湖南省某福利院麻疹暴发疫情调查及传播链分析

Epidemiological survey of a measles outbreak and its transmission chain in a child welfare agency,Hunan Province

目的探讨湖南省某福利院麻疹暴发主要特征及影响因素,分析暴发疫情的传播特点。方法以一起发生在湖南省某福利院麻疹暴发为研究现场,采用回顾性调查的方法,用统一的调查表,通过现场调查的方法对福利院护理人员进行问卷调查。用传播链示意图分析传播关系。结果此次暴发疫情中麻疹确诊病例13例,均为福利院收养儿童,儿童罹患率为11.40%,首发病例发病前13 d曾到医院就诊。该福利院儿童麻疹类疫苗1剂次接种率42.45%(45/106),麻疹类疫苗2剂次接种率15.22%(14/92)。麻疹暴发影响因素的多因素分析结果显示随着与麻疹病例接触时间的增加,患麻疹的风险逐渐增加(OR=4.881,95%CI:1.871~12.735)。结论全部麻疹病例在发病前均与前代病例有密切接触史,生活中的密切接触、医源性感染是本起暴发疫情的主要传播因素。提高麻疹类疫苗接种率、加强医疗机构院内感染控制是控制麻疹暴发疫情的关键。

Objective To explore the main characteristics and influencing factors of a measles outbreak in a child welfare agency in Hunan Province, and to analyze the transmission characteristics of the measles outbreak. Methods Retrospective investi- gation method was used to survey the measles outbreak in a child welfare agency in Hunan Province. The unified questionnaire was employed for conducting the field investigation among the nursing personnel in the child welfare agency. The transmission process was analyzed with the transmission chain diagram and contact history diagram. Results There were 13 confirmed measles cases in the measles outbreak, and all of them were children adopted by the child welfare agency, with an attack rate being 11.40% in the children. The initial case was hospitalized on day 13 before the onset of illness. The coverage rate of the first-dose measlescontaining vaccine （MCV1） in the children of the welfare agency was 42.45% （45/106} , while the coverage rate of the seconddose measles-containing vaccine （ MCV2 ） 15.22% （14/92）. Multivariate analysis of factors influencing the measles outbreak showed that the risk of measles infection was increased with the increase of time of close contact with measles cases （ OR = 4.881, 95%CI： 1.871 12.735}. Conclusions All the secondary cases have the history of close contact with their previous generation, and the close contact among children in the welfare agency and iatrogenic infection are the main factors for the spread of this outbreak. Improving the coverage rate of measles-containing vaccine and strengthening the nosocomial infection control are the key points for controlling measles outbreaks.