浙江省婴儿麻疹病例分布特征和危险因素研究

Distribution of Characteristics and Risk Factors of Infant Measles Cases in Zhejiang Province

目的了解婴儿麻疹病例分布特征和发病危险因素,为探讨针对性的预防控制措施提供参考。方法分析浙江省2009-2012年婴儿麻疹病例的分布特征,用χ2检验比较分布差异;以监测系统报告的麻疹确诊病例为病例组,非麻疹病例为对照组,开展频数匹配的病例对照研究,用Logistic回归分析危险因素。结果浙江省2009-2012年婴儿麻疹病例占总病例数的38.80%,6-8月龄病例占婴儿麻疹的58.48%。麻疹病例的男女性别比为1.95∶1.00,医院暴露比例为46.20%,有咳嗽、口腔黏膜斑和卡他症状的比例分别为88.28%、39.72%和78.82%。多因素分析显示,8-11月龄麻疹病例中含麻疹成分疫苗（Measles-containing Vaccine,MCV）免疫史有统计学意义,比值比（Odds Ratio,OR）=0.49,95%可信区间（Confindence Interval,CI）：0.27-0.89;0-7月龄发病危险因素则是在发病地居住时间〈3个月、出疹性病例接触史有统计学意义,OR分别为2.07（95%CI：1.21-3.52）、4.87（95%CI：1.62-14.62）。结论婴儿麻疹病例症状相对较重,流动人口、接触史和医院暴露等是危险因素,接种MCV是8-11月龄婴儿的有效保护措施。建议提高8月龄MCV及时接种率,加强流动儿童管理,减少医疗机构的暴露及出疹性病例的接触机会。

Objective To explore the epidemiological characteristics and risk factors for infant measles cases,and to provide evidence for specific strategies on measles prevention and control. Methods Data on measles in Zhejiang Province from 2009 to 2012 were collected by the surveillance system. Descriptive epidemiology was performed to analyze the distribution of infant measles cases,and a case-control study was conducted to study the risk factors of infant measles. Results The percentage of infant measles cases was 38. 80%,and 58. 48% of cases were from 6 to 8 months old（ 58. 48%）. The gender ratio（ male：female） was 1. 95∶ 1. 00,and 46. 20% of cases were associated with hospital exposure. The proportion of symptom with cough,Koplik spots,and catarrh in infant measles cases was 88. 28%,39. 72%,and78. 82%,respectively. Multiple factor logistic regression shows that the odds ratio（ OR） of receiving measles-containing vaccine（ MCV） was 0. 49 with 95% confidence interval（ CI） of 0. 22 - 0. 58 in cases from 8 to 11 months old,floating population and contact exposure was 2. 07（ 95% CI： 1. 21- 3. 52）,4. 87（ 95% CI： 1. 62- 14. 62） respectively in cases under 7 months old. Conclusion Nosocomial transmission,floating population,and contact exposure were risk factors for infant measles cases; these cases usually have relatively severe symptoms. We suggest that timely vaccination against measles at 8 months old needs to be improved; management of the floating population needs to be enhanced; and the chance of hospital exposure should be reduced.