【摘要】 目的随着麻疹疫苗的广泛应用,麻疹发病年龄出现"双相"趋势,在目前麻疹发病年龄结构和流行病学动态形势下,提供现阶段制定麻疹防治策略的参考依据。方法针对免疫预防30年后麻疹流行特征动态变化,结合各人群血清学监测结果,对现阶段麻疹的流行规律进行描述性流行病学分析预测。结果从麻疹疫苗广泛应用到计划免疫再到免疫规划的30年间,虽然发病年龄构成改变,北京市通州区麻疹整体发病率持续下降,维持3/10万的低发病率水平,并且临床并发症减少,轻型、不典型以及不可预防性病例增多。但2005年后发病率显著回升,表现出<8月龄婴儿和≥20岁人群发病升高的"双相"趋势,流动人口以多发、爆发为主要流行类型,成为影响该地区麻疹发病率升高的主要原因。血清学监测结果显示,1982～1991年和1992～2006年两时期婴儿麻疹疫苗初免成功率均较高(χ2=0.189,P=0.921),抗体GMT均达到较高水平;1982～1991年和2007年两时期健康人群抗体阳性率差异有统计学意义(χ2=12.784,P<0.01);相同时期的育龄妇女抗体阳性率分别为95.94%和92.51%(χ2=1.524,P=0.900),健康人群及育龄妇女抗体GMT均偏低。结论随着麻疹流行特征的改变,血清流行病学随之改变,形成了不同时期麻疹流行规律特征的免疫学基础,制定大年龄及育龄妇女的免疫策略,是降低"双相"趋势升高的有效手段。更多还原

【Abstract】 Objective With wide use of measles vaccine,ages of at onset of measles tend to be in a "two-phase" mode.It is purposed to analyze epidemiological characteristics of measles,including dynamic changes in incidence and age structure of the patients with measles,to provide scientific evidence for development of current strategies for measles control.Methods Based on data of changes in epidemiological characteristics of measles,as well as outcomes of sero-epidemiologic surveillance,during the past 30 years after regular measles immunization,rules of measles incidence were described analyzed and predicted.Results Incidence of measles declined continuously during the past 30 years in Tongzhou District,Beijing,sustaining at a lower level of 3 per 100000,with fewer complications,less typical and mild clinical manifestations,and changing in age structure of the patients,but the incidence increased significantly after the year of 2005,showing a "two-phase" mode,i.e,peaks at ages younger than 8 months and older than 20 years,which mostly occurred in migrant population with outbreaks.Results of sero-epidemiologic surveillance showed that positive conversion rate for infants with primary immunization was higher during 1982～1991 and 1992～2006,respectively(χ2=0.189,P=0.921),and geometric mean titer(GMT)of antibodies against measles achieved a higher level with statistical significance,as compared to that in healthy population(χ2=12.784,P<0.01),during those periods.Positive conversion rate in child-bearing women was 95.94 percent and 92.51 percent,respectively,significantly different from those in healthy population(χ2=1.524,P=0.900),but their GMT of antibodies were lower.Conclusion Both epidemiologic and sero-epidemiologic characteristics of measles changed,which formed immunological basis of measles outbreaks in varied periods.It suggests that development of immunization strategies for women at child-bearing ages and older children is an effective measure to cut "two-phase" age peak of measles incidence.更多还原