Evaluation of nationwide supplementary immunization in Lao People's Democratic Republic: Population-based seroprevalence survey of anti-measles and anti-rubella IgG in children and adults, mathematical modelling and a stability testing of the vaccine.
Evaluation of nationwide supplementary immunization in Lao People's Democratic Republic: Population-based seroprevalence survey of anti-measles and anti-rubella IgG in children and adults, mathematical modelling and a stability testing of the vaccine.
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DOI：
10.1371/journal.pone.0194931
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Komase K
中科院分区：
文献类型：
--
作者：
Hachiya M;Miyano S;Mori Y;Vynnycky E;Keungsaneth P;Vongphrachanh P;Xeuatvongsa A;Sisouk T;Som-Oulay V;Khamphaphongphane B;Sengkeopaseuth B;Pathammavong C;Phounphenghak K;Kitamura T;Takeda M;Komase K
尽管一些国家开展了含麻疹疫苗补充免疫活动（SIA）且疫苗接种覆盖率较高，但仍发生了麻疹疫情。我们在老挝人民民主共和国进行了一项横断面血清流行病学调查，以评估该国的人群免疫情况，该国多次大规模免疫未能消除麻疹。
2014年，基于按规模大小成比例的概率抽样，我们在全国范围内进行了多阶段整群抽样调查，从随机选取的52个村庄的2135名儿童和成人中采集了血液样本。检测了抗麻疹和抗风疹IgG，并计算了IgG阳性率。我们应用数学模型估算了2011年补充免疫活动避免的2013年先天性风疹综合征（CRS）病例数。对麻疹 - 风疹（MR）疫苗在4°C、25°C和35°C下进行了稳定性测试，以检验麻疹和风疹疫苗成分之间的稳定性差异。在2011年使用麻疹 - 风疹联合疫苗（MR疫苗）的补充免疫活动目标年龄组（5 - 21岁）中，麻疹IgG阳性率显著低于青年成年人（22 - 39岁）（86.8%[95%置信区间：83.0 - 90.6]对99.0%[98.3 - 99.8]；p < 0.001），而风疹IgG阳性率则显著更高（88.2%[84.5 - 91.8]对74.6%[70.7 - 78.5]；p < 0.001）。在补充免疫活动目标年龄组中，麻疹IgG阳性率（而非风疹IgG阳性率）随年龄增长而升高。如果感染强度保持不变或降低75%，2013年避免的CRS病例数分别为16[0 - 50]例到92[32 - 180]例。在冻干条件下，麻疹疫苗成分比风疹成分对热更敏感。
老挝人民民主共和国麻疹和风疹IgG阳性率不一致，部分原因可归结为麻疹和风疹疫苗成分在受热情况下稳定性不同。疫苗处理不当可能导致麻疹免疫原性不足，尽管补充免疫活动覆盖率较高，但随后仍引发疫情，不过缺乏直接证据。应当对疫苗进行温度监测。
Measles outbreaks have occurred in some countries despite supplementary immunization activities (SIA) using measles-containing vaccine with high vaccination coverage. We conducted a cross-sectional seroprevalence survey to estimate population immunity in Lao People's Democratic Republic where repeated mass immunization has failed to eliminate measles. In this nationwide multistage cluster sampling survey conducted in 2014 based on probability proportionate to size sampling, blood samples were collected from 2,135 children and adults living in 52 randomly selected villages. Anti-measles and anti-rubella IgG were measured, and IgG prevalence was calculated. We applied mathematical modelling to estimate the number of cases of congenital rubella syndrome (CRS) in 2013 that were averted by the 2011 SIA. A stability testing was applied to the MR vaccine at 4°C, 25°C, and 35°C to examine stability differences between measles and rubella vaccine components. Measles IgG prevalence was significantly lower in the target age groups (5–21 years) of the 2011 SIA using a combination vaccine for measles and rubella vaccine (MR vaccine) than in young adults (22–39 years) (86.8% [95% CI: 83.0–90.6] vs. 99.0% [98.3–99.8]; p<0.001), whereas rubella IgG prevalence was significantly higher (88.2% [84.5–91.8] vs. 74.6% [70.7–78.5]; p<0.001). In the SIA target age groups, prevalence of measles IgG, but not rubella IgG, increased with age. CRS cases prevented in 2013 ranged from 16 [0–50] to 92 [32–180] if the force of infection had remained unchanged or had been reduced by 75%, respectively. In freeze-dried conditions, the measles vaccine component was more heat sensitive than the rubella component. Inconsistent IgG prevalence between measles and rubella in Lao PDR can be partly explained by different stability of the measles and rubella vaccine components under heat exposure. Suboptimal vaccine handling may cause insufficient immunogenicity for measles, which subsequently leads to an outbreak despite high SIA coverage, while direct evidence is lacking. Temperature monitoring of the vaccine should be conducted.
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