Mast E E, Berg J L, Hanrahan L P, Wassell J T, Davis J P
Bureau of Community Health and Prevention, Wisconsin Division of Health, Madison 53701-0309.
JAMA. 1990 Nov 21;264(19):2529-33.
Using data from a large measles outbreak that occurred in Dane County (Wisconsin) in 1986, we conducted a case-control study to evaluate risk factors for vaccine failure and assessed the cost-effectiveness of school-based revaccination strategies. Vaccination before a change in the measles vaccine stabilizer in 1979 (odds ratio, 5.5; 95% confidence interval, 1.05 to 28.9) and vaccination before age 15 months (odds ratio, 13.9; 95% confidence interval, 5.9 to 32.6) were identified as risk factors. Revaccination strategies for all students ($3444 per case prevented), students vaccinated before 1980 ($3166 per case prevented), and students vaccinated before age 15 months ($2546 per case prevented) were evaluated, assuming use of measles-mumps-rubella vaccine after the initial case was detected in a school. However, a large proportion of cases (43% to 53%) may not have been preventable using these strategies. Therefore, revaccination in all schools assessed to be at risk for measles may be necessary to prevent large outbreaks until a two-dose vaccination schedule is fully implemented.
利用1986年发生在威斯康星州戴恩县的一次大规模麻疹疫情的数据，我们开展了一项病例对照研究，以评估疫苗失效的风险因素，并评估以学校为基础的再次接种策略的成本效益。1979年麻疹疫苗稳定剂改变之前接种疫苗（比值比，5.5；95%置信区间，1.05至28.9）以及15月龄前接种疫苗（比值比，13.9；95%置信区间，5.9至32.6）被确定为风险因素。假设在学校首次发现病例后使用麻疹-腮腺炎-风疹疫苗，对所有学生（每预防一例花费3444美元）、1980年前接种疫苗的学生（每预防一例花费3166美元）以及15月龄前接种疫苗的学生（每预防一例花费2546美元）的再次接种策略进行了评估。然而，使用这些策略可能无法预防很大一部分病例（43%至53%）。因此，在两剂次疫苗接种计划全面实施之前，可能有必要对所有被评估有麻疹风险的学校进行再次接种，以预防大规模疫情爆发。
