摘要
目的对经实验室确诊的麻疹病例进行分析,探讨麻疹疫苗接种对儿童麻疹临床发病特点的影响,以及婴儿麻疹和儿童麻疹发病特点的差异,以帮助麻疹的早期诊断。方法采集2002至2010年在首都儿科研究所隔离门诊和住院期间经RT-PCR或ELISA法确诊的麻疹患儿临床资料。采用ELISA方法检测麻疹病毒血清特异性IgM抗体,咽拭子和尿液标本采用RT-PCR方法检测麻疹病毒N基因片段。根据是否接种麻疹疫苗分为接种麻疹疫苗组和未接种麻疹疫苗组。结果①207例经病原学确诊的麻疹患儿进入分析,其中男123例,女84例。年龄0～15岁,其中<8月龄(未达到初免年龄)69例(33.3%),～1岁45例(21.7%)。未接种麻疹疫苗组154例(≤1岁亚组97例,>1岁亚组57例),接种麻疹疫苗组53例。②接种麻疹疫苗组本市户籍所占比例显著高于未接种麻疹疫苗组。两组的发病高峰均在4月份。有明确麻疹患者接触史患儿在未接种麻疹疫苗组为15.4%(24/154例),接种麻疹疫苗组为16.9%(9/53例),两组差异无统计学意义。③接种麻疹疫苗组麻疹黏膜斑和咳嗽发生率显著低于未接种麻疹疫苗组,余伴随症状两组差异无统计学意义。④未接种麻疹疫苗组>1岁亚组眼部症状发生率高于≤1岁亚组,余临床表现两亚组差异无统计学意义。结论麻疹发病年龄趋低龄化,同时临床表现更加不典型;麻疹患儿以未达到麻疹疫苗接种年龄的婴儿或漏种麻疹疫苗的流动人口为主,提示加强适龄儿童麻疹疫苗接种和对流动人口易感儿童查漏补种,对降低麻疹发病率有重要意义。
Objectives To understand the influence of measles vaccination on clinical manifestations of measles in children, different characteristics of measles in infants and children in order to improve early diagnosis of measles by analyzing the characteristics of measles cases with laboratory confirmed etiological data. Methods Clinical data were collected from children who visited the Department of Outpatient Infectious Diseases and hospitalized with clinical diagnosis of measles and confirmed by measles specific IgM and measles virus N gene fragment from January 2002 to December 2010. Measles specific IgM antibodies were tested using serum samples with ELISA. Measles virus N gene fragment was amplified from specimens of throat swabs and fresh urine by reverse transcription-polymerase chain reaction （RT-PCR）. Analyses were performed in vaccinated and unvaccinated cased separately. Results ① In total, 207 cases of measles in children with etiological diagnosis were analyzed, including 123 males and 84 females, 53 vaccinated and 154 unvaccinated. Age distribution ranged from 0 to 15 years, including 69 cases （33.3%） of younger than 8 months （who had not reached the age for primary measles vaccination）, and 45 cases （21.7%） of younger than 1 year of age. ②Cases with Beijing local residency was more common in vaccinated group than that in unvaccinated group. The peak incidence was found in April for all cases in two groups. 15.4% （24/154） cases with known exposure history in measles unvaccinated group and in unvaccinated group and 16.9% （9/53） in measles vaccinated group, with no significant difference between two groups. ③The proportions of measles with symptoms of mucosa spots （ Koplik spots） and cough were significantly lower in vaccinated group than in unvaccinated group while the other symptoms had no significant difference between two groups. ④ Of 154 unvaccinated cases, 97 were younger than 1 and 57 older than 1 year old. Symptoms of eyes was more common in the subgroup older than 1 year of age. Conclusions Measles cases with younger age have been increasing in recent years in Beijing. More and more measles cases for children have presented with atypical clinical manifestations. Most of the measles cases in this study were younger than 8 months of age which is before EPI for measles vaccination or older than 8 months of age but missed vaccination. The data indicated that strengthening measles immunization program was necessary, and early and rapid etiological diagnosis for atypical measles was important for early isolation of the cases.
出处
《中国循证儿科杂志》
CSCD
2012年第2期128-131,共4页
Chinese Journal of Evidence Based Pediatrics
关键词
儿童
麻疹
临床表现
疫苗接种
Children
Measles
Clinical manifestation
Vaccination
