青浦区托幼机构儿童与小学生水痘发病特征及危险因素研究

发布时间：2018-03-15 20:00

本文选题：水痘　切入点：流行病学　出处：《复旦大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的1.了解上海市青浦区2005-2013年水痘流行病学特征。2.掌握青浦区托幼机构儿童与小学生水痘发病特征,比较突破病例和未接种病例的疾病表现。3.探讨疫苗接种的保护效果及水痘发病的危险因素,为有效预防控制水痘流行提供依据。方法1.收集、整理中国疾病预防控制信息系统关于青浦区2005-2013年水痘病例报告资料,结合青浦区统计局和公安分局提供的人口数据,通过发病率、构成比等指标对青浦区水痘流行病学特征进行描述分析。2.用1：1配对的病例对照研究方法：病例信息来源于中国疾病预防控制信息系统,均为托幼机构儿童与小学生,比较突破病例和未接种病例的疾病表现；对照为性别、班级与患者相匹配的健康人群。采用问卷形式对患者和对照在患者发病前的生活习惯、社会环境、既往病史等相关危险因素进行调查。3.选用疫苗效率(vaccine efficacy, VE)作为疫苗保护效果的评价指标。当无法确切获得人群接种率时,选用病例对照研究的公式：VE=(1-OR)X100%。4.用SPSS17.0统计软件对数据进行有关的统计分析,一般情况构成分析计数资料采用χ2检验,计量资料采用t检验,各项因素进行单因素与多因素条件Logistic回归分析,具体采用了COX回归模型。结果1.2005-2013年水痘流行病学特征2005-2013年青浦区共报告水痘病例数5375例,平均年发病率为61.16/10万(14.09/10万～113.67/10万)。季节趋势：11月、12月及5月、6月,形成两个高峰,报告较少的是2月和8月。病例数报告排列前3位分别为青浦镇30.77%(1716/5375)、华新镇13.45%(723/5375)和徐泾镇10.16%(565/5375)。15岁发病数占总发病人数的71.44%(3840/5375),性别比为1.31：1。2005～2013年共报告水痘相关突发公共卫生事件4起,主要发生单位是小学。2.青浦区托幼机构儿童与小学生水痘发病特征观察托幼机构儿童和小学生水痘高发,年龄集中在4～8岁、年级集中在幼儿园中班到小学二年级。水痘突破病例发生较多,326例水痘病例中,突破病例占43.25%。突破水痘病例与未接种疫苗病例相比,在皮疹持续时间、疱疹个数、疱疹分布部位、是否伴有咽喉疼痛等的差异具有统计学意义(P0.05)。3.疫苗保护效果本研究中水痘疫苗总体效率(VE)为65.17%(95%CI:48.18%～76.59%)。按托幼机构和小学分层分析,疫苗效率分别为88.37%(95%CI:73.84%～ 94.83%)、43.48%(95%CI:6.87%～65.70%)。4.危险因素的病例对照研究接触史是水痘发病的危险因素,OR值为2.47(95% CI：1.358～4.495)。免疫史和勤洗手是水痘发病的保护因素,OR值分别为0.373(95%CI：0.241～0.578)、0.313(95%CI：0.210～0.467)。结论1.2005-2013年青浦区共报告水痘病例5375例,发病率处于较高水平。2.在儿童集体单位中水痘疫苗的保护效果总体较好,接种水痘疫苗可在一定程度上减轻感染水痘后的临床症状。3.采取有效的公共卫生措施,加强病例的隔离和密切接触者观察管理,以进一步控制水痘疫情的暴发、流行,减轻水痘的公共卫生危害及疾病负担。4.建议国家或疫情高发省份可考虑将水痘疫苗纳入扩大免疫规划；建议对疫苗保护效果的影响作进一步研究,并由此确定第2剂次疫苗的适当接种时间,提供儿童2剂次水痘疫苗免疫策略,建立有效的人群免疫屏障。
[Abstract]:Objective to understand the 1. Qingpu District of Shanghai city for 2005-2013 years to master the epidemiological characteristics of varicella.2. kindergarten children in Qingpu district with the primary varicella incidence characteristics, comparison of breakthrough cases and non vaccinated cases of disease.3. vaccine to investigate risk factors and protective effect of varicella disease, provide the basis for the effective prevention and control of varicella. 1. methods of collecting, sorting Chinese the disease on the Qingpu area 2005-2013 years of varicella cases report prevention and control information system, population data was provided by Qingpu area statistics bureau and Public Security Bureau, the incidence proportion on the epidemiology of varicella in Qingpu District of.2. using 1:1 matched case-control study: a case analysis method to describe information from the Chinese disease prevention and control information system, are children and pupils in kindergartens, more breakthrough cases and the unvaccinated cases of the disease The control for healthy people; gender, class and patients were matched. Using questionnaires to patients and control patients before the onset of the social environment, living habits, medical history and other related risk factors were investigated using.3. vaccine (vaccine efficacy, VE) efficiency as the evaluation indexes of vaccine protection effect. When unable to obtain the crowd vaccination rate, using case-control study formula: VE= (1-OR) X100%.4. were analyzed with SPSS17.0 statistical software for statistical data, general analysis of count data using 2 test, measurement data using t test, various factors regression analysis of single factor and multi factor Logistic, the COX regression model. Results epidemiological features of varicella 1.2005-2013 2005-2013 years in Qingpu District reported a total number of varicella cases in 5375 cases, the average annual incidence rate of 61.16/10 million (14.09/10 million to 113. 67/10 10000). Seasonal trends: November, December and May, June, the formation of the two peak, there are few reports of February and August. The number of cases report ranked the top 3 are Qingpu town 30.77% (1716/5375), 13.45% (723/5375) and Huaxin Town Xujing town 10.16% (565/5375) the total incidence of 71.44%.15 the age of incidence (3840/5375), the sex ratio of 1.31:1.2005 to 2013 reported a total of varicella related public health emergencies 4, main unit is.2. primary school kindergarten children in Qingpu district with the primary incidence features of varicella children in kindergarten and primary school students to observe the high incidence of varicella, concentrated in the age 4~8, concentrated in the kindergarten to grade the second grade primary school the varicella cases occurred in 326 cases of breakthrough, breakthrough varicella cases, cases 43.25%. breakthrough varicella cases compared with unvaccinated cases, the rash duration, the number distribution of herpes simplex, whether. The difference was statistically significant with a sore throat and protective effect of.3. vaccine (P0.05) in the study of varicella vaccine (VE) for the 65.17% overall efficiency (95%CI:48.18% ~ 76.59%). According to the analysis of kindergarten and primary school levels, vaccination rate was 88.37% (95%CI:73.84% ~ 94.83%), 43.48% (95%CI:6.87% ~ 65.70%) were risk factors of.4. the control of contact history were risk factors of incidence of varicella, OR value was 2.47 (95% CI:1.358 ~ 4.495). Immunization history and washing hands is a protective factor for the incidence of varicella, OR = 0.373 (95%CI:0.241 ~ 0.578), 0.313 (95%CI:0.210 ~ 0.467). Conclusion the 1.2005-2013 District of Qingpu reported a total of 5375 cases of varicella cases, incidence the protective effect of rate at higher levels of.2. in children with varicella vaccine in the collective unit is good as a whole, varicella vaccine can relieve the clinical symptoms of varicella infection after.3. to a certain extent, take effective Public health measures to strengthen the case isolation and close contacts to observe management, further control of varicella outbreaks, the prevalence of varicella, reduce public health risk and disease burden of.4. suggested that the state or epidemic provinces could consider varicella vaccine into immunization will expand; suggest that the effects on the protective effect of the vaccine for further study, and the second dose vaccine appropriate inoculation time, provide 2 doses of varicella vaccine immunization strategy for children, establish effective immunity barrier.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.1

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