非麻疹疫苗免疫目标人群麻疹发病相关危险因素配对病例对照研究

目的探讨非麻疹疫苗免疫目标人群麻疹发病相关危险因素，为预防控制该人群麻疹发病提供依据。方法对2008—2009年广州市白云区的麻疹病例进行1：1配对，配对因素为性别、年龄和居住地，对相关危险因素进行条件Logistic回归分析及多因素非条件Logistic回归分析。结果调查病例中71．43％的病例为流动人口；28．57％的病例或其监护人为初中以下文化程度；32．80％的病例或其监护人月均收入低于1000元；15岁以上病例既往有麻疹疫苗接种史的仅占4．65％;24．87％的病例病前3周曾与麻疹病人有过接触；32．80％患者病前3周曾去医院就诊．就诊医院级别中省市级、区县级、卫生院分别占62．29％、20．97％和17．74％，就诊科别中以儿科、内科为主，分别占70．97％和25．81％；38．10％的病例病前3周内曾乘坐公共交通工具。单因素分析显示。经济水平低（OR=0．59，OR95%CI=0．37～0．94）、未种麻疹疫苗（OR=0．32，OR95%CI=0．19～0．52）、有麻疹病例接触史（OR=0．22，OR95%CI=0．13—0．36）、流动人口（OR=0．22，OR95%CI=0．13-0．36）、就诊史（OR=0．30，OR95%CI=0．18-0．51）、就诊医院类型（OR=0．33，OR95%CI=0．18～0．51）和就诊科别（OR=0．34，OR95%CI=0．22—0．52）等因素与麻疹发病有明显的相关性。多因素Logistic分析显示，经济水平低（OR=0．49，OR95%CI=0．28-0．87）、未接种麻疹疫苗（OR=0．67，OR95%CI=0．52～0．86）、有麻疹病例接触史（OR=0．14，OR95%CI=0．08-0．25）、流动人口（OR=0．25，OR95％CI=0．15-0．43）、就诊史（OR=8．51，OR95%CI=2．65～27．30）、就诊科别（OR=0．15，OR95%CI=0．05～0．46）等因素与麻疹的发病密切相关。结论经济水平低、未接种麻疹疫苗、病前3周内有麻疹病例接触史、流动人口、病前3周内有就诊史和就诊科别等因素可能是影响非麻疹疫苗免疫目标人群麻疹发病的主要危险因素。

Paired Case-control Study of Risk Factors for Measles Mobidity among Population Not Targeted by Measles Vaccine

Objective To explore relevant risk factors for measles mobidity among population not targeted by measles vaccine and to provide evidence of the measles control among the population. Methods 1：1 paired casecontrol study was undertaken among measles cases in Baiyun during 2008-2009 and controls were selected by gener, age, and residence. We analyzed the risk factors by using conditional Logistic regression and binary Logistic regression models. Results Among enrolled cases,71.43% were floating population,28.57% were of lower than junior high school education （cases or their guardians）, 32.80% were with income of less than 1000 Yuan per month, 4.65% of cases aged over 15 years were vaccinated with measles vaccine,and 24.87% had contacted with mealses cases 3 weeks before onset. 32.80% of cases had gone to hospitals for treatment 3 weeks before onset （provincial or municipal hospitals 62.29% ,county hospitals 20.97% ,town hospitals 17.74%）and most of outpatients were pediatrics （70.97%） and internal medicine （25.81%）. 38.10% of all cases had used public vehicles 3 weeks before onset. The results of conditional Logistic regression showed that low financial situation （OR=0.59,OR95%CI=0.37-0.94）, unvaccination of measles vaccine （OR =0.32, OR95%CI=0.19-0.52）, contact history of measles cases （OR= 0.22, OR95%CI= 0.13-0.36）, floating population （OR=0.22,OR95%CI=0.13 -0.36）, visiting doctors （OR=0.30,OR95%CI=0.18 -0.51）,the type of hospital （OR=0.33, OR95%CI=0.18-0.51）and the deparment of hospital （OR=0.34, OR95%CI= 0.22-0.52）were related to measles mobidity.Muhivariate analysis showed that low financial situation（OR=0.49,OR95%CI=0.28-0.87）,unvaccination of measles vaccine （OR=0.67, OR95%CI=0.52-0.86）, contact history of measles cases （OR=0.22, OR95%CI=0.13 -0.36）, floating population（OR=0.25,OR95%CI=0.15-0.43）, visiting doctors（OR=8.51,OR95%CI=2.65-27.30） ,the deparment of hospital （OR =0.15, OR95%CI=0.05 -0.46）were statistically related to measles mobidity.Conclusions Low financial situation, unvaccination of measles vaccine, contact history of measles cases 3 weeks before onset, floating population, visiting doctors 3 weeks before onset and the type of hospital deparments are possible risk factors of measles mobidity.