Study On Measles Serological Epidemiology And Its Risk Factors Of Freshmen In Schools For Children Of Migrant Workers Before The Supplementary Immunization

Objective(1) To understand the epidemiological characteristics of measles in Qingpu District from2001to2010.(2) To investigate measles immune status of new students in schools for children of migrant workers in Qingpu District before the supplementary immunization.(3) To study the risk factors of the immunization coverage of measles in Qingpu District through understanding the basic situation of families and parents’cognition on measles vaccine and immunization of the fresh and investigate cognition condition on measles, measles vaccine and immunization of staff of immunization programme,Methods(1) A descriptive analysis was conducted for the epidemiological characteristics of measles in Qingpu District from2001to2010based on the case data and population numbers. The measles cases data were collected from the direct network report of notifiable disease monitoring system and the special surveillance of measles. The information of resident and non-resident population was collected from Qingpu statistical bureau and police bureau.(2)2towns,8schools,11grades,57classes and606new students were sampled from towns in Qingpu District by multistage sampling.(3)3ml blood samples were collected from each of the606new students before the Supplementary immunization. The measles IgG antibodies in serum samples were tested by quantitative ELISA.(4) The parents of the606new students were investigated by using a self-designed questionnaire. The basic information of the new students and their families, measles vaccination, cognition on measles vaccine and immunization, the willingness to be inoculated and the ways of getting the information were known by the investigation. And the rates were used for statistical analysis.(5) The staff of immunization programme in Qingpu District CDC and community health service centers was investigated by using a self-designed questionnaire. The questionnaire contents included the harm of measles, effectiveness of measles vaccine, cognition on measles elimination, traditional supplementary immunization, etc. The method of descriptive analysis was used for analysis on the information.ResultsMeasles epidemiological characteristics in Qingpu from2001-2010(1) From2001to2010, the epidemics occurred sporadically and the annual average morbidity was8.97/100000(0.1/100000-35.49/100000). It could be divided into2stages:the fluctuation stage (2001-2007) and decline stage (2007-2010). The incidence of disease in the fluctuation stage fluctuated every other year (2.23/100000-35.49/100000). The incidence of disease in the decline stage decreased from year to year (9.16/100000-0.10/100000).(2) Measles outbreak mainly occurred at homes, in factories and at schools for children of migrant workers. Among those places, the cases at homes were mainly2-cases and the cases in factories and schools for children of migrant workers were mainly multi-cases.(3) In a whole year in Qingpu District, measles outbreak occurred frequently, especially in spring and autumn. The cases occurring from April to June accounted for55.77%of the whole.(4) Cases under5years old and adults from20-40years old were the main cases. The number of these two groups respectively accounted for35.44%and48.90%of the whole patients, of which, Babies under8months accounted for16.21%.(5) The Population of residence booklet accounted for53.16%; reversely, the population without shanghai householder register accounted for46.84%.Measles serological epidemiology of new students before the supplementary immunization(1) The geometric mean of concentration (GMC) of measles IgG antibodies was998.96mIU/ml (95%CI:(912.93,1093.10)), with the positive rate of96.96%.(2) The GMC (F=1.19, P=0.30) and the positive rates (χ2=0.36, P=0.83) among kindergarten, primary school and junior middle school had no statistical significance. The difference of GMC (F=1.22, P=0.30) and positive rates (χ2=3.46, P=0.18) between students with different education history had no statistical significance.(3)38.29%of new students couldn’t show their immunization records,37.95%of new students had been inoculated with at least2doses of measles vaccine, and48.18% of freshmen couldn’t confirm their immunization history. There was no statistical significance to compare the new students with different immunization history (F=0.75, P=0.53).The parents’ cognition on measles vaccine and immunization(1) With the awareness rate from high to low, the parents’relevance knowledge were the disease which measles vaccine can prevent, immunization records of new students must be identified, it’s free for measles vaccine immunizatiaon, the time for the primary immunization of measles vaccine, times of measles vaccine immunization. The awareness rates of the time for the primary immunization of measles vaccine, times of measles vaccine immunization and the disease which measles vaccine can prevent were respectively17.49%,11.39%and73.76%. There was statistical significance among the awareness rate of different knowledge points (χ2=685.90, P<0.001).(2) The average score of the parents’awareness was2.72(95%CI:(2.66,2.78)). And68.98%of the parents’s scores were lower than3. The group of farther, the group of mother and the group of grandparents had no statistical significance.(F=2.894, P=0.056>0.05).(3) The rate of who were willing to let theirs children to be inoculated was88.94%. The groups with the rate from high to low were the group of mother, the group of faterh and the group of grandparents. The three groups are of no statistical significance.(χ2=4.04, P=0.13>0.05).(4) Different ways of getting informaitons for the parents with the proportion sizes form high to low were medical staff, written publicity materials, radio and TV, the others and internet. The highest proportion size was40.10%while the lowest was1.16%. There was statistical significance among different ways (χ2=359.22,P=0.00<0.05).Cognition condition on measles, measles vaccine and immunization of staff on immunization programme(1)90.48%of the staff on immunization programme held that the harm of measles was not dangerous or serious.73.02%of the respondents considered that measles is not the important infectious disease which effect human health. And88.89%thought that measles morbidity level in Qingpu district was at the stage of emanation. (2)38.10%of the respondents held that it will not be sure measles can be eliminated in Qingpu district. The proportion of who found that measles can not be eliminated is33.33%, meanwhile, the proortion was23.81%of who believed that measles can be eliminated.(3)60.32%of the respondents held that non-ideal immunization coverage of measles vaccine was the most important factor of measles, and30.16%of the respondents felt that the most important factor was increasing floating population.50.79%of the respondents thought that the rate of2times measles vaccine immunization coverage needed to be improved while39.68%of the respondents thought that the rate had been a high level.66.67%of the respondents felt the less attention that parents paid to the immunization of their children was the most important influence factor of the immunization coverage rate, meanwhile,26.98%thought that the most important influence factor was the parents could not getting enough information.74.60%of the respondents thought that the scattered children of floating population were the most important group which affected the rate of measles vaccine immunization coverage.(4)38.10%of the respondents felt that there was no need to conduct extensive supplementary immunization for measles,53.97%of the respondents felt it was necessary to carry out regular catch-up immunization of measles vaccine in target population,85.71%of the respondents felt that carrying on the sturdy practice of basic immunization and catch-up immunization at fixed period would be better for eliminating measles.(5)74.60%and25.40%of the respondents respectively thought that the face-to-face publicity from medical personnel to the parents, brochures, leaflets and pictorials were the most effective way of publicity for the parents.46.03%and36.51%of the respondents respectively thought that the most effective means to improve the vaccination rate of the measles vaccine were effectively extending the publicity of relevant knowledge and providing more convenient vaccination service.Conclusions(1) The measles morbidity level in Qingpu district is being a low and emanatory one. The key locations of measles outbreaks include homes, factories and schools for children of migrant workers. Persons who aged less than5years old and adults from20to40years old are key population of measles.(2) The GMC of measles IgG antibodies and the positive rate of new students in schools for children of migrant workers before the supplementary immunization were at a high level.(3) The investigating immunization coverage of measles vaccine was not high as the result of serological epidemiology.(4) The parents’awareness rate of measles vaccine and immunization was low, and their ways to get the information were unitary and traditional.Suggestions(1) Emphatically control epidemic situation of measles which could occur at key locations and key population. The key locations include homes, factories and schools for children of migrant workers. The key population are persons who under5years old and adults from20to40years old.(2) The education department and the health department should strengthen management of immunization records. And the new students should not be allowed to go to school before their immunization records be checked.(3) In order to promote the awareness rate of immunization we should using specific strategy and method of propaganda which according to group characteristics. The population behavior of immunization should be changed from the passive status into active; meanwhile, the immunization blank of measles vaccine could be effectively prevented.(4) We should adjust immunization strategy and grasp every links of the whole process of the work. On the one hand, we must carry on the sturdy practice of basic immunization; we should using proper immunization strategy for different population. On the other hand, the government must stress the construction of the hardware; meanwhile, the immunization department should do their best to provide high quality service.