van den Hof S, Wallinga J, Widdowson M A, Conyn-van Spaendonck M A E
National Institute of Public Health and the Environment, Department of Infectious Diseases Epidemiology, Bilthoven, The Netherlands.
Epidemiol Infect. 2002 Feb;128(1):47-57. doi: 10.1017/s0950268801006409.
We investigated which vaccination schedule gives best protection to the vaccinating population, in case there is a measles epidemic in an area with low vaccine coverage. We considered combinations of an early measles vaccination (none, at 6 months or at 9 months), a measles-mumps-rubella (MMR) vaccination around the first birthday (at either 11 or 14 months), and MMR vaccination at an older age (at either 4 or 9 years). The different estimates on measures of protection (percentage of susceptibles, number of reported cases in an epidemic year, percentage of lifetime spent susceptible) relied on a mathematical model of decline of maternal antibody levels with age, and the impact of that antibody level on seroconversion and immunity. Model parameters were estimated from a Dutch population-based serological survey on measles antibodies. Different measures of protection favoured different vaccination schedules, but dropping the age of second MMR vaccination prevents considerably more cases than an extra early measles vaccination or dropping the age of first MMR vaccination.
我们调查了在疫苗接种覆盖率较低的地区发生麻疹疫情时，哪种疫苗接种方案能为接种人群提供最佳保护。我们考虑了早期麻疹疫苗接种（无、6个月时或9个月时）、一岁左右（11个月或14个月）的麻疹-腮腺炎-风疹（MMR）疫苗接种以及较大年龄（4岁或9岁）的MMR疫苗接种的组合。对保护措施的不同估计（易感人群百分比、疫情年份报告病例数、易感状态持续时间百分比）依赖于母体抗体水平随年龄下降的数学模型，以及该抗体水平对血清转化和免疫的影响。模型参数是根据荷兰一项基于人群的麻疹抗体血清学调查估计得出的。不同的保护措施支持不同的疫苗接种方案，但将第二次MMR疫苗接种年龄提前比额外进行一次早期麻疹疫苗接种或提前第一次MMR疫苗接种年龄能预防更多病例。
