保加利亚普罗夫迪夫地区麻疹疫情暴发(2017年3月至7月)

P. Argirova, A. Petrov, N. Vatev, M. Atanasova, Mariana Mourdjeva, M. Stoycheva
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引用次数: 0

摘要

目的:分析2017年3月至7月保加利亚普罗夫迪夫地区麻疹病例的临床、流行病学和实验室特征。材料和方法:该研究包括139名麻疹住院患者,在观察期间在普罗夫迪夫圣乔治大学医院传染病诊所接受治疗。其中133例经酶联免疫吸附试验确诊。采用了以下方法:临床和流行病学分析、实验室、微生物学和影像学检查。结果:患者的年龄分布为:1岁以下婴儿占23.8%;1-3年,占24.5%;4-17岁,占30.9%;18岁以上,占20.8%。种族:罗姆人占83.5%,保加利亚人占16.5%。大多数患者(62%)报告与麻疹患者有过接触。98名患者年龄超过13个月,他们本应接种疫苗,因为保加利亚的疫苗是在13个月接种的。在这98名患者中,49%的患者接种了疫苗,28%的患者没有接种,23%的患者没有数据。最常见的临床症状为:发热97.1%,咳嗽98.6%,流鼻涕82.7%。结膜炎82%,乏力46%,腹泻51.1%。皮疹平均出现在发病第4天。Koplik斑点占71.9%,颈部淋巴结肿大占56.1%,肝肿大占25.2%,脾肿大占7.9%;支气管炎/肺炎的听诊数据为33.1%。实验室检查:白细胞减少症为32.4%,白细胞增多症为2.2%,其余65.4%结果正常。ESR升高39.1%,CRP升高76.5%。肺部X光检查符合指示,28/46为阳性。血清抗麻疹IgM(ELISA)阳性率为95.7%(133/139)。我们观察到以下并发症:肺炎12.2%,支气管炎15.1%,喉炎4.3%,中耳炎1.4%,肠胃炎14.4%和口腔炎6.5%。结论:麻疹在儿童时期仍然流行,但20.8%的患者是成年人。对患者免疫力的分析表明,尽管欧洲在2020年之前都有消灭麻疹的计划,但免疫接种周期是周期性爆发流行病的主要原因。这种疾病有典型的病程,但我们观察到并发症发生率较高。
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Epidemic Outbreak of Measles in the Region of Plovdiv, Bulgaria (March-July 2017)
Object: To analyze the clinical, epidemiological and laboratory characteristics of the cases with measles in the Plovdiv region, Bulgaria, in the period March-July 2017. Materials and Methods: The study included 139 hospitalized patients with measles, treated in the Clinic of Infectious Diseases, University Hospital “St. George”—Plovdiv, during the observed period. Diagnosis was verified by ELISA in 133 of the patients. The following methods were used: clinical and epidemiological analysis, laboratory, microbiological and imaging tests. Results: The age distribution of the patients was: infants below 1 year were 23.8%; 1 - 3 years—24.5%; 4 - 17 years—30.9%; and over 18 years —20.8%. Ethnicity: from Roma origin were 83.5% and Bulgarians—16.5%. Most of the patients (62%) reported contact with a measles patient. Ninety eight of the patients were over 13 months of age and they should have been immunized, as the vaccine in Bulgaria is applied on the 13 month. Of these 98 patients, 49% were immunized, 28% were not, and for 23% there were not data. The most common clinical symptoms were: fever—97.1%, cough—98.6% and runny nose—82.7%. Conjunctivitis was observed in 82%, asthenia in 46%, and diarrhea in 51.1%. The rash appeared average on the 4th day of the onset of complaints. Koplik’s spots were observed in 71.9%, cervical lymphadenopathy in 56.1%, hepatomegaly—in 25.2%, and splenomegaly—in 7.9%; auscultation data for bronchitis/pneumonia—in 33.1%. Laboratory tests: leucopenia in 32.4%, leukocytosis—2.2%, normal results—in the rest 65.4%. ESR was increased in 39.1% and CRP in 76.5% of the patients. X-ray of the lung was performed under indication and was positive in 28/46. The serological test—anti-measles IgM (ELISA) was positive in 95.7% (133/139). We observed the following complications: pneumonia—12.2%, bronchitis—15.1%, laryngitis—4.3%, otitis—1.4%, gastroenteritis—14.4% and stomatitis—6.5%. The outcome was fatal for one patient. Conclusions: Measles still prevails during the age of childhood, but 20.8% of the patients were adults. The analysis of the patient’s immunity showed that the lap of immunization was the main cause for periodical arising of epidemic outbreaks, although the programs for elimination of measles in Europe until 2020. The disease ran with typical course but we observed a higher rate of complications.
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