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2021, vol. 60, br. 2, str. 35-43
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Epidemija malih boginja u Nišavskom i Topličkom okrugu od 2017. do 2018. godine
Measles outbreak in the Nišava and Toplica districts from 2017 to 2018
Stojanović Miodraga, Rančić Natašaa, Milenković Nikolab, Perović Miodragc, Janićijević Ivanac, Kostić Marinac, Ilić Mirkoc, Stojanović Markoc, Jovanović Markoc, Ignjatović Aleksandraa  , Apostolović-Anđelković Marijaa
aUniverzitet u Nišu, Medicinski fakultet + Institut za javno zdravlje Niš, Niš bKlinički centar Niš cInstitut za javno zdravlje Niš, Niš
e-adresa: natasa.rancic@medfak.ni.ac.rs
Sažetak
Male boginje su pre uvođenja obavezne vakcinacije bile glavni uzrok umiranja dece mlađe od 5 godina. Cilj rada bio je da prikaže epidemiološke i kliničke karakteristike obolelih u epidemiji malih boginja, koja je počela 23. novembra 2017. godine i trajala sve do 28. jula 2018. godine, na teritoriji Nišavskog i Topličkog okruga. Primenjena je deskriptivna metoda, kojom su retrospektivno analizirani podaci od novembra 2017. godine do jula 2018. godine. Primenjena je definicija slučaja, koju je dala Komisija Evropske unije (EU) 2012. godine. U Institutu za javno zdravlje Niš, uzimana je krv za određivanje antitela i svi uzorci su slati u referentnu ustanovu Zavod za vakcine i serume "Torlak" u Beogradu, gde su testirani na prisustvo IGM i IgG antitela. Statistička analiza izvršena je u programskom paketu EPI INFO v7.2.2.6. Od 23. novembra 2017. godine do 28. jula 2018. godine, ukupno je obolelo 1327 osoba (584 muškarca i 743 žene), a prosečan uzrast obolelih bio je 35 godina. Najviše obolelih bilo je iz dobne grupe od 30 od 39 godina, 510 osoba (38,4%), a najmanje iz dobne grupe od 15 do 19 godina, 34 osobe (2,6%). Deca mlađa od jedne godine bila su zastupljena sa 5,3%, a deca iz osnovnih škola sa 4,4%, u odnosu na ukupan broj obolelih. Više od jedne četvrtine obolelih nije bilo vakcinisano, 338 osoba (25,5%); samo su 37 (2,8%) bolesnika primili dve doze kombinovane vakcine protiv malih boginja, zauški i rubele (MMR), a 50 osoba (3,8%) vakcinisano je samo jednom dozom. Za 902 (68,0%) bolesnika vakcinalni status nije bio poznat. Komplikacije su zabeležene kod 962 osobe (72,5%) i najčešće su bile kod dece mlađe od jedne godine (92,9%) i kod dece predškolskog uzrasta (88,2%). Najčešće komplikacije bile su: malnutricija (kod 823 osobe, 62,0%), dijareja (kod 590 osoba , 44,5%), pneumonija (kod 122 osobe, 9,2%), a encefalitis je zabeležen samo kod jednog deteta. Smrt zbog komplikacija potvrđena je kod 4 bolesnika; svi su imali laboratorijsku potvdu oboljenja, troje nije bilo vakcinisano, a jedno dete bilo je imunokompromitovano. Letalitet je iznosio 0,3 na 100 obolelih. Mogući uzrok ove velike epidemije bili su nedovoljna imunizacija i Mali obuhvat MMR vakcinom osetljive populacije. Zabeležena su 4 smrta ishoda kod obolelih. Nadzor nad imunizacijom, visok vakcinalni obuhvat osetljive populacije, kao i efikasnost MMR vakcine, osnovni su preduslovi za prevenciju malih boginja.
Abstract
Measles was the leading cause of death among children under 5 years of age before the introduction of mandatory vaccination. The objective of the paper was to describe the epidemiological and clinical characteristics of the affected individuals in the large measles outbreak in 2017-2018 in the Nišava and Toplica Districts. Descriptive study was done. For the investigation of the outbreak, the general principles of the case definition of the European Union (EU) Commission Decision of 2012 were used. Laboratory investigations of initial patients were conducted at the Center for Control and Prevention of Diseases in the Institute of Public Health Niš, and all specimens were sent for anti-measles IgM/IgG antibody tests to the reference laboratory of the Institute of Virology, Vaccines and Sera "Torlak" in Belgrade. A total of 1327 (584 males and 743 females) cases were reported from 23 November 2017 to 28 July 2018, when it ended. The average age was 35 years (range from < 1 to 70 years). The highest number of patients (510; 38.4%) were in the 30-39 year age group and the lowest number (34; 2.6%) was in the 15-19 year age group. Infants represented 5.3% of all affected and children from primary schools accounted for 4.4% out of all affected. One-fourth of the outbreak cases (338; 25.5%) were unvaccinated. Only 37 (2.8%) patients received two doses of the combined vaccine against measles, mumps, and rubella (MMR) and 50 (3.8%) received one dose. For the majority of affected cases (902; 68.0%) vaccination status was unknown. Measles-related complications were registered in 962 (72.5%) patients. Complications were the most common in infants (92.9%) and among children 1-6 years of age (88.2%). Malnutrition was the most frequent complication (823 cases; 62.0%) followed by diarrhea (590 cases; 44.5%) and pneumonia (122 cases; 9.2%); encephalitis was reported in 1 case. Measles-related deaths in the observed outbreak were confirmed in four patients (all laboratory-confirmed, three unvaccinated and an immune compromised child). The case-fatality rate of 0.3 per 100 measles cases was determined. The probable causes of this large measles outbreak were insufficient vaccination and low vaccine coverage with MMR vaccine and accumulation of a high susceptible population. Four measles-related deaths were registered. Monitoring of the vaccination status, high vaccine coverage and effectiveness of MMR vaccine are essential for the prevention of measles outbreaks.
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