2019年江西省一家百日咳哨点医院监测病例的流行病学与临床特征

Epidemiological and clinical characteristics of surveillance cases in a sentinel hospital for pertussis in Jiangxi Province in 2019

  • 摘要:
    目的 分析2019年江西省一家百日咳哨点医院监测病例的流行病学与临床特征,为百日咳的防控提供相应参考。
    方法 开展百日咳医院监测病例个案调查,收集其基本信息、流行病学、临床特征等信息。
    结果 2019年共调查百日咳监测病例125例,其中临床诊断病例73例(58.40%)、确诊病例52例(41.60%),发病年龄主要集中在5岁以下儿童(108例,86.40%),其中0~<1岁组婴儿病例数最多(48例,38.40%);110例发病前有百日咳疫苗接种史(88.00%),百日咳疫苗接种1~2剂次组的病例发病日期距最后一剂疫苗接种日期天数短于3~4剂次组(U=-5.990,P<0.001);3例病例可能存在百日咳家庭内传播现象;所有病例均有咳嗽症状,主要表现为痉挛性咳嗽(77例,61.60%),其他主要临床表现有发热(76例,60.80%)、呕吐(30例,24.00%)、眼结膜充血(27例,21.60%)和鸡鸣样吸气性回声 (16例,12.80%);73例(58.40%)出现并发症,其中1例死亡;病例在该哨点医院就诊前具有多次就诊经历,病例发病日期至首诊日期间隔MP25P75)为2(0,3) d;总首诊误诊率为88.00%(110/125),二级及以下医院首诊误诊率高于三级医院,差异有统计学意义(χ2=21.582,P<0.001)。
    结论 百日咳病例临床症状多不典型,首诊易被误诊,需进一步加强医疗机构尤其基层医疗机构百日咳病例早期诊断能力。

     

    Abstract:
    Objective To analyze the epidemiological and clinical characteristics of surveillance cases in a sentinel hospital for pertussis in Jiangxi Province in 2019, and to provide corresponding references for the prevention and control of pertussis.
    Methods Case investigation of pertussis was conducted among sentinel hospital surveillance cases, collecting their basic information, epidemiological characteristics, clinical characteristics, and other information.
    Results A total of 125 pertussis surveillance cases were investigated in 2019, including 73 clinically diagnosed cases (58.40%) and 52 confirmed cases (41.60%). The age of onset was mainly concentrated in children under 5 years old (108 cases, 86.40%), with the largest number of cases in infants aged less than 1-year-old (48 cases, 38.40%). Most cases had a history of receiving pertussis vaccine before onset (110 cases, 88.00%), and the intervals between the onset date and the date of last dose of pertussis vaccine in the 1‒2 doses group were significantly shorter than that in the 3‒4 doses group (U=-5.990, P<0.001). Probable household transmission of pertussis was found in 3 cases. All cases had cough symptoms, mainly manifested as whooping cough (77 cases, 61.60%), in addition to other main clinical manifestations, such as fever (76 cases, 60.80%), vomiting (30 cases, 24.00%), conjunctival congestion (27 cases, 21.60%), and inspiratory whoop (16 cases, 12.80%). A total of 73 cases (58.40%) experienced complications, including 1 death case. All the cases had multiple medical visit experiences before this visit, with an interval of 2 (0,3) days between the onset date and the first visit date. The misdiagnosis rate at the first medical visit was 88.00% (110/125), and the misdiagnosis rate of the first visit in secondary and primary hospitals was significantly higher than that in tertiary hospitals, exhibiting a statistically significant difference (χ2=21.582, P<0.001).
    Conclusion The clinical symptoms of pertussis cases are often atypical, and the first diagnosis is prone to misdiagnosis, so it’s necessary to further strengthen the early diagnosis capabilities for pertussis cases in healthcare institutions, especially in the primary healthcare institutions.

     

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