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目的通过比较不同标本在麻疹病例早期诊断和疫情控制中的优劣,探讨采集急性期疑似病例的病原学标本(咽拭子或尿液)进行病原学检测在麻疹监测中的应用意义。方法选取2013年1-12月丰台区88例麻疹病例开展流行病学调查,从不同标本的采样易操作性、小月龄病患依从性、实验室检测灵敏度、是否有助于鉴别疫苗相关病例和确定流行株等方面进行比较。结果 1岁以内儿童病例中,15.79%的儿童家长拒绝医院为孩子采血,5.26%的家长拒绝为孩子采集病原学标本,在首诊采血麻风疹双阴性的情况下,只有20%的家长同意采集恢复期血,80%的家长同意采集病原学标本。在79例既采集血标本又采集病原学标本的病例中,急性期麻疹Ig M抗体阳性检出率为65.8%(52/79),病原学标本的病毒核酸阳性检出率为96.2%(76/79)。结论通过采集咽拭子或尿液的方法进行病原学检测灵敏度高、便于采集、小月龄病患依从性更好,且有助于鉴别麻疹疫苗相关病例、确定流行株、追溯传染源,故较采血更适合做为消除麻疹阶段急性期病例首要采样方法。
Objective To compare the advantages and disadvantages of different specimens in the early diagnosis and epidemic control of measles cases and to explore the significance of etiological detection in the detection of measles by collecting the etiological specimens (throat swab or urine) from suspected cases in acute stage. Methods A total of 88 cases of measles in Fengtai District from January to December in 2013 were selected to carry out epidemiological investigation. Samples were collected from different samples for ease of handling, compliance with small-month-old patients and sensitivity of laboratory tests to identify vaccine-related cases And determine the prevalence of strains and other aspects of comparison. Results Among the cases of children aged less than one year, 15.79% of the children refused to take the blood from the hospital and 5.26% of the parents refused to collect the etiological specimens for their children. Only 20% of the parents agreed to collect Convalescent blood, 80% of parents agreed to collect etiological specimens. In 79 cases of both blood samples and etiological specimens collected, the positive rate of measles IgM antibody in acute phase was 65.8% (52/79), and that of etiological specimens was 96.2% (76.2%) / 79). Conclusion The etiological detection of throat swab or urine by the method of high sensitivity, easy to collect, the compliance of patients with small Yue is better, and help identify measles vaccine-related cases, determine the epidemic strain, trace the source of infection, so Blood is more suitable for the elimination of measles stage acute cases of the first sampling method.