Rosenthal S R, Clements C J
Health and Child Survival Fellow assigned to the Expanded Programme on Immunization, World Health Organization, Geneva, Switzerland.
Bull World Health Organ. 1993;71(3-4):421-8.
As measles continues to exact a high toll on infant mortality, particularly in developing countries, optimal strategies for the control of the disease are under discussion. As part of this debate, the place of 2-dose measles immunization schedules is reviewed regarding their potential as a strategy to improve measles control. To date, WHO has not recommended the use of a 2-dose schedule. A number of industrialized countries have already adopted a 2-dose schedule, often choosing to administer measles vaccine in the same injection as mumps and rubella vaccines. However, at present not enough is known about such schedules in developing countries to make global recommendations. Further research should include randomized controlled trials of early 2-dose schedules to investigate both technical and epidemiological issues such as the effect of blunting immunity and the duration of antibody. Long-term safety should be determined through studies of adequate size. Programmes already using 2-dose schedules are encouraged to evaluate their impact on disease incidence, cost, vaccine usage, and effect on coverage. Until further evaluation is complete, a high and timely coverage with one dose of measles vaccine in all areas remains the first priority for all immunization programmes.
由于麻疹继续对婴儿死亡率造成高昂代价，尤其是在发展中国家，因此正在讨论控制该疾病的最佳策略。作为这场辩论的一部分，对两剂次麻疹免疫程序作为改善麻疹控制策略的潜力进行了审视。迄今为止，世卫组织尚未推荐使用两剂次程序。一些工业化国家已经采用了两剂次程序，通常选择在与腮腺炎和风疹疫苗相同的注射中接种麻疹疫苗。然而，目前在发展中国家对这类程序的了解还不足以做出全球推荐。进一步的研究应包括对早期两剂次程序的随机对照试验，以调查技术和流行病学问题，如免疫减弱的影响和抗体持续时间。应通过足够规模的研究来确定长期安全性。鼓励已经采用两剂次程序的项目评估其对疾病发病率、成本、疫苗使用情况以及对覆盖率的影响。在进一步评估完成之前，所有地区及时实现一剂次麻疹疫苗的高覆盖率仍然是所有免疫规划的首要任务。
