摘要
目的分析甘肃省庆阳市某高中一起水痘暴发疫情的流行特征及其危险因素,为制定有效防控水痘措施提供依据。方法开展病例主动搜索和现场流行病学调查,以描述流行病学分析病例分布特征和罹患率差异,采用1∶2匹配病例对照研究分析危险因素。结果本次疫情共持续2个月,全校师生共909人,发现病例83例(13例突破病例)、总罹患率9.13%;临床症状主要以透明样疱疹、斑疹、丘疹、发热、食欲减退为主,皮疹主要分布在头颈部(占74.70%)、胸部(占69.88%)、背部(占69.88%);罹患率学生(9.76%)高于老师(3.37%),差异有统计学意义(χ^(2)=3.945,P<0.05);罹患率女生(15.17%)高于男生(4.02%),差异有统计学意义(χ^(2)=28.901,P<0.01);罹患率高一年级(30.65%)高于高二年级(1.60%),差异有统计学意义(χ^(2)=77.894,P<0.01);不同班级罹患率差异有统计学意义(χ^(2)=53.112,P<0.01),高一5班罹患率高于其他班级,有明显的班级、楼层聚集性。高热发生率突破病例(53.85%)低于空白免疫史病例(84.29%),差异有统计学意义(χ^(2)=6.237,P<0.05)。病例对照研究显示,与高一5班第二代病例近距离接触(同桌、聊天、肢体接触)(OR=13.516,95%CI:7.116~25.673)、逗留病例宿舍(OR=35.979,95%CI:17.156~75.452)、与病例同桌就餐(OR=4.902,95%CI:2.530~9.495)、一天洗手不足5次(OR=2.890,95%CI:1.677~4.982)均是引起水痘疫情暴发的危险因素,接种水痘疫苗是保护因素(OR=0.484,95%CI:0.245~0.959);女生课后在楼道聚集活动罹患风险高于楼下空旷地方(OR=5.147,95%CI:2.115~12.528)。结论本次疫情是一起未及时发现和报告较迟、学生带病上课、病例未按传染期隔离而引发的水痘暴发疫情;建议学校早发现、早报告,按照要求做好病例隔离、通风消毒和晨午检登记,水痘免疫空白人群接种水痘疫苗,加强1剂次疫苗接种免疫。
Objective To analyze the epidemiological characteristics and risk factors of a varicella outbreak in a high school in Qingyang city of Gansu province,and provide basis for formulating effective measures of varicella prevention and control.Methods Active case search and field epidemiological investigation were carried out by descriptive epidemiological method to analyze the distributive characteristics and the difference of attack rates of the cases.The risk factors were analyzed by 1∶2 matched case-control study.Results The outbreak lasted for 2 months.There were total of 909 teachers and students in this school,and totally 83 varicella cases(include 13 breakthrough cases)onset with total attack rate of 9.13%.The main clinical symptoms were clear-like herpes,macules,papules,fever and loss of appetite.The skin rashes mainly distributed in head and neck,accounting for 74.70%,chest,accounting for 69.88%,and backside,accounting for 69.88%.The attack rate of students(9.76%)was higher than that of teachers(3.37%),with statistical difference(χ^(2)=3.945,P0.05).The attack rate of the females(15.17%)was higher than that of the males(4.02%),with statistical difference(χ^(2)=28.901,P0.01),and that of senior grade 1(30.65%)was higher than that of senior grade 2(1.60%),with statistical difference(χ^(2)=77.894,P0.01).The difference was statistically significant in the attack rates among different classes(χ^(2)=53.112,P0.05).The attack rate of class 5 in grade 1 was higher than that of other classes,with obvious class and floor aggregation.The incidence rate of hyperpyrexia in breakthrough cases(53.85%)was lower than that in the cases without immunization history(84.29%),and the difference was statistically significant(χ^(2)=6.237,P0.05).The results of the case-control study showed the close contact with the second-generation cases(desk-mate,chatting,and physical contact)(OR=13.516,95%CI:7.116-25.673),entry and exit of the cases dormitory(OR=35.979,95%CI:17.156-75.452),dining at the same table with the cases(OR=4.902,95%
作者
刘贝琴
李学平
孙琦琦
杨明宇
LIU Bei-qin;LI Xue-ping;SUN Qi-qi;YANG Ming-yu(Qingyang Municipal Center for Disease Control and Prevention,Qingyang,Gansu 745000,China)
出处
《疾病预防控制通报》
2023年第4期31-35,48,共6页
Bulletin of Disease Control & Prevention(China)
关键词
水痘
突破病例
暴发
流行病学特征
危险因素
Varicella
Breakthrough cases
Outbreak
Epidemiological characteristics
Risk factor
