【摘要】 目的 了解实施丙类管理和疫苗接种策略后，南京市水痘流行特征变化，初步分析防控措施效果，为改进防控策略提供科学依据。方法 收集2013―2022年南京市水痘报告病例数据，利用Joinpoint回归模型分析报告发病率年度变化百分比（annual percent change, APC）和平均年度变化百分比（average annual percent change, AAPC）。利用R 4.2.0软件分析时间、人群和空间分布特征，探测空间聚集区域，比较水痘纳入丙类管理（2017―2018年）和疫苗接种后（2019―2022年）流行特征变化。结果 共报告水痘病例87 538例，年均报告发病率为102.20/10万。2018年达到峰值228.64/10万（19 057例），后持续下降至2022年的98.32/10万（9 262例），下降了57.00%。2013―2018年、2018―2022年APC分别为71.47%(95%CI:41.96%～107.10%)、-15.36%(95%CI:-35.20%～10.54%),2013―2022年AAPC为25.29%(95%CI:11.03%～41.37%)。2019―2022年病例年龄中位数[10(5,19)岁]高于2017―2018年[7(5,15)岁]（P<0.001）;<15岁各年龄组发病率下降比例为57.46%～90.46%，年龄组发病高峰被削平。学生、幼托儿童和散居儿童占比由84.53%逐年下降至75.26%，其中幼托儿童由32.51%下降至28.85%，散居儿童由11.13%下降至5.55%。主城区报告发病率低于周边地区，采取疫苗接种策略后，一级聚集区由建邺、江北、雨花台、江宁区，转换为高淳区（均P<0.001）。结论 水痘纳入丙类管理提高了南京市水痘监测质量，通过实施扩大免疫接种策略，报告发病水平显著下降，人群和空间分布特征发生变化。更多还原

【Abstract】 Objective To understand the epidemiological characteristics of varicella in Nanjingafter Class C management and vaccination strategy, analyzing the effect of prevention and controlmeasures, providing scientific basis for improving the prevention and control strategy.Methods We collected reported varicella cases data from 2013 to 2022 in Nanjing and utilizied the Joinpoint regressionmodel to calculate the annual percent change(APC) and the average annual percent change(AAPC) inincidence rates. We described the characteristics of temporal distribution, population distribution, spatialdistribution and spatial clustering of varicella in Nanjing from 2013 to 2022 by R program, and comparedthe changes of epidemiological characteristics between the Class C management(2017-2018) and thevaccination strategy(2019-2022).Results A total of 87 538 varicella cases were reported. The averageannual reported incidence was 102. 20/100 000, with the peak of 228. 64/100 000(19 057 cases) in2018, and declined to 98. 32/100 000(9 262 cases) in 2022, with a decrease of 57. 00%. The APCfrom 2013 to 2018 and from 2018 to 2022 were 71. 47%(95%CI: 41. 96%-107. 10%)、-15. 36%(95%CI:-35. 20%-10. 54%), respectively, and the AAPC was 25. 29%( 95%CI: 11. 03%-41. 37%). The median age of cases in 2019-2022 [10(5, 19)] was higher than that in 2017-2018 [7(5, 15)](P<0. 001), and the proportions of reported incidence reduction in each age groupunder 15years old were between 57. 46% and 90. 46%, and the peak of incidence in the age group was reduced.The proportion of students, kindergarten children and scattered children decreased from 84. 53% to75. 26%, among which the kindergarten children decreased from 32. 51% to 28. 85%, and the scatteredchildren decreased from 11. 13% to 5. 55%. The incidence rate in the main urban areas were lower thanthat in the surrounding areas. After vaccination strategy, the most likely clusters changed from JianyeDistrict, Jiangbei District, Yuhuatai District and Jiangning District to Gaochun District(P< 0. 001).Conclusions The quality of varicella surveillance in Nanjing has been improved after class Cmanagement. After vaccination strategy, the reported incidence decreased significantly, and thepopulation and spatial distribution characteristics changed.更多还原