2012年上海地区麻疹住院儿童临床及流行病学特征分析

Analysis on clinical and epidemiological characteristics of measles in hospitalized children in Shanghai in 2012

目的分析2012年复旦大学附属儿科医院182例麻疹住院患儿的流行病学特征，探讨影响麻疹发病的主要因素，了解麻疹病毒基因分型，为进一步控制麻疹的流行提供科学的决策依据。方法回顾性分析2012年1月1日至12月31日复旦大学附属儿科医院确诊并住院治疗的182例麻疹患儿的性别、年龄、流行趋势和发病季节、麻疹疫苗的接种史、接触史等流行病学特征和临床表现、辅助检查结果，并应用RT—PCR方法对随机采样的麻疹患儿的痰液标本进行麻疹病毒检测，PCR扩增阳性的片段进一步行麻疹基因测序分型。结果（1）临床流行病学资料：182例患者中，男125例，女57例，男：女=2．2：1；年龄3～89个月，〈9月龄127例（69．8％）；4至8月份为麻疹高发季节，4、5月份为发病最高峰；182例麻疹患儿中有麻疹疫苗接种史者11例（6．0％），其中5例接种疫苗2周内发病，无接种史者167例（91．8％），接种史不详者4例（2．2％）。流动人口（144例）中适于麻疹疫苗接种者的麻疹疫苗接种率8．5％（6／71），与本市户籍人口中适于接种年龄的患儿接种率（29．4％，5／17）比较，差异有统计学意义（χ2=8．11，P=0．004）。有明确麻疹接触史者24例（13．2％），接触史不详者153例（84．1％），否认接触史5例（2．7％）。（2）临床表现：182例均有发热及皮疹（100％），体温高于39℃者145例（79．7％），热程2—38d；典型麻疹165例（90．7％），不典型麻疹17例，轻型麻疹14例，重型麻疹2例，可疑异型麻疹1例。（3）常见并发症：肺炎96例（52．8％），喉炎80例（44．0％），支气管炎38例（20．9％），肝功能损害15例（8．2％），心肌损害11例（6．0％），高热惊厥3例（1．6％）。96例麻疹肺炎患儿中92例进行痰病原学检测，细菌培养阳性者38例（41％），最常见的病原分别为肺炎链球菌（11例，29％）、流感嗜血杆菌（6例，16％）、卡他莫拉菌（4例，11％）、大肠埃希菌（4例，11％）、假丝酵母菌（4例，11％）、肺炎支原体（4例，11％）、金黄色葡萄球菌（3例，8％）。（4）54例麻疹病毒基因型检测均为Hla基因型。结论春季为上海地区儿童麻疹的高发季节，9月龄以下婴儿及流动人口中适龄未接种疫苗的儿童为易感儿童，绝大多数表现为典型麻疹，肺炎仍是儿童麻疹的常见并发症。麻疹病毒基因型为H1a基因亚型。提高易感儿童的麻疹疫苗接种率，是预防和消除麻疹的有效措施。

Objective To investigate the main factors that influence measles morbidity and the genotype of measles virus, so as to provide evidence for scientific decision making to further control the prevalence of measles. Method A retrospective analysis included 182 children in Children＇s Hospital of Fudan University, diagnosed with measles from January 1, 2012 to December 31. The clinical and epidemiological characteristics, including the gender, age, the incidence of seasonal trends, measles vaccine vaccination history, contact history and other clinical manifestations, laboratory test results, and so on were analyzed. And the reverse transcription PCR （RT-PCR） was adopted to detect sputum specimens from suspected patients with measles ,who were selected randomly, the sequence of the part of the PCR productswas analyzed. Result （ 1 ） Clinical and epidemiological data： Totally were 182 children with measles （ 125 males ,57 females） were enrolled into this study. The age of the patients ranged from 3 months to 89 months, 127 cases were younger than 9 months （69. 8% ）. The prevalence season was from April to August, while the peak month was April and May （22.5%, 23.1%）. Among 182 hospitalized children, only 11 cases underwent measles vaccination （6. 0% ）, and among them 5 cases were within 2 weeks before disease onset. A total of 167 cases （91.8%） had not been vaccinated, most of whom were immigrants, and the measles vaccination history of the remaining 4 cases were unknown. There was a positive correlation between the measles vaccination ratio in children of the floating population （8.45% ,6/71 ） and the settled children （29.4 % ,5/17, χ2 = 8.11, P = 0. 004）. In total, 24 cases （ 13.2% ） had definite measles exposure history, with 153 cases （84. 1% ） of unknown origin,5 cases （2. 7% ） without any history of contact. （2） Clinical manifestations： All the 182 patients had fever （100%） and obvious rashes （100%） , among them 145 cases had body temperature higher than 39 ℃ （79.7%）. The fever period ranged from 2 to 38 days. Among 182 hospitalized children, 165 cases （90. 7% ） had typical measles, 17 cases had atypical measles. Among the 17 cases, two had severe measles,one had heterotypic measles. （3） The common complications： 96 cases had pneumonia （52. 8% ） ,80 had laryngitis （44. 0% ） ,38 had bronchitis （20. 9% ）, 15 had hepatic dysfunction （8.2%） , 11 had myocardial damage （ 6. 0% ）, 3 had febrile seizures （ 1.6% ） , and no patient had encephalitis. Of the 96 cases with pneumonia, 92 received sputum test; 38 were sputum culture positive （41%）. The dominant pathogens were Streptococcus pneumoniae （11/38,29% ）, Haemophilus influenzae （6/ 38,16% ） ,Moraxella eatarrhalis （4/38,11% ） , Eseheriehia eoli （4/38,11% ）, Candida albieans （4/38, 11% ） , Myeoplasma pneumoniae （ 4/38, 11% ） and Staphylococcus aureus （ 3/38,8 % ） . （ 4 ） The H1 a genotype was the only one genotype in the detected sequence of 54 measles virus strains. Conclusion Measles was more often seen in the children under the age of 9 months from the floating population. The morbidity peak month was from April to May in Shanghai. The Hla genotype was the only one genotype. We should try to improve vaccination coverage rate in the children who are at the age for vaccination, so as to prevent measles outbreak.