Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Centro de Estudos, Políticas e Informação sobre Determinantes Sociais da Saúde. Rio de Janeiro, RJ, Brasil.
Rev Saude Publica. 2022 Jun 13;56:50. doi: 10.11606/s1518-8787.2022056003805. eCollection 2022.
To analyze the epidemiological profile of cases and the pattern of spatial diffusion of the largest measles epidemic in Brazil that occurred in the post-elimination period in the state of São Paulo.
A cross-sectional study based on confirmed measles cases in 2019. Bivariate analysis was performed for socioeconomic, clinical, and epidemiological variables, according to prior vaccination and hospitalization, combined with an analysis of spatial diffusion of cases using the Inverse Distance Weighting (IDW) method.
Of the 15,598 confirmed cases, 2,039 were hospitalized and 17 progressed to death. The epidemic peak occurred in epidemiological week 33, after confirmation of the first case, in the epidemiological week 6. Most cases were male (52.1%), aged between 18 and 29 years (38.7%), identified as whites (70%). Young adults (39.7%) and children under five years (32.8%) were the most affected age groups. A higher proportion of previous vaccination was observed in whites as compared to Blacks, browns, yellows and indigenous people (p < 0.001), as well as in the most educated group compared to the other categories (p < 0.001). The risk of hospitalization was higher in children than in the older age group (RI = 2.19; 95%CI: 1.66-2.88), as well as in the unvaccinated than in the vaccinated (RI = 1.59; 95%CI: 1.45-1.75). The pattern of diffusion by contiguity combined with diffusion by relocation followed the urban hierarchy of the main cities' regions of influence.
In addition to routine vaccination in children, the findings indicate the need for immunization campaigns for young adults. In addition, studies that seek to investigate the occurrence of clusters of vulnerable populations, prone to lower vaccination coverage, are essential to broaden the understanding of the dynamics of transmission and, thus, reorienting control strategies that ensure disease elimination.
分析巴西圣保罗州消除麻疹后发生的最大规模麻疹疫情的病例流行病学特征和空间扩散模式。
这是一项基于 2019 年确诊麻疹病例的横断面研究。对社会经济、临床和流行病学变量进行了双变量分析，根据先前的疫苗接种和住院情况进行了分析，并结合使用反距离权重（IDW）法对病例的空间扩散进行了分析。
在 15598 例确诊病例中，有 2039 例住院，17 例死亡。疫情高峰出现在首例病例确诊后的第 6 周的第 33 周。大多数病例为男性（52.1%），年龄在 18 至 29 岁之间（38.7%），为白人（70%）。青年（39.7%）和五岁以下儿童（32.8%）是受影响最严重的年龄组。与黑人、棕色人种、黄种人和原住民相比，白人接种疫苗的比例更高（p<0.001），与其他类别相比，受教育程度较高的人群接种疫苗的比例更高（p<0.001）。与年龄较大的人群相比，儿童住院的风险更高（RR=2.19；95%CI：1.66-2.88），与接种疫苗的人群相比，未接种疫苗的人群住院的风险更高（RR=1.59；95%CI：1.45-1.75）。邻接性扩散模式与重新定位扩散模式相结合，遵循主要城市影响区域的城市等级制度。
除了常规为儿童接种疫苗外，研究结果表明还需要为青年开展免疫接种运动。此外，开展研究以调查易受较低疫苗覆盖率影响的脆弱人群群集的发生情况，对于扩大对传播动态的认识并重新调整确保消除疾病的控制策略至关重要。
