EPIDEMIC MEASLES IN CHICAGO IN 1983: SUSTAINED TRANSMISSION IN THE PRESCHOOL POPULATION
EPIDEMIC MEASLES IN CHICAGO IN 1983: SUSTAINED TRANSMISSION IN THE PRESCHOOL POPULATION
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1983 年芝加哥麻疹流行病：学龄前儿童中的持续传播
作者：
M. Bennish;P. Arnow;S. Doveikis;M. Beem
1983年第一周在我们的急诊室（ER）看到的两例麻疹疑似病例促使对其他病例进行积极的基于ER的监测。在1983年4月1日至1983年12月8日期间，确定了107例疑似病例，85例进行了麻疹诊断试验。在54例病例中，通过配对血清标本中CF或HI滴度升高≥4倍或通过从鼻咽分泌物中分离病毒证实麻疹。84%的病例和57%的麻疹诊断试验阴性患者出现发热、皮疹、咳嗽、鼻炎或结膜炎。所有54名麻疹患者都是土生土长的，52名是黑人。<16个月23例（43%），<5岁41例（76%）。在家庭接触者中，5岁以下儿童的发病率为38%（8/21），5至25岁人群的发病率为3%（4/116）（p<0.001）。只有7名患者在日托或学校。缺乏麻疹免疫证明的儿童被学校开除前的病例发生率（1.9/周）与被学校开除后（1.4/周）或学年结束时（2.0/周）无显著差异。麻疹抗体测定ELISA血清标本中收集的ER约1年前从170名患者年龄16个月至4岁：62（36%）血清阴性。根据目前的免疫政策和做法，可以在市中心的学龄前儿童中建立一个能够支持麻疹持续流行的免疫库。根除麻疹需要改进这一群体的免疫战略。
Two suspect cases of measles seen in our emergency room (ER) the first week of 1983 prompted active ER-based surveillance for other cases. Between 1/4/83 and 8/12/83, 107 suspect cases were identified, and 85 had diagnostic tests for measles. Measles was proven in 54 cases by ≥4-fold rise in CF or HI titers in paired serum specimens or by virus isolation from nasopharyngeal secretions. Fever, rash, and cough, coryza, or conjunctivitis were present in 84% of cases and 57% of patients with negative measles diagnostic tests. All 54 measles patients were native born, and 52 were black. 23 (43%) were <16 months old, and 41 (76%) were <5 years old. Attack rates in household contacts were 38% (8/21) for children <5 years old and 3% (4/116) for persons 5 to 25 years old (p<.001). Only 7 patients were in a day care or school. The case incidence before school exclusion of children lacking proof of measles immunization (1.9/wk) did not differ significantly from that following school exclusion (1.4/wk) or end of the school year (2.0/wk). Measles antibodies were measured by ELISA in serum specimens collected in the ER about 1 year earlier from 170 patients aged 16 months to 4 years: 62 (36%) were seronegative. With current immunization policies and practices a pool of susceptibles can develop in pre-school children of the inner city that is capable of supporting a sustained measles epidemic. Measles eradication will require improved strategies for immunization of this group.