河北省1999年麻疹流行病学分析与监测系统运转状况评价

Analysis of Measles Epidemiology and Evaluation on works of Surveillance System in Hebei Province in 1999

为了掌握河北省 1999年麻疹流行病学特点 ,对 1999年麻疹监测系统病例报告及运转情况进行了分析 ,全年共报告麻疹疑似病例 5 40例 ,临床诊断 2 80例 ,实验室确诊 12 4例 ,实验室排除 136例。 40 4例麻疹分布在全省 11个市的 6 0个县 (市、区 ,下同 ) ,占总县数的 34 9% ,报告≥ 10例的县有 10个 ,占报告县数的 16 7%。 10个县共报告麻疹 2 44例 ,占病例总数的6 0 4% ,最多 1个县报告麻疹 49例 ,具有广泛分散又相对集中的特点。全年均有发病 ,3～ 5月为高发。病例男性多于女性 ,15岁以下儿童共发病 2 86例 ,占 70 8%。学龄前儿童和小学生为重点发病对象。 5 0 2 %病例有明确免疫史。病例临床症状以轻型为主 ,但 82 3 %的 15岁以下儿童病例合并以肺炎为主的并发症。针对病例的地域分布特征 ,提出 2 0 0 0年应在保定、沧州市开展针对 15岁以下儿童的麻疹疫苗初始强化免疫。分析相关年龄麻疹病例的免疫史 ,说明我省的常规免疫工作仍存在一些问题 ,要着重提高麻疹疫苗接种的及时性和接种质量。针对目前麻疹病例临床诊断标准灵敏度高、特异度低的特点 ,要加大病例的血清学诊断力度 ,针对监测系统存在的病例漏报、迟报问题 。

This paper was to study the measles epidemiological characteristics in 1999 in Hebei Province and to monitor the running status of measles surveillance system. In 1999, a total of 540 suspected measles cases were reported in the province, of which 280 were clinically diagnosed, 124 were laboratory identified and 136 were excluded by ELISA test, so the measles cases were 404. These cases distributed in 60 counties of 11 cities of the province, accounting for 34.9% of the total counties of the province. The 10 counties that reported ten more measles cases, accounted for 16.7% of the counties giving case report, 244 measles cases were reported by 10 counties and 1 county had a highest reporting of 49 cases. These data showed measles case distribution was not only scattered but also centralized. 276 measles cases concentrated in March to May, accounting for 68.3% of the total cases. Male patients were more than the females. 70.8% of the measles cases were children under 15 years old among whom preschool and primary school children were predominant. 50.2% cases definitely had measles immune history. The clinical symtoms were mild, 82.3% of the children under 15 years old were complicated with pneumonia. According to the regional distribution of measles cases, we suggested that, in 2000, a catch-up mass immunization campaign should be implemented in children under 15years old in Cangzhou and Baoding cities. Analyzing the immune history of measles cases by age, there appeared problems in the routine immunization, suggestions about timeliness and quality of measles vaccination were given. Because of the high sensitivity and low specificity in the clinical diagnostic standard of measles cases, we suggest to put more effort to serological diagnosis. In addition, aimed to the failed reporting and delayed reporting of measles cases made by the surveillance system, a solution of strict management and professional training was proposed.