van der Maas N A T, Bondt P E Vermeer-de, de Melker H, Kemmeren J M
Centre for Infectious Disease Control Netherlands - National Institute for Public Health and the Environment, The Netherlands.
Vaccine. 2009 Mar 18;27(13):1970-3. doi: 10.1016/j.vaccine.2009.01.019. Epub 2009 Jan 30.
Acute cerebellar ataxia (ACA, sudden onset of truncal ataxia and gait disturbances) usually follows a benign illness (25% varicella). It is also described after vaccination, like MMR and varicella zoster virus (VZV). We will establish incidence rates of (varicella related) ACA and assess the attributable risk of vaccination to ACA in the Netherlands.
Data on ACA in children, following infections, like varicella, and vaccinations, obtained from prospective, active pediatric surveillance and passive surveillance on adverse events following immunizations (AEFI) were compared with hospitalization data for ataxia. Capture-recapture (CRC) method was used to estimate the burden of ACA in the Netherlands.
45 children with ACA were included (44 and 1 reported by pediatric and AEFI surveillance respectively, 30 were hospitalized). Chickenpox preceded ACA in 15 cases, one case followed MMR. Of the hospitalization reports, 13 fulfilled the criteria for ACA. Using CRC the estimated number of hospitalized ACA cases was 42. For varicella related ACA, this estimate was 10, resulting in an incidence rate of 0.7:100,000 (95%CI 0.52-0.94, all cases) and 0.17:100,000 (95%CI 0.09-0.31, varicella related cases) for children under 15 years of age.
The incidence rates were comparable with other studies. We found no association with MMR, but chickenpox was clearly related to ACA. According to age-specific seroprevalence data the incidence rate of ACA was 5:100,000 VZV infections for children up to 5 years, compared to an ACA-reporting rate of 0.15:100,000 doses VZV-vaccine. Therefore, uptake of VZV-vaccine in the immunization programme will diminish the incidence rate of ACA.
急性小脑性共济失调（ACA，表现为躯干共济失调和步态障碍突然发作）通常继发于良性疾病（25%为水痘）。接种疫苗后也有相关报道，如麻疹、腮腺炎、风疹联合疫苗（MMR）和水痘带状疱疹病毒（VZV）疫苗。我们将确定（水痘相关的）ACA发病率，并评估荷兰接种疫苗导致ACA的归因风险。
从儿童前瞻性主动监测以及免疫接种后不良事件（AEFI）被动监测中获取儿童感染水痘等感染性疾病及接种疫苗后发生ACA的数据，并与共济失调住院数据进行比较。采用捕获-再捕获（CRC）方法估算荷兰ACA的负担。
纳入45例ACA患儿（儿科监测和AEFI监测分别报告44例和1例，30例住院）。15例ACA患儿在水痘发病后出现，1例在接种MMR后出现。在住院报告中，13例符合ACA标准。采用CRC方法估算的住院ACA病例数为42例。水痘相关的ACA病例数估计为10例，15岁以下儿童中，所有病例的发病率为0.7:100,000（95%置信区间0.52 - 0.94），水痘相关病例的发病率为0.17:100,000（95%置信区间0.09 - 0.31）。
发病率与其他研究结果相当。我们未发现与MMR疫苗有关联，但水痘与ACA明显相关。根据特定年龄的血清流行率数据，5岁及以下儿童每100,000次VZV感染中ACA发病率为5例，而VZV疫苗接种报告率为每100,000剂0.15例。因此，免疫规划中接种VZV疫苗将降低ACA发病率。
