文水县2005年麻疹监测流行病学分析

目的了解交水县麻疹流行状况,加速控制和消除麻疹。方法对我县2005年麻疹监测数据进行回顾性分析。结果我县2005年麻疹流行呈散发和暴发并存模式,年龄为混合模式,但仍以<15岁儿童为主,占发病总数的74.07%。在54例病例中,有免疫史者占55.56%;无免疫史者占16.67%;免疫史不详者占27.78%。结论加强计划免疫工作,提高常规免疫接种率;开展MV初始强化免疫;控制麻疹的暴发;加强流动儿童计划免疫工作管理,提高监测系统的敏感性。     

2004-2010年聊城市麻疹流行特征与防控策略探讨

目的了解聊城市麻疹流行特征,探讨麻疹消除阶段防控策略。方法采用描述流行病学方法对聊城市2004-2010年麻疹发病资料进行分析。结果聊城市2004-2010年累计确诊麻疹病例1 991例,年平均发病率为4.97/10万,相对高发年为2008年和2010年;发病呈局部高发和高度散发状态;冬末至夏季为流行季节,其中4月和5月各出现两次发病高峰;年龄主要集中在0～2岁年龄组(占47.71%)和≥15岁年龄组(占25.51%);职业以散居儿童(占58.36%)和农民(占15.02%)为主;1岁以下散居儿童发病呈上升趋势(P<0.05),6～14岁学生发病呈下降趋势(P<0.05)。2009-2010年麻疹实验室确诊病例中,无免疫史和免疫史不详者是麻疹病例高发人群。结论全面实施以提高MV常规免疫接种率、加强病例监测工作、预防医院内感染和适时开展重点人群MV强化免疫等综合性防控策略是最终消除麻疹的关键。     

宿州市2005-2008年麻疹流行特征分析及消除对策探讨

目的研究宿州市2005-2008年麻疹的流行特征,探讨消除麻疹的措施。方法采取描述性流行病学方法 ,对麻疹监测系统的数据进行统计分析。结果 2005-2008年宿州市麻疹年均发病率为5.18/10万,2005年发病率最高;以小年龄组发病为主,5岁以下的小年龄组发病呈逐年上升趋势,尤其是1岁组儿童发病上升明显。对184例8月龄至5岁的麻疹病例进行麻疹疫苗(MV)免疫接种史情况分析,0剂次者占39.13%,1剂次者占35.33%,接种剂次不详者占22.28%。结论开展MV强化免疫活动,做好常规免疫接种工作,提高MV接种率和及时接种率,加强麻疹疑似病例的监测,预防医院内感染等是宿州市实现控制和消除麻疹目标的关键。     

2005～2009年仁寿县麻疹流行特征分析

目的:分析仁寿县2005～2009年麻疹流行病学特征,为进一步完善和制定控制与消除麻疹策略提供科学依据.方法:对仁寿县2005～2009年的麻疹病例进行描述流行病学分析.结果:2005～2009年仁寿县共报告麻疹病例126例,年平均报告发病率为1.60/10万,流行模式以散发为主,偶有流行;4～9月为高发季节;发病人群主要是散居儿童、托幼儿童和学生.小于8个月和大于18岁年龄组麻疹发病有增多趋势;报告的126例麻疹病例中,达到MV免疫月龄(≥8月龄)的有106例,其中无免疫接种史的46例(43.40%);有免疫接种史的34例(32.08%);免疫史不详的26例(24.52%).结论:加强麻疹的监测、保持MV高接种率、实施应急接种和强化免疫,有效防止麻疹暴发流行,将是今后控制和消除麻疹的重点.     

麻疹住院患者的临床分析及预防对策探讨(附462例报告)

目的 探讨住院麻疹患者的临床表现及流行新特点,为预防提供有针对性的参考对策.方法 将462例麻疹患者分为婴儿组(16d～＜1岁)、儿童组(1～17岁)、成人组(18～50岁),对其临床资料进行总结分析.结果 观察期间各月份均有麻疹住院病例,1～6月份398例,占86.1%,5月份最高,为104例,高发时间较以往向后延迟近1个月.流动人口患病多于常住人口,占68.2%.1岁以内婴儿占住院麻疹患者的49.6%,成人占28.1%,高发年龄段明显提前.麻疹集中好发年龄段,婴儿组为6～9个月龄,占64.6%;儿童组为1～5岁,占70.9%;成人组为18～39岁,占86.2%.8个月龄以上、符合麻疹计划免疫接种条件的349例中,接种疫苗者占12.0%,未接种者占88.0%;婴儿组中符合接种条件的116例中有17例接种疫苗,占14.7%;儿童组有接种史者占17.5%;成人组有明确疫苗接种史者仅占5.4%.有明确麻疹接触史者占19.0%.临床以上呼吸道卡他症状、充血性皮疹和发热为主要表现,婴儿组以肺炎、腹泻和白细胞升高多见,成人组则为一过性血尿和腹泻.结论 麻疹发病以流动人口为主,免疫接种率低.应加强流动儿童麻疹疫苗的接种或补种,其中婴儿免疫接种的起始月龄应适当提前.为保护易感人群,建议加强成人麻疹免疫抗体水平的监测,育龄妇女应列为强化免疫和监测的重点人群.     

2014年广西宾阳县麻疹疫情及应急防控措施实施效果分析

目的了解2014年宾阳县麻疹疫情、流行特征和应急防控措施实施效果,为制定消除麻疹策略和措施提供科学依据。方法对2014年宾阳县麻疹发病情况及采取的应急防控措施进行描述流行病学分析。结果 2014年宾阳县麻疹发病大幅度上升,报告麻疹病例53例,报告发病率为5.08/10万。实验室确诊24例,发病率为2.30/10万;麻疹发病集中在6月,共14例,占58.33%;麻疹发病以散居儿童为主,共16例,占66.67%;所发病例中明确有免疫史者1例,仅占4.17%;62.50%的病例发病前有医院就诊史。结论宾阳县麻疹疫情形势仍然严峻,不同地区之间免疫规划工作发展不平衡,存在输入麻疹病例风险。应提高适龄儿童含麻疹类疫苗的常规免疫接种率和及时接种率,适时开展高发人群特别是薄弱地区人群的查漏补种和强化免疫,重点关注小年龄组麻疹发病和防止院内感染的发生。     

内江市2008-2013年麻疹流行病学特征分析

目的了解内江市2008-2013年麻疹流行现状和流行特征,为做好消除麻疹工作提供参考。方法采用描述流行病学方法对2008-2013年内江市麻疹监测资料进行分析。结果内江市2008-2013年共报告麻疹病例173例,年平均报告发病率为0.79/10万;1~6月为发病高峰,占总病例数的86.71%;以农村散居儿童为主,1岁以下儿童占病例总数的37.00%;发病年龄为28天~37岁;181例麻疹病例中,无麻疹免疫史和免疫史不详者占18.78%,存在免疫空白。结论 2008-2013年内江市麻疹发病率逐年降低,目前已控制在一个较低水平,今后应继续加强儿童常规免疫和麻疹监测工作。     

固原市228例麻疹的流行病学分析

目的分析固原市麻疹流行特征,探讨控制和消除麻疹的策略。方法对固原市2005年3月-10月228例麻疹病例进行流行病学析。结果固原市2005年麻疹发病年龄以6-25岁为主,占85.1%;有麻疹接种史、病史者和抗-MV IgG1∶300以上临床不典型、病情轻。结论固原市应提高麻疹疫苗的常规免疫接种率、进行人群抗体水平测定,预测麻疹流行趋势,及时采取相应控制措施。     

大连市甘井子区2014年麻疹流行病学特征分析

目的:了解大连市甘井子区2014年麻疹流行病学特征。方法:通过中国疾病预防控制信息系统,采用描述流行病学研究方法,对该区2014年麻疹病例进行流行病学分析。结果:大连市甘井子区2014年共报告确诊麻疹病例55例,麻疹发病率5.1282/10万。病例发生主要集中在3-7月份,共51例,占全年发病数92.73%;发病年龄以0~1岁(小于8月龄10例)为主,共31例,占全年发病总数的56.36%,其次是成人组(22~42岁)15例,占全年发病总数的27.27%,职业分布以散居儿童病例最多,共38例,占发病总数的69.09%。所有病例中无免疫史者38例,占全年发病总数69.09%,免疫史不详者15例,有2剂麻疹免疫史者2例。结论:大连市甘井子区2014年麻疹高发与易感人群积累及一部分人未接种疫苗有关。     

2008-2010年罗湖区麻疹流行特征分析

目的了解罗湖区麻疹流行情况,为控制麻疹流行提供科学依据。方法采用描述流行病学方法分析罗湖区2008-2010年麻疹病例个案。结果 2008-2010年罗湖区麻疹发病率波动在1.02/10万～16/10万之间。发病高峰集中在5～8月份,占总病例数的45.23%,呈现高峰月份逐步后移现象。7岁以下儿童为主,占总病例的54.16%,20岁以上人群占总病例数35.12%,有免疫接种史占16.07%。结论消除麻疹需要建立预防接种长效工作机制,加强成人麻疹疫苗接种,确保常规免疫接种工作落实;并加强麻疹疫情监测,及时对疫点进行处理。     

Swedish experience of two dose vaccination programme aiming at eliminating measles, mumps, and rubella

In 1982 a two dose regimen was introduced in Sweden for the combined vaccination against measles, mumps, and rubella of children aged 18 months and 12 years. Since 1977 about half of the preschool children were vaccinated against measles annually, and since 1974 about 80% of 12 year old girls were vaccinated against rubella. During the period 1982 to 1985 90-93% of the eligible age cohorts of 18 month old children and 88-91% of the 12 year old children were immunised with the new combined vaccine. A study in 1982 of about 140 18 month old children who were nearly all seronegative before vaccination showed that 96%, 92%, and 99% seroconverted against measles, mumps, and rubella, respectively. A second study was carried out in 1983 of 247 12 year old children, of whom 11% lacked antibodies to measles, 27% to mumps, and 45% to rubella. This showed seroconversion in 82% and 80% against measles and mumps, respectively, and all children seroconverted against rubella. In the latest study in 1985 of 496 12 year olds 9% and 13% were seronegative against measles and mumps before vaccination, and 41% against rubella. Of these, 88% seroconverted to measles and 80% to mumps, and all converted to rubella when sera were tested by the haemolysis in gel method. After a neutralisation test against measles as well all children showed immunity to the disease. A low incidence of measles and declining figures for mumps and rubella were reported in 1984 to 1986. An outbreak of rubella during 1985 affected mainly boys in age cohorts in which only the girls had been vaccinated during the 1970s.     

Malnutrition Prevalence in Lasa Xizang Children and Adolescents

Objective To assess the prevalence of malnutrition among children and adolescents in Xizang （Tibet）. Methods We analyzed data from the Chinese National Survey on Students＇ Constitution and Health for the years 1995, 2000, 2005, and 2010 pertaining to Tibetan children and adolescents in Lase （Lhasa）, aged 7-18 years old. Numbers of survey subjects for these years were：2 393, 2 754, 2 397, and 2 643, respectively. Results Our results indicated that the rate of occurrence of stunting in Tibet has evidenced a gradual decline：for boys, from 26.8%in 2000 to 9.3%in 2010;and for girls, from 25.8%in 2000 to 10.8%in 2010. In general, the wasting rate for both boys and girls in Tibet has gradually decreased over time：for boys, from 17.7%in 1995 to 4.6%in 2005;and for girls from 12.5%in 1995 to 2.3%in 2005. The stunting rates of boys aged 7-13 years old and of girls aged 7-11 years old were 67.5%and 53.1%, respectively, while these rates for boys aged 14-18 years old and girls aged 12-18 years old were 32.5%and 46.9%, respectively. Conclusion Stunting and wasting rates of Tibetan children and adolescents indicate a gradual declining trend over time. The stunting rates of both boys and girls during early puberty were significantly higher than those during late puberty.     

云南省保山8月龄～15岁麻疹疫苗接种人群鸡蛋过敏现况调查

目的通过了解云南省保山市5县(区)8月龄~15岁麻疹疫苗接种人群鸡蛋过敏的患病率,估计因鸡蛋过敏而不能接种麻疹减毒活疫苗的免疫空白人群规模,从而为保山市消除麻疹以及接种过程中可能出现的过敏反应制订相应的策略提供基线资料。方法采取现况调查,具体为对8月龄~15岁即将接种麻疹减毒活疫苗的儿童进行问卷调查,同时对有过敏史的再进行个案调查。结果调查8月龄~15岁麻疹疫苗接种人群502 561人,患病率为3.94/万,鸡蛋过敏儿童198人,平均年龄为(8.30±4.27)岁,患病率在年龄上差异无统计学意义(P>0.05),性别上差异有统计学意义,男/女(122/76,P<0.001);5县(区)鸡蛋过敏患病率不全相同(P<0.001);鸡蛋过敏儿童可出现皮疹、腹痛、腹泻、唇肿、呕吐、发热等临床症状。个体与个体之间临床表现不完全一致,但有共同点就是出现临床症状前有食用鸡蛋病史。其中,鸡蛋过敏者有1个临床症状者79例(占48.99%),有2个临床症状者66例(占33.33%),有3个临床症状者33例(占16.67%),有4个临床症状者2例(占1.01%)。结论本次调查反映了鸡蛋过敏人群在麻疹减毒活疫苗接种对象中占有一定的比例,这类人不能接种含微量鸡蛋蛋白组份的麻疹减毒活疫苗。因此,为实现我国政府作出的到2012年消除麻疹承诺,制订相应的策略消除免疫空白人群显得尤为重要。在接种疫苗前,对这类鸡蛋过敏人群进行规模估计对保山消除麻疹有相当重要的意义。     

上海市闵行区6~11岁在校学生血红蛋白连续监测结果分析

 目的  了解上海市闵行区6～11岁在校学生贫血流行特征,为制定新形势下中小学生贫血预防措施和策略提供依据。方法   2012—2015学年连续4年对本区所有6～11岁在校学生42 872名进行血红蛋白测定。应用SPSS 18.0统计软件完成所有资料分析。结果   6～11岁在校学生贫血患病率为5.05% (95 % CI:4.84～5.26),女生贫血患病率为5.28%,显著高于男生4.84% (χ2=4.24,P=0.037)。男、女生贫血易患年龄为6岁。持续就读于希望学校学生较公办学校学生更易患贫( 男生:OR=2.37,95%CI:2.03～2.76;女生:OR=2.08,95%CI:1.74～2.49)。持续超重或肥胖的学生贫血患病风险较营养正常学生低(男生:OR=0.65,95%CI:0.55～0.76;女生:OR=0.75,95%CI:0.61～0.92)。贫血3年累积发病率为12.80% (95%CI:12.49～13.12%),其中女生为14.52%,显著高于男生的11.28% (χ2=100.26,P<0.001)。6岁组男生3年累积发病风险最高,10~11岁组女生贫血3年累积发病率最高。持续就读于希望学校的学生贫血发病风险最高(男生:RR=1.93,95%CI:1.72～2.16;女生:RR=1.20,95%CI:1.04～1.39),持续超重或肥胖是贫血发病的保护因素(男生:RR=0.75,95%CI:0.67～0.84;女生:RR=0.77,95%CI:0.68～0.88)。贫血单次检出率为14.58%,复发性贫血检出率为2.54%。不同年龄、不同性质学校、不同营养状况的男、女生贫血检出次数均以1次为主(P<0.05)。结论   上海市闵行区6～11岁在校学生贫血处于轻度流行状态。有必要继续开展全年龄段学龄儿童贫血的普查普治工作,并根据监测结果辅以个性化干预措施,加强学龄儿童家长和青春期女生健康宣教,重点关注希望学校和复发性或持续性贫血的学生。     

玉溪市1~7岁儿童麻疹疫苗免后血清流行病效果分析

目的:为了解玉溪市1~7岁年龄段儿童麻疹疫苗免后抗体产生和维持水平。方法:应用酶联免疫吸附试验对被调查的670名不同年龄段儿童进行麻疹IgG抗体水平调查。结果:麻疹抗体阳性(≥1:200)率96.72%,几何平均滴度(GMT)1:1004.29,不同年龄段及区县间麻疹抗体阳性率和GMT有统计学意义。结论:玉溪市自开展计划免疫工作以来,儿童免疫接种率一直保持较高水平,1~7岁儿童的麻疹抗体阳性率和GMT均较高,接种率和接种质量可靠,能有效地控制麻疹的流行。     

咸阳市2003-2005年麻疹流行病分析与监测系统运转状况评价

目的为了解咸阳市麻疹流行特征,方法对咸阳市2003-2005年麻疹监测系统(MSS)运转情况进行分析。结果三年全市(MSS)共报告麻疹疑似病例1243例(临床诊断282例,实验室确诊620例,实验室排除病例341例。),比法定传染病报告系统(NNDRS)高出8.84%。病例分布广泛,呈散发和爆发并存的流行病学模式,局部地区麻疹爆发影响着全市的发病水平。3—6月为麻疹高发季节,病例主要集中在0—5岁占53.29%。24.17%的报告病例无免疫史,39.36%免疫史不详。结论分析报告病例的年龄和免疫史状况说明,麻疹疫苗(MV)的初种和复种需加强,对重点地区和人群应开展MV的后续强化免疫。改进和提高MSS工作质量。     

榆林市榆阳区2007年麻疹疫情分析

目的通过分析麻疹的流行特征,为更好地预防和控制麻疹提供依据。方法对2007年榆阳区发生的麻疹病例个案进行流行病学调查。结果榆阳区2007年共报告麻疹病例214例,其中实验室确诊病例165例,临床确诊病例49例。病例主要集中在榆阳镇(占发病总数的76.17%),且出现局部暴发现象,男女发病之比为1.97∶1,时间分布以1-5月份发病最高。有免疫史的占发病总数的19.16%,免疫史不详占发病总数的62.15%,未免疫的占发病总数的18.69%。结论麻疹病例的出现与免疫空白有关。应加强对8月龄-6岁儿童的MV常规免疫2剂接种工作。加强卫生网络建设,以便加强流动人口的管理。     

418例麻疹流行病学调查分析

目的了解2006年10月～2011年10月我地区麻疹的流行情况,掌握其流行病学规律,为消除麻疹工作提供科学依据。方法对2006年10月～2011年10月麻疹的流行资料进行整理分析。结果2006年10月～2011年10月共报告麻疹病例418例。全年各月均有发病,发病高峰期集中在5～7月份,占51．20％。发病男女之比为1．68：1,发病以男性偏多。发病主要集中在6～15岁儿童,共323例,占77．27％,其中6～10岁学龄儿童占45．5％。市区居民130例,占31．1％。市郊及城乡结合部288例,占68．9％。职业分布中以学生为多数,达277例（占66．27％）。结论麻疹发病数的增多,应加强和完善麻疹监测系统,大力开展疫苗的接种工作,进一步控制和预防麻疹的流行。     

Combining vitamin A and vaccines: convenience or conflict?

The present thesis is based on 11 papers from 1995-2010. The studies have mainly taken place at the Bandim Health Project in Guinea-Bissau, West Africa, but a reanalysis of a randomised trial from Ghana is also included. My research has explored the consequences of combining high-dose vitamin A supplementation and childhood vaccines. Vitamin A deficiency is associated with increased mortality. To protect against the consequences of vitamin A deficiency the World Health Organization recommends that high-dose vitamin A supplements be given together with routine vaccines to children between 6 months and 5 years of age in more than 100 low-income countries. The recommendation is based on logistical considerations. The consequences of combining vitamin A and vaccines were not investigated in randomised trials prior to the implementation of this policy - it was assumed that the interventions were independent. My first project aimed to study the effect on the immune response to measles of providing vitamin A together with measles vaccine. We found that the two interventions were not independent. Vitamin A enhanced the antibody response to measles vaccine given at 9 months of age significantly, especially in boys. The effects were sustained over time; the children who had received vitamin A with their measles vaccine were more protected against measles at 6-8 years of age. Though vitamin A supplementation had a beneficial effect on the immune response to measles vaccine, it intrigued me that the effect of vitamin A supplementation on overall mortality was not always beneficial. While vitamin A was beneficial when given after 6 months of age, and two studies had shown a beneficial effect when given at birth, all studies testing the effect between 1-5 months of age had found no effect. These time windows are dominated by three different childhood vaccines: BCG vaccine given at birth, diphtheria-tetanus-pertussis (DTP) vaccine given between 1-5 months of age, and measles vaccine given at 9 months of age. These vaccines have been shown to have strong effects on mortality from infectious diseases in general, so-called non-specific effects. The live BCG and measles vaccine protects against more mortality than can be ascribed to the prevention of tuberculosis and measles, respectively. The inactivated DTP vaccine worryingly has been associated with increased mortality from other infectious diseases. Both positive and negative effects are strongest for girls. I proposed the hypothesis that vitamin A amplifies not only the specific vaccine effects, as we saw for measles vaccine, but also the non-specific effects of vaccines on mortality from other infectious diseases. According to my hypothesis, vitamin A would enhance the non-specific beneficial effects on mortality of BCG and measles vaccine, but also the negative effects of DTP vaccine. Hence, the hypothesis offered an explanation for the mortality-age pattern after vitamin A supplementation. Since it was formulated, I have aimed to test this hypothesis. Since it is associated with ethical problems to randomise children above 6 months of age to vitamin A supplementation, and to randomise children in general to recommended vaccines, we have had to be pragmatic when designing the trials. Hence, our studies have taken many different forms. We conducted an observational study during a vitamin A campaign in which missing vaccines were also provided, and a randomised trial testing the effect of two different doses of vitamin A during another campaign; we tested the effect of providing vitamin A with BCG at birth in two randomised trials, and we reanalysed data from one of the original randomised trials of vitamin A supplementation from the perspective of vaccination status. In all studies the main outcome was mortality. The results document that vitamin A supplements do more than protect against vitamin A deficiency. They support the hypothesis that vitamin A supplements interact with vaccines with important consequences for mortality. First, a smaller dose of vitamin A was more beneficial than a larger dose for girls. Second, the effect of vitamin A given with DTP vaccine was significantly different from the effect of vitamin A given with measles vaccine, and children, who received vitamin A with DTP vaccine, had higher mortality than children, who had received vitamin A alone, or who did not receive anything. Third, vitamin A given with BCG at birth interacted negatively with subsequent DTP vaccines in girls. Fourth, the effect of vitamin A to older children in Ghana depended on vaccination status, being beneficial in boys, but harmful in girls who received DTP vaccine during follow-up. The results also show that boys and girls respond differently to vitamin A and vaccines. It is a common assumption within public health in low-income countries that interventions can be combined without producing unexpected consequences. The work presented in this thesis confronts this assumption; the results show that vitamin A and vaccines should be seen not only as specific interventions with specific and independent effects, but as immuno-modulators, which can interact with important consequences for overall mortality. Combining interventions can be convenient and lead to synergistic health benefits, but we documented several examples, where it also leads to unexpectedly increased mortality. Thus, to optimise the child health intervention policy in low-income countries a shift in paradigm is needed. Health interventions should no longer be seen as merely specific and independent, and the policy should probably not be the same for boys and girls. Though more complex, it is necessary to evaluate all health interventions in terms of their effect on overall mortality - and their potential interactions with other health interventions and potential sex-differential effects should always be investigated. Only in this way can we assure that the children in the poorest countries get the best possible treatment and avoid using large amounts of money and resources on interventions which may, in worst case, kill them.     

Epidemiological Survey of the Prevalence of Non-fatal Injury among Children Aged 5-14 Years in China

ObjectiveTo determine the prevalence of non-fatal injuries among children aged 5–14 years in China.MethodsData of 21 973 children aged 5–14 years were extracted from the Fourth National Health Service Survey of China carried out between June 15 and July 10, 2008. Injury-related indicators included: history of ever having had an injury, and injury frequency, cause, location and severity.ResultsThe overall prevalence of non-fatal injuries among the children in the previous 12 months was 17.0 per 1000 subjects. The leading causes of non-fatal injuries were falls, animal bites, traffic accidents, falling objects and burns. The majority of children sustained only one injury. The main place of injury was at home in 40% and 54% of urban boys and girls, respectively, at school in 48% of rural boys, and at home and at school each in 33% of rural girls. Medical treatment for one day was the main option for 80% of urban boys and girls, 84% of rural boys, and 72% of rural girls.ConclusionNonfatal injuries among children aged 5–14 years are a serious public health concern in China.