Kambarami R A, Nathoo K J, Nkrumah F K, Pirie D J
Department of Paediatrics and Child Health, University of Zimbabwe Medical School, Avondale, Harare.
Bull World Health Organ. 1991;69(2):213-9.
Despite rapidly increasing measles immunization coverage in Harare city, measles remains endemic, and regular outbreaks occur. The most recent occurred in 1988, when the measles immunization coverage was 83%. We have carried out a retrospective study of the clinical and epidemiological features of this outbreak to assess whether the present immunization policy needs to be changed. Of 4357 cases of measles seen at primary health care centres and hospitals in Harare during the outbreak, 1399 (32%) were severe or involved complications that required hospital admission. The peak incidence occurred among under-2-year-olds, followed by that among 5-7-year-olds. Poor nutritional status was significantly more frequent among children who were hospitalized and among those who died. A total of 59% of all cases aged 9-59 months had documented evidence of measles immunization. The most frequent complications, which occurred most often among under-5-year-olds, were diarrhoea with dehydration, pneumonia, laryngotracheobronchitis, and convulsions, which together affected 56% of hospitalized cases. The hospital case fatality rate was low (1.43%). In Harare, measles transmission remains a problem, despite high measles immunization coverage rates; the failure rate for the standard Schwarz measles vaccine also appears to be high. There is a need to reduce the number of measles cases among under-9-month-olds and young children. Further studies into alternative measles vaccines and schedules are required.
尽管哈拉雷市麻疹免疫接种覆盖率迅速提高，但麻疹仍然流行，且时有暴发。最近一次暴发发生在1988年，当时麻疹免疫接种覆盖率为83%。我们对此次暴发的临床和流行病学特征进行了回顾性研究，以评估现行免疫政策是否需要改变。在暴发期间，哈拉雷的初级卫生保健中心和医院共接诊了4357例麻疹病例，其中1399例（32%）病情严重或出现了需要住院治疗的并发症。发病高峰出现在2岁以下儿童中，其次是5至7岁儿童。住院儿童和死亡儿童中营养状况不佳的情况明显更为常见。在所有9至59个月大的病例中，共有59%有麻疹免疫接种的记录证据。最常见的并发症发生在5岁以下儿童中，为腹泻伴脱水、肺炎、喉气管支气管炎和惊厥，这些并发症共影响了56%的住院病例。医院病死率较低（1.43%）。在哈拉雷，尽管麻疹免疫接种覆盖率很高，但麻疹传播仍是一个问题；标准的施瓦茨麻疹疫苗的失败率似乎也很高。有必要减少9个月以下婴儿和幼儿中的麻疹病例数量。需要对替代麻疹疫苗和接种程序进行进一步研究。
