Epidemiolgic characteristics and influencing factors of measles among floating children in Shenzhen:a case-control study
-
摘要:
目的 调查深圳市流动儿童麻疹病例的发病特征及导致麻疹发病的影响因素。 方法 采用描述性流行病学方法分析深圳市法定传染病报告系统报告的流动儿童麻疹病例数据, 采用群组病例对照研究方法调查其中89例病例组与相应对照组以探讨可能的影响因素。 结果 2016-2018年共报告流动儿童麻疹病例108例, 发病呈现逐年下降趋势(χ趋势2=68.35, P < 0.001)。研究结果显示, 影响流动儿童麻疹发病的危险因素包括7~21 d前就诊史(OR=7.80, 95% CI:3.51~17.35, P < 0.001)、7~21 d前去过人口密集的场所(OR=3.37, 95% CI:1.52~7.47, P=0.002)、7~21 d前有发热-出疹病人接触史(OR=4.57, 95% CI:1.41~14.84, P=0.007), 而按计划免疫规划接种则为麻疹发病的保护因素(OR=0.12, 95% CI:0.04~0.32, P < 0.001)。 结论 流动儿童必须进一步加强疫苗接种, 医疗机构应避免成为麻疹传播的关键场所, 同时加强麻疹宣教。 Abstract:Objective To investigate epidemiological characteristics of measles cases and the influencing factors of transmission of measles among floating children in Shenzhen. Methods Descriptive study was conducted in data which were collected from the report system of statutory infectious diseases from 2016 to 2018 in Shenzhen. Case-control study was conducted between 89 cases and relative controls. Results A total of 108 measles cases in floating children were reported from 2016 to 2018, and the incidence trend showed a year-on-year decline(χtrend2=68.35, P < 0.001). Analysis showed that nosocomial exposure in 7 to 21 days ago(OR=7.80, 95% CI:3.51-17.35, P < 0.001), having been to the crowded places(OR=3.37, 95% CI:1.52-7.47, P=0.002), having contact history of fever-rash patients(OR=4.57, 95% CI:1.41-14.84, P=0.007) were influencing factors of transmission of measles among floating children, and immunization at the prescribed time(OR=0.12, 95% CI:0.04-0.32, P < 0.001) was a protective factor for measles. Conclusions Vaccination must be strengthened for floating children. Medical institutions should avoid becoming a key place for measles transmission, and need to strengthen health education. -
Key words:
- Floating children /
- Measles /
- Incidence characteristics /
- Influencing factor
-
表 1 流动儿童麻疹传播影响因素的单因素logistic回归分析结果
Table 1. Analysis of univariate Logistic regression for influencing factors of measles among floating children
影响因素 病例组(n=89) 对照组(n=89) P值 OR(95% CI)值 例数 构成比(%) 例数 构成比(%) 发病前7~21 d就诊史 否 23 25.84 63 70.79 1.00 是 66 74.16 26 29.21 < 0.001 6.95(3.60~13.44) 发病前7~21 d到过人员密集的场所 否 23 25.84 53 59.55 1.00 是 66 74.16 36 40.45 < 0.001 4.23(2.24~7.98) 发热、出疹病人接触史 否 67 75.28 84 94.38 1.00 是 22 24.72 5 5.62 < 0.001 5.51(1.98~15.33) 按时免疫接种 否 38 42.70 7 7.87 1.00 是 51 57.30 82 92.13 < 0.001 0.12(0.05~0.28) 近一个月去过外地 否 74 83.15 79 88.76 1.00 是 15 16.85 10 11.24 0.284 1.60(0.68~3.79) 近一个月有外地归来者接触史 否 82 92.13 76 85.39 1.00 是 7 7.87 13 14.61 0.159 0.50(0.19~1.32) 麻疹知识了解程度a 基本缺乏 22 24.72 34 38.20 1.00 尚不充分 61 68.54 43 48.31 0.020 2.19(1.13~4.26) 较为充分 6 6.74 12 13.48 0.651 1.33(0.64~2.74) 居室通风 否 15 16.85 13 14.61 1.00 是 74 83.15 76 85.39 0.681 0.84(0.38~1.90) 居室潮湿 否 13 14.61 2 2.25 1.00 是 76 85.39 87 97.75 0.010 7.44(1.63~34.03) 居住环境卫生 否 21 23.60 11 12.36 1.00 是 68 76.40 78 87.64 0.054 0.46(0.21~1.02) 父亲学历 初中及以下 25 28.09 18 20.22 1.00 高中/中专 37 41.57 29 32.58 0.830 0.92(0.42~2.00) 大专及以上 27 30.34 42 47.19 0.051 0.46(0.21~1.01) 母亲学历 初中及以下 35 39.33 24 26.97 1.00 高中/中专 35 39.33 27 30.34 0.749 0.89(0.43~1.83) 大专及以上 19 21.35 38 42.70 0.006 0.34(0.16~0.73) 注:a了解程度包括对麻疹主要传播途径、主要症状、基本预防措施及主要发病季节的知识回答情况, 均无法答对者为基本缺乏, 未能全部答对者为尚不充分, 均能答对者为较为充分。 
下载: 导出CSV
表 2 流动儿童麻疹传播影响因素的多因素logistic回归分析结果
Table 2. Analysis of multivariate logistic regression for influencing factors of measles of floating children
影响因素 β sx Wald值 P值 OR(95% CI)值 发病前7~21 d就诊史 2.05 0.41 25.37 < 0.001 7.80(3.51~17.35) 发病前7~21 d到过人员密集的场所 1.21 0.41 8.93 0.002 3.37(1.52~7.47) 发热、出疹病人接触史 1.52 0.60 6.40 0.007 4.57(1.41~14.84) 按时免疫接种 -2.14 0.52 17.21 < 0.001 0.12(0.04~0.32)
下载: 导出CSV
-
[1] Patel MK, Gacic-Dobo M, Strebel PM, et al. Progress toward regional measles elimination-worldwide, 2000-2015[J]. MMWR Morb Mortal Wkly Rep, 2016, 65(44): 1228-1233. DOI: 10.15585/mmwr.mm6544a6. [2] Li S, Ma C, Hao L, et al. Demographic transition and the dynamics of measles in six provinces in China: a modeling study[J]. PLoS Med, 2017, 14(4): e1002255. DOI: 10.1371/journal.pmed.1002255. [3] 韩轲.疫苗时代广东省流行特征及消除策略研究[D].广州: 南方医科大学, 2016.Han K. Study on measles epidemiological characteristics, and elimination strategies in Guangdong Province at measles vaccine widely using era[D]. Guangzhou: Southern Medical University, 2016. [4] 孟凡亚, 陆志坚, 沈永刚, 等.安徽省2015-2016年麻疹发病影响因素病例对照研究[J].中华疾病控制杂志, 2017, 21(6): 581-585. DOI: 10.16462/j.cnki.zhjbkz.2017.06.010.Meng FY, Lu ZJ, Shen YG, et al. Influencing factors for measles infection in Anhui Province: a case-control study, 2015-2016[J]. Chin J Dis Control Prev, 2017, 21(6): 581-585. DOI: 10.16462/j.cnki.zhjbkz.2017.06.010. [5] Remington PL, Hall WN, Davis IH, et al. Airborne transmission of measles in a physician's office[J]. JAMA, 1985, 253(11): 1574-1577. DOI: 10.1001/jama.1985.03350350068022. [6] Fiebelkorn AP, Redd SB, Gallagher K, et al. Measles in the United States during the postelimination era[J]. J Infect Dis, 2010, 202(10): 1520-1528. DOI: 10.1086/656914. [7] 陈玲玲, 姚栩, 李红, 等.福州市492对母婴麻疹、风疹抗体水平研究[J].中华疾病控制杂志, 2017, 21(11): 1175-1177. DOI: 10.16462/j.cnki.zhjbkz.2017.11.023.Chen LL, Yao X, Li H, et al. A study on measles and rubella antibody level in 492 pairs of mothers and infants in Fuzhou[J]. Chin J Dis Control Prev, 2017, 21(11): 1175-1177. DOI: 10.16462/j.cnki.zhjbkz.2017.11.023. [8] 苏琪茹, 徐爱强, Peter Strebel, 等.中国消除麻疹的关键技术问题:专家解读共识[J].中国疫苗和免疫, 2014, 20(3): 264-270. http://www.cqvip.com/QK/90851A/20143/50265334.htmlSu QR, Xu AQ, Peter S, et al. National and international experts' consensus on key technical issues of measles elimination in China[J]. Chinese Journal of Vaccines and Immunization, 2014, 20(3): 264-270. http://www.cqvip.com/QK/90851A/20143/50265334.html [9] Fraser B. Measles outbreak in the Americas[J]. Lancet, 2018, 392(10145): 373. DOI: 10.1016/S0140-6736(18)31727-6. [10] McClure CC, Cataldi JR, O'Leary ST. Vaccine hesitancy: where we are and where we are going[J]. Clin Ther, 2017, 39(8): 1550-1562. DOI: 10.1016/j.clinthera.2017.07.003. -
