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目的了解含麻疹成分疫苗(Measles Containing Vaccine,MCV)免疫史儿童麻疹病例的临床特征,评价不同麻疹监测病例定义的效果。方法制定不同麻疹监测病例定义,在麻疹暴发疫情中通过主动监测和问卷调查,获得有MCV免疫史的疑似麻疹病例110例,通过实验室检测方法确诊78例,排除32例,分析各病例定义的灵敏度和特异度等指标。结果在确诊/排除麻疹病例中,发热、皮疹和≥1种其他症状(咳嗽、卡他性鼻炎、眼结膜炎)的发生率分别为89.7%/71.9%、69.2%/31.3%、66.7%/65.6%。现行病例定义(发热+皮疹+≥1种其他症状)的特异度最高(93.8%),但灵敏度最低(50.0%);仅发热症状的病例定义灵敏度最高(94.6%),但特异度最低(28.1%)。Kappa检验和受试者工作特征曲线显示,“发热+皮疹”是监测有MCV免疫史儿童的较优病例定义(Kappa=37.3%,曲线下面积=0.73)。结论随着MCV的使用,有必要完善现行的麻疹监测病例定义,特别是在高接种率地区或人群中;而且实验室检测将越来越重要。
Objective To understand the clinical features of children measles cases with Measles Containing Vaccine (MCV) immunization and to evaluate the effects of different measles surveillance cases. Methods To define different measles surveillance cases and to obtain 110 measles cases with history of MCV immunization through active monitoring and questionnaire survey in the outbreak of measles. 78 cases were diagnosed by laboratory test, 32 cases were excluded. Sensitivity and specificity and other indicators. Results The incidences of fever, rash and ≥1 other symptoms (cough, catarrh rhinitis, conjunctivitis) were 89.7% / 71.9%, 69.2% / 31.3%, 66.7% / 71.9%, respectively in the diagnosis / 65.6%. The current case definition (fever + rash + 1 other symptom) had the highest specificity (93.8%) but the lowest sensitivity (50.0%); the fever-only symptom definition had the highest sensitivity (94.6%) but the lowest specificity (28.1 %). The Kappa test and the subject work profile showed that “fever + rash” is a better case definition for monitoring children with MCV immunization (Kappa = 37.3%, area under the curve = 0.73). Conclusion With the use of MCV, it is necessary to refine the current definition of measles surveillance cases, especially in areas or populations of high immunization rates; and laboratory testing will become more and more important.