美国基于人群的破伤风免疫血清学调查。

A population-based serologic survey of immunity to tetanus in the United States.

作者信息

Gergen P J, McQuillan G M, Kiely M, Ezzati-Rice T M, Sutter R W, Virella G

机构信息

National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, Md.

出版信息

N Engl J Med. 1995 Mar 23;332(12):761-6. doi: 10.1056/NEJM199503233321201.

DOI:10.1056/NEJM199503233321201

PMID:7862178

Abstract

BACKGROUND

Vaccination rates are frequently considered a surrogate measure of protection. To provide more accurate estimates, serum levels of antibody against tetanus were measured as part of the third National Health and Nutrition Examination Survey (NHANES III), which studied a representative sample of the civilian, noninstitutionalized population of the United States.

METHODS

We measured tetanus antitoxin using a solid-phase enzyme immunoassay in serum samples from 10,618 persons six years of age and older who were examined during phase 1 of NHANES III in 1988 to 1991.

RESULTS

Overall, 69.7 percent of Americans six years of age and older had protective levels of tetanus antibodies (> 0.15 IU per milliliter). The rate decreased from 87.7 percent among those 6 to 11 years of age to 27.8 percent among those 70 years of age or older. Among children 6 to 16 years of age, 82.2 percent had protective levels of tetanus antibodies, with little variation according to race or ethnicity. More men than women were immune (79.0 percent vs. 62.4 percent). Mexican Americans had a significantly lower rate of immunity (57.9 percent, P < 0.05) than either non-Hispanic whites (72.7 percent) or non-Hispanic blacks (68.1 percent). Those with a history of military service, higher levels of education, or incomes above the poverty level were more likely to have protective antibody levels. Although the prevalence of immunity declined rapidly starting at the age of 40 years, most of the 107 cases of tetanus (with 20 deaths) reported in 1989 and 1990 occurred in persons 60 years of age or older.

CONCLUSIONS

Despite the fact that effective vaccines against tetanus have been available since the 1940s, many Americans do not have immunity to tetanus, and the rates are lowest among the elderly. There is an excellent correlation between vaccination rates (96 percent) and immunity (96 percent) among six-year-olds. However, antibody levels decline over time, and one fifth of older children (10 to 16 years of age) do not have protective antibody levels.

摘要

背景

疫苗接种率常被视为保护效果的替代指标。为提供更准确的估计值，作为第三次全国健康与营养检查调查（NHANES III）的一部分，对破伤风抗体的血清水平进行了测量，该调查研究了美国非机构化平民人口的代表性样本。

方法

我们采用固相酶免疫测定法，对1988年至1991年NHANES III第一阶段检查的10618名6岁及以上人群的血清样本进行破伤风抗毒素检测。

结果

总体而言，69.7%的6岁及以上美国人破伤风抗体水平具有保护性（>0.15国际单位/毫升）。该比例从6至11岁人群中的87.7%降至70岁及以上人群中的27.8%。在6至16岁儿童中，82.2%的儿童破伤风抗体水平具有保护性，且根据种族或族裔差异不大。男性的免疫率高于女性（79.0%对62.4%）。墨西哥裔美国人的免疫率（57.9%，P<0.05）显著低于非西班牙裔白人（72.7%）或非西班牙裔黑人（68.1%）。有军事服役史、受教育程度较高或收入高于贫困线的人更有可能具有保护性抗体水平。尽管从40岁开始免疫流行率迅速下降，但1989年和1990年报告的107例破伤风病例（20例死亡）中，大多数发生在60岁及以上人群中。