion of the definition of an outbreak. It considers the portion of outbreaks in the general pattern of food-borne infectious disease. The methods used to identify outbreaks are described and the importance of the potential benefits and the economic impact of outbreak recognition and control and are discussed. The paper concludes by illustrating the economic impact of intervention using three infectious diseases botulism, Salmonella and Escherichia coli O157 as case studies of outbreaks.     

流行性腮腺炎152例流行病学及临床特点调查分析

目的调查分析流行性腮腺炎患者的流行病学及临床特点,为更好地防治流行性腮腺炎提供依据。方法收集2012年9月至2013年8月收治的152例流行性腮腺炎患者资料,进行流行病学及临床特点分析。结果3～6岁、7～14岁年龄段为主要发病人群,分别为53例（34．87％）、69例（45．39％）;全年均可发病,主要集中在2012年5～7月、2012年12月至2013年2月。分别为60例（39．47％）、42例（27．63％）;有明确接触史102例（67．11％）,有明确疫苗接种史51例（33．56％）。18例（11．84％）患者出现并发症,主要为胰腺炎、脑膜脑炎、睾丸炎、心肌炎,有并发症患者多有接触史及无疫苗接种史。结论年长的青少年及成年人发病有上升趋势;有明确接触史及无疫苗接种史患者病情重,并发症多。对易感人群接种腮腺炎疫苗及采取严格隔离是控制流行性腮腺炎流行的主要措施。     

Investigation on the trend of food-borne disease outbreaks in Taiwan (1991–2010)

This article summarizes the results of 20 years (1991–2010) of investigation on food-borne disease outbreaks (FBDOs) collected by the Food and Drug Administration of the Department of Health in Taiwan. Among the 4284 FBDOs (82,342 cases) reported, the average annual number of 285 outbreaks during 2001–2010 was substantially greater than the average annual number of 143 outbreaks reported during 1991–2000. The average number of 15.5 cases per outbreak in 2001–2010 was lower than that in 1991–2000, which is 28.5 cases per outbreak. Small-scale FBDOs increased during 2001–2010. Good hygiene practices should be carried out at food service establishments and school kitchens that provide compound cooking food or meal boxes. The three most common bacterial etiology agents involved were Vibrio parahaemolyticus, Staphylococcus aureus, and Bacillus cereus. FBDOs resulting from B. cereus and Salmonella spp. exhibited an increasing trend during 2001–2010. Increased botulism FBDOs in 2001–2010 had been effectively controlled and reduced after governmental policy intervention. However, natural toxin-associated FBDOs are of concern as they can be fatal, especially the outbreaks associated with eating pufferfish by mistake.     

2000-2011年广西壮族自治区南丹县流行性腮腺炎流行病学特征分析

目的了解2000—2011年广西壮族自治区南丹县流行性腮腺炎的流行病学特征,为今后制订防治措施提供科学依据。方法收集广西壮族自治区南丹县2000—2011年报告的流行性腮腺炎病例资料,采用Excel软件进行分析。结果该县过去12年共发现流行性腮腺炎2 015例,年平均发病率为57.78/10万（2 015/3 487 563）,2010年发病率达到139.87/10万（436/311 715）,2 015例患者中95.88%（1 932/2 015）未进行麻疹、腮腺炎和风疹的联合疫苗（MMR）接种;全年每月均有腮腺炎病例出现,分为4—6月和10—12月即初夏和冬季2个高峰期,第1个高峰期是5月份,占总病例数的13.05%（263/2 015）,第2个高峰期是12月份,占总病例数的10.02%（202/2 015）;0-14岁占总病例数的84.22%（1697/2 015）,其中0-6岁占28.73%（579/2 015）,7-14岁占55.48%（1 118/2 015）;男女之比为1.63∶1;全县11个乡镇均有病例报道,其中以城关、六寨和吾隘镇3个镇的发病人数最多,占总病例的51.71%（1 042/2 015）,发病人数最低者为中堡乡,12年中发现腮腺炎病例仅21例。结论该县流行性腮腺炎年均发病率高于全区41.20/10万的平均水平,因此,近2年发病率明显上升,需进一步加强儿童MMR的接种及补种工作。     

Aseptic meningitis following mumps vaccine. A retrospective survey by the French Regional Pharmacovigilance centres and by Pasteur-Mérieux Sérums & Vaccins

Since 1989 many case series and observational studies of aseptic meningitis (AM) associated with the use of live attenuated mumps vaccines containing the Urabe AM9 strain have been reported worldwide. The aim of this retrospective reported AM in France following mumps vaccination with monovalent or multivalent vaccines containing the Urabe strain. Fifty-four cases of AM were reported to the Regional Pharmacovigilance centres or to the manufacturer from the time each vaccine was launched up until June 1992. Twenty cases were temporally associated with the administration of a monovalent mumps vaccine and 34 with a trivalent measles, mumps and rubella vaccine (MMR). A mumps virus was isolated in four cases in the cerebrospinal fluid and an Urabe-like strain was characterized twice by polymerase chain reaction (PCR). A probable mumps origin was assumed in 17 other cases where the patients presented with other clinical or biological signs of mumps infection. The clinical outcome of AM, known in 87% of the population, was always favourable. The global incidence of mumps vaccine-associated AM was 0.82/100,000 doses, which is significantly lower than the incidence in the unvaccinated population. Even considering that the actual incidence of AM is much higher when assessed by active surveillance studies, the risk/benefit ratio of mumps vaccine remains in favour of vaccination.     

Pharmacoeconomics of immunisation: a review

The effects of immunisation programmes that have existed for several decades in developed countries are demonstrated by the decrease and even eradication of smallpox, poliomyelitis, measles, mumps and hepatitis B. Cost, health policy and spontaneous evolution in the incidence of communicable diseases have a decisive influence on the use of a vaccine. Investment in vaccination policy has to be encouraged to maintain this progress made in the control of infectious diseases and to meet new challenges. Studies re-evaluating ongoing immunisation programmes are scarce. Nevertheless, it can be concluded that for vaccination against hepatitis B in professionally exposed at-risk populations, arguments for positive returns are consistent. The same holds for vaccination against S. pneumoniae and for influenza virus in the elderly. The results of the economic evaluation of revaccination against measles, when insufficient coverage exists, are inconclusive. Universal vaccination of children against Haemophilus influenzae type b (Hib) and of children of hepatitis B-positive mothers against hepatitis may require costs to be paid in order to gain extra health benefits.