2014年中国某学校风疹疫情及疫情管理

Rubella outbreak and outbreak management in a school setting, China, 2014.

作者信息

Chang Caiyun, Ma Huilai, Liang Wenjia, Hu Pei, Mo Xianghuan, An Zhijie, Zheng Huizhen

机构信息

a Jinan Center for Disease Control and Prevention , Jinan , Shandong , China.

b Chinese Field Epidemiology Training Program (CFETP), Chinese Center for Disease Control and Prevention , Beijing , China.

出版信息

Hum Vaccin Immunother. 2017 Apr 3;13(4):772-775. doi: 10.1080/21645515.2016.1252494. Epub 2016 Dec 1.

DOI:10.1080/21645515.2016.1252494

PMID:27905834

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5404362/

Abstract

BACKGROUND

An active response to a rubella outbreak may interrupt disease transmission, and outbreak response immunization (ORI) can increase immunity among persons who might otherwise not be protected. On March 17, 2014, a rubella outbreak was reported in a middle school in Guangzhou city, China. We conducted an investigation to assess impact of a policy of exclusion of cases from school and of ORI.

METHODS

Active surveillance was used to find cases of rubella. Investigators interviewed teachers and reviewed the absentee records to determine implementation details of school exclusion. ORI was recommended on 2 occasions during the outbreak, one small-scale and one large-scale. Laboratory confirmation tests included serum IgM and IgG measurements to distinguish between acute infection and immunity. A serological survey in 4 classes was used to determine immunity status and identify symptomatic and asymptomatic cases.

RESULTS

From February 17 to May 23, 2014, 162 rubella cases (24 laboratory-confirmed and 138 epidemiologically linked) were detected among 1,621 students. Cases ultimately occurred in 27 classes (72.97%) across 37 classes. In 11 classes in which exclusion from school was delayed by 1 or more days, the secondary attack rate was 12.30%, compared with 2.35% in 15 classes with immediate exclusion. ORI increased vaccine coverage from 25.83 % to 86.92%, and the final case of the epidemic was reported one month later. A serological survey of 91 students in 4 classes identified 15 cases, 6 of which were asymptomatic.

CONCLUSIONS

The outbreak happened in school with low rubella-containing vaccination coverage. Exclusion from school upon rash/fever onset was associated with lowering the secondary attack rate, but school exclusion alone was not able to stop this outbreak - a large ORI was needed. Assuring complete vaccination upon entry to school is likely to be necessary to ensure coverage is above the herd immunity threshold and prevent outbreaks from happening.

摘要

背景

对风疹疫情的积极应对可能会中断疾病传播，而疫情应对免疫接种（ORI）可提高那些原本得不到保护的人群的免疫力。2014年3月17日，中国广州市一所中学报告发生风疹疫情。我们开展了一项调查，以评估将病例排除在学校之外以及进行疫情应对免疫接种政策的影响。

方法

采用主动监测来发现风疹病例。调查人员采访了教师并查阅了缺勤记录，以确定学校排除措施的实施细节。在疫情期间分两次推荐进行疫情应对免疫接种，一次是小规模的，一次是大规模的。实验室确诊检测包括血清IgM和IgG检测，以区分急性感染和免疫情况。对4个班级进行血清学调查，以确定免疫状况并识别有症状和无症状的病例。

结果

2014年2月17日至5月23日，在1621名学生中检测到162例风疹病例（24例经实验室确诊，138例有流行病学关联）。病例最终出现在37个班级中的27个班级（72.97%）。在11个班级中，排除在学校之外的措施延迟了1天或更多天，二代发病率为12.30%，而在15个立即排除的班级中为2.35%。疫情应对免疫接种将疫苗接种覆盖率从25.83%提高到了86.92%，疫情的最后一例病例在一个月后报告。对4个班级的91名学生进行的血清学调查发现了15例病例，其中6例无症状。