目的 分析大学生水痘流行病学特征及相关危险因素,为高校大学生水痘的预防控制提供理论依据。方法 以2017年—2020年山东某高校确诊的大学生水痘患者为基础,采用描述性流行病学方法分析大学生水痘的流行特点,并采用病例对照研究方法,调查病例组、对照组研究对象的基本情况及相关影响因素,采用单因素及多因素logistic回归分析大学生水痘发病的危险因素。结果 2017年1月—2020年12月共确诊水痘学生198人,发病率为1.50 ‰;其中,2018年发病率最高(2.36‰),2020年度发病率最低(0.90‰),各年度发病率差异有统计学意义(χ2=32.003,P<0.001)。水痘发病月分布分析发现,水痘发病较多的月份依次为12月(27.27%)、11月(25.25%)、4月(13.13%),发病较少的月份为8月(0.00%)、7月(1.01%),2月(1.52%)。确诊水痘学生中,散发病例79例(39.90%),聚集/暴发病例119例(60.10%);共发生聚集/暴发77起。接种疫苗者(突破病例)64例(32.32%),未接种疫苗(无免疫史)者134例(67.68%);且突破病例体温≥38.5 ℃及发热比例均明显低于无免疫史病例,差异均有统计学意义(χ2=7.110,P=0.008;χ2=9.188,P=0.002);皮疹<50个比例明显高于无免疫史患者,差异有统计学意义(χ2=25.877,P<0.001);皮疹结痂时间明显缩短,差异有统计学意义[(6.04±4.08) vs (8.12±5.46),t=2.707,P=0.044]。对水痘发病危险因素进行分析发现,水痘病例接触史(OR=16.494)、带状疱疹病例接触史(OR=5.680)、医院暴露史(OR=3.655)及洗手频率(≤5次/天)(OR=3.216)是水痘发病的危险性因素(均P<0.05);接种过水痘疫苗(OR=0.418)、选修传染病健康教育课/参加传染病健康教育讲座(OR=0.704)是水痘发病的保护性因素(均P<0.05)。结论 大学生水痘发病率较高,且多数病例为聚集/暴发发病;控制大学校园水痘发病,除提高水痘疫苗接种率,还应加强手卫生及传染病健康教育宣传,注重密闭空间的通风和消毒。　

Objective To analyze the epidemiological characteristics and related risk factors of varicella in college students so as to provide theoretical evidences for prevention and control of varicella in college students. Methods Based on the college students with varicella diagnosed definitely in a university in Shandong Province from 2017 to 2020, the epidemic characteristics of college students' varicella were analyzed by the descriptive epidemiological method, and the basic situation and related influencing factors of the subjects in the case group and control group were investigated by a case-control research method. The risk factors of college students' varicella were analyzed by univariate and multivariate logistic regression analyses. Results From January 2017 to December 2020, 198 students were diagnosed as varicella, with the incidence rate of 1.50 ‰. The incidence rate was the highest in 2018 (2.36‰), and the incidence rate was the lowest in 2020 (0.90‰), and the difference was statistically significant among each year (χ2=32.003, P<0.001). The monthly distribution analysis of varicella showed that the months with more varicella were December (27.27%), November (25.25%), and April (13.13%), and the months with less varicella were August (0.00%), July (1.01%), and February (1.52%). Among the students diagnosed with varicella, 79 cases (39.90%) were sporadic and 119 cases (60.10%) were aggregation/outbreak. A total of 77 aggregation/outbreaks occurred. Among all the cases, 64 cases (32.32%) were vaccinated (breakthrough cases), and 134 cases (67.68%) were not vaccinated (no immunization history). The body temperature≥38.5℃ and the pro-portion of fever in breakthrough cases were significantly lower than those in cases without immune history, and the differences were statistically significant (χ2=7.110, P=0.008; χ2=9.188, P=0.002). The proportion of rashes<50 in the breakthrough cases was significantly higher than that of patients without immune history, and the difference was statistically significant (χ2=25.877, P<0.001). In addition, the crusting time of rash of the breakthrough cases was significantly shorter than that of the patients without immune history, and the difference was statistically significant [(6.04±4.08) d vs. (8.12±5.46) d, t=2.707, P=0.044). By analyzing the risk factors of varicella, it was found that the contact history of varicella cases (OR=16.494), the contact history of herpes zoster cases (OR=5.680), hospital exposure history (OR=3.655) and hand washing frequency (≤ 5 times/day) (OR=3.216) were the risk factors of varicella (all I<0.05). Vaccination with varicella vaccine (OR=0.418), and elective infectious disease health education courses/attending infectious disease health education lectures (OR=0.704) were the protective factors of varicella (both P<0.05). Conclusions The incidence rate of varicella in college students is relatively high, and most cases are due to clusters/outbreaks. In order to control the incidence of varicella in university campus, we should not only improve the vaccination rate of varicella vaccine, but also strengthen the hand hygiene and infectious disease health education and publicity, and pay attention to the ventilation and disinfection of confined space.