Mitchell Peter, Turner Nikki, Jennings Lance, Dong Hongfang
Community and Public Health, Canterbury District Health Board, PO Box 1475, Christchurch 8140, New Zealand.
J Prim Health Care. 2013 Jun 1;5(2):93-8.
Measles that develops in previously vaccinated cases has been reported to be associated with modified disease, although severity has usually been assessed by the presence or absence of symptoms. To date no studies have attempted to subjectively grade the severity of the clinical features.
To investigate both the objective and subjective severity of measles in vaccinated and unvaccinated cases in the context of a community outbreak.
A retrospective observational cohort study conducted in Christchurch in 2009 using notified data compared the presentation of measles in 14 confirmed cases that had received at least one MMR (measles, mumps, rubella) vaccination and 14 age-matched unvaccinated confirmed cases. Additional details on the subjective and objective severity of the illness were obtained from parents/guardians using a standardised telephone questionnaire.
The vaccinated group had significantly fewer clinical features on presentation (p=0.01, RR=1.3, 95% CI 1.1-1.6) and a less severe illness objectively, as measured by height and duration of fever, the number of days needing medication other than paracetamol and days required in bed. Unvaccinated cases were 2.8 times more likely to have more severe clinical features than vaccinated cases (OR=2.8, 95% CI 1.5-5.0). Unvaccinated cases were 3.0 times more likely to develop IgM antibody (RR=3.0, 95% CI 0.9-9.3).
Previously vaccinated children who develop measles are likely to have less severe disease and serology results that may be inconclusive, particularly for IgM antibody if tested in the first few days after the rash onset.
据报道，在先前接种过疫苗的病例中发生的麻疹与疾病改变有关，尽管严重程度通常通过症状的有无来评估。迄今为止，尚无研究尝试对临床特征的严重程度进行主观分级。
在社区爆发的背景下，调查接种疫苗和未接种疫苗的病例中麻疹的客观和主观严重程度。
2009年在克赖斯特彻奇进行了一项回顾性观察队列研究，使用通报数据比较了14例至少接种过一剂MMR（麻疹、腮腺炎、风疹）疫苗的确诊病例和14例年龄匹配的未接种疫苗确诊病例中麻疹的表现。通过标准化电话问卷从父母/监护人处获得有关疾病主观和客观严重程度的更多详细信息。
接种疫苗组在就诊时的临床特征明显较少（p=0.01，RR=1.3，95%CI 1.1-1.6），从客观上看病情较轻，以发热的高度和持续时间、除对乙酰氨基酚外需要用药的天数以及卧床天数来衡量。未接种疫苗的病例出现比接种疫苗病例更严重临床特征的可能性高2.8倍（OR=2.8，95%CI 1.5-5.0）。未接种疫苗的病例产生IgM抗体的可能性高3.0倍（RR=3.0，95%CI 0.9-9.3）。
先前接种过疫苗的儿童患麻疹时病情可能较轻，血清学结果可能不明确，尤其是在皮疹出现后的头几天进行检测时，IgM抗体情况更是如此。
