广州登革热溯源、预警模型及决策支持系统框架研究

发布时间：2019-04-29 11:57

【摘要】：前言登革热是一种蚊虫传播病毒性疾病,其主要传播媒介为埃及伊蚊和白纹伊蚊。登革热病毒分为四个血清型,当人体感染一种血清型病毒后,可对此病毒产生终生免疫,但是在感染其它血清型病毒后有罹患重症登革热风险。登革热目前广泛流行在全球热带和亚热带的东南亚、美洲、西太平洋和东地中海的100多个国家和地区,而且其正在向没有登革热的区域扩散,其全球发病率在过去50年增加了30倍。登革热给全球带来极大的经济负担,目前已成为严重的公共卫生问题,对此,世界卫生组织制定了2012-2020年将登革热发病率和死亡率分别降低至少50%和25%的战略目标。白纹伊蚊在中国分布广泛,是中国登革热的主要传播媒介。从新中国成立到1977年,中国没有登革热病例报道。1978年,广东省佛山市出现了建国以来的第一次登革热暴发。80年代,海南省、广东省、广西壮族自治区出现登革热大流行；进入90年代后,登革热主要发生在广东省。从1978年至今,登革热在广东省已有近40年历史,期间出现几次登革热大流行,2014年疫情又是创历史之最；登革热小暴发更是时有发生。登革热近几年形势愈演愈烈,其对我国已造成严重的公共卫生问题。认清中国登革热形势及影响登革热发生的因素,对登革热有效应对极为重要。为此,本研究将明确登革热在中国是否已经本地化及影响登革热发生的危险因素,搭建登革热决策支持系统框架,最终为决策者提供依据从而有效预防和控制登革热发生。方法与主要发现利用广州市1978-2013年数据、综合登革热病例的流行病学特征及系统进化分析和系统地理学分析发现,登革热四个血清型已在广州全部发现,其中以血清1-2型为主。最大似然树分析结果显示,除了2002-2003年外,广州不同年份检测到的登革毒株分布在不同分支上。广州和东南亚国家存在登革毒株相互传播情形。广州检测到的毒株主要来自东南亚国家,其中造成广州市登革热暴发的毒株主要来自泰国、印度尼西亚和菲律宾。在广州市荔湾区、越秀区、海珠区和白云区的研究发现,登革热本地病例发病高峰在8-11月。利用2006-2011年数据、基于泊松分布的广义线性模型分析发现,登革热本地传播与不同滞后月份的蚊虫密度、输入病例、温度、降雨、水汽压和最小相对湿度呈正相关关系,而与不同滞后月份的气压呈负相关关系。利用2006-2014年数据、基于泊松分布的广义相加模型分析发现,登革热上月本地病例、上月平均最低气温与登革热本地病例发生呈现正向线性效应关系,而登革热上月输入病例、滞后三月累积降雨与登革热本地病例发生呈正向非线性效应关系。在控制了自相关、季节性和长期趋势基础上,上月输入病例、上月平均最低温度和滞后3月累积降雨可用于预测2013-2014年登革热暴发。通过整合登革热媒介伊蚊密度数据、伊蚊耐药性数据、伊蚊带毒数据、登革热病例数据、气象数据、登革热病毒序列数据和国外疫情数据,嵌入地理信息系统、SaTScan、R等软件进行伊蚊密度插值、登革热预测、登革热早期暴发探测等分析,以GoogleTM Earth为载体,或地图、表、图的形式产出的登革热决策支持系统,可为当前登革热风险评估、指导干预及决策提供支持。结论研究显示,登革热在中国仍是一种输入性疾病,并没有成为地方性疾病,但存在本地化可能。广州市登革热本地病例发生具有明显季节性。登革热输入病例、月平均最低温度和月累积降雨变量可用于建立低成本、高效的登革热预警系统。动态、可视化的决策支持系统将可实时为登革热的预防和控制提供帮助。
[Abstract]:Dengue fever is a kind of mosquito-borne viral disease. The main media are Aedes aegypti and Aedes albopictus. Dengue virus is divided into four serotypes, and when a human body is infected with a serotype virus, the virus can be immunized for a lifetime, but there is a risk of severe dengue fever after infection with other serotype viruses. Dengue fever is now widely prevalent in more than 100 countries and regions of the global and sub-tropical South-East Asia, the Americas, the Western Pacific and the Eastern Mediterranean, and is spreading to the region without dengue, with a global incidence of 30-fold over the past 50 years. Dengue has a great economic burden on the planet, and is now a serious public health problem, in which the World Health Organization has developed the strategic objectives of reducing the incidence and mortality of dengue fever by at least 50 per cent and 25 per cent, respectively, in 2012-2020. Aedes albopictus is widely distributed in China and is the main vector of dengue fever in China. From the founding of the new China to 1977, there was no case of dengue fever in China. In 1978, the first outbreak of dengue fever in Foshan, Guangdong Province, occurred. In the 1980s, the epidemic of dengue fever in Hainan, Guangdong and Guangxi Zhuang Autonomous Region occurred. After entering the 1990s, Dengue fever is mainly in Guangdong province. Since 1978, dengue fever has occurred in Guangdong Province for nearly 40 years, and several outbreaks of dengue fever have occurred during the period. The outbreak of dengue fever in 2014 is the most in history. The small outbreak of dengue fever is a frequent occurrence. The situation of dengue fever has become more and more intense in recent years, and it has caused serious public health problems to our country. It is of great importance to recognize the situation of dengue fever in China and the factors that affect the occurrence of dengue fever. To this end, this study will determine whether the dengue fever has been localized in China and the risk factors that affect the occurrence of dengue fever, and set up a framework for the Dengue decision support system, and ultimately provide the decision-maker with the basis for effectively preventing and controlling the occurrence of dengue fever. Methods We found that the four serotypes of dengue fever have been found in Guangzhou with the data of Guangzhou City from 1978 to 2013, the epidemiological characteristics of the integrated dengue fever cases, and the systematic evolution analysis and systematic geography analysis. The results show that the four serotypes of dengue fever have been found in Guangzhou. The results of the maximum likelihood tree analysis show that, in addition to 2002-2003, the dengue virus strains detected in different years in Guangzhou are distributed on different branches. The presence of dengue virus strains in Guangzhou and South-East Asian countries. The strains detected in Guangzhou were mainly from the Southeast Asian countries, which caused the outbreak of dengue fever in Guangzhou, mainly from Thailand, Indonesia and the Philippines. In the study of Liwan District, Yuexiu District, Haizhu District and Baiyun District of Guangzhou, the incidence of local cases of dengue fever was in the range of 8-11 months. Based on the data of 2006-2011, the analysis of the generalized linear model based on the Poisson distribution shows that the local transmission of dengue fever is positively related to the mosquito density, the input case, the temperature, the rainfall, the water vapor pressure and the minimum relative humidity in different months. And negative correlation with the air pressure in different months. Based on the data of 2006-2014, the generalized addition model based on the Poisson distribution has found that the average minimum temperature in the last month and the local case of dengue fever have a positive linear effect relationship with the local case of dengue fever, and the case of the last-month input of dengue fever. There was a positive non-linear relationship between the accumulated rainfall in the third trimester and the local case of dengue fever. On the basis of the control of the autocorrelation, seasonal and long-term trends, the last-month input case, the last month's average minimum temperature and the delayed March cumulative rainfall can be used to predict the outbreak of dengue fever for the period 2013-2014. the density data of the mosquito, the drug resistance of the mosquito, the virus data of the mosquito, the data of the dengue fever case, the meteorological data, the sequence data of the dengue virus and the data of the foreign epidemic situation, the embedded geographic information system, the SaTScan, the R and the like are embedded in the mosquito density interpolation, The Dengue decision support system, which is produced in the form of Google Earth as a carrier, or a map, a table, and a map, can provide support for current dengue risk assessment, guidance intervention and decision-making, based on the analysis of dengue projections, early outbreaks of dengue fever, and the like. Conclusion The study shows that dengue fever is still an input disease in China and is not a local disease, but there is a possibility of localization. The local case of dengue fever in Guangzhou has a marked seasonal occurrence. Dengue input cases, monthly mean minimum temperature and monthly cumulative rainfall variable can be used to establish a low-cost, high-efficiency, dengue warning system. The dynamic and visual decision support system will help the prevention and control of dengue fever in real time.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R512.8

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