Chen R T, Hardy I R, Rhodes P H, Tyshchenko D K, Moiseeva A V, Marievsky V F
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
J Infect Dis. 2000 Feb;181 Suppl 1:S178-83. doi: 10.1086/315561.
A case-control study in Ukraine provided the first data on the field effectiveness of Russian-produced vaccine during the 1990 diphtheria resurgence in the former Soviet Union. For each of 262 diphtheria cases <15 years of age who were reported from January through October 1992, 2 controls, matched by age and clinic, were selected. The effectiveness of three doses of diphtheria vaccine was 98.2% (95% confidence interval: 90.3-99.9). Among controls, 84% had received three or more vaccinations by 2 years of age. These results suggest that the following five hypothesized causes of the outbreak appeared unlikely: appearance of a new "mutant" diphtheria strain, low potency of the Russian-produced diphtheria vaccine, inadequate cold chain, poor host immunogenicity due to radiation exposure from Chernobyl, and low routine childhood vaccination coverage. It is concluded that initial priority for scarce resources for controlling this outbreak should be placed on vaccination of persons susceptible to diphtheria (e.g., adults) rather than revaccination of children.
乌克兰的一项病例对照研究提供了关于前苏联1990年白喉疫情复发期间俄罗斯生产的疫苗现场有效性的首批数据。对于1992年1月至10月报告的262例15岁以下白喉病例中的每一例，选取2名按年龄和诊所匹配的对照。三剂白喉疫苗的有效性为98.2%（95%置信区间：90.3 - 99.9）。在对照中，84%在2岁时已接种三剂或更多剂疫苗。这些结果表明，以下五个假设的疫情爆发原因似乎不太可能：出现新的“突变”白喉菌株、俄罗斯生产的白喉疫苗效力低下、冷链不足、切尔诺贝利辐射暴露导致宿主免疫原性差以及儿童常规疫苗接种覆盖率低。得出的结论是，控制此次疫情的稀缺资源的首要重点应放在对白喉易感人群（如成年人）的疫苗接种上，而不是对儿童进行再接种。
