克拉玛依市水痘流行特征及医疗费用研究

发布时间：2018-05-10 14:50

本文选题：水痘 + 流行病学特征　；参考：《中国疾病预防控制中心》2017年硕士论文

【摘要】：背景:水痘是由水痘-带状疱疹病毒经初次感染引起的一种急性、高传染性的病毒性疾病。人类是其唯一的传染宿主,主要通过接触病变皮肤水疱液中的病毒或经飞沫或气溶胶传播从而造成传染,一旦易感人群中出现病例,就难以预防爆发流行的出现。如何有效控制水痘爆发流行,已成为公共卫生领域不可忽视的重要问题之一。卫生实践证明大范围接种水痘疫苗是预防水痘流行的有效措施之一。克拉玛依市水痘年均报告发病率和水痘突发公共卫生事件的发生情况来看,水痘成为学校(幼儿园)相关突发公共卫生事件中问题较为突出的传染病之一。开展克拉玛依市水痘流行病学和疾病负担调查研究,将为进一步完善克拉玛依水痘疫苗免疫策略提供相关证据。目的:通过研究克拉玛依市水痘流行病学特征、水痘疫情报告质量和漏报情况、水痘医疗费用负担和水痘疫苗纳入儿童免疫规划的效果,为进一步完善免疫策略提供依据。研究方法:利用中国疾病预防控制信息系统收集克拉玛依市水痘疫情监测资料,采用描述流行病学方法分析水痘流行病学分布特征和免疫策略实施前后流行病学特征变化情况、水痘疫情报告质量采用回顾性调查方法,对4个幼儿园所有3-6岁儿童水痘患病情况进行调查,进行水痘漏报率分析;收集辖区内二级甲等及以上医院4家水痘病例的医疗费用相关信息,分析水痘患者诊治费用。结果:2006-2016年全市共报告水痘病例5682例,年均报告发病率130.70/10万,全市水痘发病呈现季节性和地区性、人群差异,实施免疫规划后全人群水痘发病率略有下降,疫苗使用前为179.53/10万,纳入免疫规划后为146.11/10万,其中,未使用疫苗1岁组,由502.66/10万升至687.15/10万;1-4岁组发病率由749.81/10万,下降到513.99/10万。2013-2015年克拉玛依市水痘病例通过疫情监测平均报告及时率为94.07%,重卡率为1.62%,错误卡率为0.17%、必填项完整率100%。通过对4所幼儿园回顾性调查:有水痘患病史的是14例,其中11例在传染病报告疫情中有记录,有3例未报告,水痘病例未报率为21.43%(3/14)。水痘疫苗接种率为79.19%,曾患水痘14名,其中没有在门诊或住院治疗3人,未经网络报告3人。14名病例中,自述接种水痘疫苗11人,占78.57%,其中患病前接种2人,占14.28%。水痘病例医疗费用调查显示:2013-2015年全市水痘门诊病例1969人,门诊费用386874.25元,人均门诊用费196.48元,其中药费347749.27元,占89.89%;住院病例78人,住院费用245370.93元,人均医疗费用3145.76元,其中药费169672.17元,占69.15%。初步推算克拉玛依2013-2015年水痘病例医疗费用767510.16元。克拉玛依市2013-2015年水痘疫苗接种费用近160万元,而水痘疫苗接种总收益为3314214.27元,水痘疫苗接种成本:收益=1:2.1。结论:2006-2016年期间,克拉玛依市水痘疫情呈现周期性,但儿童水痘疫情呈下降趋势,尤其是2013年水痘疫苗纳入儿童免疫规划以来下降更明显。2013-2015年克拉玛依市水痘医疗费用767510.16元。在补充调查中的水痘病例中,有2例患者患病前接种了水痘疫苗,提示适龄儿童接种2剂次水痘疫苗更能有效预防水痘。通过该研究,初步掌握克拉玛依市水痘流行规律和2013-2015年水痘产生的医疗费用负担,分析1剂次水痘疫苗纳入免疫规划后的效果,同时也为克拉玛依市即将开展水痘疫苗2剂次的免疫接种方案提供支撑数据。
[Abstract]:Background: chickenpox is an acute, highly contagious viral disease caused by the initial infection of varicella zoster virus. Human is the only infectious host. It is transmitted by exposure to viruses in the blister fluid or by droplets or aerosols, and it is difficult to prevent detonation once the susceptible population appears. How to effectively control the outbreak of chickenpox has become one of the important issues that can not be ignored in the public health field. The health practice has proved that the vaccination of chickenpox in a wide range is one of the effective measures to prevent the epidemic of chickenpox. The annual reported incidence of varicella in Karamay and the occurrence of public health emergencies of chickenpox To see, chickenpox is one of the most prominent infectious diseases in public health emergencies in schools (kindergartens). The investigation of the epidemiology and disease burden of chickenpox in Karamay will provide relevant evidence for further improving the immunization strategy of Karamay varicella vaccine. The purpose of this study is to study the epidemiology of varicella in Karamay. Characteristics, the quality of the report of chicken pox and the leakage of the report, the cost burden of varicella and the effect of varicella vaccine into the children's immunization program, and provide the basis for further improving the immunization strategy. The research method: using the information system of China's disease prevention and control to collect the surveillance data of the Karamay varicella epidemic situation and the descriptive epidemiological methods. The epidemiological characteristics of chickenpox and the changes of epidemiological characteristics before and after the implementation of immunization strategies were analyzed. The quality of the report of varicella was reviewed by a retrospective survey. The prevalence of varicella in all 3-6 year old children in 4 kindergartens was investigated, the rate of varicella leakage was analyzed, and 4 chickenpox cases in the hospital were collected and above two levels in the hospital. Results: 5682 cases of chickenpox were reported in the whole city in 2006-2016 years. The annual reported incidence of chicken pox was 130.70/10 million. The incidence of chickenpox in the city was seasonal and regional, the population was different. The incidence of varicella in the whole population decreased slightly after the implementation of the immunization program, and the vaccine was 179.53/10 million before the vaccine was used. The immunization program was 146.11/10 million, of which the 1 year old group was not used, from 502.66/10 million to 687.15/10 million; the incidence rate of 1-4 year old group was from 749.81/10 million to 513.99/10 ten thousand.2013-2015 years, the average report rate of Karamay varicella cases through surveillance of epidemic situation was 94.07%, the rate of heavy card was 1.62%, the rate of error card was 0.17%, and the complete rate was 100. Through a retrospective survey of 4 kindergartens, 14 cases had a history of varicella disease, of which 11 were recorded in the epidemic report, 3 were not reported, the rate of varicella cases was 21.43% (3/14). The vaccination rate of varicella was 79.19%, and 14 chickenpox had been developed, of which 3 were not admitted to the door or in the hospital, without the network report of the 3 people.14 cases. 11 people were vaccinated against chickenpox, accounting for 78.57%. Among them, 2 people were inoculated before the disease, accounting for the medical costs of 14.28%. varicella cases, accounting for 1969 people in the city of chickenpox in 2013-2015 years, 386874.25 yuan for out-patient expenses and 196.48 yuan per capita for outpatient expenses, including 347749.27 yuan and 89.89%, 78 hospitalized cases, hospitalized expenses 245370.93, per capita medical treatment. The cost of treatment was 3145.76 yuan, of which the charge of medicine was 169672.17 yuan, accounting for 767510.16 yuan in Karamay's 2013-2015 year medical cost of varicella in Karamay. The cost of vaccinating vaccine for chickenpox was nearly 1 million 600 thousand yuan for 2013-2015 years in Karamay, and the total income of varicella vaccine was 3314214.27 yuan, and the cost of vaccinating vaccine was =1:2.1. conclusion: 2006-2016 years. In Karamay, the epidemic of chickenpox in Karamay was cyclical, but the epidemic of chickenpox in children was declining. Especially in 2013, the drop of varicella vaccine in children's immunization program decreased more obviously in the year of.2013-2015 in Karamay. 2 cases of chickenpox were inoculated with varicella vaccine in the case of chickenpox in the supplementary investigation. It is suggested that the vaccination of 2 doses of varicella vaccine for children of the age is more effective to prevent chickenpox. Through this study, the law of the epidemic of chickenpox in Karamay and the medical cost burden of 2013-2015 year's chickenpox are mastered. The effect of the 1 doses of varicella vaccine into the immunization program is analyzed, and the 2 doses of the chickenpox vaccine are also forthcoming in Karamay. The vaccination program provides support data.

【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R511.5;R181.3

【参考文献】