上海市闵行区2017—2019 年百日咳监测分析

Analysis of pertussis surveillance 2017 to 2019 in Minhang District of Shanghai

【目的】分析上海市闵行区2017—2019年百日咳监测病例的感染来源、临床症状及流行病学特征,为百日咳监测与免疫策略制订提供依据。【方法】采用描述性方法对百日咳监测病例进行流行病学分析。【结果】上海市闵行区2017—2019年共有334例病例纳入百日咳监测,237例确诊病例,除浦锦街道无病例外,其余12家镇、街道均有病例。无细胞百白破联合疫苗(DTaP)未及龄及未完成基础免疫的5月龄以下婴幼儿为高发人群,占55.27%(131/237)。病例数主要集中在3—8月,占71.31%(169/237);8月百日咳鲍特菌(BP)培养阳性率最高,为82.76%(24/29),3月聚合酶链反应(PCR)阳性率最高,为58.82%(20/34)。所有监测病例均有咳嗽症状,确诊病例咳嗽(22.05±9.81)d。共监测到64起聚集性疫情,罹患率高达37.45%(94/251),32.91%(78/237)的病例在发病前21 d有咳嗽患者接触史,其中94.87%(74/78)为家庭内成员,百日咳聚集性发病以成年人-婴幼儿(成年人向婴幼儿传播)及婴幼儿-成年人(婴幼儿向成年人传播)2种传播模式为主。【结论】5月龄以下的婴幼儿为百日咳高发人群,而家庭成员是婴幼儿百日咳病例的主要传染源,建议在青少年及成年人中开展百日咳监测与防控工作。

[Objective]To analyze the source of infection,clinical symptoms and epidemiological characteristics of pertussis surveillance cases in Minhang District of Shanghai from 2017 to 2019,so as to provide the basis for pertussis surveillance and immunization strategy.[Methods]Descriptive epidemiological method was used to analyze the pertussis surveillance cases.[Results]A total of 334 cases were included in the pertussis active surveillance system,237 cases were confirmed cases.There were 13 towns or streets in Minhang District,except for Pujin Street,all the other 12 towns or streets had cases.The high risk group(131/237,55.27%of the cases)were the infants under five months old who did not reach the age of immunization or did not complete the basic immunization of diphtheria,tetanus,and acellular pertussis combined vaccine(DTaP).The cases mainly occurred in March to July,accounting for 71.31%(169/237).The highest culturepositive rate of Bordetella pertussis was in August(82.76%,24/29);the highest positive rate of polymerase chain reaction(PCR)detection was in March(58.82%,20/34).All the monitored cases had cough symptoms with an average cough days of 22.05±9.81 in confirmed cases.A total of 64 clustered outbreaks were detected,with an attack rate of 37.45%(94/251).32.91%(78/237)of the cases had contact history with coughing patients 21 days before the onset,and 94.87%(74/78)of them were family members.The aggregation of pertussis was mainly transmitted from adults to infants and infants to adults.[Conclusion]Children under five months old are the high incidence population of pertussis,and family members are the main source of infection.It is suggested that pertussis monitoring and prevention should be carried out in adolescents and adults.