目的 了解湖北省全人群乙型病毒性肝炎(简称乙肝)免疫水平,为制定乙肝的预防控制策略提供依据.方法 采用多阶段分层随机抽样方法,于2015-2018年选取湖北省8个市(15个县、45个社区)开展全人群乙肝表面抗原(HBsAg)和乙肝表面抗体(HBsAb)水平监测.结果 湖北省全人群HBsAg携带率为2.67％、HBsAb阳性率为66.08％;HBsAg携带率和HBsAb 阳性率在地区(HBsAg:x2= 60.430,P=0.000;HBsAb:X2 = 215.599,P=0.000)、年龄(HBsAg:X2 = 109.341,P=0.000;HBsAb:x2 = 265.578,P = 0.000)、职业(HBsAg:x2 = 70.919,P = 0.000;HBsAb:x2= 480.782,P=0.000)、免疫史(HBsAg:x2= 36.725,P= 0.000;HBsAb:x2 = 27.653,P= 0.000)之间差异均有统计学意义;20岁以上(≥5.64％)、工人(7.59％)、农民(5.99％)和服务人员(5.45％)人群HBsAg携带率偏高,7～14岁(57.06％)、农民(58.98％)、学生(60.71％)和工人(60.76％)HBsAb阳性率偏低.结论 湖北省乙肝防控取得一定成绩,但仍需加大宣传教育力度,提高重点人群(20岁以上、工人、农民、服务人员和学生)乙肝疫苗接种率,开展补充免疫等,有利于降低乙肝感染风险.

目的 了解湖北省人群脊灰免疫水平,为脊灰的预防控制策略提供依据.方法 2015-2018年,采用多阶段分层随机抽样方法,抽取湖北省8个县(市、区)健康人群640人开展脊灰抗体水平监测,使用微量中和试验测定脊灰中和抗体(NA)(Ⅰ型和Ⅲ型抗体),运用卡方检验比较各组脊灰抗体阳性率.结果 脊灰Ⅰ型抗体:全人群阳性率为93.44％,性别之间差异无统计学意义(x2=0.000,P＞ 0.05),年龄之间差异有统计学意义(x2=7.371,P＜0.01),地区之间差异有统计学意义(x2=9.813,P＜0.01),年份之间差异有统计学意义(x2=19.264,P＜0.01),7岁以上年龄组人群阳性率偏低(≤92.50％),随州市阳性率偏低(75.00％);脊灰Ⅲ型抗体:全人群阳性率为92.81％,性别之间差异无统计学意义(x2=0.374,P＞0.05),年龄之间差异有统计学意义(x2=4.851,P＜0.05),地区之间差异无统计学意义(x2=0.753,P＞0.05),年份之间差异有统计学意义(x2=8.713,P＜0.05),25岁以上年龄组人群阳性率偏低(86.25％),鄂州市和随州市阳性率偏低(81.25％、85.00％).结论 持续做好脊灰常规免疫和适时的补充免疫,进一步提高地区和重点人群免疫覆盖率,有利于降低脊灰发病风险.

目的 了解湖北省免疫规划疫苗接种后免疫效果,为制定湖北省免疫规划策略提供科学依据.方法 选取湖北省3个县(市)开展免疫规划疫苗免疫成功率监测,分别监测目标人群百白破(DTaP)、麻风(MR)、麻腮风(MMR)、乙脑(JEV-L)、脊灰(OPV)5种疫苗针对疾病的疫苗免疫效果.结果 DTaP中百日咳、白喉、破伤风免疫成功率为38.00％、100％、100％,免疫前后,百日咳抗体阳性率差异无统计学意义(χ2=3.048,P>0.05),白喉和破伤风抗体阳性率差异均有统计学意义(白喉:χ2=100.00,P<0.01;破伤风:χ2=88.679,P<0.01);MR中麻疹、风疹免疫成功率为100％、98.00％,免疫前后,麻疹和风疹抗体阳性率差异均有统计学意义(麻疹:χ2=92.308,P<0.01;风疹:χ2=6.737,P<0.05);MMR中麻疹、流腮、风疹免疫成功率均为100％,免疫前后,麻疹抗体阳性率差异有统计学意义(χ2=8.701,P<0.05),流腮和风疹抗体阳性率差异均无统计学意义(χ2=0.000,P>0.05);JEV-L中乙脑免疫成功率为76.00％,免疫前后,乙脑抗体阳性率差异有统计学意义(χ2=57.545,P<0.01);OPV中脊灰免疫成功率为96.00％,免疫后,脊灰Ⅰ型中和抗体阳性率和Ⅲ型中和抗体阳性率均无统计学意义(χ2=0.000,P>0.05).结论 5种疫苗免疫成功率总体良好,但有必要优化百日咳菌苗和乙脑疫苗免疫程序,提升疫苗抗体免疫成功率,才能降低相关疾病的发病风险.

目的 基于控制图法对武汉市洪山区其它感染性腹泻病的预警界值进行分析,开展其它感染性腹泻病预警研究.方法 收集2013—2017年武汉市洪山区其它感染性腹泻病发病数据,建立预警模型,通过计算特异度、灵敏度、阴性预测值和阳性预测值,并绘制出ROC曲线,优选出其它感染性腹泻病合适的预警界值.结果 武汉市洪山区其它感染性腹泻病的合适预警界值为P55,特异度为96.30％,灵敏度为96.15％,阴性预测值为96.30％,阳性预测值为96.15％.结论 其它感染性腹泻病的预警界值设定应根据疾病发病特点并结合当地疫情信息进行优选,以提高该地区其它感染性腹泻病监测预警能力.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的比较分析2015—2017年湖北省脊髓灰质炎（脊灰）疫苗接种后疑似预防接种异常反应（AEFI）的发生特征,评价脊灰疫苗安全性。方法采用描述流行病学方法对湖北省2015—2017年AEFI信息管理系统三价脊灰减毒活疫苗（Tt OPV）、Salk株脊灰灭活疫苗（IPV-Salk）、Sabin株脊灰灭活疫苗（IPV-Sabin）、二价脊灰减毒活疫苗（b OPV）AEFI个案数据进行统计分析。结果湖北省2015—2017年t OPV、b OPV、IPV-Salk、IPV-Sabin接种后AEFI报告发生率4.78/10万剂²6.94/10万剂。4种脊灰疫苗接种后AEFI中,一般反应均占80%以上,异常反应占11.6%²0.56%,男童均多于女童,发生年龄均以&lt;1岁组为主,90%以上AEFI发生在接种后≤1 d。脊灰减毒活疫苗第1剂次AEFI发生率明显高于后续剂次,脊灰灭活疫苗各接种剂次间AEFI发生率无差异。新上市的b OPV和IPV-Sabin AEFI发生率分别高于t OPV和IPV-Salk,但多以一般反应和过敏性皮疹为主。结论湖北省脊灰疫苗安全性良好,但仍需关注罕见异常反应病例的发生。</span>

Objective To analyze the procurement and supply of Category Ⅱ vaccines in Hubei province.Methods We used the Hubei Category Ⅱ Vaccine Procurement System to collect data on procurement and delivery of Category Ⅱ vaccines in 2017 for descriptive epidemiological analysis. Results In total, 8 159 443 doses of 26 different Category Ⅱ vaccines were procured by 99 county centers for disease control and prevention ( CDCs) in 2017, yielding an average of 1 386 doses per 10 000 population.Among procured doses, rabies vaccine, hepatitis B vaccine, and influenza vaccine accounted for25. 99％, 11. 18％, and 9. 67％, respectively; 12. 00％, 13. 12％ and 12. 65％ of doses were procured in May, September, and December, respectively. The fulfillment rate of manufacturers to CDC's orders was 91. 06％ ( 9 303/10 216), increasing by month ( Z =-17. 22, P = 0. 000). Orders delivered by manufacturers accounted for 98. 77％ of received orders. Orders received by CDCs accounted for98. 55％ of orders fulfilled by manufacturers. The delivery rate within 24 days was 79. 01％, increasing by month ( Z =-8. 80, P = 0. 000). Conclusions The Category Ⅱ Vaccine Procurement and Supply system functioned well in Hubei in 2017. We should strengthen its supervision and management.

目的 分析湖北省2015—2017年流行性腮腺炎(流腮)流行病学特征,评估2017年免疫策略调整后的防控效果.方法 采用描述流行病学方法,对流腮疫情以及含腮腺炎成分的第二类疫苗使用情况进行分析.结果 湖北省2015—2017年,流腮平均报告发病率20.81/10万,各年发病率差异有统计学意义(χ2=2969.04,P=0.00),4～7月和10月至次年1月为发病高峰,男女性别比为1.48:1,5～9岁发病率最高为166.88/10万;流腮暴发疫情共48起,集中在4～6月和9～12月,全部发生在学校,小学占93.75％.2017年下半年与上半年比,发病数下降26.57％,暴发疫情下降74.07％,2015—2016年下半年比上半年均上升.2017年含腮腺炎成分疫苗共采购811600支,估算全省4～6岁儿童接种率47.58％,其中2017年上半年报告发病数排前的随州、十堰、荆门、恩施接种率>80％.结论 流腮的流行病学特征未发生改变,实施免疫策略调整后,流腮疫情得到有效控制.

目的 了解以乡(镇、街道)为单位儿童免疫规划疫苗(National Immunization Program Vaccines,NIPV)接种率.方法 采用批质量保证抽样方法确定调查样本量,入户调查2岁组和7岁组儿童,定性评价以乡为单位NIPV接种率≥90％的情况.结果 共抽查35个乡,共计2940名适龄儿童.2岁组,百白破疫苗、乙脑疫苗接种率≥90％的乡比例均为97.14％,乙肝疫苗、卡介苗、脊灰疫苗、A群流脑疫苗、含麻疹成分疫苗、甲肝疫苗接种率≥90％的乡比例为100.00％;7岁组,脊灰疫苗、乙脑疫苗、白破疫苗、A群C群流脑疫苗接种率≥90％的乡比例分别为97.14％、94.29％、88.57％、80.00％,乙肝疫苗、卡介苗、百白破疫苗、A群流脑疫苗、含麻疹成分疫苗、甲肝疫苗≥90％乡比例为100.00％.2岁组有97.14％乡NIPV接种率≥90％;7岁组有77.14％NIPV接种率≥90％.结论 湖北省以乡为单位NIPV接种率保持在较高水平,但少数乡疫苗接种率<90％.

Objective To evaluate the establishment and impact of a Category Ⅱ vaccine procurement system in Hubei province. Methods We established the Hubei Category Ⅱ vaccine procurement system platform and used descriptive epidemiological methods to analyze online data on Category Ⅱ vaccine procurement and distribution. Results From January to October 2017,county centers for disease control and prevention (CDCs) ordered 7 390 359 vials of Category Ⅱ vaccines from manufacturers through the online procurement system; manufacturers delivered 87. 71％ of procured vaccines,and CDCs received 93. 25％ of vaccines delivered by manufacturers. In October 2017,the provincial CDC completed the centralized procurement of Category Ⅱ vaccines for 2017-2018 through the system. Manufacturers applied for 129 vaccine products,121 of which were qualified for procurement following successful price negotiations. Prices for 63. 83％ of 94 traded products were reduced after negotiation. Starting in November, county CDCs purchased Category Ⅱ vaccines through the system using provincial procurement prices. Conclusions It was feasible and efficient to implement county-level online procurement of Category Ⅱ vaccines following provincial centralized procurement in Hubei province.

目的 分析武汉市洪山区2010～ 2016年疑似预防接种异常反应(Adverse Event Following Immunization,AEFI)的发生特征,分析影响因素,提高监测敏感性.方法 通过中国免疫规划信息管理系统和儿童预防接种报表信息,收集武汉市洪山区2010～2016年报告的AEFI个案数据及接种信息,采用描述性方法,对相关指标进行流行病学分析.结果 2010 ～ 2016年,洪山区共报告AEFI 385例,年平均报告率为17.85/10万剂,其中一般反应295例,占76.62％,临床表现以发热、红肿、硬结为主;异常反应72例,占18.70％,主要表现为过敏性皮疹(27.78％)、斑丘疹(40.28％)、荨麻疹(25％);严重异常反应3例(占比4.17％),其中过敏性紫癜2例,热性惊厥1例;无接种事故发生.反应多发生在2岁以下的儿童,占78.18％;每年4～9月份为AEFI报告高峰期;引起AEFI主要相关疫苗中,一类疫苗为白喉破伤风联合疫苗、乙型脑炎疫苗和含麻疹成分疫苗(40.43/10万),二类疫苗为百白破Hib联合疫苗、23价肺炎球菌多糖疫苗和无细胞百白破一灭活脊灰-b型流感嗜血杆菌联合疫苗;一类疫苗AEFI报告率为18.90/10万剂,高于二类疫苗的7.09/10万剂,差异有统计学意义(P＜0.01);所有AEFI病例,均已治愈或好转,3例严重异常反应均已治愈,转归良好.结论 武汉市洪山区AEFI监测系统运行良好,AEFI报告率与监测质量逐步提高,监测敏感性还需进一步提高.

Objective To determine clinical features of adverse events following immunization ( AEFIs) associated with inactivated enterovirus 71 ( EV71) vaccine and evaluate its safety profile in Hubei.Methods AEFI cases associated with EV71 vaccine were collected from the China AEFI Information Management System during 2016-2017 for descriptive epidemiological analysis. Results In total, 497 AEFI cases associated with EV71 vaccine were reported in Hubei during 2016-2017, for an incidence of 57. 11 per 100 000 doses. Among the 497 AEFI cases, 429 ( 49. 29 per 100 000) were common vaccine reactions, and 64 ( 7. 35 per 100 000) were rare vaccine reactions; 401 ( 60. 92 per 100 000), 75 ( 49. 60 per 100 000), and 21 ( 34. 49 per 100 000) were from vaccines of the three different manufacturers. Common reactions were fever ( 42. 40 per 100 000), injection-site swelling ( 0. 69 per100 000), and induration ( 0. 23 per 100 000); allergic rash occurred at a rate of 6. 32 per 100 000.Conclusions AEFI associated with EV71 vaccine had a low incidence, demonstrating a good safety profile for three manufacturers' vaccines.

目的 了解湖北省2010-2016年人间布鲁氏菌病(布病)流行特征,为布病防治提供科学依据.方法 利用“传染病报告信息管理系统”中2010-2016年湖北省人间布病个案数据,分析布病疫情流行特征、病例就诊等情况.利用“突发公共卫生事件报告管理信息系统”中湖北省布病暴发疫情数据,分析暴发疫情特点.结果 2010-2016年湖北省共报告布病947例,年均报告发病率为0.23/10万,发病呈现逐年增加趋势(趋势x2=838.312,P=0.001).病例以农民为主(71.28％).发病县(区)覆盖率为74.76％(77/103),波及县(区)从2010年2个增至2016年53个,呈逐年增加趋势(趋势x2=138.278,P=0.001).发病至诊断时间间隔中位数为13 d;省级医院报告病例比例呈逐年降低趋势(趋势x2=66.027,P＜ 0.05),县级医院报告病例比例呈逐年增加趋势(趋势x2=31.427,P=0.001).2010-2016年共报告2起暴发疫情,可疑的暴露因素均为接触染疫的羊只.结论 2010-2016年布病在湖北省呈现由北至南逐年扩增的趋势;基层医疗机构对布病诊断水平不断提高.建议加强布病联防联控,遏制布病的增长势头.

目的 分析湖北省2010-2016年疑似预防接种异常反应(Adverse events following immunization,AEFI)的发生特征,评价疫苗的安全性.方法 采用描述流行病学方法对湖北省2010-2016年通过AEFI信息管理系统报告的AEFI个案数据进行描述性分析.结果 湖北省2010-2016年共报告AEFI个案30 599例,年均报告发生率为24.79/10万剂.在所有AEFI中,一般反应、异常反应分别占91.05％、7.59％;男女性别比为1.41∶1;≤1岁儿童占71.43％;夏、秋季发生分别占35.58％、33.89％;99.39％的AEFI痊愈或好转;91.22％的不良反应病例接种至反应发生时间间隔≤1d.AEFI报告发生率较高的疫苗为麻疹风疹联合减毒活疫苗(76.73/10万剂)、无细胞百白破联合疫苗(48.61/10万剂)和乙型脑炎减毒活疫苗(45.28/10万剂);报告发生率最高的异常反应为过敏性皮疹(1.50/10万剂),严重过敏反应和神经系统反应报告发生率分别为0.07/10万剂、0.06/10万剂.结论 湖北省2010-2016年AEFI监测敏感性逐年提高,所有疫苗安全性良好.

目的探讨免疫规划信息管理系统建设的功能结构。方法采用模块化设计思想,利用系统分析方法,综合运用计算机技术,网络技术、通讯技术对湖北省免疫规划信息管理系统的功能结构和功能组成进行设计,通过应用支撑组件+业务功能构件的方式实现系统各项功能。结果湖北省免疫规划信息管理系统由湖北省免疫规划之窗、预防接种信息管理系统、免疫规划办公自动化系统、免疫规划GIS系统、免疫规划信息服务中心五个功能子系统构成;经过近一年的试用和改进,系统功能日趋完善,运行稳定,使用方便。结论系统功能设计合理、先进,实施效果理想,能满足当前免疫规划工作信息化需求。

为了解湖北省健康人群脊髓灰质炎抗体水平和免疫成功率情况,评价口服脊灰减毒活疫苗(Oral Poliomyelitis Attenuated Live Vaccine,OPV)预防接种的质量和效果,于2010年抽取湖北省A县开展健康人群脊髓灰质炎免疫水平监测,并在湖北省B县开展了脊灰疫苗免疫成功率监测.

OBJECTIVE:To identify the risk factors for reported sudden rise of measles incidence in November, 2011, in some areas of Hubei province.METHODS:We analyzed all measles patients reported in the measles surveillance system from November 2011 to February 2012 in two prefectures with highest attack rates and their vaccination history by reviewing vaccination records. We interviewed patients' parents by telephone to obtain the history of visiting health care within 7 to 21 days before onset. We also used case-crossover study to estimate the relative risk (RR) of hospital acquired infection and to compare the exposure to health care between 7-21 days before onset to 37-51 days before onset among measles patients.RESULTS:Totally 140 patients were reported in the two prefectures. Reported measles incidence rates among the population aged <8 m(69/100 000) and 8 m to 17 m (72/100 000) were higher than other age groups (rang from 0 to 5.8 per 100 000). Among the population aged 8 m to 17 m, estimated vaccination coverage was lower than 75%, and it was lower than 90% among those aged 18 m to 3 yrs. During 7-21 days before onset, 58% (29/50) of the patients had an exposure to health care settings, compared to 14% (7/50) of patients during 37 to 51 days before onset (MH RR = 5.4, 95% confidence interval = 2.1-14.0).CONCLUSION:Under the condition of measles vaccination coverage lower than 95%, iatrogenic infection was a risk factor for measles in Hubei.

麻疹是由麻疹病毒引起的传染性极强的疾病,严重危害儿童健康,其死亡率较高[1].我国麻疹疫情近年来有抬头的趋势,2008年和2009年,我国报告麻疹死亡人数分别为102例和39例,2010年仅上半年就报告了25例[2].麻疹疫苗强化免疫是短期内迅速提高人群免疫力、阻断麻疹病毒传播的有效手段,也是消除麻疹的重要措施之一[3].为进一步落实全国2006-2012年消除麻疹行动计划,实现湖北省到2012年,全省麻疹发病率控制在1/100万,无本地麻疹病毒传播的目标[4],2010年9～10月期间,根据卫生部的统一安排,湖北省开展了全省范围内的8月龄～4岁儿童麻疹疫苗后续强化免疫工作[5].现对此次强化免疫活动在城市地区的实施情况进行评估.

Objective To ascertain the changing epidemiological features of epidemic cerebrospinal meningitis(ECM) by analyzing results of etiological and serological surveillance of ECM.Methods Biochemical testing,serotyping,and antimicrobial susceptibility testing were performed on Neisseria meningitides strains isolated between 2006 and 2010.Multilocus sequence typing(MLST) and pulsed-field gel electrophoresis(PFGE) were used to subtype the strains.Real-time PCR was used to detect N.meningitidis-specific genes from cerebrospinal fluid specimens.Bactericidal antibodies against serogroup C N.meningitidis in healthy serum samples were measured with serum bactericidal assays(SBA).Results Serogroup B N.meningitidis predominated in 2007 and serogroup C predominated from 2008 to 2010.All of the tested strains were susceptible to six antibiotics including penicillin.Multiple drug resistance(Ciprofloxacin,Minocycline,Nalidixic acid & Cotrimoxazole) was observed in some isolates.Molecular typing indicated that N.meningitidis serogroup B strains were genetically diverse and no clearly predominant clonal group was found.The main subtype of serogroup C strains was ST-4821.Based on culturing and real-time PCR,29 of 988 suspected cases were diagnosed as N.meningitidis infection(serogroup C,22;serogroup A,2;serogroup B,5).Targeted protection(bactericidal antibody titer ≥ 1:8) against serogroup C strains was 38.1% among the population studied.Conclusion N.meningitidis is transitioning from serogroup B to C in Hubei Province.The population has inadequate immunity to N.meningitidis serogroup C.

Objective To evaluate the implementation of the supplementary immunization activities(SIAS) of the attenuated live measles vaccine(MV) in Hubei's rural district in 2010.Methods Four hundred and seventy four children between 8 months and 4 years old were selected with multi-stage stratified cluster sampling in rural area of Hubei.The self-designed questionnaire about MV SIAS was used for field visit and questionnaire survey.SPSS 17.0 was applied for data analysis.Results The immunization coverage rate was 96.6%,the supplementary inoculation rate after massive immunization stage was 50.0%.The satisfaction rate of the parents for service attitude,environment and organization were 97.2%,96.7% and 97.8% respectively.Three children had never received any measles vaccination,accounting for 6‰.Conclusion The immunization coverage rate was 95%,reaching the expected target.Further effort is needed to increase the supplementary inoculation rate.Those children never received measles vaccination should be the priority population for the elimination of measles.

麻疹是一种严重危害儿童健康的急性呼吸道传染病,传染性极强,易引起暴发流行.麻疹病毒只有一个血清型,抗原性稳定,人感染后可产生持久的免疫力,人是唯一宿主,且有安全有效的疫苗加以预防,因此,消除麻疹在理论和技术上是可行的[1,2].