Wichmann Ole, Hellenbrand Wiebke, Sagebiel Daniel, Santibanez Sabine, Ahlemeyer Gabriele, Vogt Georg, Siedler Anette, van Treeck Ulrich
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Pediatr Infect Dis J. 2007 Sep;26(9):782-6. doi: 10.1097/INF.0b013e318060aca1.
In 2006, a large measles outbreak (n = 614) occurred in Duisburg city, Germany, with 54% of cases aged >9 years. An investigation was launched to determine reasons for the resurgence of measles, assess vaccination coverage and vaccine effectiveness (VE).
A retrospective cohort-study was undertaken at a Duisburg public school affected early in the outbreak. We distributed questionnaires to all 1250 students aged 10-21 years and abstracted vaccination records. Cases were identified according to a standard clinical case definition.
Questionnaires were returned by 1098 (88%) students. Vaccination records were abstracted from 859 students, of whom 820 (95.4%) had received at least one, 605 (70.4%) 2, and 39 (4.5%) no dose(s) of measles-containing vaccine (MCV). Coverage with 2 doses was higher in younger students. We identified 53 cases (attack rate = 5%). Measles-virus sequencing revealed genotype D6. After excluding students vaccinated in 2006 and those with a history of measles, the attack rate was 53% in unvaccinated students, 1.0% in students with one, and 0.4% in those with 2 MCV-doses. VE was 98.1% (95% CI: 92-100%) in students with one and 99.4% (95% CI: 97-100%) with 2 MCV-doses. Based on observed attack rates in vaccinated and unvaccinated students with vaccination records and in students without vaccination records, one-dose-coverage among all participating students was estimated at 91%.
VE was high. Vaccination coverage was, however, insufficient to prevent the outbreak. Immunization gaps were found especially in older students. To prevent further outbreaks and to achieve the goal of measles elimination in Germany, vaccination coverage must be increased.
2006年，德国杜伊斯堡市发生了大规模麻疹疫情（n = 614），54%的病例年龄大于9岁。开展了一项调查以确定麻疹疫情复发的原因，评估疫苗接种覆盖率和疫苗效力（VE）。
在疫情早期受影响的杜伊斯堡一所公立学校进行了一项回顾性队列研究。我们向所有1250名10 - 21岁的学生发放了问卷，并提取了疫苗接种记录。根据标准临床病例定义确定病例。
1098名（88%）学生返回了问卷。从859名学生中提取了疫苗接种记录，其中820名（95.4%）至少接种过一剂含麻疹疫苗（MCV），605名（70.4%）接种过2剂，39名（4.5%）未接种过任何一剂含麻疹疫苗。年龄较小的学生两剂疫苗接种覆盖率更高。我们确定了53例病例（罹患率 = 5%）。麻疹病毒测序显示为D6基因型。排除2006年接种过疫苗的学生和有麻疹病史的学生后，未接种疫苗的学生罹患率为53%，接种过一剂疫苗的学生为1.0%，接种过2剂含麻疹疫苗的学生为0.4%。接种一剂疫苗的学生疫苗效力为98.1%（95%CI：92 - 100%），接种2剂含麻疹疫苗的学生为99.4%（95%CI：97 - 100%）。根据有疫苗接种记录的接种和未接种学生以及无疫苗接种记录学生中观察到的罹患率，估计所有参与学生中的一剂疫苗接种覆盖率为91%。
疫苗效力很高。然而，疫苗接种覆盖率不足以预防疫情爆发。尤其在年龄较大的学生中发现了免疫空白。为防止进一步的疫情爆发并实现德国消除麻疹的目标，必须提高疫苗接种覆盖率。
