2017年上海市百日咳监测病例流行病学特征分析
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摘要
目的了解上海市2017年百日咳流行病学特征,为上海市的百日咳防控工作提供参考依据。方法利用上海市2017年的百日咳监测数据,包括通过中国疾病预防控制信息系统获得的百日咳确诊病例的个案信息以及区疾病预防控制中心上报的确诊病例以及监测病例的个案调查资料。运用描述性方法进行分析。结果 2017年全市6家监测点医院共报告258例百日咳监测病例。发病高峰出现在8—9月;<18月龄占50.00%,≥20岁占41.47%;男女性别比为1∶1.28;上海市户籍与外地户籍比例为1∶1.29;全市75%的区有病例报告;5月龄至14岁的病例中50%以上的儿童已接种至少3剂含百日咳成分的疫苗。咳后吐、咳时青紫、鸡鸣回声等百日咳典型症状的占比较低,均<30%。有咳嗽症状的密切接触者中≥20岁成年人占71.88%。病例的鼻咽拭子PCR检测阳性率为30.50%;血清PT-IgG抗体检测阳性率为41.07%。结论 2017年上海市通过建立百日咳监测点医院大幅提高了监测敏感性。监测病例中百日咳典型症状出现占比较低、有免疫史的占比较高,建议调整百日咳诊断标准中百日咳疑似病例的病例定义,并逐步规范临床医生的诊断意识。
Objective To understand the epidemiological characteristics of pertussis in Shanghai in 2017 and to provide evidence for the development of pertussis prevention and control measures. Methods The incidence data of pertussis in Shanghai in 2017 were collected from national notifiable diseases registry system(NNDRS) and district CDCs in Shanghai for a descriptive analysis. Results In 2017, a total of 258 pertussis cases were reported by 6 sentinel hospitals in Shanghai. The incidence peak was during August-September. The cases in age groups <18 months and ≥20 years accounted for 50.00% and41.47% respectively. The male to female ratio of the cases was 1∶1.28. The ratio of cases with local residence to cases without local residence was 1∶1.29. The cases were distributed in 75% of the districts in Shanghai. More than 50% cases aged 5 months-14 years received at least 3 doses of pertussis-containing vaccines. The incidence rates of typical symptoms of vomiting,cyanosis or inspiratory stridor were all <30%. Among the close contacts with symptom of cough, the adults aged ≥20 years accounted for 71.88%. The positive rate of nasopharyngeal swab detection in PCR was 30.50%, while the positive rate of PTIgG was 41.07%. Conclusion The sensitivity of pertussis surveillance in Shanghai was greatly improved in 2017 due to the efforts of sentinel hospitals. Less cases showed typical symptoms of pertussis, a high proportion of cases had vaccination history. It is suggested revise the case definition of probable case of pertussis and improve the diagnosis of pertussis.
Objective To understand the epidemiological characteristics of pertussis in Shanghai in 2017 and to provide evidence for the development of pertussis prevention and control measures. Methods The incidence data of pertussis in Shanghai in 2017 were collected from national notifiable diseases registry system(NNDRS) and district CDCs in Shanghai for a descriptive analysis. Results In 2017, a total of 258 pertussis cases were reported by 6 sentinel hospitals in Shanghai. The incidence peak was during August-September. The cases in age groups <18 months and ≥20 years accounted for 50.00% and41.47% respectively. The male to female ratio of the cases was 1∶1.28. The ratio of cases with local residence to cases without local residence was 1∶1.29. The cases were distributed in 75% of the districts in Shanghai. More than 50% cases aged 5 months-14 years received at least 3 doses of pertussis-containing vaccines. The incidence rates of typical symptoms of vomiting,cyanosis or inspiratory stridor were all <30%. Among the close contacts with symptom of cough, the adults aged ≥20 years accounted for 71.88%. The positive rate of nasopharyngeal swab detection in PCR was 30.50%, while the positive rate of PTIgG was 41.07%. Conclusion The sensitivity of pertussis surveillance in Shanghai was greatly improved in 2017 due to the efforts of sentinel hospitals. Less cases showed typical symptoms of pertussis, a high proportion of cases had vaccination history. It is suggested revise the case definition of probable case of pertussis and improve the diagnosis of pertussis.
引文
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[2]张兴录,杨志伟,周军,等.我国近年百日咳流行病学特点分析[J].中国计划免疫,2000,6(2):93-95.DOI:10.3969/j.issn.1006-916X.2000.02.011.Zhang XL,Yang ZW,Zhou J,et al.An analysis on current epidemiological characteristics of pertussis in China[J].Chin JVacc Immun,2000,6(2):93-95.DOI:10.3969/j.issn.1006-916 X.2000.02.011.
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[8]汪海波,罗会明,温宁,等.我国2006-2010年百日咳流行病学分析[J].中国疫苗和免疫,2012,18(3):207-210.Wang HB,Luo HM,Wen N,et al.Epidemiological analysis on pertussis in China during 2006-2010[J].Chin J Vacc Immun,2012,18(3):207-210.
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[10]张颖,黄海涛,刘勇,等.天津市社区人群百日咳发病监测及传播特征研究[J].中国疫苗和免疫,2011,17(3):209-211,257.Zhang Y,Huang HT,Liu Y.Incidence surveillance of pertussis based on community and analysis of its transmitted features in Tianjin[J].Chin J Vacc Immun,2011,17(3):209-211,257.
[11]National Center for Immunization and Respiratory Diseases.2016final pertussis surveillance report[EB/OL].(2018-01-05)[2018-05-06].https://www.cdc.gov/pertussis/downloads/pertuss-surv-report-2016.pdf.
[12]Sala-FarréM,Arias-Varela C,Recasens-Recasens A,et al.Pertussis epidemic despite high levels of vaccination coverage with acellular pertussis vaccine[J].Enferm Infecc Microbiol Clín,2015,33(1):27-31.DOI:10.1016/j.eimc.2013.09.013.
[13]米荣,伏瑾,王晓颖,等.迁延性咳嗽婴幼儿百日咳感染临床情况调查[J].中华医学杂志,2013,93(22):1721-1725.DOI:10.3760/cma.j.issn.0376-2491.2013.22.010.Mi R,Fu J,Wang XY,et al.Clinical research of bordetella pertussis infection in infants with prolonged cough[J].Natl Med JChina,2013,93(22):1721-1725.DOI:10.3760/cma.j.issn.0376-2491.2013.22.010.
[14]黄海涛,李永成,刘勇,等.天津市百日咳家庭聚集性发病的传播特征研究[J].中华流行病学杂志,2011,32(8):843-844.DOI:10.3760/cma.j.issn.0254-6450.2011.08.026.Huang HT,Li YC,Liu Y,et al.Transmitted features of family aggregation on pertussis in Tianjin[J].Chin J Epidemiol,2011,32(8):843-844.DOI:10.3760/cma.j.issn.0254-6450.2011.08.026.
[15]Wendelboe AM,Njamkepo E,Bourillon A,et al.Transmission of bordetella pertussis to young infants[J].Pediat Infect Dis J,2007,26(4):293-299.DOI:10.1097/01.inf.0000258699.64164.6d.
[16]刘勇,黄海涛,刘鹏,等.天津地区2013年百日咳感染状况及分子流行病学特征分析[J].中华流行病学杂志,2014,35(12):1358-1361.DOI:10.3760/cma.j.issn.0254-6450.2014.12.010.Liu Y,Huang HT,Liu P,et al.The status of pertussis infection and molecular epidemiological characteristics of pertussis in Tianjin,2013[J].Chin J Epidemiol,2014,35(12):1358-1361.DOI:10.3760/cma.j.issn.0254-6450.2014.12.010.
[2]张兴录,杨志伟,周军,等.我国近年百日咳流行病学特点分析[J].中国计划免疫,2000,6(2):93-95.DOI:10.3969/j.issn.1006-916X.2000.02.011.Zhang XL,Yang ZW,Zhou J,et al.An analysis on current epidemiological characteristics of pertussis in China[J].Chin JVacc Immun,2000,6(2):93-95.DOI:10.3969/j.issn.1006-916 X.2000.02.011.
[3]SAGE.WHO SAGE pertussis working group Background paper SAGE April 2014[R].Geneva:WHO,2014.
[4]宁桂军,高源,吴丹,等.中国2011-2017年百日咳流行病学特征分析[J].中国疫苗和免疫,2018,24(3):264-267,273.Ning GJ,Gao Y,Wu D,et al.Epidemiology of pertussis in China,2011-2017[J].Chin J Vacc Immun,2018,24(3):264-267,273.
[5]中华人民共和国卫生部.WS 274-2007百日咳诊断标准[S].北京:中华人民共和国卫生部,2007.Ministry of Health of the People's Republic of China.WS274-2007 Diagnostic criteria for pertussis[S].Beijing:Ministry of Health of the People's Republic of China,2007.
[6]Centers for Disease Control and Prevention.Manual for the surveillance of vaccine-preventable diseases[M].4ht ed.Atlanta,GA:Centers for Disease Control and Prevention,2008.
[7]中华预防医学会疫苗可预防疾病儿童百日咳临床调查研究协作组.持续性咳嗽儿童百日咳临床多中心调查研究[J].中华儿科杂志,2010,48(10):748-752.DOI:10.3760/cma.j.issn.0578-1310.2010.10.007.Study Group of Pediatric Clinical Investigation of Pertussis,Program for Vaccine Preventable Diseases,Chinese Association of Preventive Medicine.Multicenter clinical investigation of pertussis in children and adolescents with persistent cough[J].Chin JPediatr,2010,48(10):748-752.DOI:10.3760/cma.j.issn.0578-1310.2010.10.007.
[8]汪海波,罗会明,温宁,等.我国2006-2010年百日咳流行病学分析[J].中国疫苗和免疫,2012,18(3):207-210.Wang HB,Luo HM,Wen N,et al.Epidemiological analysis on pertussis in China during 2006-2010[J].Chin J Vacc Immun,2012,18(3):207-210.
[9]Hamborsky J,Krogera A,Wolfe C.Epidemiology and prevention of vaccine-preventable diseases[M].13th ed.Washington DC:Public Health Foundation,2015:261-278.
[10]张颖,黄海涛,刘勇,等.天津市社区人群百日咳发病监测及传播特征研究[J].中国疫苗和免疫,2011,17(3):209-211,257.Zhang Y,Huang HT,Liu Y.Incidence surveillance of pertussis based on community and analysis of its transmitted features in Tianjin[J].Chin J Vacc Immun,2011,17(3):209-211,257.
[11]National Center for Immunization and Respiratory Diseases.2016final pertussis surveillance report[EB/OL].(2018-01-05)[2018-05-06].https://www.cdc.gov/pertussis/downloads/pertuss-surv-report-2016.pdf.
[12]Sala-FarréM,Arias-Varela C,Recasens-Recasens A,et al.Pertussis epidemic despite high levels of vaccination coverage with acellular pertussis vaccine[J].Enferm Infecc Microbiol Clín,2015,33(1):27-31.DOI:10.1016/j.eimc.2013.09.013.
[13]米荣,伏瑾,王晓颖,等.迁延性咳嗽婴幼儿百日咳感染临床情况调查[J].中华医学杂志,2013,93(22):1721-1725.DOI:10.3760/cma.j.issn.0376-2491.2013.22.010.Mi R,Fu J,Wang XY,et al.Clinical research of bordetella pertussis infection in infants with prolonged cough[J].Natl Med JChina,2013,93(22):1721-1725.DOI:10.3760/cma.j.issn.0376-2491.2013.22.010.
[14]黄海涛,李永成,刘勇,等.天津市百日咳家庭聚集性发病的传播特征研究[J].中华流行病学杂志,2011,32(8):843-844.DOI:10.3760/cma.j.issn.0254-6450.2011.08.026.Huang HT,Li YC,Liu Y,et al.Transmitted features of family aggregation on pertussis in Tianjin[J].Chin J Epidemiol,2011,32(8):843-844.DOI:10.3760/cma.j.issn.0254-6450.2011.08.026.
[15]Wendelboe AM,Njamkepo E,Bourillon A,et al.Transmission of bordetella pertussis to young infants[J].Pediat Infect Dis J,2007,26(4):293-299.DOI:10.1097/01.inf.0000258699.64164.6d.
[16]刘勇,黄海涛,刘鹏,等.天津地区2013年百日咳感染状况及分子流行病学特征分析[J].中华流行病学杂志,2014,35(12):1358-1361.DOI:10.3760/cma.j.issn.0254-6450.2014.12.010.Liu Y,Huang HT,Liu P,et al.The status of pertussis infection and molecular epidemiological characteristics of pertussis in Tianjin,2013[J].Chin J Epidemiol,2014,35(12):1358-1361.DOI:10.3760/cma.j.issn.0254-6450.2014.12.010.