Scientific Institute of Public Health, Brussels, Belgium.
Arch Public Health. 2013 Jul 8;71(1):17. doi: 10.1186/0778-7367-71-17.
From Mid-February to April 2011 one of the largest measles-outbreak in Flanders, since the start of the 2-dose vaccination scheme in 1995, took place in Ghent, Belgium. The outbreak started in a day care center, infecting children too young to be vaccinated, after which it spread to anthroposophic schools with a low measles, mumps and rubella vaccination coverage. This report describes the outbreak and evaluates the control measures and interventions.
Data collection was done through the system of mandatory notification of the public health authority. Vaccination coverage in the schools was assessed by a questionnaire and the electronic immunization database 'Vaccinnet'. A case was defined as anyone with laboratory confirmed measles or with clinical symptoms and an epidemiological link to a laboratory confirmed case. Towards the end of the outbreak we only sought laboratory confirmation for persons with an atypical clinical presentation or without an epidemiological link. In search for an index patient we determined the measles IgG level of infants from the day care center.
A total of 65 cases were reported of which 31 were laboratory confirmed. Twenty-five were confirmed by PCR and/or IgM. In 6 infants, too young to be vaccinated, only elevated measles IgG levels were found. Most cases (72%) were young children (0-9 years old). All but two cases were completely unimmunized. In the day care center all the infants who were too young to be vaccinated (N=14) were included as cases. Thirteen of them were laboratory confirmed. Eight of these infants were hospitalized with symptoms suspicious for measles. Vaccination coverage in the affected anthroposophic schools was low, 45-49% of the pupils were unvaccinated. We organized vaccination campaigns in the schools and vaccinated 79 persons (25% of those unvaccinated or incompletely vaccinated).
Clustering of unvaccinated persons, in a day care center and in anthroposophic schools, allows for measles outbreaks and is an important obstacle for the elimination of measles. Isolation measures, a vacation period and an immunization campaign limited the spread of measles within the schools but could not prevent further spread among unvaccinated family members. It was necessary to raise clinicians' awareness of measles since it had become a rare, less known disease and went undiagnosed.
2011 年 2 月至 4 月期间，在比利时根特市爆发了自 1995 年实施两剂疫苗接种计划以来规模最大的麻疹疫情之一。该疫情始于一家日托中心，感染了年龄太小而无法接种疫苗的儿童，随后传播到麻疹、腮腺炎和风疹疫苗接种率较低的人智学学校。本报告描述了此次疫情，并评估了控制措施和干预措施。
通过公共卫生当局的强制报告系统收集数据。通过问卷调查和电子免疫数据库“Vaccinnet”评估学校的疫苗接种覆盖率。将实验室确诊的麻疹病例或具有临床症状且与实验室确诊病例有流行病学联系的病例定义为病例。在疫情后期，我们仅对具有非典型临床表现或无流行病学联系的人员寻求实验室确认。为了寻找索引病例，我们确定了日托中心婴儿的麻疹 IgG 水平。
共报告了 65 例病例，其中 31 例为实验室确诊病例。25 例通过 PCR 和/或 IgM 确诊。在 6 名年龄太小而无法接种疫苗的婴儿中，仅发现麻疹 IgG 水平升高。大多数病例（72%）为幼儿（0-9 岁）。除两人外，所有病例均未完全免疫。在日托中心，所有年龄太小而无法接种疫苗的婴儿（N=14）均被纳入病例。其中 13 例经实验室确诊。其中 8 例婴儿因疑似麻疹症状住院。受影响的人智学学校的疫苗接种覆盖率较低，45-49%的学生未接种疫苗。我们在学校组织了疫苗接种活动，为 79 人接种了疫苗（占未接种或未完全接种疫苗者的 25%）。
未接种人群在日托中心和人智学学校聚集，导致麻疹爆发，是消除麻疹的重要障碍。隔离措施、休假和免疫接种运动限制了麻疹在学校内的传播，但无法阻止未接种疫苗的家庭成员之间的进一步传播。有必要提高临床医生对麻疹的认识，因为它已成为一种罕见的、不太为人所知的疾病，且未得到诊断。
