Doshi Reena H, Mukadi Patrick, Shidi Calixte, Mulumba Audry, Hoff Nicole A, Gerber Sue, Okitolonda-Wemakoy Emile, Ilunga Benoit Kebela, Muyembe Jean-Jacques, Rimoin Anne W
Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
Department of Microbiology, Kinshasa School of Medicine, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of the Congo.
Vaccine. 2015 Jun 26;33(29):3407-14. doi: 10.1016/j.vaccine.2015.04.067. Epub 2015 Apr 30.
Large-scale measles outbreaks in areas with high administrative vaccine coverage rates suggest the need to re-evaluate measles prevention and control in the Democratic Republic of Congo (DRC). Monitoring of measles Vaccine Effectiveness (VE) is a useful measure of quality control in immunization programs. We estimated measles VE among children aged 12-59 months in the Democratic Republic of Congo (DRC) using laboratory surveillance data from 2010-2012.
We used the case-based surveillance system with laboratory confirmation to conduct a case-control study using the test negative design. Cases and controls were selected based on presence (n=1044) or absence (n=1335) of measles specific antibody IgM or epidemiologic linkage. Risk factors for measles were assessed using unconditional logistic regression, stratified by age.
Among children 12-59 months, measles vaccination was protective against measles [aOR (95%C)], 0.20 (0.15-0.26) and estimated VE was 80% (95% CI 74-85%). Year of diagnosis, 2011: 6.02 (4.16-8.72) and 2012; 8.31 (5.57-12.40) was a risk factor for measles when compared to 2010. Compared to Kinshasa, children in Bas-Congo, Kasai-Oriental, Maniema and South Kivu provinces all had higher odds of developing measles. Measles VE was similar for children 12-23 months and 24-59 months (80% and 81% respectively).
Repeated occurrences of measles outbreaks and lower than expected VE estimates suggest the need to further evaluate measles vaccine efficacy and improve vaccine delivery strategies in DRC.
在行政疫苗接种覆盖率高的地区发生大规模麻疹疫情，这表明需要重新评估刚果民主共和国（DRC）的麻疹预防和控制措施。监测麻疹疫苗效力（VE）是免疫规划质量控制的一项有用措施。我们利用2010 - 2012年的实验室监测数据，估算了刚果民主共和国12 - 59月龄儿童的麻疹疫苗效力。
我们使用基于病例的实验室确诊监测系统，采用检测阴性设计进行病例对照研究。根据麻疹特异性抗体IgM的存在情况（n = 1044）或不存在情况（n = 1335）或流行病学关联来选择病例和对照。使用无条件逻辑回归评估麻疹的危险因素，并按年龄分层。
在12 - 59月龄儿童中，麻疹疫苗接种对麻疹具有保护作用[aOR（95%CI），0.20（0.15 - 0.26）]，估计疫苗效力为80%（95%CI 74 - 85%）。与2010年相比，2011年诊断年份的比值比为6.02（4.16 - 8.72），2012年为8.31（5.57 - 12.40），是麻疹的一个危险因素。与金沙萨相比，下刚果省、东开赛省、马尼埃马省和南基伍省的儿童患麻疹的几率都更高。12 - 23月龄和24 - 59月龄儿童的麻疹疫苗效力相似（分别为80%和81%）。
麻疹疫情反复发生且疫苗效力估计低于预期，这表明需要进一步评估刚果民主共和国的麻疹疫苗效力，并改进疫苗接种策略。
