探討醫院員工兩年MMR抗體及族群分布趨勢

Evaluation of the Measles, Mumps, and Rubella Antibody in a Southern Hospital Employee

近年國際交流頻繁、新住民族群、20～40歲青年族群抗體衰退等因素，陸續有麻疹、腮腺炎群突發感染事件，且類似疾病亦發生於不同國家，而醫療人員因職場曝觸麻疹、腮腺炎及德國麻疹感染（Measles, Mumps, Rubella, MMR）風險更高於一般人群，疾管署建議醫療人員，若不具有麻疹或德國麻疹免疫抗體陽性抗體證明或疫苗接種紀錄者，應接種2劑MMR混合疫苗，尤其會接觸孕婦或嬰幼兒科別者。南部某醫院每年辦理員工健康檢查，於2016、2017年MMR納入檢驗，無抗體產生者，通知免費疫苗一劑接種。故本研究將探討兩年員工MMR檢驗結果比較及各族群、年齡層抗體變化之趨勢。收集員工健檢資料庫MMR檢驗結果，歸類「有抗體」即MMR三項（IgG）皆「陽性」者；「無抗體」即MMR任一項（IgG）「陰性」或「微量」者。區分醫師、護理、醫技及行政族群，採描述性統計及卡方檢定分析。2016年MMR檢驗2,106人（78.1％），女性占77.5％，平均年齡35歲（20～71歲），平均年資7年（1～16年），有抗體佔42.3％。2017年2,440人（88.4％）有完成MMR檢驗，抗體提升63.9％，有3成（509人）來自前一年接受疫苗者，兩年抗體比較具統計意義（p＜0.001）。2016年德國麻疹抗體率（89.3％）、腮腺炎（63.8％）、麻疹（61.7％）；2017年麻疹、腮腺炎分別上升至80.7％、80.0％，兩年比較具統計意義（p＜0.001）。麻疹具抗體族群以護理提升至80.5％最佳，且多數分布21～40歲年齡層，醫師亦有79.0％，而醫技、行政族群抗體雖有提升，但未達80％。醫院體檢納入MMR檢驗及提供疫苗措施，以瞭解員工自身免疫狀況，建立全院免疫基礎值，對維護建構健康安全的職場工作環境，防範感染群突發具效益性。

Outbreak episodes of measles and mumps have occurred in Taiwan in recent years because of frequent international interactions, new immigrant groups, a decline of childhood vaccine efficacy in the 20- to 40-year age groups, and so on. Similar outbreaks also occurred in different countries. Health-care workers are at a higher risk of acquiring the diseases than the general population owing to occupational exposure to patients with measles, mumps, and rubella (MMR) infection. The Taiwan Centers for Disease Control recommended 2 doses of MMR vaccine to health-care workers who lacked other evidence of immunity and had higher risks. Health-care workers who underwent a MMR antibody examination during their health annual checkups in 2016 and 2017 in a southern hospital were enrolled. Those who were seronegative were given a vaccine dose for free. In this study, we analyzed the trend of seropositive prevalence within 2 years and in different occupations and age groups. This study provides a reference for developing a health policy in the future in this hospital. MMR data from the annual health checkups of health-care workers in 2016 and 2017 were collected. Seropositive cases were defined as those who tested positive for immunoglobulin G (IgG) in the MMR examination. Seronegative cases were defined as those with IgG negative in any one of MMR or low titer. We divided the workers by occupation into physicians, nurses, medical laboratory technicians, and administrative assistant groups. Descriptive statistics and the chi-square test were used. In 2016, 2,106 subjects (78.1%) underwent MMR examination, and the seropositive rate was 42.3%. In 2017, 2,440 subjects (88.4%) underwent MMR examinations, and the seropositive rate was up to 63.9%, which contributed to 509 subjects (30%) receiving one booster vaccine in the prior year. The difference in 2-year seropositive prevalence was significant (p < 0.001). The seropositive rate of mumps and measles increased from 63.8% and 61.7% to 80.7% and 80.0%, respectively. The difference in 2-year prevalence was significant (p < 0.001). The seropositive rate of measles was 80.5%, which was highest in the nurse group, with ages ranging from 20 to 40 years. The enrolled health-care workers who underwent MMR examinations during health checkups comprehended employee immunity status and set up a hospital basic database. A policy for providing vaccines would help construct a healthy and safe occupational environment, and prevent outbreaks.