Cutts F T, Smith P G, Colombo S, Mann G, Ascherio A, Soares A C
Epidemiology Unit, Ministry of Health, Mozambique.
Am J Epidemiol. 1990 Feb;131(2):349-55. doi: 10.1093/oxfordjournals.aje.a115504.
Monitoring measles vaccine efficacy is an important form of quality control in immunization programs. Retrospective cohort studies of vaccine efficacy were conducted in Mozambique with the aim of adopting this method for regular use. The authors studied 1,215 and 790 children aged 12-35 months in the cities of Nampula and Beira, respectively. In Nampula (1985), vaccine efficacy was estimated to be 40%, and in Beira (1986), it was estimated to be 59%. To investigate the possibility of falsely low results due to poor specificity of maternal reporting of measles cases, a seroepidemiologic study of 600 children aged 12-47 months was conducted in Nampula in 1986. The specificity and sensitivity of a maternal history of measles in an unvaccinated child were estimated as 83% and 56%, respectively. These results were used to obtain an adjusted vaccine efficacy estimate of 66%, almost double the estimate of 37% obtained using data on history of vaccination and illness alone. The large bias introduced into the vaccine efficacy estimation by low specificity of disease diagnosis is a serious limitation to the use of retrospective cohort methods to assess efficacy.
监测麻疹疫苗效力是免疫规划中质量控制的一种重要形式。在莫桑比克开展了疫苗效力的回顾性队列研究，目的是采用这种方法进行常规使用。作者分别对楠普拉市和贝拉市12至35个月大的1215名和790名儿童进行了研究。在楠普拉（1985年），疫苗效力估计为40%，在贝拉（1986年），估计为59%。为调查因母亲报告麻疹病例的特异性差而导致结果错误偏低的可能性，1986年在楠普拉对600名12至47个月大的儿童进行了血清流行病学研究。未接种疫苗儿童的母亲麻疹病史的特异性和敏感性分别估计为83%和56%。这些结果被用于获得调整后的疫苗效力估计值为66%，几乎是仅使用疫苗接种和疾病史数据获得的37%估计值的两倍。疾病诊断特异性低给疫苗效力估计带来的巨大偏差是使用回顾性队列方法评估效力的一个严重限制。
