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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。
Objective To study the clinical symptoms and influencing factors of measles in the vaccine era and to evaluate the surveillance results of different measles cases. Methods From 2004 to 2008, Jinhua City, measles monitoring system, select the cases were classified as confirmed measles and measles cases, and the absence of clinical symptoms information of 3041 cases of suspected measles cases as the study to collect their gender, age, measles Attenuated live vaccine immunization history and clinical symptoms and other information. Results The incidences of cough, catarrh rhinitis and conjunctivitis were 97.3% / 74.4%, 82.3% / 50.0% and 79.6% / 51.0%, respectively, in the confirmed / excluded cases of measles. The differences were statistically significant (χ2 = 373.107, χ2 = 355.836, χ2 = 272.085; P <0.001). Age and immune history are the influencing factors of catarrhal rhinitis. After adjusting the age mixed factors, odds ratio (OddsRatio) of catarrh rhinitis in measles patients with 1 dose and ≥2 doses immunization, OR adjusted) were 0.410 [95% confidence interval (CI) 0.270-0.623, P <0.01] and 0.394 (95% CI: 0.285-0.545, P <0.01), respectively. In addition, the history of immunization is also related to conjunctivitis. Compared with 0 doses, the OR of conjunctivitis in measles patients immunized with 1 dose and ≥2 doses were 0.620 (95% CI: 0.432 ~ 0.890, P <0.05) and 0.618 (95% CI: 0.427 to 0.950, P <0.01). The current definition of measles surveillance has the highest sensitivity (98.9%) with a specificity of 12.8%; a case definition of “fever, rash with cough, catarrh rhinitis, and conjunctivitis” The highest specificity (68.2%); the case definition of “fever, rash, accompanied by symptoms of cough and catarrhal rhinitis” had a better Kappa value and a better receiver operating characteristic curve. Conclusion In the vaccine era, most patients with measles were mild and atypical infections. Laboratory tests have become an important basis for differential diagnosis. In the process of elimination of measles, depending on the incidence rate to select the appropriate case definition of measles monitoring to improve monitoring effectiveness.