Ge Yan-Ling, Zhai Xiao-Wen, Zhu Yan-Feng, Wang Xiang-Shi, Xia Ai-Mei, Li Yue-Fang, Zeng Mei
Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China.
Department of Hematology, Children's Hospital of Fudan University, Shanghai 201102, China.
Chin Med J (Engl). 2017 Jun 5;130(11):1320-1326. doi: 10.4103/0366-6999.206358.
Despite substantial progress toward measles control are making in China, measles outbreaks in immunocompromised population still pose a challenge to interrupt endemic transmission. This study aimed to investigate the features of measles in pediatric hematology and oncology patients and explore the reasons behind the outbreak.
We collected demographic, epidemiological, and clinical data of immunocompromised measles children. All suspected measles cases were laboratory-confirmed based on the presence of measles IgM and/or identification of measles RNA. The clinical data were statistically analyzed by t-test for continuous variables and Fisher's exact test for categorical variables.
From March 9 to July 25 in 2015, a total of 23 children with malignancies and post hematopoietic stem cell transplantation (post-HSCT) were notified to develop measles in Shanghai. Of these 23 patients with the median age of 5.5 years (range: 11 months-14 years), 20 (87.0%) had received 1-3 doses of measles vaccine previously; all patients had fever with the median fever duration of 8 days; 21 (91.3%) had cough; 18 (78.3%) had rash; 13 (56.5%) had Koplik's spot; 13 (56.5%) had complications including pneumonia and acute liver failure; and five (21.7%) vaccinated patients died from severe pneumonia or acute liver failure. Except the first patient, all patients had hospital visits within 7-21 days before measles onset and 20 patients were likely to be exposed to each other.
The outcome of measles outbreak in previously vaccinated oncology and post-HSCT pediatric patients during chemotherapy and immunosuppressant medication was severe. Complete loss of protective immunity induced by measles vaccine during chemotherapy was the potential reason. Improved infection control practice was critical for the prevention of measles in malignancy patients and transplant recipients.
尽管中国在麻疹控制方面取得了重大进展，但免疫功能低下人群中的麻疹暴发仍然对阻断地方性传播构成挑战。本研究旨在调查儿科血液学和肿瘤学患者中麻疹的特征，并探讨暴发背后的原因。
我们收集了免疫功能低下麻疹患儿的人口统计学、流行病学和临床数据。所有疑似麻疹病例均根据麻疹IgM的存在和/或麻疹RNA的鉴定进行实验室确诊。连续变量的临床数据采用t检验进行统计分析，分类变量采用Fisher精确检验进行统计分析。
2015年3月9日至7月25日，上海共有23例恶性肿瘤患儿和造血干细胞移植后（HSCT后）患儿被报告患麻疹。这23例患者的中位年龄为5.5岁（范围：11个月至14岁），其中20例（87.0%）此前接种过1-3剂麻疹疫苗；所有患者均有发热，中位发热持续时间为8天；21例（91.3%）有咳嗽；18例（78.3%）有皮疹；13例（56.5%）有科氏斑；13例（56.5%）有并发症，包括肺炎和急性肝衰竭；5例（21.7%）接种过疫苗的患者死于重症肺炎或急性肝衰竭。除首例患者外，所有患者在麻疹发病前7-21天内均有过就诊，20例患者可能相互接触。
先前接种过疫苗的肿瘤学和HSCT后儿科患者在化疗和免疫抑制药物治疗期间麻疹暴发的后果严重。化疗期间麻疹疫苗诱导的保护性免疫完全丧失是潜在原因。改善感染控制措施对于预防恶性肿瘤患者和移植受者的麻疹至关重要。
