目的 分析2012年复旦大学附属儿科医院182例麻疹住院患儿的流行病学特征,探讨影响麻疹发病的主要因素,了解麻疹病毒基因分型,为进一步控制麻疹的流行提供科学的决策依据.方法 回顾性分析2012年1月1日至12月31日复旦大学附属儿科医院确诊并住院治疗的182例麻疹患儿的性别、年龄、流行趋势和发病季节、麻疹疫苗的接种史、接触史等流行病学特征和临床表现、辅助检查结果,并应用RT-PCR方法对随机采样的麻疹患儿的痰液标本进行麻疹病毒检测,PCR扩增阳性的片段进一步行麻疹基因测序分型.结果 (1)临床流行病学资料:182例患者中,男125例,女57例,男∶女=2.2∶1;年龄3～ 89个月,＜9月龄127例(69.8％);4至8月份为麻疹高发季节,4、5月份为发病最高峰;182例麻疹患儿中有麻疹疫苗接种史者11例(6.0％),其中5例接种疫苗2周内发病,无接种史者167例(91.8％),接种史不详者4例(2.2％).流动人口(144例)中适于麻疹疫苗接种者的麻疹疫苗接种率8.5％ (6/71),与本市户籍人口中适于接种年龄的患儿接种率(29.4％,5/17)比较,差异有统计学意义(x2=8.11,P=0.004).有明确麻疹接触史者24例(13.2％),接触史不详者153例(84.1％),否认接触史5例(2.7％).(2)临床表现:182例均有发热及皮疹(100％),体温高于39℃者145例(79.7％),热程2～38 d;典型麻疹165例(90.7％),不典型麻疹17例,轻型麻疹14例,重型麻疹2例,可疑异型麻疹l例.(3)常见并发症:肺炎96例(52.8％),喉炎80例(44.0％),支气管炎38例(20.9％),肝功能损害15例(8.2％),心肌损害11例(6.0％),高热惊厥3例(1.6％).96例麻疹肺炎患儿中92例进行痰病原学检测,细菌培养阳性者38例(41％),最常见的病原分别为肺炎链球菌(11例,29％)、流感嗜血杆菌(6例,16％)、卡他莫拉菌(4例,11％)、大肠埃希菌(4例,11％)、假丝酵母菌(4例,11％)、肺炎支原体(4例,11％)、金黄色葡萄球菌(3例,8％).(4)54例麻疹病毒基因型检测均为H1a基因型.结论 春季为上海地区儿童麻疹的高发季节,9月龄以下婴儿及流动人口中适龄未接种疫苗的儿童为易感儿童,绝大多数表现为典型麻疹,肺炎仍是儿童麻疹的常见并发症.麻疹病毒基因型为H1a基因亚型.提高易感儿童的麻疹疫苗接种率,是预防和消除麻疹的有效措施.
目的 分析2012年複旦大學附屬兒科醫院182例痳疹住院患兒的流行病學特徵,探討影響痳疹髮病的主要因素,瞭解痳疹病毒基因分型,為進一步控製痳疹的流行提供科學的決策依據.方法 迴顧性分析2012年1月1日至12月31日複旦大學附屬兒科醫院確診併住院治療的182例痳疹患兒的性彆、年齡、流行趨勢和髮病季節、痳疹疫苗的接種史、接觸史等流行病學特徵和臨床錶現、輔助檢查結果,併應用RT-PCR方法對隨機採樣的痳疹患兒的痰液標本進行痳疹病毒檢測,PCR擴增暘性的片段進一步行痳疹基因測序分型.結果 (1)臨床流行病學資料:182例患者中,男125例,女57例,男∶女=2.2∶1;年齡3～ 89箇月,＜9月齡127例(69.8％);4至8月份為痳疹高髮季節,4、5月份為髮病最高峰;182例痳疹患兒中有痳疹疫苗接種史者11例(6.0％),其中5例接種疫苗2週內髮病,無接種史者167例(91.8％),接種史不詳者4例(2.2％).流動人口(144例)中適于痳疹疫苗接種者的痳疹疫苗接種率8.5％ (6/71),與本市戶籍人口中適于接種年齡的患兒接種率(29.4％,5/17)比較,差異有統計學意義(x2=8.11,P=0.004).有明確痳疹接觸史者24例(13.2％),接觸史不詳者153例(84.1％),否認接觸史5例(2.7％).(2)臨床錶現:182例均有髮熱及皮疹(100％),體溫高于39℃者145例(79.7％),熱程2～38 d;典型痳疹165例(90.7％),不典型痳疹17例,輕型痳疹14例,重型痳疹2例,可疑異型痳疹l例.(3)常見併髮癥:肺炎96例(52.8％),喉炎80例(44.0％),支氣管炎38例(20.9％),肝功能損害15例(8.2％),心肌損害11例(6.0％),高熱驚厥3例(1.6％).96例痳疹肺炎患兒中92例進行痰病原學檢測,細菌培養暘性者38例(41％),最常見的病原分彆為肺炎鏈毬菌(11例,29％)、流感嗜血桿菌(6例,16％)、卡他莫拉菌(4例,11％)、大腸埃希菌(4例,11％)、假絲酵母菌(4例,11％)、肺炎支原體(4例,11％)、金黃色葡萄毬菌(3例,8％).(4)54例痳疹病毒基因型檢測均為H1a基因型.結論 春季為上海地區兒童痳疹的高髮季節,9月齡以下嬰兒及流動人口中適齡未接種疫苗的兒童為易感兒童,絕大多數錶現為典型痳疹,肺炎仍是兒童痳疹的常見併髮癥.痳疹病毒基因型為H1a基因亞型.提高易感兒童的痳疹疫苗接種率,是預防和消除痳疹的有效措施.
목적 분석2012년복단대학부속인과의원182례마진주원환인적류행병학특정,탐토영향마진발병적주요인소,료해마진병독기인분형,위진일보공제마진적류행제공과학적결책의거.방법 회고성분석2012년1월1일지12월31일복단대학부속인과의원학진병주원치료적182례마진환인적성별、년령、류행추세화발병계절、마진역묘적접충사、접촉사등류행병학특정화림상표현、보조검사결과,병응용RT-PCR방법대수궤채양적마진환인적담액표본진행마진병독검측,PCR확증양성적편단진일보행마진기인측서분형.결과 (1)림상류행병학자료:182례환자중,남125례,녀57례,남∶녀=2.2∶1;년령3～ 89개월,＜9월령127례(69.8％);4지8월빈위마진고발계절,4、5월빈위발병최고봉;182례마진환인중유마진역묘접충사자11례(6.0％),기중5례접충역묘2주내발병,무접충사자167례(91.8％),접충사불상자4례(2.2％).류동인구(144례)중괄우마진역묘접충자적마진역묘접충솔8.5％ (6/71),여본시호적인구중괄우접충년령적환인접충솔(29.4％,5/17)비교,차이유통계학의의(x2=8.11,P=0.004).유명학마진접촉사자24례(13.2％),접촉사불상자153례(84.1％),부인접촉사5례(2.7％).(2)림상표현:182례균유발열급피진(100％),체온고우39℃자145례(79.7％),열정2～38 d;전형마진165례(90.7％),불전형마진17례,경형마진14례,중형마진2례,가의이형마진l례.(3)상견병발증:폐염96례(52.8％),후염80례(44.0％),지기관염38례(20.9％),간공능손해15례(8.2％),심기손해11례(6.0％),고열량궐3례(1.6％).96례마진폐염환인중92례진행담병원학검측,세균배양양성자38례(41％),최상견적병원분별위폐염련구균(11례,29％)、류감기혈간균(6례,16％)、잡타막랍균(4례,11％)、대장애희균(4례,11％)、가사효모균(4례,11％)、폐염지원체(4례,11％)、금황색포도구균(3례,8％).(4)54례마진병독기인형검측균위H1a기인형.결론 춘계위상해지구인동마진적고발계절,9월령이하영인급류동인구중괄령미접충역묘적인동위역감인동,절대다수표현위전형마진,폐염잉시인동마진적상견병발증.마진병독기인형위H1a기인아형.제고역감인동적마진역묘접충솔,시예방화소제마진적유효조시.
Objective To investigate the main factors that influence measles morbidity and the genotype of measles virus,so as to provide evidence for scientific decision making to further control the prevalence of measles.Method A retrospective analysis included 182 children in Children's Hospital of Fudan University,diagnosed with measles from January 1,2012 to December 31.The clinical and epidemiological characteristics,including the gender,age,the incidence of seasonal trends,measles vaccine vaccination history,contact history and other clinical manifestations,laboratory test results,and so on were analyzed.And the reverse transcription PCR (RT-PCR) was adopted to detect sputum specimens from suspected patients with measles,who were selected randomly,the sequence of the part of the PCR products was analyzed.Result (1) Clinical and epidemiological data:Totally were 182 children with measles (125 males,57 females) were enrolled into this study.The age of the patients ranged from 3 months to 89 months,127 cases were younger than 9 months (69.8％).The prevalence season was from April to August,while the peak month was April and May (22.5％,23.1％).Among 182 hospitalized children,only 11 cases underwent measles vaccination (6.0％),and among them 5 cases were within 2 weeks before disease onset.A total of 167 cases (91.8％) had not been vaccinated,most of whom were immigrants,and the measles vaccination history of the remaining 4 cases were unknown.There was a positive correlation between the measles vaccination ratio in children of the floating population (8.45％,6/71) and the settled children (29.4％,5/17,x2 =8.11,P =0.004).In total,24 cases (13.2％) had definite measles exposure history,with 153 cases (84.1％) of unknown origin,5 cases (2.7％) without any history of contact.(2) Clinical manifestations:All the 182 patients had fever (100％) and obvious rashes (100％),among them 145 cases had body temperature higher than 39 ℃ (79.7％).The fever period ranged from 2 to 38 days.Among 182 hospitalized children,165 cases (90.7％) had typical measles,17 cases had atypical measles.Among the 17 cases,two had severe measles,one had heterotypic measles.(3) The common complications:96 cases had pneumonia (52.8％),80 had laryngitis (44.0％),38 had bronchitis (20.9％),15 had hepatic dysfunction (8.2％),11 had myocardial damage (6.0％),3 had febrile seizures (1.6％),and no patient had encephalitis.Of the 96 cases with pneumonia,92 received sputum test;38 were sputum culture positive (41％).The dominant pathogens were Streptococcus pneumoniae (11/38,29 ％),Haemophilus influenzae (6/ 38,16％),Moraxella catarrhalis (4/38,11％),Escherichia coli (4/38,11％),Candida albieans (4/38,11％),Mycoplasma pneumoniae (4/38,11％) and Staphylococcus aureus (3/38,8 ％).(4) The H1a genotype was the only one genotype in the detected sequence of 54 measles virus strains.Conclusion Measles was more often seen in the children under the age of 9 months from the floating population.The morbidity peak month was from April to May in Shanghai.The H1 a genotype was the only one genotype.We should try to improve vaccination coverage rate in the children who are at the age for vaccination,so as to prevent measles outbreak.
