成人麻疹病例的监测与控制

自广泛使用麻疹疫苗以来,麻疹的发病率有了大幅度降低,但成人麻疹病例不断出现。由于成人麻疹病例临床症状较重,对患者危害较大,所以引起了我们的重视。为了解我市成人麻疹的发病情况,进一步做好麻疹的控制工作,我们对1999年1月—2002年5月全市麻疹监测数据库中的50例成人麻疹病例进行了分析。现将有关情况报告如下:1 资料收集与分析1.1 资料收集 1999年1月—2002年5月麻疹监测实验室确诊病例完整的流行病学资料。包括患者基本情况、临床特征、流行病学特点、病例就诊情况及最终诊断等。实验室监测     

2005—2009年邳州市控制与消除麻疹工作进展

目的通过对邳州市2005—2009年控制与消除麻疹工作进展的分析,找出控制与消除麻疹工作的薄弱环节,明确防控工作重点,提出现阶段防控的策略和措施。方法对邳州市麻疹疫情及监测工作进行分析。结果 2005—2009年邳州市麻疹疫情总体呈上升趋势,进入2008年增速加快,2009年达20年来最高峰,发病率为20.24/10万。2—5月为麻疹发病高峰。男女发病比例1.41∶1。麻疹发病年龄<1岁的占47.5%,≥20岁的占12.9%。结论继续保持和巩固麻疹疫苗的基础免疫接种率,加大强化免疫力度,消除免疫空白人群。加强疫情监测力度和敏感性;加强全市健康人群麻疹抗体水平监测及免疫成功率的监测。     

麻疹控制与消除几个问题的榷商

从就麻疹控制与消除标准，有利条件，不利因素、措施及要注重的问题，有待解决的重要理论与实际问题作了讨论。     

麻疹的控制与消除

麻疹,作为一种疫苗可预防的疾病(Vaccine Preventable disease),在理论上应该是可以通过以免疫为主导措施达到控制乃致消除(Elimination),进而达到消灭(Eradiation)的目的。但在实践上欲达到消除和消灭的目的还存在着难以逾越的障碍,从免疫预防角度来说,就是易感人群始终存在,因为现今使用的疫苗对有母体传递抗体的婴儿,疫苗免疫不能获得绝大多数免疫成功;免疫成功后的人群抗体水平要逐步下降再次成为易感者。仅管如此,只要采取积极有力的措施是可以将麻疹发病率控制在一个极低水平。在我国现阶段还是不提消除或消灭麻疹这个目标为宜。     

麻疹疫苗应急接种控制爆发流行的效果

麻疹流行早期,开展麻疹疫苗(MV)应急接种,可以有效地控制疫情蔓延,终止流行.2001年上半年,昆山市开发区发生成人麻疹流行,其中三家企业发生爆发,迅即采取应急接种MV措施,取得了明显控制效果.     

麻疹的免疫预防与控制消除策略

麻疹是一种具有极强传染性且传播机制极易实现的急性呼吸道传染病。在广泛使用麻疹疫苗前,其发病率及死亡率经常居儿童各种传染病的首位,至今仍是发展中国家引起急性下呼吸道感染（ALRI）的主要原因[1];WHO估计,全球目前每年因麻疹死亡的儿童约140万［2］。近年来我国麻疹的发病率虽已控制在一定水平,但在不同地区和年份仍有较大起伏,学校等集中人群中麻疹暴发流行时有发生[3、4]。如何进一步采取有效措施将麻疹发病率控制在一个极低水平,进而实现消除和消灭麻疹的目的,已成为摆在广大卫生工作者面前的一项重要课题。本文特就当前…     

2000-2010年全球麻疹控制进展(译文)

在1980年普遍使用麻疹疫苗前,全球估计有260万人死于麻疹.WHO和UNICEF认识到其疾病负担后,开始实施加速降低麻疹死亡策略:通过常规免疫服务和补充免疫活动(supplementary immunization activities,SIAs)给所有儿童接种2针次含麻疹成分(measles-containing vaccine,MCV)的疫苗,同时加强监测.此策略自2001年实施以来,麻疹死亡人数从2000年的73.3万下降至2008年的16.4万.在2010年世界卫生大会上,所有成员国提出将2015年的麻疹控制指标作为实现全球最终消灭麻疹的里程碑,指标包括:①在国家层面提高常规免疫第1针含麻疹疫苗(MCV1)覆盖率超过90％,在每一区县或同等行政单位层面疫苗接种覆盖率超过80％;②使麻疹年发病率下降至0.05/万以下并维持之;③与2000年估计值相比,使麻疹死亡率下降95％以上.     

控制和消除麻疹策略分析

麻疹作为计划免疫所针对的疾病之一,已得到有效控制,发病率呈下降趋势。麻疹疫苗接种率和接种质量的提高在麻疹预防工作中起了重要作用,研究麻疹防制策略可以为控制和消除麻疹提供科学指导。     

麻疹的预防与控制

麻疹（Measles）是由麻疹病毒引起的急性呼吸道传染病，在疫苗前时代，除新生儿短时期内受母传麻疹特异性抗体保护外，人人易感，好发于儿童，发病率高，呈周期性流行，是严重危害儿童健康的1种疾病。随着麻疹疫苗的广泛应用，麻疹发病率大幅度下降。     

麻疹的预防与控制

1麻疹病原学及流行病学 麻疹(Measles)是由麻疹病毒引起的急性呼吸道传染病,在疫苗前时代,除新生儿短时期内受母传麻疹特异性抗体保护外,人人易感,好发于儿童,发病率高,呈周期性流行,是严重危害儿童健康的1种疾病.随着麻疹疫苗的广泛应用,麻疹发病率大幅度下降.广东省疾病预防控制中心,广东广州 510300     

Jamaica''s measles elimination experience.

OBJECTIVES: This article describes the effort to eliminate measles from Jamaica and its impact on measles incidence. METHODS: In addition to routine measles vaccination, the Jamaican Ministry of Health implemented a strategy of a 1-time-only catch-up vaccination campaign, conducted in 1991, and periodic follow-up campaigns, the first of which occurred in 1995. RESULTS: Since 1991, despite careful surveillance, no serologically confirmed indigenous cases of measles have occurred in Jamaica. CONCLUSIONS: Measles virus circulation has been interrupted in Jamaica. The Jamaican experience provides further evidence that global measles eradication is achievable.     

Monitoring measles elimination in Victoria

OBJECTIVES: To weigh the evidence from outbreak data that Victoria has achieved, and is maintaining, elimination of measles. To identify age groups that measles vaccination has not protected adequately. METHODS: Data on observed measles outbreaks in Victoria since the start of 1998 are used to estimate the reproduction number of cases, and the probability that it is maintained below unity, its threshold value for elimination. The relative susceptibility to measles is estimated as a function of age, with confidence intervals. RESULTS: Seventeen measles introductions led to secondary cases, while 22 were single-case introductions. From these, the probability that the reproduction number for cases exceeds unity is estimated to be 0.044, or less, depending on assumptions made. There is no evidence that the reproduction number increased over time. Those aged between 19 and 32 years were most susceptible, followed by those in the first and second year of life. CONCLUSIONS: The data provide strong evidence that Victoria has maintained elimination of measles over the period 1998 to mid-2003. There is scope to improve the immunisation coverage. It is not clear how much outbreak intervention is contributing to the success in achieving apparent elimination. IMPLICATIONS: To prevent importations from causing a major epidemic of measles, Victoria must maintain its immunisation coverage and outbreak control at current levels, or better. It is important to monitor the control of measles even when elimination is achieved.     

Role of oral-fluid based measles diagnostic methods for measles global elimination

Measles eradication is biologically feasible. There is an availability of a safe, effective and inexpensive vaccine; a proven elimination strategy; high Local demand; and an effective global partnership and initiative to support vaccination. Measles eradication is a cost-effective scenario and a good investment to avoid expensive epidemics and save those children die due to measles. Laboratory investigations are indispensable to monitor the progress of measles elimination. This role will require the development of more sensitive diagnostic methods suitable for diagnosis and surveillance, genetic analysis of measles strains and a technology which is transferable worldwide. Measles diagnosis relies increasingly on serological tests. The practical utility of oral-fluid methods (antibody and genetic) in evaluating and refining measles immunization programs would, additionally, provide support for a global surveillance initiative. The utility of in a population survey, in a vaccine sero-conversion study and application in molecular epidemiological use is demonstrated in this review. It is to be hoped that this review will assist in the wider uptake and acceptance of methodology in both developed and developing country situation. More research needed for further evaluation of a recently developed point-of-care test for measles diagnosis: detection of measles-specific IgM antibodies and viral nucleic acid for wider use oral-fluid methodology. There is a strong case and imperative for the promotion of methods by World Health Organization in its global program of control/eradication of measles over the coming decade.     

Progress towards measles elimination in Singapore

ObjectiveWe describe the epidemiological trends of measles in Singapore in relation to its progress towards measles elimination and identify gaps in fulfilling the World Health Organization Western Pacific Regional Office regional measles elimination criteria.MethodsEpidemiological data on measles maintained by the Communicable Diseases Division, Ministry of Health from 1981 to 2012 were collated and analysed. Data on measles vaccination coverage were obtained from the National Immunization Registry and School Health Services, Health Promotion Board. To assess the seroprevalence of the population, the findings of periodic seroepidemiological surveys on measles were traced and reviewed.FindingsWith the successful implementation of the National Childhood Immunization Programme using the monovalent measles vaccine, measles incidence declined from 88.5 cases per 100,000 in 1984 to 6.9 per 100,000 in 1991. Resurgences were observed in 1992, 1993 and 1997. A ‘catch-up’ vaccination programme using the trivalent measles, mumps and rubella (MMR) vaccine was conducted in 1997, followed by introduction of the two-dose vaccination schedule in January 1998. Measles incidence subsequently declined sharply to 2.9 per 100,000 in 1998. Vaccination coverage was maintained at 95% for the first dose and 92–94% for the second dose. Seroprevalence surveys showed seropositivity for measles IgG antibodies in over 95% of adults in 2004, and in 83.1% of children aged 1–17 years in 2008–2010. Sporadic cases with occasional clusters of two or more cases continued to occur among the unvaccinated population, especially children aged below 4 years. The predominant measles virus genotype has shifted from D9 to the B3 and G3 genotypes, which are endemic in neighbouring countries.ConclusionSingapore has made good progress towards the elimination of endemic measles. To further eliminate sporadic cases of measles, the national immunisation schedule has recently been amended to vaccinate children with 2 doses of MMR vaccine before 2 years of age.     

浙江省麻疹消除进展研究

目的评价浙江省麻疹消除进展,为实现麻疹控制目标提供控制指标依据。方法采用指数曲线模型预测麻疹发病率,季节趋势模型模拟麻疹季节模式,定基比计算预期季节模式。结果麻疹季节模型的平均残差率在-2.48/100万~4.63/100万,2009年浙江省麻疹实际发病率多数在目标线内,仅有13周的实际发病率略超出目标发病率,但幅度不大,波动在0.002/100万~0.209/100万,且均在预警线范围内;欲实现2012年消除麻疹的目标,2012年最后一周的周发病率的目标发病率应在0.004 8/100万以下,预警值和行动值分别为0.016 8/100万,0.022 8/100万。结论浙江省麻疹实际发病率与预测发病率接近,控制效果较好,指数曲线模型可为实现麻疹控制目标提供控制指标依据,为当前的麻疹控制措施提供一定参考。     

Rubella elimination programme strengthened through measles elimination programme in Catalonia

The drastic fall in rubella cases recorded in Catalonia from 1988 on, when the second dose of Measles-Mumps-Rubella (MMR) vaccine was implemented, and especially from 1998, when the measles elimination programme began, led to the introduction, in May 2002, of the rubella and congenital rubella syndrome elimination by 2005 programme. From May 2002 to May 2004, 13 suspected rubella cases were reported to the Statutory Disease Reporting System; of these, one postnatal case and one congenital rubella case were confirmed (15.4%), both being imported cases. Through the screening of viruses established in the measles elimination programme, 28 possible cases were analyzed and six (21.4%) confirmed imported postnatal rubella cases were detected. The small number and imported nature of the cases of rubella and the detection of the majority of the confirmed cases through the measles elimination programme, strongly suggests that both programmes should continue.     

Monitoring of measles elimination using molecular epidemiology

The different measles virus genotypes are confined to more or less distinct geographic regions. Molecular characterization of virus isolates has been successfully used to determine epidemiological links between cases and the geographic origin of imported viruses. In Europe, indigenous measles has been eliminated in some countries, but in others the disease is still endemic. Intra-outbreak variability can be used to differentiate between sporadic endemic cases and a 'pseudo-outbreak' of unrelated imported cases. The interruption of virus circulation by mass vaccination campaigns could be demonstrated by comparing the variability of pre-campaign viruses with post-campaign isolates. Simplified tools are being developed that could bring genotyping within reach of laboratories that do not have the possibility of sequencing.     

2010年保定市麻疹流行病学特征与消除麻疹工作进展情况

目的分析保定市2010年麻疹流行病学特征与消除麻疹的进展状况,为2012年消除麻疹提供科学依据。方法利用麻疹监测信息管理报告系统的数据,对保定市2010年的麻疹流行特征及为消除麻疹所采取的措施进行描述流行病学分析。结果保定市2010年麻疹发病呈大幅度上升,发病率为26.61/10万,比2009年上升了393%,为1999年开展麻疹监测以来的最高年份;每年3—5月为发病高峰;病例主要集中在山区县和较大的县级市;发病主要集中在≤2岁、其次为3～5岁、20～34岁年龄组。结论 2012年保定市实现消除目标形势严峻,必须认真贯彻落实《全国消除麻疹行动方案》中的各项措施,提高常规免疫接种率及首针及时率,并加强重点地区、重点人群免疫规划管理,做好疫情调查和处置,提高麻疹监测系统的敏感性和特异性。