温州市麻疹疫情流行病学调查分析

EPIDEMIOLOGICAL INVESTIGATION ON MEASLES IN WENZHOU

[目的]调查疫情上升原因。[方法]分析流行病学特征,对危险因素进行病例一对照分析。[结果]2004年～2005年3月8日,温州市市辖区≤14岁人群发病率最高(513/10万)。病例中≤7岁流动儿童占60%,而人群中仅占35%。多元线性回归分析显示,流动人口估计发病率为8.2/万(95%CI:6.0～10),常住人口估计发病率为1.2/万(95%CI:0.0～2.5)。医院暴露OR=9.5(95%CI:5.1～18);有接触史OR=7.9(95%CI:3.2～20);疫苗接种率病例组12%,对照组45%,疫苗效力85%(95%CI=69%～93%)。[结论]麻疹接种率低、院内感染的存在、大量的流动人口是造成本次疫情传播主要因素。建议应急接种,控制院内感染。

[Objective] In 2004 and 2005 a measles outbreak affected Zhejian Province, China.Local officials believed that unvaccinated children of migratory workers were responsible for the outbreak. We began an investigation in 3 districts of Wenzhou Prefecture with an incidence rate =157 per 105, to identify the transmission factors and take control measures. [ Methods] Measles reports to the surveillance system with fever and maculopapular rash lasting ≥ 3 days plus cough or catarrh, in aresident of central Wenzhou city were used. A case-control study on the risk factors was conducted. [Results] From 2004 to March 8. 2005. central Wenzhou had the highest measles incidence rate, 513/10^5, in children below 14 years old. Children of migrant workers accounted for 60% of cases below 7 years but only 35% of population below 7 years. By multiple linear regression, the estimated incidence rate for migratory population was 8.2/10 000 （95%CI： 6.0- 10） and 1.2/10 000 for resident （95%CI： 0.0- 2.5） . 85% of ease-persons had visited a hospital outpatient clinic during their incubation period compared to 13% control-persons for a comparable period （0R=9.5, 95%CI： 5.1- 1.8） . 29% of case-persons had face-to- face contact with another person with a rash compared to 4.8% control-persons （0R=7.9, 95%CI： 3.2-20） . Overall, 12% of case-persons had measles vaccination compared to 45% of control-persons （vaccine effectiveness [ VE] = 85%, 95%CI= 69%-93%） . In migrant populations, 13% of case-persons had vaccine compared 45%of control-persons （VE = 81%, 95%CI = 55%-92% ） . In resident population, 10% of case-persons had vaccine compared 46% of control-persons （VE = 87%, 95%CI= 56%-96%） . [Conclusion] Low vaccination coverage large migrant working population nosocomial infection are the main factors for the prevalence of measles. We should control nosocomial infection and conduct emergent vaccination.