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Umfang og áhrif mislingafaraldranna 1846 og 1882 á Íslandi

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Authors
Sandra Gunnarsdóttir
Haraldur Briem
Magnús Gottfreðsson
Issue Date
2014-04

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Other Titles
Extent and impact of the measles epidemics of 1846 and 1882 in Iceland
Citation
Læknablaðið 2014,100 (4):211-6
Abstract
Inngangur: Mislingar hafa færst í vöxt sums staðar í hinum vestræna heimi og í mars 2014 greindist mislingatilfelli á Íslandi í fyrsta skipti frá árinu 1996. Sjúkdómurinn getur valdið dauða eða alvarlegum fylgikvillum og því brýnt að minna á hversu skæður hann getur orðið og mikilvægi bólusetninga. Vegna einangrunar Íslands barst sjúkdómurinn sjaldan til landsins fyrir 20. öld. Faraldrar voru því fáir en afar útbreiddir og mannskæðir. Sérstaða Íslands að þessu leyti gerir það að verkum að auðvelt er að meta áhrif mislinga á fjölmennt, næmt þýði. Efniviður og aðferðir: Frásagnir og lýðfræðileg gögn sýna að um mitt ár 1846 og 1882 bárust mislingar til landsins og voru báðir faraldrar afar mannskæðir. Í þessari rannsókn var leitast við að greina umfang og áhrif faraldranna tveggja með yfirferð kirkjubóka. Niðurstöður: Í faraldrinum 1846 jókst fjöldi dauðsfalla mjög í júní og náði hámarki í júlí þegar 741 einstaklingur lést, um fjórföld aukning umfram það sem vænta mátti. Faraldurinn var að mestu genginn yfir í desember. Staðbundinn faraldur geisaði á Austurlandi árið 1869. Faraldurinn árið 1882 hófst um mitt ár og náði fjöldi dauðsfalla hámarki í júlí þegar 1084 létust. Það var fimmföld aukning miðað við það sem vænta mátti. Umframdánarhlutfall var hæst í N-Ísafjarðarsýslu, eða 4,7%, en ekkert í A-Skaftafellssýslu þar sem mislingar gengu 13 árum áður. Þeir sem létust í faraldrinum árið 1882 voru flestir í aldurshópnum 0-4 ára, eða 64,6%. Þá var dánarhlutfall kvenna á barneignaaldri rúmlega tvöfalt hærra en karla og fæðingatíðni 7-9 mánuðum eftir hámark 1882 faraldursins lækkaði marktækt um 50%. Ályktun: Þessi rannsókn varpar ljósi á alvarlegar afleiðingar mislinga í næmu þýði og sýnir verndandi áhrif hjarðónæmis. Unnt er að auðkenna flest dauðsföll mislingafaraldranna 1846 og 1882 á Íslandi. ----------------------------------------------------------------------------------------
Measles have increased in incidence in some parts of the developed world in the past 10-15 years. They can be fatal and lead to severe sequelae.Measles were infrequently introduced to Iceland in the 19th century and consequently, epidemics were few but associated with an extremely high mortality. The availability of 19th century church registries enables studies on the impact of measles on mortality. MATERIALS AND METHODS: Historical accounts mention two major measles epidemics, starting mid-year 1846 and 1882. We analysed these two epidemics using contemporary historical sources, mainly original church registries. RESULTS: In the 1846 epidemic the data show a clear increase in mortality in June and reach a peak in July of 741 fatal cases total, a four-fold increase from expected baseline rate. The epidemic subsided in the ensuing five months. A cluster of measles was described in the eastern region of Iceland in 1869 but did not spread further. The epidemic of 1882 reached its peak in July, when 1084 individuals died, a five-fold increase from the expected rate. Excess mortality was highest in N-Isafjardarsysla county, 4,7 %, and none in A-Skaftafellssysla county where the illness was described 13 years previously. The highest numbers of fatal cases in the 1882 epidemic (64,6%) was among 0-4 year old children. The number of fatalities among women of child-bearing age was more than two-fold compared to men; the number of births 7-9 months following the 1882 peak dropped significantly by 50%. CONCLUSIONS: This study highlights the consequences of measles following introduction into a largely susceptible population and also documents the importance of herd immunity. Information can be identified on most individual fatalities during the 1846 and 1882 measles epidemics in Iceland.
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Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn
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