Naus M, Puddicombe D, Murti M, Fung C, Stam R, Loadman S, Krajden M, Tang P, Lem M
British Columbia Centre for Disease Control, Vancouver, BC.
Faculty of Medicine, University of British Columbia, Vancouver, BC.
Can Commun Dis Rep. 2015 Jul 2;41(7):169-174. doi: 10.14745/ccdr.v41i07a02.
Although Canada eliminated endemic measles in 1998, outbreaks are expected to occur periodically through import-related transmission in geographically clustered unvaccinated communities. In the spring of 2014, in association with an outbreak in the Netherlands, a large measles outbreak occurred in British Columbia in a community unvaccinated for religious reasons.
Case finding with assistance of the local community, its school and religious leaders and local health care providers was conducted to identify confirmed, probable and suspect cases. Measles control guidelines were implemented with limited uptake of measles-containing vaccine (MCV) but higher adherence with infection control measures and travel restrictions.
A total of 433 cases (325 confirmed and 108 probable) were identified. Rash onset ranged from February 22 to June 9, with 98% during March and April. Fifty-seven percent of cases were students of one school. The median age of cases was 11 years and 68% of cases were aged five to 19 years. Ninety-nine percent of cases were unvaccinated. One case had encephalitis and recovered. Only five cases occurred outside of the affected community. Genotyping results were consistent with importation from the Netherlands outbreak.
This outbreak in a community with low-vaccination rates affected largely the pediatric-age population, compatible with acquisition of measles immunity by adult members due to prior wild-type measles infection. Although vaccine hesitancy persisted in this population, containment of the outbreak was facilitated by a high degree of community cooperation with infection control measures and restriction of movement.
尽管加拿大在1998年消除了地方性麻疹，但预计在未接种疫苗的地理聚集社区中，与输入相关的传播会定期引发疫情。2014年春季，与荷兰的一次疫情相关联，不列颠哥伦比亚省一个因宗教原因未接种疫苗的社区发生了大规模麻疹疫情。
在当地社区、学校、宗教领袖和当地医疗服务提供者的协助下进行病例查找，以确定确诊、可能和疑似病例。实施了麻疹控制指南，含麻疹疫苗（MCV）的接种率有限，但感染控制措施和旅行限制的依从性较高。
共确定433例病例（325例确诊，108例可能）。出疹时间从2月22日至6月9日，98%的病例在3月和4月。57%的病例是一所学校的学生。病例的中位年龄为11岁，68%的病例年龄在5至19岁之间。99%的病例未接种疫苗。1例发生脑炎，已康复。仅5例病例发生在受影响社区之外。基因分型结果与从荷兰疫情输入一致。
这次在疫苗接种率低的社区爆发的疫情主要影响了儿童年龄组人群，这与成年成员因先前感染野生型麻疹而获得麻疹免疫力相符。尽管该人群中疫苗犹豫现象持续存在，但社区与感染控制措施和行动限制的高度合作促进了疫情的控制。
