2010年含麻疹成分疫苗补充免疫前后北京市麻疹流行特征变化分析

Changes of epidemiological characteristics of measles in Beijing before and after supplementary immunization campaigns of measles vaccine in 2010

目的分析北京市2010年8月龄，14岁儿童含麻疹成分疫苗（Mcv）补充免疫前后2007--2010和2011—2014年的麻疹流行特征及疫隋情况。方法麻疹病例资料来自北京市全部医疗机构向“中国疾病预防控制信息系统传染病报告信息管理系统”报告的、发病时间为2007年1月1日至2014年12月31日临床诊断和实验室确诊的麻疹病例。麻疹暴发疫情资料来自北京市下辖16个区（县）cDc向“中国疾病预防控制信息系统_麻疹监测信息报告管理系统”报告的，发生时间为2009年1月1日至2014年12月31日的麻疹暴发疫情。采用Maplno8．5地理信息系统软件绘制麻疹发病率的区（县）分布专题地图，绘制时按照每组上下界值之间间隔相等的原则对当年发病率进行分组，分析不同区（县）发病率情况。结果2007--2010和2011—2014年，全市分别报告麻疹病例7722例和3132例，年平均发病率分别为11．59／10万和3．84／10万。与2007--2010年相比，2011—2014年的麻疹病例数和年平均发病率分别下降了59．4％和66．9％。2011—2014年≥15岁病例构成比逐年上升，分别为57．7％（56／97）、62．0％（49／79）、65．5％（370／565）和71．4％（1707／2391）；2007--2010年成年人高发年龄为20～34岁，2011—2014年后移了5岁，为25～39岁。2009---2010、2011—2012和2013--2014年，8—17月龄麻疹病例中未接种MCV的比例依次为50．3％（447／889）、30．3％（10／33）和57．8％（201／348）。2013--2014年的0～7月龄、8月龄-14岁、15—39岁和≥40岁的病例在发病前7—21d有就医史的比例分别为59．8％（238／398）、49．3％（237／481）、32．2％（529／1641）和37．6％（164／436）。2013--2014年，医院暴发痰隋共11起，2009--2010年为2起；2014年，大学为学校暴发的主体，占3／4；2009---2012年集体用工单位发生暴发共11起，全部为工厂、餐饮服务或大型市场等外省户籍人员集中场所；2013—2014年，写字楼是疫情暴发的主要的集体用工单位场所，占6／16。结论2010年的麻疹疫苗补充免疫有效降低了麻疹发病水平，但常规免疫仍需加强；成年^、麻疹高发问题较突出；医院、写字楼、大学等特殊场所为北京市麻疹疫情多发场所。

Objective To investigate the changes of epidemiological characteristics of measles in Beijing before and after Supplementary Immunization Campaigns （SIA） （2007-2010 vs 2011-2014） of measles-containing vaccine （MCV） among children aged between 8 months and 14 years in 2010. Methods Descriptive epidemiologieal analysis was conducted on surveillance data of measles cases （clinical cases and laboratory confirmed cases）, with the occurrence during 2007-2014, and of outbreaks, with the occurrence during 2009-2014, from National Nofifiable Disease Reporting System. MapInfo geographic information system （Version 8.5） was used to illustrate the distribution of measles incidence by district. Annual measles incidence was classified into 5 groups at the same intervals between the upper and lower limits to analyze the morbidity of the different areas. Results In total, 7 722 and 3 132 measles cases were reported during 2007-2010 and 2011-2014, with the annual incidence of 11.59 and 3.84 cases per 100 000 population, respectively. Comparing with the results during 2007-2010, total number of measles cases and average annual incidence during 2011-2014 were decreased by 59.4%, and 66.9%, respectively. Among measles cases during 2011-2014, percentage of cases aged 15 years or above were 57.7% （56/97）, 62.0% （49/79）, 65.5% （370/565）, and 71.4% （ 1 707/2 391 ）, respectively, which increased by years. During 2007-2010, the highest risk age for adults was 20-34, while 2011-2014, 5 years older： 25-39. During 2009-2010, 2011-2012, and 2013-2014, 50.3% （447/889）, 30.3% （10/33）, and 57.8% （201/348）, respectively, of measles cases aged 8-17 months were unvaccinated by MCV. Percentages of measles cases aged 0-7 months, 8 months-14 years, 15-39 years and 40 years or above during 2013-2014, who visited hospitals 7-21 days before disease onset, were 59.8% （238/398）, 49.3% （237/481）, 32.2% （529/1641）, and 37.6% （164/436）, respectively. A total of 11 nosocomial measles outbreaks occurred during 2013-2014, which was much higher than that during 2009-2010 （2 nosocomial outbreaks）. And universities accounted for the majority of outbreak settings of schools （3/4）. All 11 outbreaks among grouped employees during 2009-2012 occurred in factories, restaurants, or large shopping centers, while the largest proportion （6/16） of that kind of outbreaks during 2013-2014 occurred in office buildings. Conclusions SIA of MCV in 2010 effectively decreased measles transmission in Beijing. But routine immunization of MCV still needed to be improved. The issue of adult measles has been a prominent problem. Hospitals, office buildings and universities were the focus of prevention of measles transmission.