| 郑庆鸣,曾华堂,王铁强,刘义,王广力,梅树江,张顺祥.深圳市一起学校水痘暴发的现场流行病学调查[J].Chinese journal of Epidemiology,2013,34(9):906-910 |
| 深圳市一起学校水痘暴发的现场流行病学调查 |
| Field epidemiological study on a varicella outbreak among schoolchildren in Shenzhen |
| Received:May 22, 2013 |
| DOI： |
| KeyWord: 水痘|暴发|学生 |
| English Key Word: Varicella|Disease outbreaks|Schoolchildren |
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| Abstract: |
| 目的 探讨学校水痘暴发疫情的流行病学特征、传播因素和扩散方式，明确疫情控制的难点。方法 根据现场流行病学调查方法和步骤，确定病例定义并完成病例搜索，描述病例 三间分布特征，重点分析可能的传播因素与该起疫情间的关系，采用回顾性队列研究探讨相关传播因素。结果 该起水痘暴发的总罹患率为4．4％(122／2742)，小学生罹患率(8．3％，118／1419)明显高于初中生(0．3％，4／1323)，但小学生罹患率的性别差异无统计学意义。疫情波及全校9个年级22个班，罹患率最高的是五年级(23．7％)和三年级(13．4％)，呈现明显的班级聚集性。该起疫情为人与人接触传播，共持续72 d，出现4个发病高峰。“军训”促成疫情在首发病例的班级内传播，而疫情期间全校组织学生健康体检，又引发疫情的跨年级传播；未及时有效的落实隔离措施，是该起水痘在班级内传播的原因，但参加校外辅导班和乘坐社区免费接送车与疫情扩散的关联无统计学意义。该起疫情突破性水痘病例占所有病例的52．5％(64／122)，病例均接种过一剂次水痘减毒活疫苗(VarV)，从接种到发病的时间中位数为7年，接种疫苗与病程的差异无统计学意义，提示可能由于VarV剂次不足或接种疫苗年限较长而引发疫情。结论 水痘暴发是学校重要的突发公共卫生事件。隔离措施难于落实，且跨班级的疫情传播链一旦形成，一般性的控制措施很难在短时间内显效。 |
| English Abstract: |
| 0bjective Both epidemiologic characteristics and transmission mode of a varicella outbreak among schoolchildren in Shenzhen city were studied and related contrOl measures were discussed． Methods Case definition was established． Case-finding and face-to-face investigation were conducted，followed by analysis on distributions of time，place and persons of theoutbreak．Association between possible modes of transmission and the outbreak was explored． Retrospective cohort study was carried out．Results The overall attack rate of this outbreak was 4．4％(122 of 2742)．The attack rate among primary schoolchildren(8．3％，118／1419)was higher than that in the middle．school children(0．3％．4／1323)．There were no statistically significant differences on the attack rates between male and female students．A total of 22 classes from the 9 grades were affected by this outbrealConelusion Varicella outbreak has been one of the most grievous public health problems in schools，posting challenges on the implementation of isolation measures，in particular．Once the chain of transmission is in place．it is dimcult to make the universal measures effective within a short period． |
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