2018—2019年浙江省宁海县百日咳回顾性调查分析

Retrospective investigation and analysis of pertussis in Ninghai County,Zhejiang Province from 2018 to 2019

【目的】探讨浙江省宁海县不同免疫状态下实验室确诊百日咳病例的发病特点,为制订宁海县百日咳预防控制策略提供依据。【方法】通过中国疾病预防控制信息系统收集2018—2019年宁海县百日咳报告病例数据,利用宁波市免疫规划信息管理系统和现场调查收集百日咳报告病例相关疫苗的免疫史,采用描述流行病学方法对所收集的数据进行分析。【结果】64例呼吸道分泌物百日咳杆菌核酸检测阳性者,其中0~岁组占56.25%,职业以散居儿童为主,暂无青少年及成人病例报告。所有病例均出现阵发性痉挛样咳嗽,78.13%的病例出现白细胞计数升高,62.5%淋巴细胞百分比例升高,59.38%完成≥3剂免疫疫苗,69.39%完成最后一剂疫苗接种与发病间隔时间1年,31.25%发病前有明确的同类患者接触史。百日咳的误诊率高达92.19%,同期健康人群百日咳IgG综合抗体阳性率1.05%。【结论】进一步提升实验室检测能力有助于明确诊断。发病以0~岁组儿童为主,绝大多数病例至少有一剂次免疫史,临床症状以痉挛性咳嗽最突出,白细胞、淋巴细胞升高者,应警惕百日咳鲍特菌感染。

[Objective] To characterize the incidence of laboratory confirmed pertussis cases by immunization status in Ninghai County,and to provide evidence for improving pertussis prevention and control strategy in Ninghai County.[Methods] Data of reported pertussis cases in Ninghai County from 2018 to 2019 were collected through the National Notifiable Infectious Disease Reporting System.The immunization history of vaccines related to pertussis was collected through the Ningbo Immunization Planning Information Management System and field investigation.Descriptive epidemiological methods were used to analyze the collected data.[Results] The respiratory secretions collected in the 64 cases tested positive for nucleic acid of Bordetella pertussis bacilli,of which 56.25% aged 0-1 year.They were mainly pre-school children.No adolescent or adult case was reported.All cases had whooping cough.Of the cases,78.13% had an increase in white blood cell count,62.5% had an increase in lymphocyte percentage,59.38% had completed three or more doses of pertussis vaccination,69.39% had a time interval of 1 year between the onset and last dose of pertussis vaccination,and 31.25% reported close contact with pertussis patients before the onset.The misdiagnosis rate of pertussis was as high as 92.19%.In contrast,the prevalence of anti-pertussis IgG antibody in health population was 1.05%.[Conclusion] Further improvement in the laboratory testing capacity can help clarify the diagnosis of pertussis.Generally,children aged 0-1 year are mainly affected,of which vast majority have received at least one dose of pertussis vaccination.Clinical symptoms are characterized by whooping cough.Additionally,elevated white blood cells and lymphocytes should be on the alert to pertussis infection.