Ströhle A, Eggenberger K, Steiner C A, Matter L, Germann D
Institut fr Medizinische Mikrobiologie, Universität Bern.
Schweiz Med Wochenschr. 1997 Jun 28;127(26):1124-33.
Since 1991, 6 years after the recommendation of universal childhood vaccination against measles, mumps, and rubella (MMR triple vaccine), Switzerland is confronted with a large number of mumps cases affecting both vaccinated and unvaccinated children. Up to 80% of the children suffering from mumps between 1991 and 1995 had previously been vaccinated, the majority with the Rubini vaccine strain. On the basis of a case-control study including 102 patients and 92 controls from the same pediatric population, a study of the humoral immune-response following vaccination with the Rubini vaccine in 6 young adult volunteers, and two different genetic studies, we investigated the complex problem of large scale vaccine failure in Switzerland. We conclude that the recently reported large number of Swiss mumps cases was caused by at least four interacting factors: 1. A vaccine coverage of 90-95% at the age of 2 years is necessary to interrupt mumps wild virus circulation. The nationwide vaccine coverage in Switzerland of some 80% in 27-36 month-old children is too low. 2. Primary vaccine failures (absence of seroconversion or unprotective low levels of neutralizing antibodies), as well as secondary vaccine failures due to the rapid decline of antibodies to mumps virus in our volunteers and controls, seem to be frequent after vaccination with the Rubini strain. 3. Despite its reported Swiss origin, the Rubini strain does not belong to the mumps virus lineages recently circulating in this area but is closely related to American mumps virus strains. 4. Differences in protein structure between the vaccine strain and the circulating wild type strains, and in particular a different neutralization epitope in the hemagglutinin neuraminidase protein, may additionally contribute to the lack of protection in vaccinated individuals.
自1991年，即推荐普及儿童麻疹、腮腺炎和风疹联合疫苗（MMR三联疫苗）6年后，瑞士面临大量腮腺炎病例，接种疫苗和未接种疫苗的儿童均受影响。1991年至1995年期间，患腮腺炎的儿童中高达80%此前已接种疫苗，多数接种的是鲁比尼疫苗株。基于一项病例对照研究（包括来自同一儿科人群的102例患者和92例对照）、一项对6名年轻成人志愿者接种鲁比尼疫苗后的体液免疫反应的研究以及两项不同的基因研究，我们调查了瑞士大规模疫苗失效这一复杂问题。我们得出结论，近期报告的大量瑞士腮腺炎病例至少由四个相互作用的因素导致：1. 2岁时疫苗接种覆盖率达到90 - 95%对于阻断腮腺炎野生病毒传播是必要的。瑞士全国27 - 36月龄儿童约80%的疫苗接种覆盖率过低。2. 初次疫苗失效（血清转化缺失或中和抗体水平低无保护作用），以及由于我们的志愿者和对照中腮腺炎病毒抗体迅速下降导致的二次疫苗失效，在接种鲁比尼毒株后似乎很常见。3. 尽管鲁比尼毒株据报道源自瑞士，但它并不属于该地区近期流行的腮腺炎病毒谱系，而是与美国腮腺炎病毒毒株密切相关。4. 疫苗株与流行的野生型毒株之间蛋白质结构的差异，尤其是血凝素神经氨酸酶蛋白中不同的中和表位，可能进一步导致接种疫苗个体缺乏保护。
