摘要
目的研究疫苗时代麻疹临床症状特征及其影响因素,并评价不同麻疹病例定义的监测效果。方法从2004～2008年金华市麻疹监测系统中,选择病例分类为确诊麻疹和排除麻疹的病例,且临床症状信息无缺失的3041例疑似麻疹病例作为本次研究对象,收集其性别、年龄、麻疹减毒活疫苗免疫史及临床症状等信息。结果确诊/排除麻疹病例的咳嗽、卡他性鼻炎、眼结膜炎发生率分别为97.3%/74.4%、82.3%/50.0%、79.6%/51.0%,差异均有统计学意义(χ2=373.107,χ2=355.836,χ2=272.085;P均<0.001)。年龄和免疫史是卡他性鼻炎的影响因素,调整年龄混杂因素后,与0剂次免疫者相比,1剂次和≥2剂次免疫的麻疹患者发生卡他性鼻炎的比值比(OddsRatio,OR调整)分别为0.410[95%可信区间(Confidence Interval,CI)为0.270～0.623,P<0.01]和0.394(95%CI:0.285～0.545,P<0.01)。另外,免疫史也是眼结膜炎的相关因素,与0剂次免疫者相比,免疫1剂次和≥2剂次的麻疹患者发生眼结膜炎的OR粗分别为0.620(95%CI:0.432～0.890,P<0.05)和0.618(95%CI:0.427～0.950,P<0.01)。现行麻疹监测病例定义的灵敏度最高(98.9%),其特异度为12.8%;以"发热、出疹,并伴有咳嗽、卡他性鼻炎、眼结膜炎三样症状"的病例定义,其特异度最高(68.2%);以"发热、出疹,并伴有咳嗽和卡他性鼻炎症状"的病例定义,其Kappa值和受试者工作特征曲线较理想。结论疫苗时代,麻疹患者多为轻型、不典型感染,实验室检测结果已成为临床鉴别诊断的重要依据。在消除麻疹进程中,要视不同发病率来选择合适的麻疹监测病例定义,以提高监测效力。
Objectives To describe clinical features of measles and to determine influential factors of it since introduction of measles vaccine,and to examine accuracy of measles surveillance case definition in detecting measles currently.Methods After cases missed clinical signs or symptoms were deleted,3041 suspected measles（inclusive of confirmed measles cases and non-measles cases） were selected as sample of the study through Measles Surveillance System from 2004 to 2008.Data regarding sex,age,history of vaccination for measles,and clinical manifestation of illness（i.e.cough,coryza,conjunctivitis） were collected.Results Of 1893 confirmed measles cases,prevalence rates of cough,coryza and conjunctivitis were 97.3%,82.3% and 79.6%,while rates were 74.4%,50.0% and 51.0% of 1148 non-measles cases.There were obvious differences between confirmed measles cases and non-measles cases,the confirmed measles cases were more likely to get cough（χ2=373.107;P0.001）,coryza（χ2=355.836;P0.001） and conjunctivitis（χ2=272.085;P0.001） than non-measles cases.Of the three indicators（age,sex,previous vaccination for measles）,age and history of vaccination were significantly associated with prevalence of the＂coryza＂symptom,and history of vaccination were significantly associated with prevalence of the ＂conjunctivitis＂symptom.After adjusting confounding factor＂age＂,compared with measles cases without vaccination cases who were vaccinated once[ORadjusted=0.410（95%CI：0.270,0.623）] and more than once[ORadjusted=0.394（95%CI：0.285,0.545）]were less likely to have＂ coryza＂ symptom.Similarly,measles cases vaccinated for measles only once previously tended to be lower at risk for＂conjunctivitis＂symptom at presentation[ORcrude= 0.620（95% CI：0.432,0.890）].Cases vaccinated for measles at least two times previously,ORcrude（95%CI） value was 0.618（0.427,0.950）.The cases definition of current measles surveillance system had maximum sensitivity（98.9%） but low specificity（12.8%）.Specificity（68.2%） was highest when a generalized maculopapular rash,fever,cough,coryza and conjunctivitis were defined as cases.Both Kappa value and ROC figure were more ideal,which was case definition included a generalized maculopapular rash,fever,cough and coryza.Conclusion Currently,laboratory confirmation is essential to ensure an accurate identification of each measles case because actual measles cases may have a mild and atypical presentation during vaccine era.It was crucial to improve accuracy of surveillance for measles that adequate case definition was selected according to incidence on measles elimination progress.
出处
《中国疫苗和免疫》
CAS
2010年第5期430-434,共5页
Chinese Journal of Vaccines and Immunization
基金
浙江省金华市科学技术项目(20083011)
关键词
麻疹
临床
监测
灵敏度
特异度
Measles
Clinic
Surveillance
Sensitivity
Specificity
