2019-2022年浙江省水痘突发疫情概况及突破病例相关因素分析  

Overview of the outbreak of varicella in Zhejiang Province from 2019 to 2022 and analysis of associated factors for breakthrough cases

作　　者：邓璇[1] 刘芯蕊 周洋[1] 沈灵智[1] 严睿[1] 唐学雯[1] 朱瑶 徐校平[1] 何寒青[1] Deng Xuan;Liu Xinrui;Zhou Yang;Shen Lingzhi;Yan Rui;Tang Xuewen;Zhu Yao;Xu Xiaoping;He Hanqing(Department of Immunization Program,Zhejiang Provincial Center for Disease Control and Prevention,Hangzhou 310051,China;School of Public Health,Sun Yat-Sen University,Guangzhou 510080,China)

机构地区：[1]浙江省疾病预防控制中心免疫规划所,杭州310051 [2]中山大学公共卫生学院,广州510080

出　　处：《中华预防医学杂志》2024年第3期315-324,共10页Chinese Journal of Preventive Medicine

基　　金：浙江省医药卫生科技计划项目(2023KY629);北京市自然科学基金-昌平创新联合基金项目(L234005)。

摘　　要：目的:分析2019-2022年浙江省水痘突发公共卫生事件相关信息(PHEEs)中水痘病例的流行情况,探索突破病例的相关因素。方法:基于中国疾病预防控制中心信息系统、浙江省水痘PHEEs个案数据库及浙江省疫苗与预防接种综合管理信息系统,对2019-2022年浙江省水痘PHEEs中报告病例的流行病学特征进行分析,匹配水痘疫苗免疫史,以“是否突破”和“突破病例的接种剂次”2个维度分别建立logistic回归模型,分析突破病例的相关因素。结果:2019-2022年浙江省累计报告水痘病例144 276例,年报告发病率为47.35/10万~82.80/10万,其中,非突破病例109 172例(75.67%),突破病例34 517例(23.92%),接种史不详587例(0.41%)。累计报告水痘PHEEs 214起,99.07%的报告场所为学校。随着年份的增长,每年高中报告的水痘疫情起数构成比显著增加( χ^(2)趋势=5.742, P=0.017)。多因素logistic回归模型显示:以非突破病例为参照,发病年份( OR=1.585,95% CI:1.343~1.878)、发病月份(以1月份为参照, OR=2.311~15.652)、报告地市(以杭州市为参照,嘉兴市 OR=2.370,金华市 OR=2.197,丽水市 OR=0.134)、发病年龄( OR=0.887,95% CI:0.826~0.944)、疫情报告场所(以小学及以下为参照,高中及以上 OR=0.516,95% CI:0.305~0.897)及出疹数量( OR=0.569,95% CI:0.458~0.703)均为相关因素。以1剂次突破病例为参照,初免年龄( OR=0.045,95% CI:0.014~0.107)、末次接种距发病的时间间隔( OR=0.037,95% CI:0.011~0.087)及发病年龄( OR=20.724,95% CI:8.383~72.485)均为相关因素。 结论:2019-2022年浙江省报告水痘PHEEs中,报告高峰已向青少年及年轻成人转移。疫苗接种虽无法完全阻止水痘带状疱疹病毒感染及发病,但可减轻临床症状,推迟发病年龄。ObjectiveTo evaluate the epidemiological characteristics and explore the associated factors of breakthrough cases(BC)from Public Health Emergency Events(PHEEs)of varicella in Zhejiang Province from 2019 to 2022.MethodsData on cases were obtained from the China Information System for Disease Control and Prevention and the PHEEs Reporting Information Database of Varicella in Zhejiang Province.History records were matched through the Zhejiang Provincial Immunization Information System.Descriptive analysis and multiple logistic regression model with a bidirectional stepwise selection method were performed to explore associated factors for BC during 2019-2022.ResultsA total of 144276 varicella cases were reported from 2019 to 2022,with the annual reported incidence of 47.35-82.80 cases per 100000 population.Among these cases,109172 were non-breakthrough cases(NBC,accounting for 75.67%),34517 were BC(23.92%),and the rest 587 cases had unclear vaccination history on varicella(0.41%).A total of 214 PHEEs of varicella were reported,of which 99.07%occurred in school settings.The proportion of PHEEs that occurred in high school increased significantly as time went on(χ^(2) trend=5.742,P=0.017).Multiple logistic regression model which focused on"BC vs.NBC(as the reference)"indicated that the year of onset(OR=1.585,95%CI:1.343-1.878),the month of onset(taking January as the reference,OR=2.311-15.652),city(taking Hangzhou as the reference,Jiaxing OR=2.370,Jinhua OR=2.197,Lishui OR=0.134),age(OR=0.887,95%CI:0.826-0.944),PHEEs setting(taking"primary school and below"as the reference,"high school and above"OR=0.516,95%CI:0.305-0.897),and the number of rashes(OR=0.569,95%CI:0.458-0.703)were associated factors.Multiple logistic regression model which focused on"two-dose BC vs.one-dose BC(as the reference)"showed that the age of initial vaccination(OR=0.045,95%CI:0.014-0.107),the time interval from onset to the last dose(OR=0.037,95%CI:0.011-0.087)and the age of onset(OR=20.724,95%CI:8.383-72.485)were associated factors.ConclusionD

关 键 词：水痘 突破病例 相关因素 监测 

分 类 号：R511.5[医药卫生—内科学]