Epidemic of measles following the nationwide mass immunization campaign.
Epidemic of measles following the nationwide mass immunization campaign.
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DOI：
10.1186/1471-2334-13-139
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发表时间：
2013-03-18
影响因子：
3.7
通讯作者：
Zhu BP
中科院分区：
文献类型：
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作者：
Gao J;Chen E;Wang Z;Shen J;He H;Ma H;Zeng G;Zhu BP
2010年，温州市中国在全国范围内开展麻疹大规模免疫接种活动后，爆发了一场旷日持久的麻疹疫情。我们对中国地区麻疹疫情进行了调查，以确定本次疫情的致病因素，并为制定消除麻疹策略提供循证建议。麻疹是按照国家标准病例定义诊断的。我们根据麻疹患者接种疫苗的比例估计了人群接种疫苗的覆盖率。病例对照调查以2010年11月1日至12月31日在温州医学院附属第二医院(S医院)就诊的所有麻疹患者为病例，在S医院同期就诊的所有患者中随机抽取对照组，就诊频次按就诊月匹配。我们回顾了病例患者和对照患者的医疗记录，以比较他们在潜伏期(发病前7-21天)在S医院及其静脉补液室(IV室)的暴露历史。2010年9月1日至2011年1月11日温州市麻疹发病率为3.3/10万。在所有年龄段中，8-11岁的儿童发病率最高(171/10万)。在不符合接受MMIC的年龄但应该在MMIC之后常规接种疫苗的儿童中，疫苗接种率仅为52%。在病例对照调查中，60%(25/42)的病例患者与21%(35/168)的对照患者去过S医院(调整后的ORM-H = 5.5，95%CI = 2.7~11)。在S医院接受治疗的未接种疫苗的儿童中，84%(21/25)的病例患者去过静脉输液室(调整后的ORM-H = 9.2，95%CI = 1.5~59)，而对照组患者的比例为38%(11/29)。在MMIC后，儿童中放松的常规麻疹疫苗接种是导致这次疫情的主要因素。S医院输液室的暴露促进了疫情的蔓延。为实现消灭麻疹的目标，中国公共卫生部门应加大力度，提高麻疹常规疫苗接种的及时性，减少医院内传播。
A prolonged measles epidemic occurred in Wenzhou City, China after a nationwide measles mass immunization campaign (MMIC) in 2010. We conducted an investigation to identify factors contributing to this epidemic and to provide evidence-based recommendations for measles elimination strategies in China. Measles was diagnosed using the national standard case-definitions. We estimated the population vaccination coverage based on the proportion of measles patients that had been vaccinated. In a case–control investigation, all measles patients who received treatment in The Second Affiliated Hospital of Wenzhou Medical College (Hospital S) during November 1 to December 31, 2010 served as cases; controls were randomly selected among all other patients who received treatment in Hospital S during the same time period, frequency matched by month of hospital visit. We reviewed medical records of case- and control-patients to compare their exposure history at Hospital S and to its intravenous rehydration room (IV room) during the incubation period (7–21 days before their illness onset). The attack rate of measles in Wenzhou City was 3.3/100,000 during September 1, 2010 to January 11, 2011. Children aged 8-11 m had the highest attack rate (171/100,000) of all age groups. In children not age-eligible for the MMIC but should have been routinely vaccinated after the MMIC, the vaccination rate was only 52%. In the case–control investigation, 60% (25/42) of case-patients compared with 21% (35/168) of control-patients had visited Hospital S (adjusted ORM-H = 5.5, 95% CI = 2.7–11). Among unvaccinated children who had received treatment in Hospital S, 84% (21/25) of case-patients compared 38% (11/29) of control-patients had visited the IV room (adjusted ORM-H = 9.2, 95% CI = 1.5–59). Relaxed routine measles vaccination among children after the MMIC was the main factor responsible for this epidemic. Exposure in the IV room at Hospital S facilitated the epidemic. To reach the goal of measles elimination, the Chinese public health authorities should make greater efforts to improve timely routine measles vaccination, and to reduce nosocomial transmission.
影响因子：
3.6
作者：
Li, Yuan;Guo, Hongxiong;Fontaine, Robert E.
通讯作者：
Fontaine, Robert E.