南昌地区儿童麻疹265例分析
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摘要
目的分析南昌地区儿童麻疹的流行病学与临床特征,以寻求消除麻疹策略。方法用描述性统计学方法回顾性分析2013年确诊的265例儿童麻疹患者的流行病学与临床特征。结果 265例患儿中发病年龄以6～12月龄居多(195例),占73.6%;178例(67.2%)患儿在发病前有麻疹接触史;典型麻疹194例(73.2%);重型麻疹18例(6.8%),其中5例(1.9%)死亡,主要死因为重症肺炎、呼吸衰竭。结论儿童麻疹发病率升高与未及时接种麻疹疫苗、入院就诊麻疹暴露和未母乳喂养密切相关。因此,麻疹消除须增加麻疹疫苗接种覆盖率,加强麻疹监控,尽可能减少院内暴露,提倡母乳喂养。重型患儿须重点防治呼吸衰竭、心力衰竭,以减少病死率。
Objective To analyze the epidemiological and clinical features of the children with measles in Nanchang, and propose the reasonable strategies of eliminating measles. Methods Epidemiological and clinical features of 265 children with measles in 2013 were retrospectively analyzed by using descriptive statistical analysis. Results Among the involved 265 children, the onset age was6-12 months old in 195 cases, accounting for 73.6%, 178 cases(67.2%) had contact history of measles before onset, 194 cases(73.2%)were typical measles, 18 cases(6.8%) were severe measles and 5 cases(1.9%) of them died of severe pneumonia and respiratory failure.Conclusions The high incidence of measles in children is closely related to the absence of measles vaccine immunization, nosocomial exposure to measles and non-breast-feeding. Therefore, it is essential to improve vaccination coverage, strengthen measles surveillance,reduce nosocomial exposure and advocate breast feeding for the elimination of measles. Severe measles patients need to focus on the prevention and treatment of respiratory failure and heart failure in order to reduce mortality.
Objective To analyze the epidemiological and clinical features of the children with measles in Nanchang, and propose the reasonable strategies of eliminating measles. Methods Epidemiological and clinical features of 265 children with measles in 2013 were retrospectively analyzed by using descriptive statistical analysis. Results Among the involved 265 children, the onset age was6-12 months old in 195 cases, accounting for 73.6%, 178 cases(67.2%) had contact history of measles before onset, 194 cases(73.2%)were typical measles, 18 cases(6.8%) were severe measles and 5 cases(1.9%) of them died of severe pneumonia and respiratory failure.Conclusions The high incidence of measles in children is closely related to the absence of measles vaccine immunization, nosocomial exposure to measles and non-breast-feeding. Therefore, it is essential to improve vaccination coverage, strengthen measles surveillance,reduce nosocomial exposure and advocate breast feeding for the elimination of measles. Severe measles patients need to focus on the prevention and treatment of respiratory failure and heart failure in order to reduce mortality.
引文
[1]Lixia W,Guang Z,Lee LA,et al.Progress in accelerated measles control in the People's Republic of China,1991-2000[J].JInfect Dis,2003,187(Suppl 1):S252-S257.
[2]李黎,余文周,税铁军,等.全国2003~2006年麻疹发病年龄特征分析[J].中国计划免疫,2007,13(2):101-105.
[3]邓燕艺,甘宁,覃艺,等.广西玉林市261例麻疹流行病学和临床特点分析[J].传染病信息,2015,28(1):42-44.
[4]中华人民共和国卫生和计划生育委员会.麻疹诊断[J].传染病信息,2017,30(4):Ⅰ-Ⅸ.
[5]Ma C,Hao L,Zhang Y,et al.Monitoring progress towards the elimination of measles in China:an analysis of measles surveillance data[J].Bull World Health Organ,2014,92(5):340-370.
[6]Zhao H,Lu PS,Hu Y,et al.Low titers of measles antibody in mothers whose infants suffered from measles before eligible age for measles vaccination[J].Virol J,2010,7:87.
[7]Martins CL,Garly ML,Bale C,et al.Protective efficacy of standard Edmonston-Zagreb measles vaccination in infants aged 4.5 months:interim analysis of arandomised clinical trial[J].BMJ,2008,337:a661.
[8]Aaby P,Martins CL,Garly ML,et al.The optimal age of measles immunization in low-income countries:a secondary analysis of the assumptions underlying the current policy[J].BMJ Open,2012,2:e000761.
[9]祁恒春.麻疹暴发流行与医疗机构诊疗暴露分析及防控[J].黑龙江医学,2015,39(5):575-576.
[10]傅利军,郭天英,吴建宏,等.医院就诊情况与麻疹高发关联的病例对照研究[J].疾病监测,2014,29(5):383-386.
[11]李卫光,徐华,朱其凤,等.儿科病房4例麻疹医院感染暴发流行病学调查[J].中国感染控制杂志,2013,12(1):41-43.
[12]Low C,Thoon KC,Lin R,et al.Possible nosocomial transmission of measles in unvaccinated children in a Singapore public hospital[J].Western Pac Surveill Response J,2012,3(4):7-11.
[13]张银瑞,张会芬,石晓娜.儿童麻疹合并重症肺炎呼吸衰竭治疗与护理[J].护理实践与研究,2013,10(14):59-60.
[14]杨小涛,杨震,王艳春.静脉丙种球蛋白联合甲泼尼龙治疗麻疹合并重症肺炎的临床疗效分析[J].中外医疗,2015,(29):139-141.
[15]马超,苏琪茹,郝利新,等.中国2012~2013年麻疹流行病学特征与消除麻疹进展[J].中国疫苗和免疫,2014,20(3):193-199.
[2]李黎,余文周,税铁军,等.全国2003~2006年麻疹发病年龄特征分析[J].中国计划免疫,2007,13(2):101-105.
[3]邓燕艺,甘宁,覃艺,等.广西玉林市261例麻疹流行病学和临床特点分析[J].传染病信息,2015,28(1):42-44.
[4]中华人民共和国卫生和计划生育委员会.麻疹诊断[J].传染病信息,2017,30(4):Ⅰ-Ⅸ.
[5]Ma C,Hao L,Zhang Y,et al.Monitoring progress towards the elimination of measles in China:an analysis of measles surveillance data[J].Bull World Health Organ,2014,92(5):340-370.
[6]Zhao H,Lu PS,Hu Y,et al.Low titers of measles antibody in mothers whose infants suffered from measles before eligible age for measles vaccination[J].Virol J,2010,7:87.
[7]Martins CL,Garly ML,Bale C,et al.Protective efficacy of standard Edmonston-Zagreb measles vaccination in infants aged 4.5 months:interim analysis of arandomised clinical trial[J].BMJ,2008,337:a661.
[8]Aaby P,Martins CL,Garly ML,et al.The optimal age of measles immunization in low-income countries:a secondary analysis of the assumptions underlying the current policy[J].BMJ Open,2012,2:e000761.
[9]祁恒春.麻疹暴发流行与医疗机构诊疗暴露分析及防控[J].黑龙江医学,2015,39(5):575-576.
[10]傅利军,郭天英,吴建宏,等.医院就诊情况与麻疹高发关联的病例对照研究[J].疾病监测,2014,29(5):383-386.
[11]李卫光,徐华,朱其凤,等.儿科病房4例麻疹医院感染暴发流行病学调查[J].中国感染控制杂志,2013,12(1):41-43.
[12]Low C,Thoon KC,Lin R,et al.Possible nosocomial transmission of measles in unvaccinated children in a Singapore public hospital[J].Western Pac Surveill Response J,2012,3(4):7-11.
[13]张银瑞,张会芬,石晓娜.儿童麻疹合并重症肺炎呼吸衰竭治疗与护理[J].护理实践与研究,2013,10(14):59-60.
[14]杨小涛,杨震,王艳春.静脉丙种球蛋白联合甲泼尼龙治疗麻疹合并重症肺炎的临床疗效分析[J].中外医疗,2015,(29):139-141.
[15]马超,苏琪茹,郝利新,等.中国2012~2013年麻疹流行病学特征与消除麻疹进展[J].中国疫苗和免疫,2014,20(3):193-199.
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