Measles vaccination coverage estimates from surveys, clinic records, and immune markers in oral fluid and blood: a population-based cross-sectional study
Measles vaccination coverage estimates from surveys, clinic records, and immune markers in oral fluid and blood: a population-based cross-sectional study
复制标题
DOI：
10.1186/1471-2458-13-1211
复制
发表时间：
2013-12-20
影响因子：
4.5
通讯作者：
Levine, Orin S.
中科院分区：
文献类型：
--
作者：
Hayford, Kyla T.;Shomik, Mohammed S.;Levine, Orin S.
背景：低收入国家最近爆发的麻疹和脊髓灰质炎表明，估算疫苗接种覆盖率的传统方法不能充分识别易感儿童。在口服液(OF)或血液中预防疫苗可预防疾病的免疫标志物可能会产生更准确的有效疫苗接种历史的衡量标准，但与传统的疫苗接种覆盖率指标相比，抗体调查是否是监测免疫计划绩效的可行和信息丰富的工具仍存在疑问。本研究比较了孟加拉农村地区儿童麻疹疫苗接种状况的六项指标，包括口腔液和血液中的免疫标志物，并评估了使用每项指标估计麻疹疫苗接种率的意义。方法：对孟加拉国米尔扎普尔12-16个月的儿童进行横断面人口调查，从产妇报告、接种卡记录、“卡+病史”和计划免疫门诊记录等常规指标中确定麻疹疫苗接种史(MCV1)。所有参与者的口腔液体(n=1226)和子集的血液(n=342)进行了麻疹免疫球蛋白抗体检测，作为MCV1病史的指标，并与传统的MCV1接种率指标进行了比较。结果：孕产妇报告产生了最高的MCV1接种率估计值(90.8%)，其次是计划免疫记录(88.6%)，以及卡片+病史(84.2%)。即使在调整了不完全血清转换和检测性能(71.5%)后，OF对麻疹的血清保护作用(57.3%)也明显低于其他指标。在有血液结果的儿童中，88.6%是血清保护的，这显著高于卡片+病史和血清状态的覆盖率，但与母亲报告和计划免疫记录的覆盖率一致。有疫苗接种卡或计划免疫记录的儿童比没有卡或记录的儿童更有可能接种MCV1。尽管大多数指标的MCV1接种率估计值相似，但所有指标的儿童内一致性较差。结论：OF中的麻疹免疫球蛋白抗体不适合作为监测该环境下麻疹疫苗接种率的免疫标志物。由于传统的MCV1指标之间的一致性一般，可以使用血液样本的免疫标记物监测来验证传统的MCV1指标，并生成可跨指标进行比较的调整结果。
Background: Recent outbreaks of measles and polio in low-income countries illustrate that conventional methods for estimating vaccination coverage do not adequately identify susceptible children. Immune markers of protection against vaccine-preventable diseases in oral fluid (OF) or blood may generate more accurate measures of effective vaccination history, but questions remain about whether antibody surveys are feasible and informative tools for monitoring immunization program performance compared to conventional vaccination coverage indicators. This study compares six indicators of measles vaccination status, including immune markers in oral fluid and blood, from children in rural Bangladesh and evaluates the implications of using each indicator to estimate measles vaccination coverage.Methods: A cross-sectional population-based study of children ages 12-16 months in Mirzapur, Bangladesh, ascertained measles vaccination (MCV1) history from conventional indicators: maternal report, vaccination card records, 'card + history' and EPI clinic records. Oral fluid from all participants (n = 1226) and blood from a subset (n = 342) were tested for measles IgG antibodies as indicators of MCV1 history and compared to conventional MCV1 coverage indicators.Results: Maternal report yielded the highest MCV1 coverage estimates (90.8%), followed by EPI records (88.6%), and card + history (84.2%). Seroprotection against measles by OF (57.3%) was significantly lower than other indicators, even after adjusting for incomplete seroconversion and assay performance (71.5%). Among children with blood results, 88.6% were seroprotected, which was significantly higher than coverage by card + history and OF serostatus but consistent with coverage by maternal report and EPI records. Children with vaccination cards or EPI records were more likely to have a history of receiving MCV1 than those without cards or records. Despite similar MCV1 coverage estimates across most indicators, within-child agreement was poor for all indicators.Conclusions: Measles IgG antibodies in OF was not a suitable immune marker for monitoring measles vaccination coverage in this setting. Because agreement between conventional MCV1 indicators was mediocre, immune marker surveillance with blood samples could be used to validate conventional MCV1 indicators and generate adjusted results that can be compared across indicators.