美国监测发现风疹地方性传播的充分性。

Averhoff Francisco, Zucker Jane, Vellozzi Claudia, Redd Susan, Woodfill Celia, Waterman Steve, Baggs James, Weinberg Michelle, Rodriquez-Lainz Alfonso, Carrion Veronica, Goto Collin, Reef Susan E

National Center for Preparedness, Detection, and Control of Infectious Diseases (proposed), Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

Clin Infect Dis. 2006 Nov 1;43 Suppl 3:S151-7. doi: 10.1086/505948.

BACKGROUND

Reported rubella cases in the United States are at the lowest numbers since the introduction of vaccine, suggesting that endemic transmission may have been interrupted. It is necessary to validate that the observed absence of rubella is due to the disappearance of disease rather than a failure of rubella surveillance.

METHODS

Adequate rubella surveillance to detect ongoing transmission is characterized by evidence that rubella investigations are being conducted, detection of importations, and lack of spread from confirmed cases. We reviewed rubella surveillance data and activities from 5 sources: (1) data reported to the national surveillance system; (2) a survey of health departments and public health laboratories, including questions regarding any links between measles and rubella surveillance; (3) enhanced rubella surveillance activities in California and in New York City; (4) sentinel surveillance along the US-Mexico border; and (5) case detection in 8 large health maintenance organizations (HMOs).

RESULTS

During 2002-2004, 35 cases of rubella were reported to the national system, including 12 (34%) imported cases. The 39 programs that responded to our survey reported conducting 1482 investigations for rubella; according to another national survey, 1921 investigations were conducted for measles. Forty-one laboratories responded to our survey and reported conducting 6428 tests for acute rubella. No previously undetected (or unreported) cases of rubella or congenital rubella syndrome were identified by our survey or reviews of surveillance in California, New York, and along the US-Mexico border, and no additional cases were detected in the HMO database.

CONCLUSIONS

No previously unrecognized spread cases or outbreaks of rubella were detected. Surveillance in the United States is sufficiently sensitive to identify indigenous cases of rubella, if they were occurring, supporting the contention that rubella has been eliminated from the United States.

背景

美国报告的风疹病例数处于疫苗引入以来的最低水平，这表明地方性传播可能已被阻断。有必要证实所观察到的风疹病例缺失是由于疾病消失而非风疹监测失败所致。

方法

充分的风疹监测以发现持续传播，其特征在于有证据表明正在进行风疹调查、检测到输入病例以及确诊病例无传播扩散。我们回顾了来自5个来源的风疹监测数据和活动：（1）向国家监测系统报告的数据；（2）对卫生部门和公共卫生实验室的一项调查，包括关于麻疹和风疹监测之间任何关联的问题；（3）加利福尼亚州和纽约市加强的风疹监测活动；（4）美国-墨西哥边境沿线的哨点监测；以及（5）8家大型健康维护组织（HMO）中的病例检测。

结果

在2002 - 2004年期间，向国家系统报告了35例风疹病例，其中12例（34%）为输入病例。对我们的调查做出回应的39个项目报告开展了1482次风疹调查；根据另一项全国性调查，开展了1921次麻疹调查。41个实验室对我们的调查做出回应并报告开展了6428次急性风疹检测。通过我们的调查以及对加利福尼亚州、纽约市和美国-墨西哥边境沿线监测的审查，未发现先前未被检测到（或未报告）的风疹或先天性风疹综合征病例，并且在HMO数据库中也未检测到其他病例。