长春市2011-2015年手足口病疫情特征分析及趋势预测

发布时间：2018-01-14 05:12

本文关键词：长春市2011-2015年手足口病疫情特征分析及趋势预测　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：手足口病是我国法定丙类传染病报告中发病数最高的,自2008年以来全国年发病数均超过100万例,2014年更达270万例以上。我国手足口病主要发生在5岁及以下儿童,尤其是1-3岁年龄组更易发展为重症和危重症病例,严重影响了儿童的身心健康,给家庭和社会也带来了巨大的经济负担。手足口病病原体种类多样,传播途径复杂,容易在短时间内出现较大范围流行,需采取针对性措施,才能加以预防和控制。目的:本研究旨在对长春市2011-2015年手足口病的发病状况进行描述,分析其流行特征、EV71和Cox A16等病原构成特点和主导毒株情况,建立模型对发病情况进行预测,并使用2016年发病数据进行验证,从而为今后的预防和控制提供参考资料。方法:本研究收集长春市2011-2015年手足口病的疫情监测数据,采用流行病学描述性研究方法对整体疫情和重症病例进行三间分布分析,利用Mapinfo 9.5软件对不同年份的手足口病地区发病率进行描述,分析不同时间、地区、人群间手足口病的流行特征;用Excel 2016软件对病原学检测数据数据进行整理,对病原构成的分布情况进行描述性分析;使用R软件建立ARIMA季节乘积模型,对2016年1-7月的短期发病趋势进行预测和分析。采用SPSS 18.0软件进行统计分析,计数资料采用率或构成比进行描述,组间比较采用卡方检验,检验水准与时间序列分析中的平稳性检验、残差检验的检验水准一致,均为α=0.05。结果:1、2011-2015年长春市累计报告手足口病病例11339例,年平均发病率29.56/10万,重症病例291例,死亡病例3例。各年度发病均呈现明显的季节性特点,峰值出现在7月份;长春市手足口病的高发地区集中在南部,以汽车区和高新区为主,其他地区有不同程度的散发,城区整体发病高于外县(市)区;疫情病例主要集中在0-5岁儿童(93.43%),男女发病比为1.48:1,散居儿童居多(79.88%)。2、2011-2015年发生291例手足口病重症病例,发病率为0.76/10万,其中2014年重症病例最多,共发生133例,发病率为1.73/10万。时间分布特点与整体疫情基本保持一致,具有典型的季节特征。5年间重症病例数外县(市)区(175例)显著高于城区(116例)。人群分布来看重症病例中男性发病高于女性,男女发病比为1.69:1。各年度重症病例均集中在1-3岁年龄组(244例),以散居儿童为主(243例),是重症病例的主要发病群体。3、病原学结果显示2011-2015年间,长春市疾控中心实验室共检测现住址为本市的病例标本共2113份,占报告病例的18.63%,阳性标本1342份,阳性率为63.51%。病原构成以EV71为主(43.00%),其次为Cox A16(39.94%),其他肠道病毒(17.06%)最少,但其呈现增长趋势。经卡方检验,不同性别间感染的肠道病毒类型差异没有统计学意义(c2=5.605,P=0.061),但不同年龄组间(c2=53.526,P0.001)、不同病例类型间(c2=148.511,P0.001)感染的肠道病毒类型差异有统计学意义。长春市2011-2015年间重症病例的病原学构成主要以EV71为主。4、R语言时间序列分析结果显示,ARIMA(1,0,1)(1,1,0)12模型是预测长春市手足口病短期发展趋势的最优模型。2016年长春市手足口病1-7月实际发病率与预测发病率基本吻合,1-7月的实际发病率均在预测发病率的95%置信区间范围之内。结论:1、长春市2011-2015年手足口病在时间分布上呈现鲜明的季节性特点,主要集中在6-8月份;在地区分布上城区高于外县(市)区,高发病率地区集中在汽车区和高新区;人群分类上以散居儿童为主,年龄集中在0-5岁幼儿,男性居多。2、长春市2011-2015年手足口病重症病例时间分布与整体疫情一致,具有季节性特征;人群分布以散居儿童为主,1-3岁组高发,男性居多;外县(市)区整体报告病例数高于城区。3、长春市2011-2015年手足口病病原构成以EV71为主,其次是Cox A16,其他肠道病毒比例最少,但呈现增多趋势。4、对2011-2015年月发病率进行时间序列分析,ARIMA(1,0,1)(1,1,0)12模型可以较好地预测长春市手足口病的短期发展趋势。
[Abstract]:The incidence of HFMD is our country legal class C infectious disease report of the highest number since 2008. The annual incidence of more than 1 million cases in 2014, more than 2 million 700 thousand cases of HFMD in China. Mainly occurred in children under 5 years old, especially the 1-3 age group was more likely to develop severe disease and in critical cases, serious impact on children's physical and mental health, to family and society also brought huge economic burden. HFMD pathogen species diversity, transmission complex, prone to a wide range of popularity in a short period of time, need to take specific measures to prevent and control. The objective of this study was to describe the incidence of HFMD in 2011-2015 Changchun City, to analyze the epidemic characteristics, EV71 and Cox A16 characteristics and etiology of dominant strains, establish the model to predict the incidence and morbidity data, 2016 In order to verify, to provide reference for the prevention and control in the future. Methods: This study collected Changchun 2011-2015 HFMD epidemic monitoring data, using the method of descriptive epidemiology analysis on the overall distribution of three outbreaks and severe cases, using Mapinfo 9.5 software for different years HFMD incidence rate is described. The analysis of different time, region, epidemic characteristics between groups of hand foot and mouth disease; pathogen detection data to collate data using Excel 2016 software, makes a descriptive analysis of the distribution of pathogens; establish multiple seasonal ARIMA model using the R software, analyze and predict the short-term incidence trend of 2016 1-7 months. Statistical analysis was performed by SPSS 18 software, count data use rate or composition are described. The groups were compared by chi square test, inspection level analysis and time series in the flat Stability test, residual test examination standard, both alpha =0.05. results: 12011-2015 Changchun cumulative reported HFMD cases in 11339 cases, the average annual incidence rate of 29.56/10 million, 291 severe cases and 3 death cases. The annual incidence showed obvious seasonal characteristics, the peak appeared in July; Changchun hand foot and mouth disease in high incidence areas concentrated in the south, in the automotive and High-tech Zone, other regions are distributed in different degrees, the whole city was higher than that in the county (city) district; epidemic cases mainly concentrated in the 0-5 years old children (93.43%), the incidence of male and female ratio is 1.48:1, the majority of children (79.88%) of 291 cases HFMD cases occurred in.22011-2015 years, the incidence rate of 0.76/10 million, which in 2014 the most severe cases, a total of 133 cases, the incidence rate of 1.73/10 million. Time distribution characteristics and the overall situation remained the same, with the typical seasonal characteristics .5 between the number of severe cases outside the county (city) district (175) was significantly higher than that in urban areas (116 cases). The distribution of severe cases in male group was higher than that of female, male and female incidence ratio of 1.69:1. were concentrated in each year of severe cases in 1-3 age group (244 Cases), with children as the main (243 cases) that is the main pathogenesis of severe cases of.3 group, the pathogen results showed that during 2011-2015, the CDC laboratory Changchun total detection current address for the city a total of 2113 cases, accounting for 18.63% of the reported cases, 1342 specimens were positive, the positive rate of 63.51%. disease was the original form based on EV71 (43%), followed by Cox A16 (39.94%) and other enterovirus (17.06%) at least, but its growth trend. The chi square test, the difference of enterovirus type infection between different gender was not statistically significant (c2=5.605, P=0.061), but among different age groups (c2=53.526, P0.001), different types of cases Between (c2=148.511, P0.001) with statistically significant difference of enterovirus infection. A type mainly based EV71.4 case 2011-2015 years of severe Changchun the pathogen, R language time series analysis showed that the ARIMA (1,0,1) 12 (1,1,0) model is the best model for.2016 prediction Changchun, hand foot and mouth disease short-term development trend Changchun years of hand foot and mouth disease in 1-7 months the actual incidence and prediction of incidence with 1-7 months of actual incidence in predicting the incidence of 95% confidence interval range. Conclusion: 1, Changchun, 2011-2015 years of HFMD in distribution showed distinct seasonal characteristics, mainly concentrated in 6-8 months distribution in the region is higher than the city; the county (city) District, high incidence areas concentrated in the automotive and high-tech zone; population classification in scattered children mainly concentrated in the age of 0-5 years old children, male.2, Changchun 2011-2015 years of hand Foot and mouth disease severe cases of time distribution and overall epidemic consistent with seasonal characteristics; population distribution in scattered children. The age group of 1-3 in male; the county (city) district overall number of reported cases of higher than the city of.3, 2011-2015 of pathogen of HFMD in Changchun city which is dominated by EV71, followed by Cox A16, the proportion of other enteroviruses at least, but showed an increasing trend in.4, the time series analysis of 2011-2015 monthly incidence rate (1,0,1), ARIMA (1,1,0) 12 model can better predict the short-term trend of hand foot mouth disease Changchun.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.5;R181.3

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