中国2009～2015年麻疹暴发疫情报告与调查处置情况分析

Surveillance and Response to Measles Outbreaks in China,2009-2015

目的分析中国（未包括香港、澳门特别行政区和台湾地区,下同）2009-2015年报告的麻疹暴发疫情流行病学特征、采取的调查与处置措施,为进一步做好麻疹暴发调查处置提供循证依据。方法对全国31个省（自治区、直辖市,下同）2009-2015年通过麻疹监测系统（Measles Surveillance System,MSS）报告的麻疹暴发疫情的病例信息、暴发调查与处置数据进行描述性流行病学分析。结果 2009-2015年全国共报告麻疹暴发疫情1 426起,涉及病例8 696例,死亡12例。麻疹暴发规模、暴发持续天数呈2009-2012年持续下降、2013-2015年持续回升态势。报告暴发起数、病例数从2009年的319起、2 071例,降至2012年的13起、324例,又持续回升至2015年的329起、1 847例。暴发持续天数中位数（范围）从2009年的8（1-114）天,降至2012年的4（1-13）天,回升至2015年的8（1-245）天。麻疹暴发经实验室确诊1 385起（97.12%）,有247起（17.32%）报告了麻疹病毒基因型鉴定结果,其中242起为H1基因型、3起为D9基因型、2起为D8基因型。发生在社区和学校的暴发比例从2009年的55%和26%降至2015年的26%和11%;发生在单一家庭和成人集体单位的比例从2009年的12%和8%降至2015年的30%和17%。有477起暴发针对8月龄-14岁儿童评估含麻疹成分疫苗接种率,其中6起（1.26%）为〈30%、12起（2.52%）为30%-59%、27起（5.66%）为60%-79%、47起（9.85%）为80%-89%、385起（80.71%）≥90%,相应地,开展了应急接种的比例分别为100%、100%、85.19%、80.85%、88.57%。结论 2009-2012年报告麻疹暴发疫情显著下降,但2013年以来暴发疫情数量、规模和持续时间回升。需要进一步做好麻疹暴发疫情的甄别、及时报告、落实疫情控制措施。

Objective To analyze outbreaks reported through the Measles Surveillance System（ MSS）and further improve measles outbreak preparedness. Methods Measles outbreaks are reported by local centers for disease control and prevention（ CDCs） through the MSS. We used descriptive methods to evaluate patterns of outbreaks reported during 2009-2015. Results Between 2009 and 2015,a total of1 426 measles outbreaks were reported in China,with 8 696 outbreak-related cases and 12 measles-related deaths. The scale and duration of these outbreaks trended downward during 2009-2012,and trended upward during 2013-2015. Numbers of outbreaks and cases decreased from 319 and 2 071 in 2009 to 13 and 324 in 2012,but then increased to 329 and1 847 in 2015. The median duration（ range）decreased from 8（ 1-114） days in 2009 to 4（ 1-13） days in 2012,but then increased to 8（ 1-245） days in 2015. Among the outbreaks,97%（ 1 385） were laboratory confirmed. Among 247 outbreaks with identified genotypes, 242 were H1,3 were D9,and 2 were D8. Community and school outbreaks decreased from 55% and 26%in 2009 to 26% and 11% in 2015. Within-family and adult-setting outbreaks increased from 12% and8% in 2009 to 30% and 17% in 2015. Measles-containing vaccine（ MCV） coverage surveys among children aged 8 months to 14 years were conducted during 477 outbreaks. MCV coverage rates were 30% in 6（ 1. 26%） outbreaks,30%-59% in 12（ 2. 52%）,60%-79% in 27（ 5. 66%）,80%-89%in 47（ 9. 85%）,and ≥90% in 385（ 80. 71%） outbreaks. In these coverage rate groupings,emergency immunization activities were implemented in 100%,100%,85. 19%,80. 85% and 88. 57% of outbreaks,respectively. Conclusions Measles outbreaks significantly decreased between 2009 and 2012.However,outbreaks were more frequent,larger in scale,and longer-lasting from 2013. Timely identification and rapid response to outbreaks are important to prevent and control spread of measles.