西安市疫区人口肾综合征出血热疫苗覆盖率及接种策略研究

摘要

目的 了解西安市农村疫区人口肾综合征出血热(HFRS)疫苗接种率及人口流动特征,为接种策略的修订提供参考依据.方法 2013年采用横断面调查,从西安市HFRS传统疫区周至县、户县、长安区、临潼区中分别抽取3个村,每个村抽取20户,调查该户所有人口基本情况,同时调查其16～ 60岁HFRS疫苗接种适龄人口的一般情况、疫苗接种情况和外出务工情况等.结果 共调查996人,HFRS疫苗接种适龄人群占69.3％(690/996),其中曾经接种过HFRS疫苗者占49.0％(338/690).53.9％(372/690)适龄人口有长期打工行为.在本县域内打工者HFRS疫苗接种比例(56.8％,67/118)显著高于本市(本县外,37.0％,60/162)和市外(39.1％,36/92,x2=10.74、6.44,P均＜0.017).每周回家人群60.3％(76/126)有接种史,每年回家1次人群中无接种史或接种史不详者所占比例最高,为83.3％(35/42).随着疫苗接种率的增加,HFRS发病率显著下降(Y=-0.524X+ 38.319,t=-4.581,P＜0.05).结论 经过HFRS疫苗的免费接种,疫苗覆盖率与最大防病效益的发挥具有一定差距.现行接种策略需调整.%Objective To describe the vaccine inoculation rate of hemorrhagic fever with renal syndrome (HFRS) and the movement characteristics of rural population in the Xi'an epidemic area.Methods This was a cross-sectional study.The study covered all the four HFRS traditional high incidence areas (counties):Zhouzhi,Huxian,Chang'an and Lintong.Three villages were selected in each county and 20 households were selected in each village in 2013.Participants included all the persons of these families.People 16-60 years old were interviewed face to face about their sociodemographic and environmental information,and at the same time related HFRS vaccine history and characters of migrant workers were collected.Results Nine hundred and ninety-six persons were investigated,69.3 percent (690/996) were vaccinate-age population.Of all,49.0 percent (338/690) had HFRS vaccine history and 53.9 percent (372/690) had worked away from home most of the year.The inoculation proportion of workers which worked in their own counties (56.8％,67/118) were higher than that of workers worked outside (37.0％,60/162;39.1％,36/92,x2 =10.74,6.44,all P ＜ 0.017).In the workers that went back home every week,60.3 percent (76/126) had vaccinated.Workers that went back home once a year had the lowest proportion of inoculation (16.7％,7/42).The morbidity of HFRS decreased significantly accompany with ascend of inoculation rate (Y =-0.524X + 38.319,t =-4.581,P ＜ 0.05).Conclusions After the free vaccinations,there is still a gap between the vaccine inoculation rate and prevention benefit.The current vaccination strategies need to be adjusted.