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Article(id=1320427660140986443, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320427658937225679, articleNumber=null, orderNo=null, doi=10.11847/zgggws1149456, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764691200000, receivedDateStr=2025-12-03, revisedDate=1768665600000, revisedDateStr=2026-01-18, acceptedDate=1775836800000, acceptedDateStr=2026-04-11, onlineDate=1792744086537, onlineDateStr=2026-10-23, pubDate=1786291200000, pubDateStr=2026-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792744086537, onlineIssueDateStr=2026-10-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792744086537, creator=13701087609, updateTime=1792744086537, updator=13701087609, issue=Issue{id=1320427658937225679, tenantId=1146029695717560320, journalId=1319373219989389464, year='2026', volume='42', issue='8', pageStart='897', pageEnd='1024', issueExtLink='null', onlineDate='null', pubDate='1786291200000', pubDateStr='2026-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792744086250, creator='13701087609', updateTime=1792747993375, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1320444046678544663, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320427658937225679, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1320444046678544664, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320427658937225679, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=897, endPage=901, ext={EN=ArticleExt(id=1320427660338118732, articleId=1320427660140986443, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Protective effectiveness of acellular diphtheria-tetanus-pertussis vaccine against pertussis in infants and young children aged 2 years and under in Gansu province: a retrospective cohort study based on population-based surveillance data, columnId=1320427660187120197, journalTitle=Chinese Journal of Public Health, columnName=Special Report—Evaluating the Protective Effect of Childhood Vaccination, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the vaccine effectiveness (VE) of the adsorbed acellular diphtheria-tetanus-pertussis (DTaP) vaccine in infants and young children aged 2 years and under in Gansu province, thereby providing evidence for optimizing the immunization strategies for pertussis in underdeveloped western regions of China.

Methods

A retrospective cohort was established, including 176 688 resident children born in Gansu province from January 1 to December 31, 2023. The Poisson regression model was adopted to calculate the relative risk (RR) for evaluating the VE of 1–4 doses of DTaP vaccine against pertussis and pertussis-related hospitalization, after adjusting for factors such as region and sex.

Results

The coverage rates of the 1st to 4th doses of DTaP vaccine among infants and young children aged 2 years and under in Gansu province were 92.88%, 91.15%, 89.22%, and 41.96%, respectively. The VE of the 1st to 4th doses against pertussis was 43.67% (95%CI: 39.60%–55.21%), 71.30% (95%CI: 50.13%–79.96%), 90.91% (95%CI: 88.82%–92.68%), and 99.20% (95%CI: 77.91%–99.80%), respectively. The VE of the 1st to 4th doses against pertussis-related hospitalization was 56.14% (95%CI: 18.13%–77.80%), 63.90% (95%CI: 22.71%–85.46%), 73.02% (95%CI: 58.10%–82.34%), and 94.40% (95%CI: 64.32%–98.70%), respectively.

Conclusions

The DTaP vaccine provides significant protection against pertussis and pertussis-related hospitalization in infants and young children aged 2 years and under in Gansu province in a dose-dependent manner. Efforts should focus on improving the timeliness of primary immunization and the coverage of booster doses.

, authors=Yongzhuo JIAO, Jing AN, Shuyu LIU, Xuefeng LIANG, Xiaoshu ZHANG, authorsList=Yongzhuo JIAO, Jing AN, Shuyu LIU, Xuefeng LIANG, Xiaoshu ZHANG, authorCompany=null, correspAuthors=Xiaoshu ZHANG, authorNote=null, correspAuthorsNote=
ZHANG Xiaoshu, E-mail:
, copyrightStatement=Copyright © 2026 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1320427660933709903, articleId=1320427660140986443, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=无细胞百白破疫苗对甘肃省2岁及以下婴幼儿患百日咳的保护效果：基于人群监测数据的回顾性队列研究, columnId=1320427660346503751, journalTitle=中国公共卫生, columnName=专题报道——儿童疫苗接种保护效果研究, runingTitle=null, highlight=null, articleAbstract=
目的

评价吸附无细胞百白破疫苗（DTaP）对甘肃省2岁及以下婴幼儿患百日咳的保护效果（VE），为完善西部欠发达地区百日咳的免疫策略提供科学依据。

方法

纳入2023年1月1日—12月31日甘肃省出生的176 688名常住儿童，构建回顾性队列。使用Poisson回归模型计算风险比（RR），在校正地区、性别等因素后评价1～4剂DTaP预防百日咳及住院的VE。

结果

甘肃省2岁及以下婴幼儿1～4剂次DTaP接种率分别为92.88%、91.15%、89.22%、41.96%。预防百日咳的VE分别为43.67%（95%CI=39.60%～55.21%）、71.30%（95%CI=50.13%～79.96%）、90.91%（95%CI=88.82%～92.68%）、99.20%（95%CI=77.91%～99.80%）；预防百日咳住院的VE分别为56.14%（95%CI=18.13%～77.80%）、63.90%（95%CI=22.71%～85.46%）、73.02%（95%CI=58.10%～82.34%）、94.40%（95%CI=64.32%～98.70%）。

结论

DTaP对甘肃省2岁及以下婴幼儿的百日咳及其导致的住院具有保护效果，且保护效果随接种剂次增加而增强。应大力提升DTaP基础免疫及时率与加强免疫接种率。

, authors=焦永卓, 安婧, 刘舒瑜, 梁雪枫, 张晓曙*, *, authorsList=焦永卓, 安婧, 刘舒瑜, 梁雪枫, 张晓曙, authorCompany=null, correspAuthors=张晓曙, authorNote=

焦永卓（1986—），副主任医师，硕士，研究方向：传染性疾病控制

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张晓曙，E-mail：
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Current Opinion in Immunology, 2015, 35: 48-54., articleTitle=null, refAbstract=null), Reference(id=1320427669175517331, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=17, rfOrder=16, authorNames=null, journalName=null, refType=null, unstructuredReference=张延炀, 刘迎迎, 李军, 等. 青少年及成人百日咳流行现况及疫苗免疫策略[J]. 现代疾病预防控制, 2025, 36(4): 242-249., articleTitle=null, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1320427661160202320, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, xref=null, ext=[AuthorCompanyExt(id=1320427661172785233, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, companyId=1320427661160202320, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730000, China), AuthorCompanyExt(id=1320427661185368146, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, companyId=1320427661160202320, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=甘肃省疾病预防控制中心，兰州 730000)])], figs=[ArticleFig(id=1320427665312563320, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, language=EN, label=Fig.1, caption=Dose-dependent dynamic observation time framework, figureFileSmall=MBaTE+tQhjD2Bx2/l5T7aw==, figureFileBig=cNvXKdjNz/LFWAXKNub/Vw==, tableContent=null), ArticleFig(id=1320427665383866489, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, language=CN, label=图1, caption=剂次依赖的动态观察时间框, figureFileSmall=MBaTE+tQhjD2Bx2/l5T7aw==, figureFileBig=cNvXKdjNz/LFWAXKNub/Vw==, tableContent=null), ArticleFig(id=1320427665572610170, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, language=EN, label=Tab.1, caption=

DTaP vaccination coverage among infants and young children aged 2 years and under by city (prefecture) in Gansu province

, figureFileSmall=null, figureFileBig=null, tableContent=
市、州队列
人口/人		接种剂次/人基础免疫
接种率/%		加强免疫
接种率/%
01234
天水市18 74942118 32818 08417 8328 38395.1144.71
临夏州22 70962822 08121 57821 12610 79993.0347.55
嘉峪关市2 3611222 2392 1952 1861 17792.5949.85
定西市18 22189817 32317 08516 8328 40392.3846.12
酒泉市6 1424135 7295 6835 6652 97092.2348.36
甘南州7 8173267 4917 3327 0783 09990.5539.64
陇南市18 0041 09016 91416 49515 9706 35188.7035.28
兰州市23 4342 36721 06720 85220 6938 92988.3038.10
平凉市12 35695411 40211 17610 7714 55487.1736.86
庆阳市16 0401 67214 36814 07713 7366 39785.6439.88
金昌市2 6893592 3302 3022 2941 31085.3148.72
白银市10 6779549 7239 4779 0363 92584.6336.76
张掖市7 7799916 7886 5776 4543 46982.9744.59
武威市9 7101 3828 3288 1417 9684 36482.0644.94
合计176 68812 577164 111161 054157 64174 13089.2241.96
), ArticleFig(id=1320427665656496251, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, language=CN, label=表1, caption=

甘肃省各市、州≤2岁婴幼儿DTaP接种情况

, figureFileSmall=null, figureFileBig=null, tableContent=
市、州队列
人口/人		接种剂次/人基础免疫
接种率/%		加强免疫
接种率/%
01234
天水市18 74942118 32818 08417 8328 38395.1144.71
临夏州22 70962822 08121 57821 12610 79993.0347.55
嘉峪关市2 3611222 2392 1952 1861 17792.5949.85
定西市18 22189817 32317 08516 8328 40392.3846.12
酒泉市6 1424135 7295 6835 6652 97092.2348.36
甘南州7 8173267 4917 3327 0783 09990.5539.64
陇南市18 0041 09016 91416 49515 9706 35188.7035.28
兰州市23 4342 36721 06720 85220 6938 92988.3038.10
平凉市12 35695411 40211 17610 7714 55487.1736.86
庆阳市16 0401 67214 36814 07713 7366 39785.6439.88
金昌市2 6893592 3302 3022 2941 31085.3148.72
白银市10 6779549 7239 4779 0363 92584.6336.76
张掖市7 7799916 7886 5776 4543 46982.9744.59
武威市9 7101 3828 3288 1417 9684 36482.0644.94
合计176 68812 577164 111161 054157 64174 13089.2241.96
), ArticleFig(id=1320427665719410812, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, language=EN, label=Tab.2, caption=

Distribution of pertussis cases by age group and number of DTaP doses received among infants and young children aged 2 years and under in Gansu province

, figureFileSmall=null, figureFileBig=null, tableContent=
分组/月龄总病例数0剂次1剂次2剂次3剂次4剂次
病例数构成比/%病例数构成比/%病例数构成比/%病例数构成比/%病例数构成比/%
3.5～<6.020212260.407235.6483.9600.0000.00
6.0 ～<18.02999030.104515.053110.3713344.4800.00
18.0～24.024312.5000.0000.001875.00312.50
合计52521540.9511722.29397.4315128.7630.57
), ArticleFig(id=1320427665803296893, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, language=CN, label=表2, caption=

甘肃省不同月龄≤2岁婴幼儿百日咳病例免疫剂次分布

, figureFileSmall=null, figureFileBig=null, tableContent=
分组/月龄总病例数0剂次1剂次2剂次3剂次4剂次
病例数构成比/%病例数构成比/%病例数构成比/%病例数构成比/%病例数构成比/%
3.5～<6.020212260.407235.6483.9600.0000.00
6.0 ～<18.02999030.104515.053110.3713344.4800.00
18.0～24.024312.5000.0000.001875.00312.50
合计52521540.9511722.29397.4315128.7630.57
), ArticleFig(id=1320427665878794366, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, language=EN, label=Tab.3, caption=

Effectiveness of different doses of DTaP vaccine in preventing pertussis among infants and young children aged 2 years and under in Gansu province

, figureFileSmall=null, figureFileBig=null, tableContent=
剂次暴露人日病例数/例发病密度/（/10万人日）RR（95%CI）Z值P值VE（95%CI）/%
07 645 2582152.811.00———
17 385 4221171.580.56（0.45～0.69）−5.000.00043.67（39.60～55.21）
24 832 351390.810.29（0.21～0.40）−7.170.00071.30（50.13～79.96）
359 084 8741510.260.09（0.08～0.11）−22.590.00090.91（88.82～92.68）
413 343 32130.020.01（0.00～0.02）−8.310.00099.20（77.91～99.80）
), ArticleFig(id=1320427665966874751, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, language=CN, label=表3, caption=

甘肃省≤2岁婴幼儿接种不同剂次DTaP预防百日咳发病的效果比较

, figureFileSmall=null, figureFileBig=null, tableContent=
剂次暴露人日病例数/例发病密度/（/10万人日）RR（95%CI）Z值P值VE（95%CI）/%
07 645 2582152.811.00———
17 385 4221171.580.56（0.45～0.69）−5.000.00043.67（39.60～55.21）
24 832 351390.810.29（0.21～0.40）−7.170.00071.30（50.13～79.96）
359 084 8741510.260.09（0.08～0.11）−22.590.00090.91（88.82～92.68）
413 343 32130.020.01（0.00～0.02）−8.310.00099.20（77.91～99.80）
), ArticleFig(id=1320427666046566528, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, language=EN, label=Tab.4, caption=

Effectiveness of different doses of DTaP vaccine in preventing pertussis-related hospitalization among infants and young children aged 2 yearsand under in Gansu province

, figureFileSmall=null, figureFileBig=null, tableContent=
剂次暴露人日住院病例数/例发病密度/（/10万人日）RR（95%CI）Z值P值VE（95%CI）/%
07 725 326310.401.00———
17 385 719130.180.44（0.24～0.81）−2.490.01356.14（18.13～77.80）
24 831 85370.150.36（0.15～0.85）−2.440.01563.90（22.71～85.46）
359 104 667640.110.27（0.18～0.41）−5.990.00073.02（58.10～82.34）
413 343 32130.020.06（0.02～0.20）−4.770.00094.40（64.32～98.70）
), ArticleFig(id=1320427666130452609, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427660140986443, language=CN, label=表4, caption=

甘肃省≤2岁婴幼儿接种不同剂次DTaP预防百日咳住院的效果比较

, figureFileSmall=null, figureFileBig=null, tableContent=
剂次暴露人日住院病例数/例发病密度/（/10万人日）RR（95%CI）Z值P值VE（95%CI）/%
07 725 326310.401.00———
17 385 719130.180.44（0.24～0.81）−2.490.01356.14（18.13～77.80）
24 831 85370.150.36（0.15～0.85）−2.440.01563.90（22.71～85.46）
359 104 667640.110.27（0.18～0.41）−5.990.00073.02（58.10～82.34）
413 343 32130.020.06（0.02～0.20）−4.770.00094.40（64.32～98.70）
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焦永卓 , 安婧 , 刘舒瑜 , 梁雪枫 , 张晓曙 *, *
中国公共卫生 | 专题报道——儿童疫苗接种保护效果研究 2026,42(8): 897-901
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中国公共卫生 |专题报道——儿童疫苗接种保护效果研究 2026 , 42 (8) : 897 -901
无细胞百白破疫苗对甘肃省2岁及以下婴幼儿患百日咳的保护效果：基于人群监测数据的回顾性队列研究
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焦永卓, 安婧, 刘舒瑜, 梁雪枫, 张晓曙*, *
作者信息
  • 甘肃省疾病预防控制中心，兰州 730000
通讯作者:
张晓曙，E-mail：
作者简介:

焦永卓（1986—），副主任医师，硕士，研究方向：传染性疾病控制

Protective effectiveness of acellular diphtheria-tetanus-pertussis vaccine against pertussis in infants and young children aged 2 years and under in Gansu province: a retrospective cohort study based on population-based surveillance data
Yongzhuo JIAO, Jing AN, Shuyu LIU, Xuefeng LIANG, Xiaoshu ZHANG
Affiliations
  • Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730000, China
    • Corresponding Author:
    ZHANG Xiaoshu, E-mail:
出版时间: 2026-08-10 doi: 10.11847/zgggws1149456
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摘要
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目的

评价吸附无细胞百白破疫苗（DTaP）对甘肃省2岁及以下婴幼儿患百日咳的保护效果（VE），为完善西部欠发达地区百日咳的免疫策略提供科学依据。

方法

纳入2023年1月1日—12月31日甘肃省出生的176 688名常住儿童，构建回顾性队列。使用Poisson回归模型计算风险比（RR），在校正地区、性别等因素后评价1～4剂DTaP预防百日咳及住院的VE。

结果

甘肃省2岁及以下婴幼儿1～4剂次DTaP接种率分别为92.88%、91.15%、89.22%、41.96%。预防百日咳的VE分别为43.67%（95%CI=39.60%～55.21%）、71.30%（95%CI=50.13%～79.96%）、90.91%（95%CI=88.82%～92.68%）、99.20%（95%CI=77.91%～99.80%）；预防百日咳住院的VE分别为56.14%（95%CI=18.13%～77.80%）、63.90%（95%CI=22.71%～85.46%）、73.02%（95%CI=58.10%～82.34%）、94.40%（95%CI=64.32%～98.70%）。

结论

DTaP对甘肃省2岁及以下婴幼儿的百日咳及其导致的住院具有保护效果，且保护效果随接种剂次增加而增强。应大力提升DTaP基础免疫及时率与加强免疫接种率。

无细胞百白破疫苗（DTaP）  /  疫苗保护效果（VE）  /  剂量依赖性  /  婴幼儿  /  回顾性队列研究  /  甘肃省
Objective

To evaluate the vaccine effectiveness (VE) of the adsorbed acellular diphtheria-tetanus-pertussis (DTaP) vaccine in infants and young children aged 2 years and under in Gansu province, thereby providing evidence for optimizing the immunization strategies for pertussis in underdeveloped western regions of China.

Methods

A retrospective cohort was established, including 176 688 resident children born in Gansu province from January 1 to December 31, 2023. The Poisson regression model was adopted to calculate the relative risk (RR) for evaluating the VE of 1–4 doses of DTaP vaccine against pertussis and pertussis-related hospitalization, after adjusting for factors such as region and sex.

Results

The coverage rates of the 1st to 4th doses of DTaP vaccine among infants and young children aged 2 years and under in Gansu province were 92.88%, 91.15%, 89.22%, and 41.96%, respectively. The VE of the 1st to 4th doses against pertussis was 43.67% (95%CI: 39.60%–55.21%), 71.30% (95%CI: 50.13%–79.96%), 90.91% (95%CI: 88.82%–92.68%), and 99.20% (95%CI: 77.91%–99.80%), respectively. The VE of the 1st to 4th doses against pertussis-related hospitalization was 56.14% (95%CI: 18.13%–77.80%), 63.90% (95%CI: 22.71%–85.46%), 73.02% (95%CI: 58.10%–82.34%), and 94.40% (95%CI: 64.32%–98.70%), respectively.

Conclusions

The DTaP vaccine provides significant protection against pertussis and pertussis-related hospitalization in infants and young children aged 2 years and under in Gansu province in a dose-dependent manner. Efforts should focus on improving the timeliness of primary immunization and the coverage of booster doses.

acellular diphtheria-tetanus-pertussis vaccine  /  vaccine effectiveness  /  dose dependence  /  infants and young children  /  retrospective cohort study  /  Gansu province
焦永卓, 安婧, 刘舒瑜, 梁雪枫, 张晓曙. 无细胞百白破疫苗对甘肃省2岁及以下婴幼儿患百日咳的保护效果：基于人群监测数据的回顾性队列研究. 中国公共卫生, 2026 , 42 (8) : 897 -901 . DOI: 10.11847/zgggws1149456
Yongzhuo JIAO, Jing AN, Shuyu LIU, Xuefeng LIANG, Xiaoshu ZHANG. Protective effectiveness of acellular diphtheria-tetanus-pertussis vaccine against pertussis in infants and young children aged 2 years and under in Gansu province: a retrospective cohort study based on population-based surveillance data[J]. Chinese Journal of Public Health, 2026 , 42 (8) : 897 -901 . DOI: 10.11847/zgggws1149456
正文
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百日咳是由百日咳鲍特菌引起的急性呼吸道传染病[1]，曾是全球婴幼儿死亡的主要原因之一[2]。自2007年起，我国将无细胞百白破疫苗（DTaP）纳入国家免疫规划，适龄儿童接种率持续保持在较高水平。然而，2015年以来我国百日咳发病率呈现回升态势[3–5]，婴幼儿重症及死亡风险尤为突出[6]。甘肃省地处西部，经济与卫生资源分布不均，评估DTaP在适龄儿童中的保护效果，对于巩固免疫屏障、优化资源分配至关重要。本研究基于甘肃省全人群数据，旨在评价DTaP对2岁及以下婴幼儿的保护效果，以期为区域免疫策略的制定提供科学依据。
1　资料与方法
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1.1　资料来源
研究对象为甘肃省2023年1月1日—2023年12月31日出生儿童。从甘肃省免疫规划信息系统（系统中2023年出生儿童建卡数占甘肃统计年鉴出生人口数的98.89%）获取研究对象接种个案信息，从甘肃省免疫规划系统的百日咳专病模块获取研究对象百日咳病例个案信息，2个系统个案导出的时间均为2025年5月25日，个案导出条件均为出生日期为2023年1月1日—2023年12月31日。来自2个系统的研究对象个案信息通过婴幼儿身份信息/父母身份证号关联，在数据获取和处理过程中，对个人隐私信息进行匿名化处理并严格保密。本研究经甘肃省疾病预防控制中心伦理委员会审查批准（甘疾伦2026年第〔003〕号）。诊断标准依据《百日咳诊疗方案（2023年版）》[7]；纳入标准：（1）甘肃省2023年出生的常住儿童；（2）在甘肃省免疫规划系统中有完整的建卡与接种信息。排除标准：（1）接种过DTaP-Hib四联或DTaP-IPV-Hib五联疫苗者；（2）在3月龄前曾确诊百日咳者。最终共176 688名儿童纳入分析。
1.2　研究方法（图1）
以所有研究对象的数据构建回顾性队列，采用剂次依赖的动态观察时间框架，用以近似估算各种接种剂次状态下的暴露时间。图1所示的时间段在横轴上存在先后关系，但对于每一个具体的研究对象，其在队列中的暴露时间是根据实际的接种日期被精确划分到唯一的剂次组中。例如，一名儿童在接种第2剂次后，其观察时间即从第1剂次组转移到第2剂次组，不会在2组中重复计算。每名研究对象的暴露人日随其接种状态的改变而动态划分。考虑到疫苗产生有效免疫保护所需的时间，本研究设定了14 d的免疫建立期。即在接种后14 d内发生的百日咳病例，其暴露人日仍计入上一剂次（或未接种）组，病例不计入本剂次的保护效果分析。此外，由于回顾性研究难以精确获知感染时间，本研究统一以百日咳的发病日期作为分析的基准时间。
1.2.1　观察期
2024年1月1日—12月31日。自2024年1月1日起所有纳入队列的研究对象均进入观察期，观察终点分别为患百日咳（以发病日期计）、死亡或到达2024年12月31日。
1.2.2　暴露人日计算
在动态观察框下（图1），研究对象在发病日即退出队列，其暴露时间计算至发病前一日，发病后的时间不计入暴露人日，以确保暴露时间仅反映发病前的风险暴露状态。假设每月30 d以标准化计算暴露人日数，观察期内接种DTaP的研究对象为暴露组，未接种的为非暴露组。
1.2.3　DTaP免疫接种率
基础免疫接种率为完成3剂次DTaP接种的适龄儿童占应种人数的比例，加强免疫接种率为完成4剂次DTaP接种的适龄儿童占应种人数的比例。发病密度是指单位人日内的发病人数（/10万人日）。
1.3　统计分析
使用R 4.4.1软件进行数据分析。采用频数与构成比描述计数资料。以多变量Poisson回归模型计算接种1～4剂DTaP相对于未接种的风险比（relative risk, RR）值及其95%置信区间，将地区（市、州）和性别作为协变量纳入模型分析。保护效果（vaccine effectiveness, VE）计算公式为：VE=（1−RR）×100%，检验水准α=0.05（双侧）。
2　结　果
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2.1　基本情况（表1）
共纳入176 688名儿童，均在系统中获得有效身份信息，将纳入对象的DTaP接种记录与百日咳发病情况匹配。队列人口占比居前3位的为兰州市（13.26%）、临夏州（12.85%）和天水市（10.61%）。全省DTaP第1～4剂次接种率分别为92.88%、91.15%、89.22%、41.96%，由于队列人群年龄≤2岁，部分对象尚未达到接种年龄，即使达到第4剂接种年龄的应种儿童（达到第4剂接种年龄且与第3剂的接种间隔≥6个月）加强免疫接种率也仅为56.09%（132 163人）。不同市、州的基础免疫接种率和加强免疫接种率呈现一定的分布不均，其中基础免疫接种率为82.06%～95.11%，加强免疫接种率为35.28%～49.85%。
2.2　百日咳病例特征（表2）
研究期间共随访到百日咳病例525例，无死亡病例；男女性别比为1.34:1；实验室确诊病例占91.60%，其余均为临床诊断病例；住院病例占22.48%，病例主要集中在3～8月龄（55.24%）。病例的免疫史分布与月龄相关，3.5～<6.0月龄组以无免疫史为主（61.31%），而6.0～<18.0月龄和18.0～24.0月龄组则以完成3剂次免疫者为主（分别为44.48%和75.00%）。
2.3　DTaP保护效果
2.3.1　预防百日咳发病的VE（表3）
DTaP预防发病的VE随剂次递增显著提升，分别为1剂次43.67%（95%CI=39.60%～55.21%）、2剂次71.30%（95%CI=50.13%～79.96%）、3剂次90.91%（95%CI=88.82%～92.68%）、4剂次99.20%（95%CI=77.91%～99.80%）。发病密度同步下降，分别为0剂次组2.81/10万人日，1剂次组1.58/10万人日，2剂次组0.81/10万人日，3剂次组0.26/10万人日，4剂次组0.02/10万人日。
2.3.2　预防百日咳住院的VE（表4）
预防住院的VE呈剂量依赖性，分别为1剂次56.14%（95%CI=18.13%～77.80%）、2剂次63.90%（95%CI=22.71%～85.46%）、3剂次73.02%（95%CI=58.10%～82.34%）、4剂次94.40%（95%CI=64.32%～98.70%）。住院密度从0剂次组0.40/10万人日降至4剂次组0.02/10万人日。
3　讨　论
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本研究基于人群水平的监测数据，通过回顾性队列研究设计，评估了DTaP疫苗对2岁及以下婴幼儿百日咳发病及其住院病例的保护效果。结果显示，DTaP疫苗在2岁及以下婴幼儿中呈现出良好的保护效果，尤其对于预防重症具有重要意义；另外，疫苗的保护效果随着接种剂次的增加显著上升，完成3剂次基础免疫与4剂次全程免疫后的保护效果分别达到90.91%与99.20%。这为DTaP疫苗全程接种的必要性提供了有力的证据。此外，百日咳病例主要集中在3～8月龄（55.24%），其中3.5～<6.0月龄组病例中无免疫史者占比高达61.31%。提示尽管甘肃省首剂DTaP接种率较高（92.88%），但首剂接种时间是否及时、能否在暴露高峰前建立有效免疫保护，仍是小月龄婴幼儿发病风险的重要影响因素。
本研究发现，与基础3剂次接种后的效果相比，加强剂次对百日咳发病和住院的预防效果更为显著，与山东省的一项队列研究结果相似[8]，也与国内外多项研究结论相近。有研究表明，北京市、广东省、山东省等地开展的儿童接种后保护效果的病例对照研究显示，完成3剂次DTaP基础免疫对百日咳的保护效力达90%以上[9–12]；武汉市开展的一项病例对照研究显示，在10岁及以下儿童中接种1剂次、2剂次、3剂次和4剂次百白破疫苗的VE分别为79.9%、92.2%、94.6%和99.2%[13]。美国一项1:5的匹配病例对照研究显示，4剂次DTaP的VE可达97.7%[14]。瑞士的一项病例队列研究结果表明，在2岁以下婴幼儿中，基础免疫对预防百日咳住院的保护效果优于加强免疫[15]。甘肃省2岁及以下婴幼儿的加强免疫接种率偏低，部分原因为近1/4婴幼儿（44 509人）截至数据导出时间尚未达到第4剂次DTaP的接种年龄，达到第4剂次接种年龄的婴幼儿加强免疫接种率也仅为56.09%，表明延迟接种情况比较严重。甘肃省2024年一项接种率专项调查结果表明，监护人因时间冲突、对接种程序不了解或儿童临时患病而推迟接种，是影响及时接种的常见原因，提示家长依从性可能不足。更值得注意的是，本研究发现，6～<18月龄病例中，已完成3剂次基础免疫的“突破性感染”占比达44.48%。这可能与婴幼儿随年龄增长活动范围扩大、暴露风险增高有关，此时基础免疫提供的保护可能不足以阻断感染，这也反映出及时加强免疫以巩固和提升免疫水平的重要性。
本研究发现，在完成1～3剂次DTaP接种后，疫苗预防百日咳发病的VE点估计值均高于预防百日咳住院的VE，这一现象与通常的理论预期有所不同。可能由以下原因所致：（1）病例定义的差异。“发病”病例包含了所有实验室确诊的百日咳病例，其中大部分为轻症；而“住院”病例均为重症，其数量远少于“发病”病例。较少的住院病例数可能导致VE估计值的置信区间更宽，估计稳定性较差。（2）可能存在诊断和收治偏倚。已接种疫苗的婴幼儿若发生百日咳，症状可能较轻，但警惕性高的家长或医生仍会对其进行实验室检测，导致病例被纳入“发病”组；然而，只有当病情确实严重时才会住院。相反，未接种疫苗的婴幼儿发生重症百日咳的风险更高，更易达到住院标准。这种非差分（对于发病）和差分（对于住院）可能导致了防住院VE被低估。（3）从免疫学角度看，DTaP诱导的系统性IgG抗体对于中和血液和深部组织（如肺部）中的百日咳鲍特菌效果显著[16]。因此，在本研究中观察到了4剂次接种后极高的防住院效果（94.40%）。但对于上呼吸道黏膜感染的预防，系统免疫的作用相对有限。后续研究需要更大的样本量，特别是对重症病例的持续监测，以更精确地评估DTaP对不同临床严重程度终点的影响。
另外，本次研究中2岁及以下婴幼儿百日咳病例主要集中在3～8月龄（55.24%），且小月龄婴幼儿也是百日咳重症高风险人群。有研究表明，孕期接种预防百日咳的疫苗可以有效降低新生儿百日咳感染率[17]。可参考国际成功经验，推动育龄期妇女孕期接种TDAP疫苗策略的论证与实施，为无法通过自身接种获得及时保护的婴幼儿提供被动免疫。值得关注的是，我国已于2025年将百白破疫苗基础免疫首剂接种时间从3月龄提前至2月龄。这项关键调整旨在让婴幼儿在3月龄前就建立起初步免疫屏障，直接针对并有望削减本研究发现的小月龄发病高峰。新程序通过更早提供保护，理论上能显著降低3月龄内婴儿的感染与重症风险。未来，需重点监测新程序在该人群中的保护效果，特别是评估其对2～3月龄婴儿发病率的影响，与本研究基线数据比较，以验证策略调整的有效性，并为后续免疫程序优化提供科学依据。
本研究存在一定的局限性。首先，采用的剂次依赖动态观察时间框架虽能更精确地匹配不同接种状态下的暴露风险，但在计算上较为复杂，且可能引入一定的错分偏倚。其次，受限于回顾性数据，尽管已校正地区和性别，但仍可能存在其他未测量的混杂因素（如家庭、社会经济状况等）对VE估计产生潜在影响。
综上所述，DTaP对2岁及以下婴幼儿百日咳发病及住院具有良好的保护效果。当前工作重点应是全力保障新免疫程序（2、4、6、18月龄及6周岁）各剂次，尤其是首剂和加强剂的及时接种。同时，应前瞻性探索孕妇接种等补充策略，构建立体防控体系。未来需持续监测新程序效果及疫苗免疫持久性，为优化防控策略提供循证依据。

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2026年第42卷第8期
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doi: 10.11847/zgggws1149456
  • 接收时间：2025-12-03
  • 首发时间：2026-10-23
  • 出版时间：2026-08-10
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  • 收稿日期：2025-12-03
  • 修回日期：2026-01-18
  • 录用日期：2026-04-11
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    甘肃省疾病预防控制中心，兰州 730000

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张晓曙，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
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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