呼吸系统疾病专栏

儿童麻疹757例临床特征分析

  • 苗敏 ,
  • 王彩英 ,
  • 庞琳
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  • 首都医科大学附属北京地坛医院儿科(北京 100015)

收稿日期: 2021-11-04

  网络出版日期: 2022-08-09

Analysis of clinical characteristics of measles in 757 children

  • Min MIAO ,
  • Caiying WANG ,
  • Lin PANG
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  • Department of Pediatrics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China

Received date: 2021-11-04

  Online published: 2022-08-09

摘要

目的 总结儿童麻疹的临床特点,为其防控及临床诊治提供依据。方法 回顾性分析2009年3月—2019年7月收治的757例麻疹患儿的临床资料。患儿按年龄分为<8月龄组和≥8月龄组,比较两组患儿的临床特征。结果 757例麻疹患儿中男505例(66.7%)、女252例(33.3%);中位年龄8.7(6.7~12.0)月,以<1岁患儿(71.7%)为主。每年3~5月份为发病高峰期。未接种疫苗者653例(86.3%)。临床表现以发热(99.5%)、皮疹(100.0%)、咳嗽(72.0%)、麻疹黏膜斑(Koplik斑,58.4%)多见,并发症以肺炎(77.5%)最常见。<8月龄患儿251例,≥8月龄506例。与≥8月龄组相比,<8月龄组典型皮疹、咳嗽、呼吸困难、腹泻及重型麻疹发生率较高,高热发生率较低,差异有统计学意义(P<0.05)。临床治愈738例(97.5%),死亡19例。死亡患儿中<1岁14例,≥1岁5例;16例未接种疫苗;8例有基础疾病。结论 儿童麻疹高发于春夏季节,好发于未接种麻疹疫苗的<1岁的男孩,临床以典型麻疹表现为主,可导致死亡,尤其合并基础疾病者。

本文引用格式

苗敏 , 王彩英 , 庞琳 . 儿童麻疹757例临床特征分析[J]. 临床儿科杂志, 2022 , 40(8) : 591 -596 . DOI: 10.12372/jcp.2022.21e1532

Abstract

Objective To summarize the clinical characteristics of measles in children and to provide a basis for the prevention and control, clinical diagnosis and treatment of measles. Methods Clinical data of 757 children with measles admitted to the Department of Pediatrics, Beijing Ditan Hospital, Capital Medical University from March 2009 to July 2019 were retrospectively analyzed. The children were divided into <8 months old age group and ≥8 months old age group according to their age. Clinical characteristics of the two groups were compared. Results There were 505 boys (66.7%) and 252 girls (33.3%) recruited, the median age was 8.7 (6.7-12.0) months, with most children younger than 1 year old (71.7%). The peak of measles is from March to May every year. 653 children (86.3%) were not vaccinated. The clinical manifestations were fever (99.50%), rash (100%), cough (71.99%), measles mucosal plaque (Koplik plaque, 58.4%), etc, the most common complication was pneumonia (77.54%). There were 251 children (33.2%) <8 months old and 506 children (66.8%) ≥8 months old. Compared with ≥8 months old age group, the incidence of typical rash, cough, dyspnea, diarrhea, and severe measles was higher than that in <8 months old age group, and the incidence of high fever was lower, and the difference was statistically significant (P<0.05). There were 738 clinical cures (97.5%) and 19 deaths. Among the deceased children, 14 were <1 year old and 5 were ≥1 year old; 16 were not vaccinated; 8 had underlying diseases. Conclusions Measles in children is prevalent in spring and summer, most common in unvaccinated boys <1 year of age, and the main clinical manifestation is typical measles, which can lead to death, especially those combined with underlying diseases.

参考文献

[1] Patel MK, Dumolard L, Nedelec Y, et al. Progress toward regional measles elimination-worldwide, 2000-2018[J]. MMWR Morb Mortal Wkly Rep, 2019, 68(48): 1105-1111.
[2] Paules CI, Marston HD, Fauci AS, et al. Measles in 2019 - going backward[J]. N Engl J Med, 2019, 380(23): 2185-2187.
[3] Bedford H, Elliman D. Measles: neither gone nor forgotten[J]. BMJ, 2018, 362: k3976.
[4] Yang XT, Tang TT, Yang ZK, et al. Evaluation of measles vaccination coverage in Lincang City, Yunnan Province, China[J]. Hum Vaccin Immunother, 2021, 17(9): 3145-3152.
[5] Holt Ed. Global surge in measles should be “a wake-up call”[J]. Lancet, 2019, 394(10215): 2137.
[6] Filia A, Bella A, Del Manso M, et al. Ongoing outbreak with well over 4,000 measles cases in Italy from January to end August 2017 - what is making elimination so difficult?[J]. Euro Surveill, 2017, 22(37): 30614.
[7] Fadic RR, Repetto DG. Measles: historical background and current situation[J]. Rev Chi Pediatr, 2019, 90(3): 253-259.
[8] Zheng HZ, Jia KM, Sun RY, et al. Epidemiological changes in measles infections in southern China between 2009 and 2016: a retrospective database analysis[J]. BMC Infect Dis, 2020, 20(1): 197.
[9] Moss WJ. Measles[J]. Lancet, 2017, 390(10111): 2490-2502.
[10] Rasool MH, Rafiq A, Nawaz MZ, et al. Sero-epidemiology and risk factor analysis of measles among children in Pakistan[J]. Pol J Microbiol, 2018, 67(2): 227-231.
[11] Lo Vecchio AL, Krzysztofiak A, Montagnani C, et al. Complications and risk factors for severe outcome in children with measles[J]. Arch Dis Child, 2020, 105(9): 896-899.
[12] 中华人民共和国国家卫生和计划生育委员会. 麻疹诊断[J]. 传染病信息, 2017, 30(4): I-IX.
[13] 马蕊, 卢莉, 张朱佳子, 等. 2010年含麻疹成分疫苗补充免疫前后北京市麻疹流行特征变化分析[J]. 中华预防医学杂志, 2015, 49(12): 1036-1041.
[14] 马超, 苏琪茹, 郝利新, 等. 中国2012-2013 年麻疹流行病学特征与消除麻疹进[J]. 中国疫苗和免疫, 2014, 20(3): 193-199.
[15] Qin SR, Ding Y, Yan R, et al. Measles in Zhejiang, China, 2004-2017: population density and proportion of floating populations effects on measles epidemic[J]. Health Secur, 2019, 17(3): 193-199.
[16] Ma C, Rodewald L, Hao LX, et al. Progress toward measles elimination - China, January 2013-June 2019[R]. MMWR Morb Mortal Wkly Rep, 2019, 68(48): 1112-1116.
[17] 陈必全, 夏春琴. 2009-2013 年麻疹住院患儿的免疫状态、流行病学及临床特点[J]. 中国感染控制杂志, 2014, 13(4): 218-221.
[18] Casasoprana A, Honorat R, Grouteau E, et al. A comparison of adult and pediatric measles patients admitted to emergency departments during the 2008-2011 outbreak in the Midi-Pyrénées region of France[J]. Jpn J Infect Dis, 2014, 67(2): 71-77.
[19] Chovatiya R, Silverberg JI. Inpatient morbidity and mortality of measles in the United States[J]. PloS One, 2020, 15(4): e0231329.
[20] Sindhu TG, Geeta MG, Krishnakumar P, et al. Clinical profile of measles in children with special reference to infants[J]. Trop Doct, 2019, 49(1): 20-23.
[21] Coetzee S, Morrow BM, Argentet AC, et al. Measles in a South African paediatric intensive care unit: again![J]. J Paediatr Child Health, 2014, 50(5): 379-385.
[22] Cáceres VM, Strebel PM, Sutter RW, et al. Factors determining prevalence of maternalantibody to measles virus throughout infancy: a review[J]. Clin Infect Dis, 2000, 31(1): 110-119.
[23] Leuridan E, Hens N, Hutse V, et al. Early waning of maternal measles antibodies in era of measles elimination: longitudinal study[J]. BMJ, 2010, 340: c1626.
[24] Hao LX, Ma C, Wannemuehler KA, et al. Risk factors for measles in children aged 8months-14 years in China after nationwide measles campaign: a multi-site case-control study, 2012-2013[J]. Vaccine, 2016, 34(51): 6545-6552.
[25] Schneider-Schaulies S, Schneider-Schaulies J. Measles virus-induced immunosuppression[J]. Curr Top Microbiol Immunol, 2009, 330: 243-269.
[26] Li JJ, Zhao Y, Liu Z, et al. Clinical report of serious complications associated with measles pneumonia in children hospitalized at Shengjing Hospital, China[J]. J Infect Dev Ctries, 2015, 9(10): 1139-1146.
[27] 刘霞, 马静, 张忠晓, 等. 儿童重症肺炎2 044例肺泡灌洗液细菌病原学分析[J]. 中国实用儿科杂志, 2014, 29(6): 438-441.
[28] 李怡秋, 喻文雅, 闫玉英. 石家庄市2004-2013年麻疹流行特征分析[J]. 医学动物防制, 2016, 32(4): 453-455.
[29] Carazo S, Billard MN, Boutin A, et al. Effect of age at vaccination on the measles vaccine effectiveness and immunogenicity: systematic review and meta-analysis[J]. BMC Infect Dis, 2020, 20(1): 251.
[30] Carazo Perez S, De Serres G, Bureau A, et al. Reduced antibody response to infant measles vaccination: effects based on type and timing of the first vaccine dose persist after the second dose[J]. Clin Infect Dis, 2017, 65(7): 1094-1102.
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