Article(id=1241759335580241943, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202309522, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1695830400000, receivedDateStr=2023-09-28, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773988096375, onlineDateStr=2026-03-20, pubDate=1727193600000, pubDateStr=2024-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773988096375, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773988096375, creator=13701087609, updateTime=1773988096375, updator=13701087609, issue=Issue{id=1241759317016252418, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='18', pageStart='3265', pageEnd='3456', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773988091898, creator=13701087609, updateTime=1773991617194, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241774103024174010, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241774103024174011, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3422, endPage=3427, ext={EN=ArticleExt(id=1241759336171638811, articleId=1241759335580241943, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Epidemiology of varicella and effectiveness of varicella vaccine in Jinan, 2006—2022, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the epidemiological characteristics of varicella and effectiveness of varicella vaccine in Jinan.

Methods

We collected data of varicella surveillance in Jinan from 2006 to 2022 from the Chinese Information System for Disease Control and Prevention and vaccination data for children born during 2010-2021 form the Jinan Immunization Planning Information System. All reported varicella cases from 2006 to 2022 in Jinan were analyzed with descriptive epidemiological methods; Coverage and effectiveness of varicella vaccine for children born during 2010 to 2021 were conducted with the screening method.

Results

61 145 cases of varicella were reported in Jinan during 2006—2022, yielding an annual average incidence of 51.82 per 100 000 population; the incidence ranged from 74.48 per 100 000 in 2008 to 28.47 per 100 000 in 2022.Peak varicella incidences occurred between April and June and between November and the following January. The highest incidence rate was 5-9 years old group from 2006—2016 and was 15-19 years old group from 2017 to 2022.Coverage levels for one doses was 77.32% in the 2010-2021births; the overall effectiveness of varicella vaccine was 91.83% (95%CI: 91.43%-92.30%). Coverage levels for two doses was 45.86% in the 2010—2018 births; the overall effectiveness of varicella vaccine was 95.14%(95%CI: 94.56%-95.66%).

Conclusion

The high incidence age group shifted from 5-9 years old to 15-19 years old. It was suggested that the vaccine administration should be used to targeted age groups. Levels of vaccine effectiveness for 2 doses of varicella vaccine were greater than levels of Vaccine effectiveness for one-doses. We suggest to introduce 2 dose of varicella vaccine into the national immunization program for children.

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目的

分析济南市2006—2022年水痘流行特征和水痘疫苗保护效果。

方法

收集中国疾病预防控制信息系统和济南市免疫规划信息系统中济南市2006—2022年水痘监测资料和2010—2021年出生人群水痘疫苗接种信息,采用描述性流行病学方法分析济南市2006—2022年水痘流行特征,采用筛查法分析2010—2021年出生儿童水痘疫苗接种率和疫苗保护效果。

结果

济南市2006—2022年共报告水痘病例61 145例,年均报告发病率为 51.82 /10万,各年发病率在2008年的74.48 /10万至2022年的28.47 /10万之间,每年4至6月和11月至次年1月为水痘发病的两个高峰期。2006—2016年济南市5~9岁年龄组发病率最高,2017—2022年15~19岁年龄组发病率最高。2010—2021年出生儿童第一剂次水痘疫苗的累计接种率为77.32%,总保护效果为91.83%(95%CI:91.43%~92.30%),2010—2018年出生儿童第二剂次水痘疫苗累计接种率为45.86%,总保护效果为95.14%(95%CI:94.56%~95.66%)。

结论

高发年龄组从5~9岁转向15~19岁年龄组,建议符合条件的青少年积极接种水痘疫苗;水痘疫苗保护效果2剂次比1剂次更好,建议将水痘疫苗2剂次接种纳入免疫规划。

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韩莹,E-mail:
王勤富,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=CAw209uaDucDceQPLESm+g==, magXml=en5t3+KfeyaInBOEdbeVhQ==, pdfUrl=null, pdf=W5ckNhp8Hf+T0qqGGdg4Jg==, pdfFileSize=1372603, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=Z5Dd0Cz7H+08HmPjOoQ3lA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=SkN0WquCkUuZ0+LTHAKW7w==, mapNumber=null, authorCompany=null, fund=null, authors=

武晶晶(1982—),女,硕士,副主任医师,研究方向:疫苗针对疾病的预防控制工作

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武晶晶(1982—),女,硕士,副主任医师,研究方向:疫苗针对疾病的预防控制工作

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The Turkish Journal of Pediatrics, 2018, 60(1): 56-62., articleTitle=Outbreak of varicella in preschool children despite one-dose vaccination, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241759349983482114, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, xref=1., ext=[AuthorCompanyExt(id=1241759350008647939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, companyId=1241759349983482114, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Jinan Municipal Center for Disease Control and Prevention, Jinan, Shangdong 250021, China), AuthorCompanyExt(id=1241759350117699848, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, companyId=1241759349983482114, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.济南市疾病预防控制中心,山东 济南 250021)]), AuthorCompany(id=1241759351174664468, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, xref=2., ext=[AuthorCompanyExt(id=1241759351279522075, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, companyId=1241759351174664468, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.平阴县疾病预防控制中心)])], figs=[ArticleFig(id=1241759368102875950, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=EN, label=Fig.1, caption=Case report of varicella in Jinan from 2006 to 2022, figureFileSmall=XNtujYrUV5DpznK/eVQdQQ==, figureFileBig=Z5Dd0Cz7H+08HmPjOoQ3lA==, tableContent=null), ArticleFig(id=1241759368333562682, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=CN, label=图1, caption=2006—2022年济南市水痘报告发病数和发病率, figureFileSmall=XNtujYrUV5DpznK/eVQdQQ==, figureFileBig=Z5Dd0Cz7H+08HmPjOoQ3lA==, tableContent=null), ArticleFig(id=1241759369025622878, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=EN, label=Fig.2, caption=Monthly distribution of varicella reported case in Jinan from 2006 to 2022, figureFileSmall=5WkbT4oDwjx8/pGw8MCWYw==, figureFileBig=FJ3OEyO2wX4+sGGj7qH6wA==, tableContent=null), ArticleFig(id=1241759369264698221, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=CN, label=图2, caption=济南市2006—2022年水痘病例月分布, figureFileSmall=5WkbT4oDwjx8/pGw8MCWYw==, figureFileBig=FJ3OEyO2wX4+sGGj7qH6wA==, tableContent=null), ArticleFig(id=1241759369445053306, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=EN, label=Fig.3, caption=The distribution of varicella cases by age group in Jinan from 2006 to 2022, figureFileSmall=u8Fmiup15s0bPKkbTZrzrg==, figureFileBig=q7KrP2YSXgtXnA3Bb8Jurw==, tableContent=null), ArticleFig(id=1241759369545716607, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=CN, label=图3, caption=2006—2022年水痘病例年龄别发病率, figureFileSmall=u8Fmiup15s0bPKkbTZrzrg==, figureFileBig=q7KrP2YSXgtXnA3Bb8Jurw==, tableContent=null), ArticleFig(id=1241759369835123603, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=EN, label=Fig.4, caption=The distribution of varicella cases by occupation in Jinan from 2006 to 2022, figureFileSmall=S5cQAqqMb4NWkkKejZMUHA==, figureFileBig=Ags8kwVYX5ZP79Q9zoHZzg==, tableContent=null), ArticleFig(id=1241759370174862243, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=CN, label=图4, caption=2006—2022年济南市水痘病例的职业构成, figureFileSmall=S5cQAqqMb4NWkkKejZMUHA==, figureFileBig=Ags8kwVYX5ZP79Q9zoHZzg==, tableContent=null), ArticleFig(id=1241759370497823662, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=EN, label=Table 1, caption=

The distribution of varicella cases by counties in Jinan from 2006 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
地区发病数发病率(/10万)构成比(%)
历下区9 89481.2016.18
市中区8 37068.7013.69
槐荫区6 34975.3010.38
天桥区9 85682.8016.12
历城区13 43367.4221.97
长清区3 95739.816.47
平阴县2 54343.144.16
济阳县1 31914.492.16
商河县1 35613.562.22
章丘区4 06822.096.65
合计61 14551.83100.00
), ArticleFig(id=1241759371139552193, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=CN, label=表1, caption=

2006—2022年济南市水痘报告发病地区分布

, figureFileSmall=null, figureFileBig=null, tableContent=
地区发病数发病率(/10万)构成比(%)
历下区9 89481.2016.18
市中区8 37068.7013.69
槐荫区6 34975.3010.38
天桥区9 85682.8016.12
历城区13 43367.4221.97
长清区3 95739.816.47
平阴县2 54343.144.16
济阳县1 31914.492.16
商河县1 35613.562.22
章丘区4 06822.096.65
合计61 14551.83100.00
), ArticleFig(id=1241759371353461705, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=EN, label=Table 2, caption=

Coverage and vaccine effectiveness of varicella vaccine in the 2010—2021 birthsl

, figureFileSmall=null, figureFileBig=null, tableContent=
出生年份出生儿童数水痘病例数1剂次水痘疫苗
出生人群接种数PPV
(%)
病例接种数PCV
(%)
保护效果
(95%CI)(%)
201072 4861 49945 26462.4534322.8882.16(79.95~84.28)
201167 7471 16646 02467.9429925.6483.72(81.55~85.85)
201277 7241 00955 62671.5721421.2189.31(87.63~90.87)
201364 57878448 51075.1223429.8585.91(83.72~88.04)
201497 23590375 66877.8224026.5889.68(88.13~91.18)
201568 79953853 51877.7910319.1493.24(94.58~96.15)
2016119 05169297 68382.0511716.9195.55(94.56~96.37)
2017101 85449884 36582.839919.8894.86(93.62~95.89)
201890 86537869 49776.485213.7695.10(93.44~96.35)
201991 45724679 25686.662510.1698.26(97.37~98.85)
202067 93515359 92188.2095.8899.16(98.36~99.57)
202168 12510748 43771.1010.9399.62(97.25~99.95)
合计987 8567 973763 76977.321 73621.7791.83(91.43~92.30)
出生年份出生儿童数水痘病例数2剂次水痘疫苗
出生人群接种数PPV
(%)
病例接种数PCV
(%)
保护效果
(95%CI)(%)
201072 4861 49932 69945.11815.4093.05(91.30~94.44)
201167 7471 16634 29050.61877.4692.13(90.21~93.68)
201277 7241 00942 56654.77434.2696.32(95.10~97.29)
201364 57878437 52258.10344.3496.73(95.39~97.68)
201497 23590362 06663.83414.5497.3(96.31~98.03)
201568 79953844 83465.17101.8698.99(98.11~99.46)
2016119 05169284 78271.21121.7399.29(98.74~99.60)
2017101 85449867 26466.0471.4199.27(98.45~99.65)
201890 86537847 02951.7600.00100
201991 457246-----
202067 935153-----
202168 125107-----
合计987 8567 973453 05245.863153.9595.14(94.56~95.66)
), ArticleFig(id=1241759371567371221, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759335580241943, language=CN, label=表2, caption=

济南市2010—2021年出生儿童水痘疫苗接种率和保护效果

, figureFileSmall=null, figureFileBig=null, tableContent=
出生年份出生儿童数水痘病例数1剂次水痘疫苗
出生人群接种数PPV
(%)
病例接种数PCV
(%)
保护效果
(95%CI)(%)
201072 4861 49945 26462.4534322.8882.16(79.95~84.28)
201167 7471 16646 02467.9429925.6483.72(81.55~85.85)
201277 7241 00955 62671.5721421.2189.31(87.63~90.87)
201364 57878448 51075.1223429.8585.91(83.72~88.04)
201497 23590375 66877.8224026.5889.68(88.13~91.18)
201568 79953853 51877.7910319.1493.24(94.58~96.15)
2016119 05169297 68382.0511716.9195.55(94.56~96.37)
2017101 85449884 36582.839919.8894.86(93.62~95.89)
201890 86537869 49776.485213.7695.10(93.44~96.35)
201991 45724679 25686.662510.1698.26(97.37~98.85)
202067 93515359 92188.2095.8899.16(98.36~99.57)
202168 12510748 43771.1010.9399.62(97.25~99.95)
合计987 8567 973763 76977.321 73621.7791.83(91.43~92.30)
出生年份出生儿童数水痘病例数2剂次水痘疫苗
出生人群接种数PPV
(%)
病例接种数PCV
(%)
保护效果
(95%CI)(%)
201072 4861 49932 69945.11815.4093.05(91.30~94.44)
201167 7471 16634 29050.61877.4692.13(90.21~93.68)
201277 7241 00942 56654.77434.2696.32(95.10~97.29)
201364 57878437 52258.10344.3496.73(95.39~97.68)
201497 23590362 06663.83414.5497.3(96.31~98.03)
201568 79953844 83465.17101.8698.99(98.11~99.46)
2016119 05169284 78271.21121.7399.29(98.74~99.60)
2017101 85449867 26466.0471.4199.27(98.45~99.65)
201890 86537847 02951.7600.00100
201991 457246-----
202067 935153-----
202168 125107-----
合计987 8567 973453 05245.863153.9595.14(94.56~95.66)
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济南市2006—2022年水痘流行特征及水痘疫苗保护效果分析
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武晶晶 1 , 邹丽萍 1 , 贺玉静 1 , 郭丽 1 , 谢元忠 2 , 韩莹 1 , 王勤富 1
现代预防医学 | 疾病预防控制 2024,51(18): 3422-3427
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现代预防医学 | 疾病预防控制 2024, 51(18): 3422-3427
济南市2006—2022年水痘流行特征及水痘疫苗保护效果分析
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武晶晶1, 邹丽萍1, 贺玉静1, 郭丽1, 谢元忠2, 韩莹1 , 王勤富1
作者信息
  • 1.济南市疾病预防控制中心,山东 济南 250021
  • 2.平阴县疾病预防控制中心
  • 武晶晶(1982—),女,硕士,副主任医师,研究方向:疫苗针对疾病的预防控制工作

通讯作者:

韩莹,E-mail:
王勤富,E-mail:
Epidemiology of varicella and effectiveness of varicella vaccine in Jinan, 2006—2022
Jing-jing WU1, Li-ping ZOU1, Yu-jing HE1, Li GUO1, Yuan-zhong XIE2, Ying HAN1 , Qin-fu WANG1
Affiliations
  • Jinan Municipal Center for Disease Control and Prevention, Jinan, Shangdong 250021, China
出版时间: 2024-09-25 doi: 10.20043/j.cnki.MPM.202309522
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目的

分析济南市2006—2022年水痘流行特征和水痘疫苗保护效果。

方法

收集中国疾病预防控制信息系统和济南市免疫规划信息系统中济南市2006—2022年水痘监测资料和2010—2021年出生人群水痘疫苗接种信息,采用描述性流行病学方法分析济南市2006—2022年水痘流行特征,采用筛查法分析2010—2021年出生儿童水痘疫苗接种率和疫苗保护效果。

结果

济南市2006—2022年共报告水痘病例61 145例,年均报告发病率为 51.82 /10万,各年发病率在2008年的74.48 /10万至2022年的28.47 /10万之间,每年4至6月和11月至次年1月为水痘发病的两个高峰期。2006—2016年济南市5~9岁年龄组发病率最高,2017—2022年15~19岁年龄组发病率最高。2010—2021年出生儿童第一剂次水痘疫苗的累计接种率为77.32%,总保护效果为91.83%(95%CI:91.43%~92.30%),2010—2018年出生儿童第二剂次水痘疫苗累计接种率为45.86%,总保护效果为95.14%(95%CI:94.56%~95.66%)。

结论

高发年龄组从5~9岁转向15~19岁年龄组,建议符合条件的青少年积极接种水痘疫苗;水痘疫苗保护效果2剂次比1剂次更好,建议将水痘疫苗2剂次接种纳入免疫规划。

水痘  /  水痘疫苗  /  流行特征  /  保护效果
Objective

To analyze the epidemiological characteristics of varicella and effectiveness of varicella vaccine in Jinan.

Methods

We collected data of varicella surveillance in Jinan from 2006 to 2022 from the Chinese Information System for Disease Control and Prevention and vaccination data for children born during 2010-2021 form the Jinan Immunization Planning Information System. All reported varicella cases from 2006 to 2022 in Jinan were analyzed with descriptive epidemiological methods; Coverage and effectiveness of varicella vaccine for children born during 2010 to 2021 were conducted with the screening method.

Results

61 145 cases of varicella were reported in Jinan during 2006—2022, yielding an annual average incidence of 51.82 per 100 000 population; the incidence ranged from 74.48 per 100 000 in 2008 to 28.47 per 100 000 in 2022.Peak varicella incidences occurred between April and June and between November and the following January. The highest incidence rate was 5-9 years old group from 2006—2016 and was 15-19 years old group from 2017 to 2022.Coverage levels for one doses was 77.32% in the 2010-2021births; the overall effectiveness of varicella vaccine was 91.83% (95%CI: 91.43%-92.30%). Coverage levels for two doses was 45.86% in the 2010—2018 births; the overall effectiveness of varicella vaccine was 95.14%(95%CI: 94.56%-95.66%).

Conclusion

The high incidence age group shifted from 5-9 years old to 15-19 years old. It was suggested that the vaccine administration should be used to targeted age groups. Levels of vaccine effectiveness for 2 doses of varicella vaccine were greater than levels of Vaccine effectiveness for one-doses. We suggest to introduce 2 dose of varicella vaccine into the national immunization program for children.

Varicella  /  Varicella vaccine  /  Epidemiological characteristic  /  Vaccine effectiveness
武晶晶, 邹丽萍, 贺玉静, 郭丽, 谢元忠, 韩莹, 王勤富. 济南市2006—2022年水痘流行特征及水痘疫苗保护效果分析. 现代预防医学, 2024 , 51 (18) : 3422 -3427 . DOI: 10.20043/j.cnki.MPM.202309522
Jing-jing WU, Li-ping ZOU, Yu-jing HE, Li GUO, Yuan-zhong XIE, Ying HAN, Qin-fu WANG. Epidemiology of varicella and effectiveness of varicella vaccine in Jinan, 2006—2022[J]. Modern Preventive Medicine, 2024 , 51 (18) : 3422 -3427 . DOI: 10.20043/j.cnki.MPM.202309522
水痘是由水痘-带状疱疹病毒引起具有高度传染性的急性呼吸道传染病,临床特征是全身同时出现丘疹、水疱及结痂。水痘通常是一种自限性疾病,但可继发皮肤细菌感染、肺炎、脑炎、肝炎等并发症,甚至引起死亡。水痘在世界范围内均有发病,易感者接触后96%以上呈显性感染,易在无免疫力的儿童中形成流行或暴发[1-2]。随着麻疹、白喉、流行性脑脊髓膜炎等疫苗针对传染病发病数大幅下降,中国报告水痘发病数已居儿童疫苗可预防传染病之首[3]。现对2006—2022年济南市水痘疫情进行流行病学分析,同时对济南市2010—2021年出生人群水痘疫苗保护效果进行评价,以全面了解济南市水痘疫情流行特征和水痘疫苗接种率及其保护效果,为济南市水痘疫情防控提供指导依据。
收集中国疾病预防控制信息系统中关于济南市2006—2022年水痘发病资料和突发公共卫生事件相关资料,收集山东省济南市免疫规划信息系统中2010—2021年出生人群水痘疫苗的免疫史及建卡数,剔除不符合接种逻辑和重卡情况。
使用筛查法[4]进行水痘疫苗保护效果评价。当年出生队列人群中接种第1或第2剂次水痘疫苗的比例称为人群中接种疫苗百分比(Percent of population vaccinated,PPV);当年出生队列水痘病例中接种第1或第2剂次水痘疫苗的比例称为病例中接种疫苗比例(Proportion of cases vaccinated,PCV);疫苗保护效果=(PPV-PCV)/[PPV(1-PCV)]。筛查法需在疫苗接种率稳定的阶段才适合使用,因此本文选择2010—2021年出生队列儿童进行分析。
收集中国疾病预防控制信息系统2010—2021年出生的水痘病例信息,病例免疫史是按照病例姓名、性别、出生日期或者姓名、身份证号在山东省济南市免疫规划信息系统后台进行上述关键数据相匹配得出。出生人群免疫史直接从山东省济南市免疫规划信息系统获取。
采用描述性流行病学方法分析2006—2022年济南市水痘病例分布特征。相关数据采用WPS和Epi Info 7.2进行数据处理分析。山东省建议儿童满1周岁接种第1剂水痘疫苗,4周岁接种第2剂,因此分别分析2010—2021年和2010—2018年出生队列儿童第1剂次和第2剂次水痘疫苗保护效果。
济南市2006—2022年共报告水痘病例 61 145例,年均报告发病率为 51.82 /10万。
2006—2022年济南市各年报告发病率(/10万)波动在28.47/10万(2022年)~74.48/10万(2008年)之间。2007—2009年呈现第一个发病高峰,2019年呈现第二个发病高峰。见图1
2006—2022年各月均有水痘病例报告,每年4至6月(春末夏初峰)和11月至次年1月(冬季峰)为水痘发病的两个高峰期,分别占总病例数的29.43%、36.91%。2020年和2022年的“春末夏初峰”不明显,另外2022年冬季峰在11月出现,12月水痘报告病例数快速下降。见图2
2006—2022年济南市所有区县每年均有水痘病例报告,各区县年均报告发病率在13.56/10万(商河县)~82.80/10万(天桥区)之间。年均发病率前五位的是天桥区(82.80/10万)、历下区(81.20/10万)、槐荫区(75.30/10万)、市中区(68.70/10万)、历城区(67.42/10万)。北部商河县和济阳县一直处于低发状态。见表1
2006—2022年济南市报告的水痘病例中,男性34 008例,女性27 137例,性别比为1.25:1,年均报告发病率分别为56.98/10万、46.55/10万。2006—2022年<1岁、1~4岁、5~9岁、10~15岁、15~19岁、20~24岁、≥25岁水痘病例年均发病率(/10万)159.83、57.38、280.93、188.63、173.01、64.03、8.34。2006—2016年济南市5~9岁年龄组发病率最高,2017—2022年15~19岁年龄组发病率处于各年龄组最高水平。见图3
济南市2006—2022年水痘病例职业前5位的为学生、托幼儿童例、散居儿童、家务及待业例和商业服务,分别占55.64%、16.80%、10.59%、3.78%、3.26%。见图4
济南市2006—2022年共报告水痘突发公共卫生事件46起,均发生在学校,占同时期全市学校突发传染病事件总数的16.31%(46/282),共报告病例1 348例。2006—2022年共发生在幼儿园5起(其中2006—2016年发生2起,2017—2022年3起);小学22 起(16起,6起);中学10 起(1起,9起);大学3 起(2起,1起);民办寄宿制学校4起(0起,4起);其他学校2起(1起,1起)。
2010—2021年出生儿童第一剂次水痘疫苗的接种率(PPV)为77.32%,病例中疫苗接种比例(PCV)为21.77%,总保护效果为91.83%(95%CI:91.43%~92.30%),其中2010年出生儿童保护效果为82.16%(79.95%~84.28%),2021年为99.62%(97.25%~99.95%);2010—2018年出生儿童第二剂次水痘疫苗接种率为45.86%,病例中疫苗接种比例为3.95%,总保护效果为95.14%(95%CI:94.56%~95.66%),其中2010年出生儿童保护效果为93.05%(91.30%~94.44%),2018年为100%。见表2
2006—2022年济南市水痘年均报告发病率(51.82 /10万)高于全国[3,5]及其他部分地区平均发病水平[6-8],可能与济南市为省会城市,人口密度大、流动人口多等因素造成。同时有研究表明[9],济南市水痘发病率较高,与气压、日照时间、降雨量相关,相对湿度和温度低可能增加水痘的发病率。
与全国其他地市报告发病率呈上升趋势不同[10-12],2006—2022年济南市报告发病呈明显的“双峰”分布,第一个高峰在2007—2009年,第二个高峰在2017—2019年。形成第一个高峰的原因可能是2005年国家传染病报告管理系统开通了水痘报告管理功能,随后几年济南市水痘报告大幅上升;第二个高峰形成原因可能是受疫苗事件的影响,群众对疫苗接种产生不信任,同时该时期出现二类疫苗供应不足,再则国家二类疫苗开始实施零差价服务,预防接种人员对二类疫苗接种积极性下降等原因造成水痘疫苗接种率下降、发病增加。2010—2016年两个发病高峰之间水痘报告发病呈平稳波动,可能与这期间济南市将水痘疫苗纳入常规预防接种服务,接种率逐年提高和2012年开始实施两剂次免疫策略有关。2020—2022年水痘发病明显降低,2022年报告发病率(28.47/10万)降至历年最低水平,这可能与新冠疫情期间各种防控措施有关。
济南市水痘季节分布方面,每年呈现“春末夏初峰”和“冬季峰”的双峰现象,与国内多地研究结果相似[13-14]。与其他年份相比,济南市2020年和2022年“春末夏初峰”不明显,可能是此时段内济南市受新冠疫情的影响,要求学生居家上网课,进入公共场所必须佩戴口罩等,使水痘传播途径不易形成、易感人群防护较好有关。与往期相反,2022年12月水痘报告病例大幅降低,可能与这期间国家卫生健康委员会颁布了《关于进一步优化落实新冠肺炎疫情防控措施的通知》,全国除绝大部分普通新冠患者居家治疗外,新冠危重症病例的大幅增长导致医疗卫生资源紧张,正常的医疗秩序受到影响,水痘可能出现漏报现象。
从地理分布来看,2006—2022年济南市各区县均有水痘病例报告,但各区县发病率差异较大,最高为天桥区的82.80/10万,最低为商河县的13.56/10万,两者相差6倍。水痘高发地区主要集中在中心城区,这与中心城区人口密度大、流动人口多、省市级优质医疗资源相对集中,医务人员传染病报告意识较强、区域经济发展水平较好,病例就诊意愿较高等相关。
本研究发现,2006—2016年济南市5~9岁年龄组发病率最高,与此相应,全市突发公共卫生事件此时期以小学居多,而2017—2022年15~19岁年龄组发病率处于各年龄组最高水平,同期全市突发公共卫生事件以中学为主,这与全国[3,5,15]及其他省市[11,16]近年来以5~9岁年龄组发病率最高且突发公共卫生事件主要发生在小学不同,表明济南市水痘发病已向较大年龄组转移。这可能是由于我市水痘疫苗接种以小年龄组儿童为主,使其发病率持续下降,但随着时间的推移,受种者体内抗体水平与抗体阳性率随接种时间的增长而降低[17],从而导致大龄学生或成人发病的增加。WHO建议[18],水痘疫苗应达到并维持在80%以上的高水平免疫覆盖率,才能阻断疾病的传播;如果仅达到部分接种覆盖率,会引起水痘流行特征发生改变,导致发病年龄后移、较大儿童及成人病例率增加。近几年济南市水痘疫苗接种率在70%左右[19],处于部分接种覆盖水平,起不到阻断水痘病毒传播的效果。提示济南市应继续提高水痘疫苗接种率,才能避免水痘发病向较大儿童和成人转移。文献表明[14],儿童患者症状和皮疹均较轻,成人患者症状较重,成人致死性并发症病死率较5~9岁儿童高30~40倍。因此,在目前水痘流行状况下,建议未患过水痘且未接种过水痘疫苗或仅接种过一剂次水痘疫苗的大年龄学生或成人,按照《山东省非免疫规划疫苗接种方案(2021年版)》积极进行水痘疫苗接种。
非免疫规划疫苗接种率高低与各地区疫苗接种政策、经济发展水平等有关[20-21]。济南市2010—2021年出生儿童水痘疫苗第一剂次水痘疫苗累计接种率为77.32%,2010—2018年出生儿童第二剂次水痘疫苗累计接种率为45.86%,与浙江省、北京市等国内经济发达的省市水痘疫苗接种率仍有一定差距[22]。济南市第二剂次水痘疫苗接种率明显低于第一剂次,可能与济南是省会城市,流动儿童较多及水痘疫苗第二剂次接种宣传力度不足有关。济南市2010—2021年出生儿童第一剂次水痘疫苗保护效果在82.16%~99.62%之间,表明随着时间的推移,水痘疫苗第一剂次保护效果显著下降。第二剂次水痘疫苗总保护效果为95.14%(95%CI:94.56~95.66),研究队列人群保护效果在92.13%~100%之间,随着时间的推移未出现明显的下降,表明接种2剂水痘疫苗比1剂具有更好的保护效果。研究表明[23-24],接种一剂次水痘疫苗不能预防局部病毒循环和暴发,两剂次水痘疫苗接种可使突破病例发生风险降低3倍,且能有效减少暴发发生,从而进一步人群降低发病率和死亡率。因此有必要在第一剂次接种的基础上,进行第二剂次水痘疫苗接种,以提高水痘疫苗的保护效果。
综上所述,现阶段济南市儿童水痘疫苗接种率维持在中等覆盖水平,尚不能阻断水痘病毒传播,济南市水痘发病率依然较高,高发人群从5~9岁组儿童转向15~19岁组大龄学生或成人,随接种时间的推移,第一剂次的保护效果下降明显,第二剂次保护效果可维持在90%以上的较高水平。由于水痘疫苗属于自费疫苗,家庭经济收入和疫苗价格是自费疫苗接种的重要阻碍因素,部分人群接种意愿较低,“自愿、自费”接种难以改变水痘高发的现实情况,因此建议济南市将两剂次水痘疫苗接种纳入免疫规划,为适龄儿童进行免费接种,对于有效控制水痘的传播和流行,具有迫切且重要的公共卫生意义。
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2024年第51卷第18期
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doi: 10.20043/j.cnki.MPM.202309522
  • 接收时间:2023-09-28
  • 首发时间:2026-03-20
  • 出版时间:2024-09-25
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  • 收稿日期:2023-09-28
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    1.济南市疾病预防控制中心,山东 济南 250021
    2.平阴县疾病预防控制中心

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2种不同金属材料的力学参数

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属数
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genus
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占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
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Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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