| Background:Measles is caused by the measles virus as a rash of acute systemic respiratory tract infectious diseases. Patients of measles are the only source of infection. Measles is transmitted mainly through droplet transmission, the time from prior to the onset of 1-2 days to 5 days after the rash is contagious period, especially in the precursor phase with oral mucosa plaques which is the strongest contagious period. Individuals are susceptible to this disease.Although the incidence rate of measles in children has been reduced due to the universal application of measles vaccine, but in recent years, the morbidity rates in infants and young children and adults are increasing up. In addition, the clinical symptoms of measles have also become no regular.Measles is one of seven kinds of infectious diseases of immunization program in China, one of top six diseases according to the incidence cases in 35 kinds of infectious diseases which are regularly reported to the country according to the infectious law. Measles is also one of major infectious diseases which are seriously endangering population health. In China, before the vaccine use, the incidence rates of measles fluctuated at between 158-1432/100,000 from 1956 ~ 1965 according to national report, with an average rate of 766/100,000. The year of 1959 had the highest incidence rate with 1432.41/100,000, more than 9000,000 cases and 260,000 deaths were reported, the mortality rate reached to 39.7/100,000. From the beginning of 1965 with the use of measles vaccine, especially in 1978 with carrying out immunization program, the incidence rate of measles had been effectively controlled. Since 1987, the annual incidence rates had been about 10/100,000 according to national reports. However, in recent years, especially since the 2005, incidence of measles has been in a high state. The incidence cases during Jan. 2008 to April,2008 were all higher than those of the same periods of the previous 4 years, and deaths every month, more than one time of measles outbreaks in primary and middle schools.Measles epidemic in Shandong Province is also not optimistic. In 2008, 9441 confirmed measles cases were reported by the province's network of epidemic straight reporting system, the incidence rate was 10.08/100,000, and the year 2008 has the highest rate in nearly 20 years. There were seven death cases with the fatality rate being 0.07%. Since 2005, Licheng District, Jinan has been consecutively high level of measles incidence. The number of confirmed measles cases in 2008 were 130 (excluding high-tech area) with an incidence rate of 15.16/100,000, making Licheng district rank second in Jinan city.In November 10, 2006, the Ministry of Health developed "2006-2012 National Plan of Action for the Elimination of Measles". In January, 2007, the conference of National Plan of Action for Measles Elimination was held in Beijing which put forward: (l)the National Measles morbidity would be controlled at 1/100,000 in 2012 (excluding the importing cases); (2) no indigenous measles virus transmission; (3) promoting immunization program development through the elimination of measles.To ensure finishing the 2012 goals of eliminating measles in Licheng District, it is necessary to timely analyze the characteristics of measles, explore its major factors so as to provide the basement for developing and implementing effective strategies and measures for measles control.Objectives:Measles is a kind of infectious disease which our country will intend to eliminate it in 2012. Licheng District had been a low incidence rates of measles before 2005 since 1978. However, this district has been an upward trend of measles incidence since 2005, especially from the end of 2007 to 2008. The incidence rate of measles of Licheng District in 2008 was the highest among those rate of nearly past 30 years, and occurred many new features of epidemic. This study is aimed to explore the major factors related to epidemic measles and to provide basement for developing and implementing effective strategies and measures of measles control so as to ensure the 2012 goals of eliminate measles. Methods:In this study, descriptive epidemiology was adopted to analyze the data of Diseases Reporting System and measles surveillance system in 2008 in Licheng. 1:1 case-control study was carried out to explore the related factors of measles in children and adults. The awareness status of measles related knowledge was understood by analyzing data form questionnaire survey of urban and rural residents. The causes of small-month-old infant measles were also studied by detecting small-month-old measles antibody level.Results:1. With having carried out child immunization program and promoted measles vaccine since 1978 in Licheng District, the incidence rates of measles had been controlled under 5/100,000, especially during 1996 and 2004 the incidence rate of measles were under 1/100,000. Since 2005, Licheng District has been high status in measles incidence consecutively for 4 years, especially from the end of 2007, the incidence rates of measles was highest.2. The number of confirmed measles cases in Licheng District in 2008 was 130 with an incidence rate of 15.16/100,000. There were two age groups of higher incidence rates of measles, one was of children aged 0-1, the other was of 25-30 years old. There were 69 cases aged lower than 1-year-old with the percent of total cases 53%, especially aged in children with 6, 7, 8 -month-old. There were 43 cases aged from 6 months to 8 years old with the percent of total cases of 33%. The highest incidence months of measles were during March to May months. The towns with higher incidence of measles were concentrated in Hong Lou, including Wang Sheren, Hua Shan, Gang Gou, Zhong Gong, Tang Wang. The main trends were sporadic from the urban and rural zones to the township.3. Single variable analysis showed that having low level of knowledge of the measles, the history of mobile were associated with measles which their OR values were 4.545 (95%CI: 1.686-12.251), 4.000 (95%CI: 1.147-13.951) respectively. Conditional logistic regression model showed having low level of knowledge of the measles was associated with measles which the OR value was 3.992 (95%CI: 1.445-11.030)4. Single variable analysis showed that children with low weight, bad living conditions, the history of medical prior to the onset, history of disease, history of immunization were associated with measles of children which their OR values were 3.031 (95%CI: 1.620-5.670), 3.227 (95%CI: 1.740-5.987), 5.516 (95CI: 1.984-15.340), 3.395 (95CI:1.355-8.506), 25.581 (95%CI: 11.268-58.074) respectively. Conditional Logistic regression model showed low weight, the history of medical prior to the onset, history of disease, history of immunization were associated with measles of children which their OR values were 3.542 (95%CI: 1.354-9.262), 4.394 (95%CI: 1.113-17.351), 12.425(95%CI: 2.632-58.658), 47.261 (95%CI:15.568-143.470) respectively.5. The srudy on the level of measeles' antibodies by detecing mothers and infants with different months found that there were statistically corrleation between neonatal antibody and the consistent rate of maternal antibody was 95%. Only 26.67% of 3-month-old children had postive antibody which was significantly higher that of 0-month-old children (P<0.01). The rate of positive antibody of 6-month-old was decreased to 15.83% which was significantly lower that that of 3-month-old children (P<0.05). The rate of positive antibody of 8-month-old children was 16.67% which was very close to that of 6-month old children (P>0.05). The rate of positive antibody of 9-month-old children was increased to 87.5% after the first needle of measles vaccinie which was significantly higher than that of 8-month-old children (P<0.01). The results showed that it was very important that getting antibody from mother and timely being injected first needle of measeles vaccine could reduce measels incidence of children with low age group.6. The awareness rate of measles related knowledge was only 29% in urban and rural residents which suggested that health education should be largely carried out in urban and rural residents.Conclusions:1. The epidemiological characteristics of measles in Licheng District, Jinan city were that the mode of measles epidemic was sporadic, the measles cases were major in chilidren with infants low than 1-year-old and adults with above 25-year-old, especially in children with 6-month-old. Cases were more seen during March and May with some cases happening in other months. The incidence areas were developed from connection between urban and rural areas to the towns.2. Not knowing the knowledge of measles and the history of migration were associated with adult measles.3. Children's malnutrition, medical history prior to the onset, history of disease, history of measles vaccine were associated with children measles. Preventing nosocomial infection and timely injecting vaccination were very important in preventing children measles. 4. Analysis on the level of measles antibody of small-month-old children showed that maternal antibody had a certain protective effect on infant measles, the postive rate of antibody was reduing with age, the lowest rate of antibody was in children after 6 month old which the antibody shouldn't protect small-month-old children. The first needle of measles vaccine should be carried out to protect measles in 8-month-old children as well as 6-month-old.5. The awareness rate of measles related knowledge was low in urban and rural residents which suggested that health education should be comprehensively carried out in urban and rural residents.
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