儿童麻疹128例流行病学及临床分析

Epidemiological and Clinical Analysis of 128 Children with Measles

目的了解麻疹疫苗广泛接种后,近年儿童麻疹新出现的流行病学趋势及新出现的临床特点。方法收集并分析本院近3 a收治的128例麻疹患儿,总结其年龄分布、地区分布、疫苗接种等流行病学特点,同时总结临床表现、病情程度、并发症、误诊情况等临床特点,分析临床特点与流行病学之间的关联性。结果城市患儿中90%为单次接种疫苗者,其中3～8岁学龄前儿童及<8个月婴儿发病率升高,分别占35%及27%。<8个月龄婴儿中67%的母亲为疫苗接种者。城市患儿中轻型麻疹及异型麻疹比例分别占59%及27%,早期误诊率高达40%。农村患儿中68%未接种疫苗,86%为典型发病年龄儿童,61%为典型麻疹,7%为重型麻疹,28%为轻型麻疹。128例中,轻型麻疹及异型麻疹比例明显升高,分别占41%及16%,典型麻疹仅占37%。128例中表现为典型麻疹皮疹者占56%,有柯氏斑者82%,3～4 d出疹者77%,出疹期发热加剧者100%,自上而下出疹者89%,有疹退后色素沉着者93%,有疹退后脱屑者81%。结论小月龄婴儿及单次接种疫苗的学龄前儿童成为疫苗时代麻疹的新兴高发人群,以轻型麻疹及异型麻疹多见,临床表现不典型,临床表现中以皮疹形态及出疹时间最为多变,出疹时发热加剧的特点极少变化。对母亲为疫苗免疫接种者的婴儿建议将麻疹疫苗初次接种时间提前,对学龄前儿童建议适当提前疫苗复种时间。

Objective To investigate the new epidemiology and clinical manifestation of measles in children in recent years. Methods One hundred and twenty -eight cases of children＇s measles were collected, and their epidemiologieal and clinical characteristics of age distri- bution, endemic distribution, vaccination, clinical manifestation, complication and misdiagnosis were discussed. Results Among the patients living in urban,90% cases were single dose vaccination,35% cases were between 3 -8 years old,27% cases were less than 8 months old, 59% cases were mild measles,27% cases were atypical measles,40% cases were misdiagnosed at first visit,and 67% cases of measles less than 8 months old were babies of vaccine immunized mother. Among the patients living in rural,68% cases had no vaccination,86% cases were at age of typical onset,61% cases were typical measles,7% cases were severe measles,and 28% cases were mild measles. Among all cases of measles,mild measles and atypical measles were as high as 41% and 16% ,but typical measles were only 37%. In all patients,56% cases had typical measles rash,82% cases had Koplik＇s spots,77% cases had typical onset of eruption,100% cases had higher fever in erup- tion stage,89% cases had typical downward sequence of eruption,93% cases had skin pigmentation,and 81% cases had desquamation. Con- chlsions Less than 8 months infants and single dose vaccinated pre - school children are newly susceptible group of measles. Mild measles and atypical measles markedly increased,with atypical clinical symptoms, variable rash and variant onset, but the character of aggravated fever in eruption stage scarcely changes. Infants of vaccine immunized mother and pre - school children are advised to vaccinate ahead of schedule.