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目的描述离石区2014年麻疹暴发原因,对采取的措施进行效果评价,为更好地指导麻疹防控工作提供依据。方法采用主动搜索、病例调查、查验接种证等方法进行资料收集,并进行流行病学特征分析;采用酶联免疫吸附试验(ELISA)对血清学标本进行麻疹IgM抗体检测。用逆转录聚合酶链反应(RT-PCR)方法对咽拭子标本进行核酸检测。用Vero/slam细胞培养麻疹核酸阳性咽拭子标本,分离出麻疹病毒后进行核酸序列测定。结果 2014年9月26日~12月1日共报告271例确诊麻疹病例;散居儿童最先开始发病,随后小学生和幼托儿童,最后成人发病;病例以15岁以下儿童、散居儿童为主;78.60%的病例无免疫史;69.4%的病例为非离石区户籍;麻疹IgM抗体阳性62例,核酸阳性69例,分离出13株H1a基因型麻疹病毒;评估的适龄儿童含麻疹成分疫苗(MCV)接种率<75%;累计应急接种麻疹风疹联合疫苗(MR)71 882剂次。结论 MCV常规免疫接种率低是造成此次暴发疫情的主要原因;采取以MR应急接种为主的综合措施能有效阻断麻疹暴发疫情的传播。
Objective To describe the causes of measles outbreak in Lishi area in 2014 and evaluate the effect of measures taken to provide evidence for better guidance on prevention and control of measles. Methods The methods of active search, case investigation and vaccination were used to collect the data, and the epidemiological characteristics were analyzed. The serological samples were detected by enzyme-linked immunosorbent assay (ELISA). The nucleic acid detection of throat swab specimens was performed by reverse transcription-polymerase chain reaction (RT-PCR). Measles nucleic acid positive throat swab specimens were cultured with Vero / slam cells and the measles virus was isolated and sequenced. Results A total of 271 confirmed cases of measles were reported from September 26 to December 1, 2014; scattered children started their illness first, followed by primary school children and kindergarten children, and finally adults. The cases were mainly children under 15 and scattered children. 78.60% of the cases had no history of immunization; 69.4% of the cases were of non-family members; 62 cases were positive for measles IgM antibody and 69 were positive for nucleic acid; 13 strains of H1a genotype were isolated from measles virus; MCV) vaccination rate <75%; cumulative vaccination of measles and rubella combined vaccine (MR) 71 882 doses. Conclusion The low rate of routine MCV vaccination is the main reason for the outbreak. The combination of MR vaccination can effectively block the spread of measles outbreak.