摘要
目的了解儿童麻疹病例的临床特征,评价不同麻疹监测病例定义的监测效果。方法制定相关定义,在麻疹暴发疫情现场通过主动健康监测和问卷调查,获得符合定义的疑似病例151例,通过实验室检测方法确诊107例,排除44例,再对这些疑似病例进行分析。结果确诊和排除病例,发热发生率分别为82.2%和65.9%,差异有统计学意义（χ^2=4.768,P〈0.05）;皮疹发生率为67.3%和31.8%,差异有显著的统计学意义（χ^2=16.002,P〈0.01）;1种或以上咳嗽、卡他性鼻炎、眼结膜炎（3C）症状的发生率为74.8%和63.6%,差异无统计学意义（χ^2=1.896,P〉0.05）。确诊病例有含麻疹成分疫苗（MCV）免疫史者发生皮疹、3C症状的危险性比无免疫史者低。现行病例定义（发热＋皮疹＋≥1种3C）的特异度最高（81.8%）,但灵敏度最低（56.1%）,仅发热单一症状的病例定义灵敏度最高（82.2%）但特异度最低（34.1%）,而含＂皮疹＂症状的病例定义相对较优。再结合Kappa值和受试者工作特征曲线（ROC）,认为＂发热＋皮疹＂是儿童的较优病例定义（Kappa=36.2%,ROC曲线下面积=0.713）。有MCV免疫史者的该定义的灵敏度、特异度均优于其他3种含＂皮疹＂的监测病例定义,特别是在≥2剂次MCV免疫者中。结论随着MCV的使用,有必要修改完善现行的麻疹监测病例定义,特别是在高接种率地区或人群;但同时实验室检测结果可能将越来越重要。
Objective To describe clinical features of children measles, and to evaluate the efficacy of the different surveillance case definitions. Methods After establishing some related definitions,151 children suspected measles were obtained by health monitoring and questionnaire on the outbreak, 107 of which were confirmed by laboratory detection and44 were excluded. Then they were further analyzed. Results The fever occurred rates were 82.2% and 65.9% respectively between confirmed and excluded cases with statistical difference（ χ^2=4.768,P〈0.05）; rash incidences were 67.3% and31.8% with statistical differences（ χ^2=16.002,P〈0.01）; the incidences of them with cough,coryza,conjunctivitis（3C）were74.8% and 63.6% without statistical differences（ χ^2=1.896,P〉0.05）. The risk of getting rash and 3C in the confirmed cases with MCV＇s history was lower than those without the history. The current case definition of measles surveillance（fever＋rash＋≥one of 3C） had maximum specificity（81.8%）but minimum sensitivity（56.1%）. Oppositely, the single symptom of fever had minimum specificity（34.1%） but maximum sensitivity（82.2%）.Case definition including ＂rash＂ had better surveillance efficacy. Along with the Kappa value and Receiver Operator Characteristic（ROC） curve, ＂fever ＋ rash＂ was the best case definition for children measles（Kappa=36.2%, area under ROC curve=0.713）. The sensitivity and specificity of ＂fever ＋ rash＂ in suspected cases with MCV＇s history were better than the other 3 surveillance case definitions including ＂rash＂, especially in those with ≥2 MCV doses. Conclusion As MCV is used widely, the surveillance case definition for Measles should be amended and improved, especially in the high vaccination-rate areas or population.But meanwhile laboratory detection will possibly be more and more important.
作者
杨波
刁峰萍
王军
YANG Bo DIAO Feng-ping WANG Jun(Center for Disease Control and Prevention of Haizhu District, Guangzhou, Guangdong 510200,China Maternal and Child Health Hospital of Haizhu District of Guangzhou)
出处
《中国公共卫生管理》
2016年第5期576-579,共4页
Chinese Journal of Public Health Management
基金
广东省医学科学技术研究基金项目(A2016085)
关键词
麻疹
监测
评价
免疫
measles
surveillance
evaluation
immunization
