一起中学水痘暴发疫情的调查  

Investigation of a varicella outbreak in a middle school

作　　者：曹阳 李臻 刘方[1] 张楠[1] 王海滨[1] 张士尧[1] 马建新[1] 贾滨[1] CAO Yang;LI Zhen;LIU Fang;ZHANG Nan;WANG Haibin;ZHANG Shiyao;MA Jianxin;JIA Bin(Chaoyang District Center for Disease Control and Prevention,Chaoyang,Beijing 100021,China)

机构地区：[1]北京市朝阳区疾病预防控制中心,北京朝阳100021

出　　处：《应用预防医学》2024年第5期318-322,共5页Applied Preventive Medicine

基　　金：北京市朝阳区科技计划(CYSF2104)。

摘　　要：目的分析北京市朝阳区一起中学水痘暴发疫情同时涉及校园带状疱疹(HZ)病例的流行病学调查处置情况,为今后校园水痘以及HZ的科学防控提供参考依据。方法对该中学水痘以及HZ病例开展主动搜索,并对个案进行流行病学调查。采用描述性流行病学方法描述疫情的流行特征,分析有VarV免疫史组和无VarV免疫史组的罹患率,并对VarV保护效果(vaccine effectiveness,VE)进行评价。结果2021年10月31日~12月16日共搜索到该校的HZ病例1例,水痘病例6例,初一学生水痘罹患率为0.37%(4/1083),教师水痘罹患率为0.63%(2/319),两者间差异无统计学意义(P=0.625)。剔除VarV免疫史不详、既往患过水痘的学生,学生水痘病例所在楼层的学生中,有1剂次免疫史的占14.45%(76/526),有2剂次免疫史的占84.98%(447/526);有VarV免疫史组的罹患率为0.57%(3/523),无VarV免疫史组的罹患率为33.33%(1/3),两组罹患率间差异有统计学意义(χ^(2)=10.115,P=0.023),RR值为0.017(95%CI:0.002~0.122)。接种VarV总体保护效果为98.29%(95%CI:87.807%~99.757%)。共采集学生水痘病例疱疹液或痂皮样本3件,教师HZ病例痂皮样本1件,PCR检测VZV核酸结果均为阳性。全基因组测序两两比对序列一致性结果为99.85%~99.99%。结论2剂次VarV接种程序具有较好的保护效果;即使有VarV免疫史人群比例较高,校园内仍可能发生水痘暴发疫情,区别是疫情规模较小。建议今后加强校园HZ病例监测并提高对教师水痘的关注,及时隔离处置,防止疫情进一步扩散。Objective To analyze the epidemiological investigation and treatment of a varicella outbreak in Chaoyang district,Beijing,involving herpes zoster(HZ)cases on campus,and to provide reference for scientific prevention and control of varicella and HZ on campus in the future.Methods An active search for varicella and HZ cases and epidemiological investigation were carried out in the affected middle school.Utilizing descriptive epidemiological method to describe the epidemic characteristics of the outbreak.The attack rates of the groups with and without VarV immunization history were analyzed,and the vaccine effectiveness(VE)of VarV was evaluated.Results A total of 1 case of HZ and 6 cases of varicella occurred in the middle school from October 31 to December 16,2021.The incidence rate of varicella was 0.37%(4/1083)for first-year students and 0.63%(2/319)for teachers,with no statistical significance(P=0.625).Excluding students with unknown VarV immunization history and previous varicella,among the students on the floor where the varicella cases were located,14.45%(76/526)had a history of 1 dose of immunization and 84.98%(447/526)had a history of 2 doses of immunization.The attack rate in the group with a history of VarV immunization was 0.57%(3/523),and the attack rate in the group without a history of VarV immunization was 33.33%(1/3).The difference in attack rate between the two groups was statistically significant(χ^(2)=10.115,P=0.023),and the RR value was 0.017(95%CI:0.002-0.122).The overall VE was 98.29%(95%CI:87.807%-99.757%).The skin samples of 3 varicella cases and 1 HZ case were collected,and the nucleic acid test results were positive.The sequence consistency of whole genome sequencing pairwise alignment was 99.85%-99.99%.Conclusions The 2-dose varicella vaccination program has a good protective effect.Even with a high coverage rate of the chickenpox vaccine,there is still a possibility of varicella outbreaks in schools,but the scale of the outbreak is likely to be smaller.It is important to strengthen the

关 键 词：水痘 暴发 疫苗保护效果 带状疱疹(HZ) 

分 类 号：R511.5[医药卫生—内科学]