陇南市麻疹及风疹疑似病例IgM抗体检测分析

目的分析2013年甘肃省陇南市疑似麻疹、风疹病例血清学检测结果,了解其流行特征,为促进免疫规划工作提供科学依据。方法用ELISA法检测麻疹、风疹疑似病例血清标本的IgM抗体。结果全年共检测麻疹、风疹IgM抗体266份,检出麻疹IgM抗体阳性141份,阳性率53.00%;检出风疹IgM抗体阳性57份,阳性率21.43%;麻疹发病以4岁以内儿童及20岁以上成人为主,风疹以青少年居多;流行季节主要为3─6月。结论提高易感人群的免疫力仍是免疫规划工作的重点;城镇流动人口的增加是引起麻疹流行的重要原因,应加强流动人口的管理,为易感人群接种免疫疫苗,以建立和保持人群高水平的免疫屏障,同时做好疫情监测,预防疾病的暴发流行。     

2011—2012年甘肃省麻疹实验室网络运转与监测分析

目的评价2011—2012年甘肃省麻疹实验室运转状况,为如期实现消除麻疹目标提供依据。方法对2011--2012年甘肃省麻疹实验室网络（MLN）血清IgM检测、病原学监测、实验室质量控制数据进行分析。结果麻疹监测系统（MSS）报告甘肃省疑似麻疹1275例,采集血清标本1242份,采集率97．41％;麻疹IgM抗体阳性710份,阳性率57．16％;检测风疹血清标本1198份,阳性率20．36％;2011—2012年共收到疑似麻疹、风疹咽拭子标本1019份,分离出58株麻疹病毒,鉴定为Hla基因亚型;分离出风疹病毒20株,为1E基因型;2011—2012年甘肃省疾病预防控制中心麻疹实验室。通过了世界卫生组织和国家麻疹实验室组织的现场认证,血清盲样考核和血清复核符合率均为100．00％;全省14个市、州疾病预防控制中心麻疹网络实验室,连续两年通过了省疾病预防控制中心组织的职能考核和现场认证,血清盲样考核符合率96．67％,血清抽样复核符合率98．41％。结论2011—2012年甘肃省MLN运转良好,为麻疹疑似病例实验室诊断和麻疹流行监测提供了技术支撑,为阻断麻疹病毒传播提供了科学依据。     

2005年新疆麻疹疑似病例IgM抗体检测结果分析

目的对新疆麻疹疑似病例进行鉴别诊断,正确掌握强化免疫后麻疹疫情动态。方法2004年11月对全疆学龄前和学龄儿童进行麻疹疫苗强化免疫,2005年对收到的237例麻疹疑似病例血清标本测定了麻疹IgM抗体和风疹IgM抗体。结果麻疹IgM抗体阳性率3.38%,风疹IgM抗体阳性率67.62%,8个月~14岁年龄组184例,风疹阳性率最高(64.67%)。结论有部分风疹病例误诊为麻疹,提示我们在麻疹消除阶段应密切注意风疹的流行和监测。     

2005～2012年甘肃陇南市麻疹疑似病例IgM抗体检测结果分析

目的检测麻疹疑似病例血清中麻疹IgM抗体,为麻疹的预防和控制提供科学依据。方法用酶联免疫吸附试验（ELISA）对2005～2012年甘肃陇南市839例麻疹疑似病例的血清标本进行IgM抗体检测,数据用Spss19．0软件进行统计学分析。结果共检出麻疹IgM抗体阳性534份,阳性率63．6％;每年都有病例报告,其中2008年阳性率最高,为82．6％;各区（县）均检出阳性病例,不同地区阳性检出率差异有统计学意义（χ2=86．917,P〈0．05）;发病人群集中在8月龄。25岁年龄段,占阳性病例总数的74．5％;麻疹每月均有发病,但高峰在3～7月。结论检测麻疹IgM抗体对病例的早发现、早诊断、早治疗、及时采取控制措施起到关键作用,各级医疗机构要重视疑似病例的血清采集工作,同时应大力加强麻疹基础免疫和重点人群的强化免疫工作;高度重视查漏补种工作,消除免疫空白点,提高免疫接种的覆盖率和及时率;加强健康教育工作,提高麻疹预防知识的知晓率。     

巨细胞病毒活动感染与冠心病

目的：探讨人类巨细胞病毒（HCMV）近期感染与冠心病（CAD）的关系。方法：用ELISA法检测正常人群（365例）和CAD（急性心肌梗死41例、心绞痛79例和隐匿型CAD111例）人群血清HCMV—IgM抗体,并通过检测血清肌酸肌酶同工酶（CK—MB）将CAD人群分为急性组和慢性组,比较两组HCMV—IgM抗体水平的差异。结果：在231例病人血清标本中,HCMV—IgM抗体阳性95例（41．1％）;在对照组中,365例健康查体者HCMV—IgM抗体阳性84例（23．0％）。两组相比较有极显著性差异（X^2=22．08,P〈0．0001）。急性心肌梗死组阳性24例（58．5％）同心绞痛组31例（39．2％）和隐匿型CAD组40例（36％）相比,HCMV—IgM抗体阳性率有显著性差异（X^2=4．04,P〈0．05和6．21,P〈0．025）。CK—MB阳性组43例（51．2％）和CK—MB阴性组55例（37．4％）相比,HCMV—IgM抗体阳性率有显著性差异（X^2=4．15,P〈0．05）。结论：CAD人群有较高的HCMV—IgM抗体阳性率,急性CAD人群的HCMV—IgM抗体阳性率要显著高于慢性CAD。     

猪群血液内麻疹血凝抑制抗体样物质的观察研究

目的 了解麻疹血凝抑制抗体样物质在猪群中的分布情况。方法 采用麻疹血凝抑制试验,并用白陶土法去除非特异性凝集素的干扰。结果 检测１９２份猪血标本,麻疹血凝抑制抗体阳性１５８份,阳性率８２．２９％,平均抗体滴度（ＧＭＴ）１：３．５,以１：２￣１：４的低抗体为主（７８．４８％）。结论 在本地猪群血液中所检出的麻疹血凝抑制抗体样物质,并非由于猪感染与麻疹病毒有近缘关系的牛瘟病毒或犬瘟病毒而出现的一种交叉     

2009─2013年甘肃省风疹病原学监测结果分析

目的了解甘肃省风疹病毒流行情况,进行风疹野病毒流行株的分离、鉴定。方法2009—2013年从甘肃省风疹暴发和散发病例中采集具有风疹典型症状患者咽拭子标本255份,经用非洲绿猴肾细胞／淋巴信号激活因子转染的非洲绿猴肾细胞（Veto/SLAM）从风疹病例咽拭子标本中分离风疹野病毒,用逆转录．聚合酶链反应（RT-PCR）对风疹病毒株进行基因型别检测分析。结果2009—2012年甘肃省共报告疑似风疹7964例,临床诊断7334例,实验室诊断630例,对送检的255份风疹疑似病例咽拭子标本中分离出35株风疹野病毒,分离率为13．73％;分离鉴定出的35株风疹野病毒病例中,年龄主要集中在15岁以下,共30株,占阳性毒株总数的85．71％,15岁以上的5株,占阳性毒株的14．29％;35株风疹野病毒流行株主要分布在甘肃省9个市、州的17个县、区。结论甘肃省2009～2013年风疹野病毒流行优势株为IE基因型,是甘肃省风疹病毒优势株。     

抗体捕捉酶联免疫吸附法在流行性乙型脑炎早期诊断上的应用

用MacELISA测定了138份临床疑似乙脑病人的血清标本,并与HI试验进行了比较。MacELLSA能特异、敏感地检出乙脑患者发病第2天的IgM抗体,阳性率为55.56％。第4、5病日,IgM抗体阳性率高达92.86％。10例正常人和10份流行性出血热病毒抗体阳性的血清标本无一份阳性。     

2006年娄底市麻疹实验室监测结果分析

目的 揭示娄底市麻疹IgM抗体的分布特征,探讨该市麻疹相对高发的主要原因.方法 采集麻疹疑似病例血清标本用ELISA法检测IgM抗体,全部数据录入MS Excel并用SPSS软件进行分析.结果 308份合格血清IgM总阳性率为50.99%,其中按要求完整填写相关信息的219份,标本总阳性率为49.32%;按有明确免疫史、无免疫史和免疫史不详分3组统计,其阳性率分别为38.46%,46.52%和52%,3组阳性率无统计学差异(χ2=1.793 0,P=0.408 0);按采样时间分组统计,出疹后5～10日采样检测阳性率显著高于其他组(χ2=16.967 0,P＜0.000 1),对其中麻疹IgM阴性的34份血清做风疹IgM检测,结果仅有4份显示弱阳性.结论 麻疹IgM检测采样的最佳时间为出疹后5～10日;免疫空白人群和原始免疫失败为本市麻疹感染发病的主要影响因素.     

9月龄～6岁健康儿童麻疹和风疹抗体水平监测

目的 了解新疆阿克苏地区9月龄～6岁健康儿童麻疹和风疹抗体水平,及时发现免疫薄弱人群,采取针对性免疫措施.方法 采用分层随机抽样法,采集839名9月龄～6岁健康儿童血清标本,采用酶联免疫吸附试验(ELISA)检测麻疹和风疹IgG抗体.结果 839名儿童麻疹抗体阳性率为94.3％,抗体几何平均滴度(GMT)为1 541.2 mIU/ml;风疹抗体阳性率为92.1％,抗体几何平均滴度(GMT)为958.4 mIU/ml.不同免疫剂次和不同年龄组儿童麻疹、风疹抗体阳性率和GMT水平不同,差异有统计学意义(P＜0.05).结论 阿克苏地区9月龄～6岁健康儿童麻疹、风疹IgG抗体水平总体较高,但仍存在薄弱环节,1岁以下儿童是麻疹和风疹的高危人群,应加强此部分人群的针对性免疫策略.     

Comparative evaluation of assays for IgM detection of rubella and measles infections

BackgroundSerological diagnosis of infections due to measles and rubella viruses is done by IgM detection. The aim of this study was to comparatively evaluate commercial systems for detecting IgM against both viruses, including those of ELISA, in indirect and capture formats, chemiluminescence and electrochemiluminescence.MethodsSeven (for rubella) and six (for measles) assays were studied. One hundred and sixty two samples were included in the study (from 90 rubella and 72 measles cases), and all were analyzed in all the assays.ResultsThe ranges of sensitivity, specificity and agreement for rubella were 94.8–100%, 52.4–100% and 75.5–98.1%, respectively. The corresponding ranges for measles assays were 87.0–100%, 53.3–100%, and 73.0–99.4%.ConclusionThe best-performing assays were chemiluminescence (for measles and rubella IgM), and electrochemiluminescence (for rubella IgM).     

Post mass-immunization measles outbreak in Taoyuan County, Taiwan: dynamics of transmission, vaccine effectiveness, and herd immunity.

OBJECTIVES: Analysis of national surveillance data and a seroepidemiologic investigation were conducted to elucidate the causes and epidemiologic characteristics of a measles outbreak in Taoyuan, Taiwan, 1994. METHODS: Measles cases were identified through a national surveillance system. Reported cases and their physician or school nurses were interviewed to trace additional suspect cases and were sampled for serologic diagnosis. Measles-specific IgG and IgM were assayed. A confirmed case was defined as being positive for measles IgM test but not having received measles vaccination within the previous 3 months. RESULTS: The outbreak began in Taoyuan City in December 1993 and continued to spread in primary schools and kindergartens, but caused only sporadic cases in neighboring towns. Among 42 confirmed cases, 15 (38%) were primary school children and 16 (38%) were kindergarten children. Among 24 confirmed cases with a vaccination record, 7 had one dose of vaccination, 4 had two doses of vaccination, and 13 (54%) were unvaccinated. The overall measles susceptible proportion at a kindergarten before the outbreak was 8.1% (17/209) and the overall measles cumulative incidence among susceptibles was 0.65 (11/17). CONCLUSIONS: A measles vaccination coverage of 82% with the first dose at 9 months of age and 63% with the second dose (measles, mumps, and rubella) at 15 months was inadequate to block measles virus circulation in Taoyuan City in 1994. The city center, with a growing population, represents a high risk as an epicenter for measles outbreaks. Measles outbreaks may occur in a school population with 92% herd immunity.     

Population-based case-control study of measles, mumps, and rubella and inflammatory bowel disease

BACKGROUND: Previous controversy was generated over the hypothesis that a paramyxovirus such as measles or vaccination against such viruses might be causally associated with inflammatory bowel disease (IBD). We aimed to determine if Crohn's disease (CD) or ulcerative colitis (UC) subjects are more likely to be seropositive for measles, mumps, or rubella than controls. METHODS: Using our population-based University of Manitoba IBD Research Registry we recruited CD (n = 235) and UC (n = 137) subjects ages 18-50 years for a study involving detailed questionnaires and venipuncture. We accessed the population-based databases of Manitoba Health (single provincial health insurer) to get age-, gender-, and geography-matched non-IBD controls (n = 310). We used a standard enzyme-linked immunosorbent assay (ELISA) to measure serum antibodies. RESULTS: Seropositivity for measles and mumps was similar in controls (98.1%, 78.4%, respectively) as in CD (96.2%, 72.3% respectively) and in UC (95.5%, 74.6%, respectively). However, controls were significantly more likely to be seropositive for rubella (98.1%) than were CD cases (91.0%, P < 0.0002) or UC cases (93.3%, P = 0.01). Males accounted for the significantly lower rates of seropositivity to rubella with CD. While we determined that significantly more controls than CD were vaccinated, we cannot be sure if the increased rate of rubella seropositivity in controls is secondary to wildtype or vaccine-associated infection. CONCLUSIONS: These data suggest there is no association of having acquired measles, mumps, or rubella (by natural infection or through vaccination) and CD or UC. If anything, these data may suggest some protective effect of having acquired rubella infection or vaccine against acquiring CD.     

Expansion of the global measles and rubella laboratory network 2005-09

Enhancing measles surveillance with integration of epidemiologic and laboratory information is one of the key strategies for accelerated measles control and elimination. The World Health Organization (WHO) Global Measles and Rubella Laboratory Network (LabNet) has been developed since 2000 to currently include 690 laboratories serving 183 countries. The LabNet testing strategy follows well-validated, standardized procedures for confirming suspected cases and for monitoring measles and rubella virus transmission patterns. The strength of the LabNet is a strong quality assurance program that monitors the performance of all laboratories through annual proficiency testing and continuous assessment. In the 5-year period 2005-2009, the results of >1 million measles immunoglobulin M (IgM) tests have been reported by the LabNet and, in addition, sequence information on >7000 measles and 600 rubella viruses has been shared. Progress with the development of the LabNet during 2005-2009 is discussed.     

A large rubella outbreak, Romania--2003

Romania experienced a large rubella outbreak in 2002-03, with more than 115,000 reported cases nationwide, and an incidence of 531 reported cases per 100,000 population. The incidence was highest in children of school age. The cohorts of adolescent girls vaccinated in 1998 and 2002 (when a rubella-containing vaccine was available) had significantly lower incidence rates (p<0.001) compared with those in boys in the same age groups who were not vaccinated. In 2003, of the 150 suspected congenital rubella syndrome (CRS) cases reported, seven (4.6%) were confirmed by positive rubella IgM antibodies. In the absence of available rubella containing vaccine for outbreak control, an outbreak response plan to improve the detection of cases and to limit rubella virus transmission was developed. The following activities were conducted: surveillance of pregnant women with suspected rubella or history of exposure to rubella virus was implemented, with follow up of pregnancy outcomes; surveillance for CRS was strengthened; existing infection control guidelines to prevent disease transmission within healthcare facilities were reinforced; and a communication plan was developed. In May 2004, Romania is introducing measles, mumps and rubella (MMR) vaccine for routine vaccination of children aged 12 to 15 months, while continuing vaccination of girls in the 8th grade of school (13-14 years of age) with rubella-only vaccine.     

Progress toward measles and rubella elimination in Egypt

Measles and rubella were common infectious diseases in Egypt during the prevaccine era. Monovalent measles vaccine was introduced in 1977, and measles vaccination coverage increased from <50% to >90% from 1980 to 1999; however, measles outbreaks continued to occur at 2- to 4-year intervals during this period. After the introduction of a second routine dose of measles vaccine as a combined measles-mumps-rubella (MMR) vaccine in 1999 and the implementation of measles immunization campaigns targeting 6- to 16-year-old children during 2000-2003, reported measles cases dramatically decreased by 2003. In 2002, Egypt established a goal to eliminate measles and rubella and to prevent congenital rubella syndrome (CRS) by 2010. Large-scale rubella and measles outbreaks in 2005-2007, however, led to a revision of the plan of action to achieve the 2010 goals. A nation-wide measles-rubella immunization campaign, targeting children, adolescents, and young adults 2-20 years old, was conducted in 2 phases during 2008-2009 and achieved coverage >95%. With the decrease to record low levels of cases of measles and rubella in 2009 and 2010, Egypt should achieve measles and rubella elimination in the near future, but high coverage(>95%) with 2 doses of measles-rubella vaccine needs to be maintained, measles-rubella surveillance strengthened, and CRS surveillance developed.     

Enhanced laboratory surveillance for the elimination of rubella and congenital rubella syndrome in the Americas

One of the reasons the 1997 Technical Advisory Group on Vaccine-Preventable Diseases recommended acceleration of rubella and congenital rubella syndrome (CRS) prevention efforts was the fact that the enhanced measles surveillance system in the Americas found that 25% of reported measles cases were laboratory-confirmed rubella cases. Until 1997, the laboratory network primarily focused on measles diagnosis. Since 1999, due to the accelerated rubella control and CRS prevention strategy, laboratories have supported the regional measles, rubella, and CRS elimination goals. The measles-rubella laboratory network established in the Americas provides timely confirmation or rejection of suspected measles and rubella cases, and determination of the genotypic characteristics of circulating virus strains, critical information for the programs. A quality assurance process has ensured high-quality performance of procedures in the network. Challenges are occurring, but the measles-rubella laboratory network continues to adapt as the requirements of the program change, demonstrating the high quality of the laboratories in support of public health activities and elimination goals.     

婴儿麻疹风疹减毒活疫苗联合免疫血清流行病学研究

目的为探讨麻疹、风疹减毒活疫苗联合免疫的可行性。方法于1997年4～12月随机选择了342名8月龄婴儿进行研究,所有入选婴儿被随机分成3组,第1组105人,皮下接种BRD-Ⅱ株风疹疫苗;第2组105人,分别在左右臂同时皮下接种风疹疫苗和麻疹疫苗;第3组132人,皮下接种沪191株冻干麻疹疫苗。结果在免疫前,第1组与第2组的风疹血凝抑制(HI)抗体阳性率均为2.86％,几何平均滴度(GMI)均为1:1.06,第2组与第3组麻疹HI抗体阳性率分别为2.86％和5.30％,GMT为1:1.02和1:1.60。免疫后1个月,第1组与第2组的风疹HI抗体阳性率分别为98.10％和99.05％,GMT分别为1:144.15和1:148.99。两者的差异无显著的统计学意义。第2组与3组的麻疹HI抗体阳性率分别为99.05％和97.73％,GMT分别为1:35.10和1:32.85,两者的差异亦无显著的统计学意义。所有免疫的儿童均未发现局部和全身反应。结论研究结果表明:风疹、麻疹减毒活疫苗联合免疫可产生与常规免疫相同的免疫应答,风疹疫苗初免月龄定于8月龄与麻疹疫苗联合免疫是可行的。