水痘暴发疫情中突破性病例流行病学特征分析  

Epidemiological analysis on breakthrough cases from varicella outbreaks in Minhang district of Shanghai

作　　者：杜艳[1] 余峰[1] 张莉萍[1] 金宝芳[1] 王烨[1] 梅克雯[1] 李捷[1] 

机构地区：[1]上海市闵行区疾病预防控制中心,上海201101

出　　处：《中国预防医学杂志》2014年第2期109-113,共5页Chinese Preventive Medicine

基　　金：上海市卫生局科研课题(20114085)

摘　　要：目的分析水痘暴发疫情中突破性病例的流行病学特征，为水痘防控措施的制定提供依据。方法采用描述性流行病学方法，对闵行区水痘报告资料和水痘暴发疫情资料进行描述，并按照时间、空间、人群间分布对暴发疫情中突破性病例流行病学特征进行描述和比较。数据采用Excel2007录人、作图，并用SPSS13．0进行分析比较。结果闵行区20082012年共报告水痘病例9968例，以散发为主兼有局部暴发。期间共发生水痘暴发124起，平均每起疫情的持续时间为45．8d（约2个周期）；暴发病例数共1225例，其中392例为突破性病例[有水痘减毒活疫苗接种史（VarV）仍发病，均为1剂次]，突破性病例发生率为32．00％（392／1225），2008年发生率最低，为21．47％（79／368），2012年最高，为46．85％（67／143），并有上升趋势。突破性病例在暴发疫情中作为指示病例有10起，占8．06％（10／124）。时间分布显示，突破性病例每年3～5月及10～12月各出现一个高峰，与无接种史病例高峰基本一致；地区分布显示，突破性病例在全区12个社区中均有发生，暴发疫情患病率随着各地接种率不同表现出明显地区差异（χ^2=254．003，P〈0．01），VarV接种率较低的社区水痘暴发时患病率较高。突破性病例主要发生在5～岁组，占64．80％（254／392），其次是10～岁组，占27．04％（106／392）。结合不同年龄组接种率分析显示，一剂VarV对3～4岁儿童起到了很好的保护作用，但对5岁以上儿童保护作用减弱；突破性病例发病与VarV接种时间间隔平均为（6．17±2．26）年，其中≥3年者占92．86％（364／392），≥5年者占68．37％（268／392）；疫苗品种间差异无统计学意义（χ^2=1．950，P=0．3773），近年来VarV接种到发病的间隔年限有后移倾向。结论近年来上海市闵行区水痘暴发疫情中突破性病例发生�Objective To analyze the epidemiological characteristics of break-through cases in varicella out- breaks, and to provide evidence for varicella prevention and control. Methods A descriptive epidemiological method was used to describe the reported data of varicella outbreaks and sporadic cases from 2008 to 2012, as well as the epidemiological features of breakthrough cases from outbreaks in accordance with time, space and population distribution. SPSS 13.0 was used for data analysis. Results A total of 9 968 varicella cases were reported in Minhang district from 2008 to 2012, most of which were sporadic cases, some were from local outbreaks. 124 local varieella outbreaks were recorded with average duration of 45.8 days and total 1 225 cases. 392 were breakthrough cases with the incidence of 32.00% （392/1 225） which was the lowest in 2008 （21.47%） and the highest in 2012 （46.85%） and showed an uprising trend. Breakthrough cases were used as the index cases in 10 outbreaks, accounting for 8.06% of the total. Analysis on time distribution of break through cases revealed that March to May and October to December were two peak seasons which was basically the same as unvaccinated regular cases. The breakthrough cases appeared in 12 communities with different inci dence in accordance to local vaccine coverage （ 2 254. 003, P〈0.01）. Majority of breakthrough cases were children under 5, accounting for 64.80%. In general, one dose of VarV vaccination could trigger a high pro tection in children ages 3 to 4, but not for those over 5. Further analysis on the interval from VarV vaccination to disease onset showed that the mean interval was 6.17±2.26 years. The intervals of 92.86% cases were 3 years and longer, while more than half were even longer than 5 years. There were no significant differences be- tween the vaccine types （χ^2 =1. 950, P=0. 377 3）. The interval period seemed shortened in recent years. Conclusions The breakthrough cases in varicella outbreaks have been increasing, and due to the atyp

关 键 词：水痘 暴发 突破性病例 流行病学特征 

分 类 号：R511.5[医药卫生—内科学]