常州市麻疹流行趋势及传播影响因素的病例对照研究

发布时间：2018-03-27 12:47

本文选题：麻疹　切入点：流行趋势　出处：《苏州大学》2013年硕士论文

【摘要】：研究背景中国消除麻疹采取的综合性措施已取得重大成绩，麻疹疫情大幅度回落，但局部地区仍存在麻疹病毒持续传播，特别是对小月龄和成人麻疹感染易感性及其在麻疹传播动力学中所起的作用等消除麻疹的技术问题目前仍没有定论。研究目的弄清不同年龄段人群中麻疹易感因素，探索可能对成人采取的免疫措施效果及麻疹初免月龄的调整对小月龄发病的影响等内容，对目前消除麻疹进程中出现的麻疹流行态势及控制策略的研究提供可靠的理论和实践支持，从而达到降低麻疹发病率和死亡率的最终目的。研究方法根据《全国麻疹监测方案》要求，调查全市范围内在2009年～2013年发病的麻疹实验室确诊病例，按照1：2的比例，在每一名麻疹实验室确诊病例现住村（社区）选择2名年龄组匹配的对照，就病例和对照的发病与就诊情况、可能的暴露史、居住地和旅行史、既往麻疹患病史和疫苗接种史、卫生服务情况、社会人口学和经济学信息等内容进行入户个案访谈调查。本次调查采用Epidata软件建立调查数据库，严格按照双录入的要求进行录入，数据分析采用SAS9.1统计软件包完成。根据研究目的，不同年龄组病例与对照分析不同内容，分别进行单因素和多因素分析，结果中的图表使用Microsoft Excel2003完成。研究结果 2004～2012年九年内天宁区、钟楼区、武进区的年平均发病率居前三位，分别为20.50/10万，13.94/10万，13.20/10万，以上地区属于经济较活跃地区，流动人口迁徙频繁。麻疹发病存在季节性升高的特点，3～5月份的发病数占总病例数的70.01%，虽然6月份开始出现发病下降趋势，但是流行持续时间较长，超过3个月。九年内总体高发年龄分布呈现“三峰”现象，分别集中在0～1岁，5～10岁和20岁以上年龄段，，但是2009～2012年的四年内各年龄段发病率较前五年呈现下降趋势，1岁以下年龄段发病数占该四年发病总数的29.67%，15岁以上年龄段发病数达四年发病总数的47.69%，呈现明显“双向移位”。2004～2012年病例主要集中在散居儿童(1475例，42.67％)和学生(445例,占12.87％)，工人居第三位（376例，10.88％）。2004～2012年所有麻疹调查病例中常住人口（户籍在居住地县区）1603例，占47.44%，流动人口（户籍不在居住地县区）1855例，占54.90%。麻疹病例以未免疫为主（65.61%）。病例对照研究显示，以父母为主的看护方式、外来流动人口、发病前7～21天的麻疹病人接触史和医院暴露史是＜8月龄婴儿麻疹发病的危险因素。对8月龄～14岁年龄段单因素分析显示1胎、家长对预防接种态度积极和有麻疹疫苗接种史是麻疹发病的保护性因素，随着接种次数的增加麻疹发病的危险性减小，父亲初高中及以下文化程度、母亲初高中及以下文化程度、外来流动人口、发病前7～21天的麻疹病人接触史和医院暴露史是该年龄段麻疹发病的危险因素；多因素分析则显示，家长对预防接种的态度积极、有麻疹疫苗接种史是8月龄～14岁儿童麻疹发病的保护因素，麻疹发病的危险因素有外来流动人口、发病前7～21天医院暴露史和接种次数较少。对＞14岁年龄段单因素分析显示外来流动人口、发病前7～21天的麻疹病人接触史和医院暴露史是该年龄段麻疹发病的危险因素；多因素分析则显示，麻疹发病的危险因素有外来流动人口、发病前7～21天医院暴露史。结论 2009年和2010年麻疹疫苗强化免疫效果显著。传染源管理不严，“新”易感者流入，家长对接种麻疹疫苗的认识不够是麻疹发病的重要因素。开展高质量的麻疹疫苗常规免疫和强化免疫活动，特别是加强流动人口的接种管理，提高易感人群麻疹疫苗接种率，通过健康教育提高家长麻疹相关知识的认知和自我防护意识，加强传染源的管理是消除麻疹的有效手段。
[Abstract]:Research background
China take comprehensive measures to eliminate measles has made significant achievements, the measles epidemic fell sharply, but the local area still exists in the continuous spread of measles virus, especially on the susceptibility of adult measles infection and young age and played in the role of measles transmission dynamics of measles elimination technology is still inconclusive.
research objective
Understand the different age groups in measles susceptible factors, explore the immune effect and measures on adult measles can take months beginning from the adjustment effect on young age onset, support the theory and practice of the reliable elimination of measles epidemic situation and control strategy of measles in the process, so as to achieve the ultimate objective to reduce the incidence and mortality of measles.
research method
According to the national measles surveillance program "requirements, investigation within the city from 2009 to 2013 the incidence of measles laboratory confirmed cases, according to the proportion of 1:2 in each case confirmed measles laboratory now living village (community) in 2 age groups, according to the case, and the possible pathogenesis and treatment, exposure history, residence and travel history, history of disease and measles vaccination history, health services, social demography and economics information for the home interview survey. The Epidata software to establish the survey database used in this survey, in strict accordance with the double entry entry requirements, data analysis using statistical software SAS9.1. According to the study to patients in different age groups and different contents were comparative analysis, single factor and multi factor analysis, the results of using Microsoft Excel2003 to complete the chart.
Research results
Zhonglou District 2004~2012 years within nine years, Wujin Tianning District, the average annual incidence rate in the top three, respectively 20.50/10 million, 13.94/10 million, 13.20/10 million, more than the area belongs to the economically active regions, floating population migration frequently. The incidence of measles are characteristic of the seasonal rise, the total number of cases of incidence of 3~5 months the 70.01%, although the June onset decline, but the epidemic continues for a long time, more than 3 months. Presents "three peaks" phenomenon in the overall age distribution within nine years, were concentrated in 0~1 years old, 5~10 years old and over the age of 20 years old, but four years 2009~2012 years in each age the rate of the previous five years showed a downward trend, the four years accounted for 29.67% of the total incidence of age 1 years of age the incidence, over 15 years of age four years amounted to 47.69% of the total incidence, showed the "two-way shift".2004 ~ 2012 case Mainly in scattered children (1475 cases, 42.67%) and students (445 cases, 12.87%), the worker ranks third (376 cases, 10.88%).2004 to 2012 all measles cases of resident population (registered residence in 1603 cases, accounting for 47.44% of the county), floating population (domicile is not in residence district) 1855 cases 54.90%., accounting for measles cases in an immune response (65.61%).
The case-control study showed that parents care in the way of floating population, before the onset of contact history and hospital 7~21 days of exposure to measles patients is less than 8 month old risk factors. The incidence of measles in infants of single factor of 8 month old to 14 years of age analysis showed that the 1 child, parents of the pre vaccination measles vaccine and a positive attitude vaccination is a protective factor for the incidence of measles, with increased risk of measles vaccination times reduced, junior high school and the culture level of father, mother of junior and senior high school education level and below, the floating population, before the onset of contact history and 7~21 days of hospital patients with measles exposure history are the risk factors of the age of measles; multivariate analysis showed that parents' attitudes to vaccination have positive measles vaccination history was a protective factor of 8 month old ~ 14 years old children measles, measles incidence due to danger Known as the floating population, exposure to 7~21 days before the onset of a smaller number of hospital history and inoculation. In 14 years of age, single factor analysis showed that the floating population, before the onset of contact history and 7~21 days of hospital patients with measles exposure history are the risk factors of the age of measles; multivariate analysis showed that the risk of measles there are factors of floating population, 7~21 days before the onset of hospital exposure history.
conclusion
In 2009 and 2010 measles masscampaign significantly. The source of infection management is not strict, the "new" susceptible inflows, enough parents' understanding of measles vaccination is an important factor in the incidence of measles. Carry out high quality measles vaccine routine immunization and immunization activities, in particular to strengthen the vaccination management of floating population, improve the susceptibility the measles vaccination rate, improve parents measles related knowledge awareness and self-protection awareness through health education, strengthen the management of infectious sources is an effective means of eliminating measles.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R511.1

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