臺灣博碩士論文加值系統

目的:
台灣地區自1986年起，對國中三年級女生實施全面接種德國麻疹疫苗措施。自1992年起改為國三男女生、國小學童全面接種 MMR疫苗，至1994年國中三年級以下全部接種完成。育齡婦女自1987年度起接種德國麻疹疫苗。目前施打方式是滿十五個月及國小一年級新生及育齡婦女接種MMR疫苗。自1992年實施MMR疫苗接種工作後，德國麻疹病例均在個位數字，無先天性德國麻疹個案。然，2001年卻出現三例先天性德國麻疹，其中二例生母為非台灣籍配偶。本研究之目的是要藉由偵測血清抗體陽性率來評估台灣德國麻疹疫苗注射之成效。

方法:
本研究乃針對台北縣學校國小、國中、高中及大學 (7∼9歲, 1995∼1997出生世代; 11∼13歲, 1991∼1993出生世代; 15∼17歲, 1987∼1989出生世代; 19∼ 22歲, 1982∼1985出生世代) 之女學生及同時間至衛生署台北醫院做產檢及健康檢查之女性 25∼33歲 (1971∼1979出生世代) 和 34∼44歲 (1960∼1970出生世代) 進行抽樣採血。用ELISA方法偵測德國麻疹抗體陽性率，來比較不同年齡世代之抗體陽性率差別。參與者並給予一份有關疫苗施打史、德國麻疹感染史、父母社經地位、教育程度、籍貫、兄弟姊妹數等之問卷調查來看其和德國麻疹抗體陽性率之相關性。疫苗施打之涵蓋率及成效也被探討和其他國家做比較。

結果:
共搜集1144案例，其中德國麻疹抗體陽性率在7∼9歲為282/287(98.3%)，在11∼13歲為234/235 (99.6%)，15∼17歲為179/185 ( 96.8%)，19∼22歲為110/119( 92.4%)，25∼33歲為197/242 (81.4%)，34∼44歲為68/76 (89.5%)。以年齡層25∼33歲德國麻疹抗體陽性率為最低。育齡婦女 (25∼44歲) 抗體陰性者中，51/53 (96.2%) 為非台灣籍。案例中無發現有過德國麻疹感染症狀者。抗體陰性率和學生之年齡、母親低教育程度、沒打德國麻疹疫苗及為外籍婦女之小孩有關 (p<0.05)。在婦女方面，抗體陰性率除上述外又和外籍、未婚、低胎數及低收入之婦女有關。在學校中，疫苗施打之涵蓋率為99.6%。跟美國及義大利比較，台灣實有不錯之成績。

結論:
台灣目前之德國麻疹疫苗注射己有不錯的成效。未來要根絕德國麻疹及先天性德國麻疹，外籍婦女及台灣高齡產婦疫苗注射將為重要之課題。

Background:
Rubella vaccination has been started since 1986 in Taiwan, the vaccination policy have changed many times. At present, children in Taiwan receive routine MMR vaccine at 15 months old and then receive a booster dose at primary school entry. Susceptible women of child-bearing age also receive MMR vaccine.

Objectives:
This study is carried out to examine age-specific seroprevalence of antibodies against rubella and to elucidate associated factors for seropositivity in northern Taiwan.

Study design:
A cross-sectional study was conducted to survey school girls aged 7∼9 years (1995∼1997 cohorts), 11∼13 years (1991∼1993 cohorts), 15∼17 years (1987∼1989 cohorts), and 19∼22 years (1982∼1985 cohorts) in Taipei County. Child bearing women aged 25∼33 years (1971∼1979 cohorts) and women older than 34 years old who came to Taipei Hospital for pre-marital, pre-labor examination, and other health examinations were also included. Rubella seropositivity was defined as serum rubella IgG antibody level ≧ 10 IU/ml by enzyme immunoassay. Participants are given an informed consent and a questionnaire detailing socioeconomic status, education level, race of mother, number of siblings, and history of rubella infection and rubella vaccination. For women older than 25 years old, ethnicity, marital status, and parity were also asked. Possible predictors of rubella seropositivity and differences in seroprevalence for each age group were calculated by multiple logistic regression. Vaccination coverage rate was also investigated.

Results:
Total 1144 cases were recruited. The geometric mean rubella specific IgG antibody value was found be 76.1± 61.7 IU/ml. Rubella seropositivity rates were 282/287 (98.3 %) positive in persons aged 7∼9 years, 234/235 (99.6%) in aged 11∼13 years, 179/185 (96.8%) in aged 15∼17 years, 110/119 (92.4%) in aged 19∼22 years, and 197/242 (81.4%) in aged 25∼33 years, in aged 34∼44 years 68/76 (89.5%). Seropositivity decreased with age and was the lowest in the 25∼33-year-old age group. For child bearing age women (25∼44 years old), 51 out of 53 (96.2%) seronegative women were foreigners. Age, maternal low education level, foreign mother, and no vaccination at 15 months old were correlated with seronegativity in students (p < 0.05). In addition to previous predictors, foreigners, not married, low parity, and low family income were associated with seronegativity in women. Vaccine coverage rate in students was 99.6%. Comparing with United States and Italy, rubella seropositivity rates and vaccine coverage rate are higher in Taiwan.

Conclusion:
The vaccine program has promoted effectively immunity. However, to eliminate rubella and chronic rubella syndrome, more effort should be made to vaccinate susceptible foreign brides and old age reproductive Taiwanese women.

Chinese Abstract………………………………………………………….4
English Absract… ……………………………………………6

Chapter 1 Introduction
Rubella virus………………………………………………… 8
Congenital rubella syndrome ……………………………..8
Rubella epidemiology in Taiwan……………………….. 8
Rubella vaccine program in Taiwan……………………….11
Rubella vaccine program in other countries……………14
Specific aims………………………………………………… 24

Chapter 2 Materials and methods
Study subjects………………………………………………..25
Response rate ………………… …………………………… 25
Questionnaires …………………………… ………………..26
Serologic tests ……………………………………………..26
Statistical analysis…………………………………………27

Chapter 3 Results
Rubella seroprevalence in different age groups………28
Rubella IgG antibody titer and Vaccine coverage …..32
Predictors of rubella seropositivity …….……….. 32
Effectiveness of present rubella vaccination program 37

Chapter 4 Discussion
Representativeness of the sample and bias………………41
Seroprevalence and geometric mean titers……………… 42
Limitations ………………………………..……………… …44
Comparison with previous studies in Taiwan ……………44
Comparison with other countries……………………………45
Predictors of rubella seropositivity…………………… 46
Barriers and suggestions ……………………………………48

Chapter 5 Conclusions…………………………………………50

Reference ………………………………………………………. 51-55

Tables
Table 1: Seroprevalence of rubella among females after the 1977 epidemic in Taiwan……………………………………………9
Table 2: Risk factors associated with seropositivity of antibodies against rubella in Taiwan ……………………….10
Table 3: Rubella and MMR Vaccination Program in Taiwan..12
Table 4: Rubella vaccine program in neighborhood countries and countries where foreign brides come from………………17
Table 5: Risk factors associated with seropositivity of antibodies against rubella in other countries……………21
Table 6: Seroprevalence of rubella in northern Taiwan by nationalty …………………………………………………………29
Table 7: Geometric mean titers of antibodies against rubella among seropositive study participants……………33
Table 8-1: Univariate analysis of predictors of the rubella seronegativity in students………………………………………36
Table 8-2: Multivariate analysis of predictors of the rubella seronegativity in students……………………………37
Table 9-1:Univariate analysis of predictors of the rubella seronegativity in women……………………………………………39
Table 9-2: Multivariate analysis of predictors of the rubella seronegativity in women…………………………………40
Table 10: Comparison of seroprevalence rates by age in different studies……………………………………………… …43

Figures
Figure 1: Rubella notificated cases in Taiwan …………… 13
Figure 2: Rubella vaccination program in other countries…15
Figure 3: Rubella notificated cases in other Countries……18
Figure 4: Rubella seroprevalence in other countries……… 19
Figure 5: Rubella vaccine coverage rate in other countries20
Figure 6: Rubella seroprevalence, geometric mean titer of antibodies against rubella, and rubella vaccine coverage rate in northern Taiwan. ………………………………………… 30
Figure 7: Comparison of rubella seroprevalence in Taiwan, USA, Finland , and Italy ………………………………………….31
Figure 8: Geometric mean titers of antibodies against rubella in different age groups for seropositive vaccines and nonvaccinees……………………… ………….…… ……… .34
Figure 9: Comparison of rubella vaccine coverage in Taiwan, Finland, France, Germany, and Italy ……………………….…35

Appendix …………………………………. …………………… 56-59

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