冈比亚常规接种乙型肝炎疫苗的影响：引入 20 年后。
Impact of routine vaccination against type b in The Gambia: 20 years after its introduction.
机构信息
Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
出版信息
J Glob Health. 2020 Jun;10(1):010416. doi: 10.7189/jogh.10.010416.
BACKGROUND
In 1997, The Gambia introduced three primary doses of type b (Hib) conjugate vaccine without a booster in its infant immunisation programme along with establishment of a population-based surveillance on Hib meningitis in the West Coast Region (WCR). This surveillance was stopped in 2002 with reported elimination of Hib disease. This was re-established in 2008 but stopped again in 2010. We aimed to re-establish the surveillance in WCR and to continue surveillance in Basse Health and Demographic Surveillance System (BHDSS) in the east of the country to assess any shifts in the epidemiology of Hib disease in The Gambia.
METHODS
In WCR, population-based surveillance for Hib meningitis was re-established in children aged under-10 years from 24 December 2014 to 31 March 2017, using conventional microbiology and Real Time Polymerase Chain Reaction (RT-PCR). In BHDSS, population-based surveillance for Hib disease was conducted in children aged 2-59 months from 12 May 2008 to 31 December 2017 using conventional microbiology only. Hib carriage survey was carried out in pre-school and school children from July 2015 to November 2016.
RESULTS
In WCR, five Hib meningitis cases were detected using conventional microbiology while another 14 were detected by RT-PCR. Of the 19 cases, two (11%) were too young to be protected by vaccination while seven (37%) were unvaccinated. Using conventional microbiology, the incidence of Hib meningitis per 100 000-child-year (CY) in children aged 1-59 months was 0.7 in 2015 (95% confidence interval (CI) = 0.0-3.7) and 2.7 (95% CI = 0.7-7.0) in 2016. In BHDSS, 25 Hib cases were reported. Nine (36%) were too young to be protected by vaccination and five (20%) were under-vaccinated for age. Disease incidence peaked in 2012-2013 at 15 per 100 000 CY and fell to 5-8 per 100 000 CY over the subsequent four years. The prevalence of Hib carriage was 0.12% in WCR and 0.38% in BHDSS.
CONCLUSIONS
After 20 years of using three primary doses of Hib vaccine without a booster Hib transmission continues in The Gambia, albeit at low rates. Improved coverage and timeliness of vaccination are of high priority for Hib disease in settings like Gambia, and there are currently no clear indications of a need for a booster dose.
背景
1997 年，冈比亚在其婴儿免疫计划中引入了三剂单价 b 型（Hib）结合疫苗，而没有加强针，同时在西海岸地区（WCR）建立了基于人群的 Hib 脑膜炎监测。2002 年，随着 Hib 疾病的报告消除，该监测停止。2008 年重新建立，但2010 年再次停止。我们的目的是在 WCR 重新建立监测，并在该国东部的巴斯健康和人口监测系统（BHDSS）继续监测，以评估 Hib 疾病在冈比亚的流行病学变化。
方法
在 WCR，使用传统微生物学和实时聚合酶链反应（RT-PCR），从 2014 年 12 月 24 日至 2017 年 3 月 31 日，为年龄在 10 岁以下的儿童重新建立 Hib 脑膜炎的基于人群的监测。在 BHDSS，从 2008 年 5 月 12 日至 2017 年 12 月 31 日，仅使用传统微生物学对 2-59 个月的儿童进行 Hib 疾病的基于人群的监测。2015 年 7 月至 11 月，对学龄前和在校儿童进行了 Hib 带菌调查。
结果
在 WCR，使用传统微生物学检测到 5 例 Hib 脑膜炎病例，而通过 RT-PCR 检测到另外 14 例。在 19 例病例中，有 2 例（11%）年龄太小，无法通过疫苗接种保护，有 7 例（37%）未接种疫苗。2015 年，在 1-59 个月的儿童中，使用传统微生物学的 Hib 脑膜炎发病率为每 100000 名儿童 0.7（95%置信区间（CI）为 0.0-3.7），2016 年为 2.7（95%CI 为 0.7-7.0）。在 BHDSS，报告了 25 例 Hib 病例。其中有 9 例（36%）年龄太小，无法通过疫苗接种保护，有 5 例（20%）接种疫苗的年龄不足。疾病发病率在 2012-2013 年达到每 100000 名儿童 15 例的峰值，随后四年降至每 100000 名儿童 5-8 例。WCR 的 Hib 带菌率为 0.12%，BHDSS 的带菌率为 0.38%。
结论
在使用三剂单价 Hib 疫苗而没有加强针 20 年后，Hib 在冈比亚仍在继续传播，尽管传播率较低。在冈比亚等国家，提高疫苗接种覆盖率和及时性是 Hib 疾病的当务之急，目前没有明确迹象表明需要加强针。
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