Tang Zhen-Zhu, Xie Yi-Hong, Jiraphongsa Chuleeporn, Liu Xuan-Hua, Li Zhong-You, Chongsuvivatwong Virasakdi
Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China; International Field Epidemiology Training Program, Bureau of Epidemiology, Ministry of Public Health, Nonthaburi, Bangkok, Thailand.
Am J Infect Control. 2016 Apr 1;44(4):e51-8. doi: 10.1016/j.ajic.2015.11.005. Epub 2015 Dec 28.
Following a period (2009-2012) during which zero measles cases were reported, a measles outbreak occurred in 2013 in Bama County, Guangxi, China, that involved more than 100 children younger than age 8 months. We aimed to identify the pitfalls and risk factors while implementing the control measures.
An outbreak investigation and a case-control study was conducted among children younger than age 8 months. The serum specimens of the study subjects and their mothers were tested for measles immunoglobulin M and immunoglobulin G.
The attack rate was 2.3/1,000 population. The median (interquartile range) age was 18.6 months (7.9-52.8 months). The coverage of 2-dose measles-containing vaccine was only 34%. The case-control study revealed 2 independent risk factors: low education level of main caregiver (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.31-6.22) and visiting a hospital 7-21 days before the date of symptoms onset (OR, 9.84; 95% CI, 4.27-22.67). The population attributable fraction of the latter was 52.8%. The mothers of the cases had nonsignificantly higher levels of immunoglobulin M and were significantly more likely to have protective levels of immunoglobulin G than those of the controls. This suggests a reactive rather than protective role of the antibody to the child's infection.
In a near-elimination but low measles-containing vaccine coverage community, supplementary immunization activities should be emphasized for children and women who are potential future mothers. The minimum age of measles-containing vaccine should be further reduced. Hospital measles transmission must also be strictly prevented.
在一段时期（2009 - 2012年）报告零麻疹病例之后，2013年中国广西巴马县发生了麻疹疫情，涉及100多名8月龄以下儿童。我们旨在确定实施控制措施过程中的缺陷和风险因素。
对8月龄以下儿童进行了疫情调查和病例对照研究。检测了研究对象及其母亲的血清标本中的麻疹免疫球蛋白M和免疫球蛋白G。
发病率为2.3/1000人口。年龄中位数（四分位间距）为18.6个月（7.9 - 52.8个月）。含麻疹疫苗2剂次接种率仅为34%。病例对照研究揭示了2个独立风险因素：主要照料者教育水平低（比值比[OR]，2.86；95%置信区间[CI]，1.31 - 6.22）以及在症状出现日期前7 - 21天去过医院（OR，9.84；95% CI，4.27 - 22.67）。后者的人群归因分值为52.8%。病例组母亲的免疫球蛋白M水平略高但无统计学意义，且其免疫球蛋白G具有保护性水平的可能性显著高于对照组母亲。这表明抗体对儿童感染起反应性而非保护性作用。
在接近消除麻疹但含麻疹疫苗接种率低的社区，应强调对儿童和未来可能成为母亲的妇女开展补充免疫活动。含麻疹疫苗的最低接种年龄应进一步降低。还必须严格预防医院内的麻疹传播。
