Emek M, Islek D, Atasoylu G, Ozbek O A, Ceylan A, Acikgoz A, Tay Z, Demiral Y, Oktem M A, Unal B
Department of Public Health, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
Department of Public Health, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
Public Health. 2017 Jun;147:51-58. doi: 10.1016/j.puhe.2017.01.026. Epub 2017 Mar 8.
Despite an ongoing measles elimination programme, a measles outbreak occurred in 2013 in Turkey. Population-based seroprevalence studies are needed to determine seronegativity and explore the reasons for this outbreak. This study aimed to explore the seroprevalence of measles and its association with various social determinants in a provincial population in Turkey in the year following a measles outbreak.
Cross-sectional study.
This study was conducted in Manisa Province in 2014 in a sample of 1740 people aged >2 years. The dependent variable was the seroprevalence of measles. Independent variables were sex, age, migration, household size, household density, income, education level, existence of chronic disease and occupational class. Blood samples were collected from participants at family health centres. The presence of specific measles antibodies in serum samples was determined using an anti-measles virus IgG enzyme-linked immunosorbent assay test. Chi-squared test and logistic regression analysis were performed.
Overall, data from 1250 people were analysed. The seroprevalence of measles in the whole study population was 82.2% (95% confidence interval 80.0-84.2). Seroprevalence was 55.4% among subjects aged 2-9 years, 48.7% among subjects aged 10-19 years, 74.1% among subjects aged 20-29 years and 93.6% among subjects aged 30-39 years (P < 0.01). Seroprevalence in subjects aged >40 years was >95%. The lowest seroprevalence was found in primary school children (40.2%), followed by those below the age for primary education (69.8%) and secondary school graduates (75.1%). The prevalence of measles seronegativity was not associated with any of the social determinants when adjusted for age.
The seroprevalence of measles was lower than expected in the study population and was particularly low in subjects aged <30 years of age despite previous vaccination. Seroprevalence was not associated with social determinants of health that confirmed either an even distribution of virus exposure or fair access to vaccination services. However, the current seroprevalence cannot be sufficiently effective to reach the measles elimination targets, suggesting that it may be necessary to re-evaluate the need for an extra dose of measles vaccine.
尽管土耳其正在实施麻疹消除计划，但2013年该国仍发生了麻疹疫情。需要开展基于人群的血清流行率研究，以确定血清阴性率并探究此次疫情爆发的原因。本研究旨在探讨麻疹疫情爆发后的次年，土耳其某省人群中麻疹的血清流行率及其与各种社会决定因素的关联。
横断面研究。
2014年在马尼萨省对1740名年龄大于2岁的人群进行了抽样研究。因变量为麻疹血清流行率。自变量包括性别、年龄、移民情况、家庭规模、家庭密度、收入、教育水平、慢性病患病情况和职业类别。在家庭健康中心采集参与者的血样。采用抗麻疹病毒IgG酶联免疫吸附试验检测血清样本中特异性麻疹抗体的存在情况。进行卡方检验和逻辑回归分析。
总体上，对1250人的数据进行了分析。整个研究人群中麻疹血清流行率为82.2%（95%置信区间80.0 - 84.2）。2至9岁人群的血清流行率为55.4%，10至19岁人群为48.7%，20至29岁人群为74.1%，30至39岁人群为93.6%（P < 0.01）。40岁以上人群的血清流行率>95%。小学儿童的血清流行率最低（40.2%），其次是未达到小学入学年龄的儿童（69.8%）和中学毕业生（75.1%）。调整年龄后，麻疹血清阴性率与任何社会决定因素均无关联。
研究人群中麻疹血清流行率低于预期，尽管此前已接种疫苗，但30岁以下人群的血清流行率尤其低。血清流行率与健康的社会决定因素无关，这证实了病毒暴露分布均匀或疫苗接种服务可公平获取。然而，当前的血清流行率不足以有效实现麻疹消除目标，这表明可能有必要重新评估额外一剂麻疹疫苗的必要性。
