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目的分析云南省德钦县1起成人麻疹暴发的原因,评价防控措施的效果。方法对疑似麻疹患者进行个案调查,收集病例血清和咽拭子/尿液标本,开展血清学和病原学检测。在全县范围内开展发热和/或出疹病例的主动搜索,采用回顾性队列研究分析引起暴发的主要因素。在首例病例报告4天后开展20-40岁人群含麻疹成分疫苗(MCV)应急免疫,并评价免疫后麻疹抗体水平。结果在42例麻疹暴发病例中,来自毗邻地区就诊病例23例,德钦本地病例19例。89.47%的德钦本地病例为20-40岁成人。病例的9株麻疹病毒分离株经鉴定为H1a基因型。在搜索的发热和/或出疹病例中,有明确病例接触史者中麻疹发病比例(10.1%,16/158)高于无病例接触史者(0.3%,3/1 209),且75%(12/16)的有明确病例接触者为医院暴露。德钦县20-40岁人群累计应急接种MCV 10 596人,接种后人群麻疹IgG抗体阳性率为100%,几何平均滴度为1∶1 452.87,疫情得到有效控制。结论本起成人暴发主要为易感人群的累积和院内感染引起。尽早开展以应急接种为主的综合防控措施可以迅速控制疫情。
Objective To analyze the causes of adult measles outbreak in Deqin County, Yunnan Province and evaluate the effect of prevention and control measures. Methods A case investigation was conducted on suspected measles patients. Serum and throat swabs / urine samples were collected and serological and etiological tests were performed. An active search of fever and / or rash cases across the county was conducted using a retrospective cohort study to analyze the major factors that triggered the outbreak. Four days after the first case report, an emergency measles vaccine (MCV) vaccine was administered to individuals aged 20-40 years and measles antibody levels after immunization. Results Of the 42 cases of measles outbreaks, 23 cases were from adjoining districts and 19 cases were local to Deqin. 89.47% of Deqin’s local cases were adults aged 20-40 years. Nine cases of measles virus isolates were identified as the H1a genotype. Among the cases of fever and / or rash that were detected, the incidence of measles in those with a clear history of exposure was higher (10.1%, 16/158) than those without history of exposure (0.3%, 3/1 209) and 75% (12/16) have clear case contacts for hospital exposure. A total of 10 596 MCVs were vaccinated in the age group of 20-40 years old in Deqin County. The positive rate of measles IgG antibody was 100% after inoculation, and the geometric mean titer was 1: 1 452.87. The outbreak was effectively controlled. Conclusion This adult outbreak mainly caused by the accumulation of susceptible people and nosocomial infections. As soon as possible to carry out emergency vaccination-based comprehensive prevention and control measures can quickly control the outbreak.