AN EXPLOSIVE POINT-SOURCE MEASLES OUTBREAK IN A HIGHLY VACCINATED POPULATION - MODES OF TRANSMISSION AND RISK-FACTORS FOR DISEASE
AN EXPLOSIVE POINT-SOURCE MEASLES OUTBREAK IN A HIGHLY VACCINATED POPULATION - MODES OF TRANSMISSION AND RISK-FACTORS FOR DISEASE
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DOI：
10.1093/oxfordjournals.aje.a115106
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发表时间：
1989-01-01
影响因子：
5
通讯作者：
ORENSTEIN, WA
中科院分区：
文献类型：
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作者：
CHEN, RT;GOLDBAUM, GM;ORENSTEIN, WA
1985年，在美国伊利诺斯州的一所高中，在暴露于剧烈咳嗽的指示病例后，发生了69例继发病例，全部发生在一代人中。根据学校记录，该校1，873名学生在疫情爆发前的疫苗接种率为99.7%。作者研究了这种不寻常的疾病爆发的传播方式和风险因素。在发生接触的学生时代，没有学校集会，很少或没有空气再循环。对58例继发病例（84%）进行了接触访谈;其中只有11例继发病例（19%）可能在教室、公共汽车或校外接触过指示病例。使用Reed-Frost流行病模型，只有22-65%的继发病例可能在班级交流期间与指示病例有过至少一次人与人之间的接触，这表明仅凭这种传播方式无法解释此次疫情。对前45例病例和90例匹配对照的比较表明，病例比对照更不可能有提供者可核实的学校疫苗接种记录（比值比（OR）= 8.1），更可能在12个月以下（OR = 8.6）或12-14个月（OR = 7.0）接种疫苗。尽管疫苗接种水平很高，但由于1）麻疹空气传播，2）高接触率，3）学校疫苗接种记录不准确，或4）年轻人接种疫苗的免疫力不足，中学可能会发生爆炸性麻疹疫情。
In 1985, 69 secondary cases, all in one generation, occurred in an Illinois (USA) high school after exposure to a vigorously coughing index case. The school''s 1,873 students had a pre-outbreak vaccination level of 99.7% by school records. The authors studied the mode of transmission and the risk factors for disease in this unusual outbreak. There were no school assemblies and little or no air recirculation during the schooldays that exposure occurred. Contact interviews were completed with 58 secondary cases (84%); only 11 secondary cases (19%) of these may have had exposure to the index case in the classrooms, buses, or out of school. With the use of the Reed-Frost epidemic model, only 22-65% of the secondary cases were likely to have had at least one person-to-person contact with the index case during class exchanges, suggesting that this mode of transmission alone could not explain this outbreak. A comparison of the first 45 cases and 90 matched controls suggested that cases were less likely than controls to have provider-verifiable school vaccination records (odds ratio (OR) = 8.1) and more likely to have been vaccinated at less than age 12 months (OR = 8.6) or at age 12-14 months (OR = 7.0). Despite high vaccination levels, explosive measles outbreaks may occur in secondary schools due to 1) airborne measles transmission, 2) high contact rates, 3) inaccurate school vaccination records, or 4) inadequate immunity from vaccinations at younger ages.