浙江省平湖市5 141名婴幼儿五价轮状病毒疫苗保护效果分析

A retrospective cohort survey on the protective effect of pentavalent rotavirus vaccine among 5 141 infants and young children in Pinghu City, Zhejiang Province

  • 摘要:
    目的 了解五价轮状病毒(RV)疫苗预防婴幼儿感染性腹泻的保护效果,为制定婴幼儿感染性腹泻防治策略提供依据。
    方法 采用回顾性队列研究,对2019年1月—2021年6月在平湖市出生的常住儿童追踪随访2年,收集研究对象发病信息和五价RV疫苗接种信息,分析接种不同剂次五价RV疫苗儿童RV感染的发病密度,计算疫苗保护率。
    结果 共调查5 141名常住儿童,五价RV疫苗接种率为31.63%,全程接种率为30.83%;RV感染发病154例,发病密度为1 392.69/10万人年;流动儿童875名,占17.02%,全程接种率为20.46%,本市儿童4 266名,占82.98%,全程接种率为32.96%,两者全程接种率差异有统计学意义(χ2=53.209,P<0.001);男童和女童占比分别为51.94%和48.06%,全程接种率分别为29.74%和32.01%,差异无统计学意义(χ2=3.111,P=0.078);出生体重正常儿童与出生体重异常儿童占比分别为91.56%和8.44%,全程接种率分别为31.82%和20.05%,差异有统计学意义(χ2=25.852,P<0.001)。观察对象未接种五价RV疫苗3 515名,118例发病,发病密度为1 503.32/10万人年(发病率为3.36%),41名未全程接种(仅接种1~2剂次),发病密度为1 058.54/10万人年(发病率2.44%),1 585名全程接种,35例发病,发病密度为1 123.96/10万人年(发病率为2.21%),发病率差异有统计学意义(χ2趋势=4.988,P=0.026),未全程接种疫苗保护率为28.00%(95%CI:22.00%~33.50%),全程接种疫苗保护率为35.10%(95%CI:29.80%~40.00%)。
    结论 接种五价RV疫苗可有效预防婴幼儿轮状病毒感染,其中全程接种效果优于未全程接种,建议加强RV流行毒株监测,研发更有针对性的疫苗,并通过扩大国家免疫规划、加强宣传教育等途径提高婴幼儿RV疫苗接种率和全程接种率,有效降低婴幼儿感染性腹泻的发生率。

     

    Abstract:
    Objective To understand the protective effect of pentavalent rotavirus (RV) vaccine in preventing infectious diarrhea among infants and young children, and to provide a basis for formulating prevention and control strategies for this population.
    Methods A retrospective cohort study was conducted to follow up resident children born in Pinghu City from January 2019 to June 2021 for two years. Data on morbidity and pentavalent RV vaccine inoculation were collected to analyze the incidence density of rotavirus infection among children inoculated with different doses of the pentavalent RV vaccine, and to calculate the vaccine protection rate.
    Results A total of 5 141 resident children were surveyed, with a RV vaccination rate of 31.63% and a full vaccination rate of 30.83%. There were 154 cases of RV infection, with an incidence density of 1 392.69/100 000 person-years. Among the 875 migrant children (17.02%), the full vaccination rate was 20.46%, while among the 4 266 local children (82.98%), the full vaccination rate was 32.96%. The difference in full vaccination rate between migrant children and local children was statistically significant (χ2=53.209, P<0.001). The proportions of boys and girls were 51.94% and 48.06%, respectively, with a full vaccination rate of 29.74% and 32.01%, respectively; and the difference was not statistically significant (χ2=3.111, P=0.078). The proportions of children with normal birth weight and abnormal birth weight were 91.56% and 8.44%, respectively, with a full vaccination rate of 31.82% and 20.05%, respectingly; and the difference was statistically significant (χ2=25.852, P<0.001). Among the 3 515 children who were not vaccinated with the pentavalent RV vaccine, 118 of which were infected, with an incidence density of 1 503.32/100 000 person-years (with an incidence rate of 3.36%). Among the 41 children who were partially vaccinated (received only 1-2 doses), the incidence density was 1 058.54/100 000 person-years (with an incidence rate of 2.44%). Among the 1 585 fully vaccinated children, 35 of which were infected, with an incidence density of 1 123.96/100 000 person-years (with an incidence rate of 2.21%); and the difference in incidence rate was statistically significant (χ2=4.988, P=0.026). The protection rate for partial vaccination was 28.00% (95%CI:22.00%‒33.50%), while for full vaccination was 35.10% (95%CI: 29.80%‒40.00%).
    Conclusion Pentavalent RV vaccination can effectively prevent rotavirus infection in infants and young children, in which the full vaccination is more effective than partial vaccination. It is recommended to strengthen the monitoring of circulating RV strains in the city, develop more targeted vaccines, and increase the RV vaccine coverage rate and full vaccination rate among infants and young children through the expansion of the national immunization program and enhancement of public education, so as to effectively reduce the incidence of infectious diarrhea in infants and young children.

     

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