一起山区小学流行性腮腺炎暴发疫情调查与疫苗保护效果

许宇翔; 孔德亮; 吕玉玲; 廖梅婷; 黎玉华; 申文豪; 黄国华

doi:10.16835/j.cnki.1000-9817.2023.11.027

一起山区小学流行性腮腺炎暴发疫情调查与疫苗保护效果

doi: 10.16835/j.cnki.1000-9817.2023.11.027

1.
广东省广州市花都区疾病预防控制中心公共卫生部, 510800
2.
广东省现场流行病学培训项目
3.
肇庆市疾病预防控制中心免疫规划科

详细信息

作者简介:
许宇翔(1987-), 男, 海南万宁人, 硕士, 主管医师, 主要从事现场流行病学调查与分析工作

通讯作者:
孔德亮, E-mail: 7319865@qq.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R512.1 R181.3 G478
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- 被引次数: 0
出版历程
- 收稿日期: 2023-07-03
- 修回日期: 2023-09-06
- 网络出版日期: 2023-11-27
- 刊出日期: 2023-11-25

Field investigation of a mumps outbreak and evaluation of vaccine effectiveness in a remote village school

1.
Department of Public Health, Guangzhou Center for Disease Control and Prevention of Huadu District, Guangzhou (510800), Guangdong Province, China

摘要

摘要: 目的对一起发生在肇庆市某山区寄宿制小学的流行性腮腺炎暴发疫情开展流行病学调查, 评估含腮腺炎成分疫苗(MuCV)的保护效果, 为制定疫情防控对策提供参考。方法通过现场个案调查、访谈获得病例资料和疫情相关流行病学信息, 运用描述性和回顾性队列研究, 分析疫情流行特征, 探索危险因素, 评价疫苗保护效果。结果共搜索到腮腺炎病例166例, 均为学生, 腮腺炎总罹患率为7.79%, 首发病例2018年10月11日发病, 末位病例2018年12月9日发病, 疫情持续60 d; 年龄集中在10~13岁, 占比66.27%;男生罹患96例, 女生70例, 男女之间罹患率差异无统计学意义(χ²=2.40, P>0.05)。全校34个班级中涉及28个班级, 有11个班级罹患率>10%, 主要分布在二、四、六年级, 不同年级学生的罹患率差异有统计学意义(χ²=96.89, P < 0.01);不同楼层之间罹患率差异有统计学意义(χ²=67.35, P < 0.01), 三楼高于其他楼层。住宿生58名, 有12例病例, 住宿生患病风险是非住宿生的1.89倍(RR=1.89, 95%CI=1.10~3.23);未接种MuCV者罹患率高于接种者(χ²=5.70, P < 0.05), VE%(95%CI)=35%(7%~55%); 接种1剂次的疫苗保护效果为34%(4%~54%); 保护效果随接种时间的延长呈下降趋势(χ_趋势²=6.53, P < 0.05), 接种6年后失去保护效果(χ²=1.12, P>0.05)。结论病例发现和隔离不及时、MuCV接种率低、接种1剂次疫苗的保护效果随时间而减弱导致本次疫情的暴发和持续传播。
- 流行性腮腺炎 /
- 疾病暴发流行 /
- 发病率 /
- 疫苗 /
- 学生
Abstract: Objective To investigate the outbreak of mumps in a remote village school of Zhaoqing City, to evaluate and vaccine effectiveness (VE) of mumps-containing vaccine (MuCV), so as to provide reference for the formulation of epidemic prevention and control strategies. Methods Through on-site case investigations and interviews, case data and epidemic related epidemiological information were obtained.Descriptive and retrospective cohort studies were used to analyze the epidemic characteristics, explore risk factors, and evaluate the protective effect of vaccines. Results Totally 166 cases of mumps were found, and all of them were students.The total attack rate was 7.79% and the outbreak lasted for 60 days.The first case occurred on October 11th and the last case occurred on December 9th in 2018.Most of the cases aged from 10 to 13 years old, accounting for 66.27%.There were 96 male patients and 70 female patients, with no statistically significant sex difference in the incidence rate (χ²=2.40, P>0.05).Involving 28 classes, 11 of which had an incidence rate more than 10%, mainly distributed in grades 2, 4 and 6.There were statistically significant differences in incidence rates among different grades (χ²=96.89, P < 0.01) and different floors (χ²=67.35, P < 0.01), with the third floor higher than the other floors.Twelve out of 58 boarding pupils were cases, and boarding pupils were 1.89 times higher in risk of contracting mumps than day students (RR=1.89, 95%CI=1.10-3.23).Pupils without being given the shot of MuCV were higher in the infection rate than those having the shot (χ²=5.70, P < 0.05), and the VE% was 35%(95%CI=7%-55%).The VE% of one dose was 34%(4%-54%), while the effectiveness of protection was declined with time (χ_trend²=6.53, P < 0.05).The effectiveness of vaccine almost diasappeared six years after the shot (χ²=1.12, P>0.05). Conclusion Delayed case report and isolation, low rate of receiving MuCV, and decreasing effectiveness of one shot MuCV are closely assocaited with the outbreak and ongoing spread of the epidemic.
- Mumps /
- Disease outbreaks /
- Incidence /
- Vaccines /
- Students
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表 1 肇庆市某小学不同楼层和年级学生流行性腮腺炎罹患率比较

Table 1. Comparison of mumps attack rates by floors and grades of a school in Zhaoqing City

组别	选项	人数	病例数	χ²值	P值
楼层	四	525	42(8.00)	67.35	< 0.01
	三	527	79(14.99)
	二	538	36(6.69)
	一	542	9(1.66)
年级	一	350	2(0.57)	96.89	< 0.01
	二	335	23(11.34)
	三	357	11(1.40)
	四	360	50(13.89)
	五	367	20(3.00)
	六	363	60(16.53)
注： ()内数字为罹患率/%。

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表 2 肇庆市某小学部分学生含腮腺炎成分疫苗接种情况与发病的关系

Table 2. Relations between MuCV vaccination and infection in an outbreak of a school in Zhaoqing City

接种疫苗	选项	人数	病例数	罹患率/%	RR值(95%CI)	VE%(95%CI)
是否接种	是	273	37	13.55	0.65(0.45~0.93)^*	35(7~55)
	否	338	71	21.01	1.00
剂次	0	338	71	21.01	1.00
	1	258	36	13.95	0.66(0.46~0.96)^*	34(4~54)
	2	15	1	6.67	0.30(0.04~2.01)	70(0~96)
接种1剂次后	未接种	338	71	21.01	1.00
时长/年	0~ < 3	12	1	8.33	0.40(0.06~2.62)	60(0~94)
	3~ < 6	103	11	10.68	0.51(0.28~0.92)^*	49(8~72)
	6~ < 9	109	18	16.51	0.78(0.49~1.25)	22(0~51)
	≥9	34	6	17.65	0.84(0.40~1.79)	16(0~60)
疫苗类型^a	未接种	338	71	21.01	1.00
	MMR	232	29	12.50	0.60(0.40~0.89)^**	40(11~60)
	MM	40	7	17.50	0.96(0.82~1.12)	4(0~18)
注： a仅有1人接种腮腺炎减毒活疫苗，且发病，未纳入统计；P < 0.05，*P < 0.01。

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