长宁区手足口病流行特征及经济负担研究

发布时间：2018-06-06 04:21

本文选题：手足口病 + 聚集性事件　；参考：《复旦大学》2012年硕士论文

【摘要】：[目的] 分析长宁区2005-2011年手足口病疫情、2009年-2011年手足口病聚集性事件的流行特征和病原学检测结果,系统描述长宁区手足口病流行特征；对2010年长宁区管理的病例开展回顾性调查,了解手足口病的经济负担;综合探讨手足口病的干预措施效果,为改进防控措施提供依据。 [方法] 利用中国疾病预防控制信息系统收集上海市长宁区2005-2011年的手足口病疫情资料,描述其流行病学特征；收集2009-2011年长宁区手足口病聚集性事件调查处置资料,描述其流行病学特征；采集聚集性病例、监测点医院临床诊断病例的咽拭子标本进行病原学分型,描述其病原学特征；对2010年长宁区管理的手足口病病例,经知情同意后,通过设计好的调查问卷进行经济负担调查,分析手足口病疾病负担。 [结果] 1.2005-2011年长宁区共发生手足口病2575例,年平均发病率59.7/10万。全区10个街道/镇均有病例发生,年平均发病率居前3位的是新泾镇(184.7/10万)、周桥(64.3/10万)、程桥(60.9/10万),发病率居后3位的是天山(23.6/10万)、新华(25.7/10万)、华阳(31.8/10万)街道。全年均有病例报告,呈现明显的季节性发病趋势,春末夏初(5-7月)、秋末冬初(10-12月)两个发病高峰,分别占总发病数的50.6%、24.8%。以男性发病为主,男女比例为1.5：1；0-6岁的学龄前儿童发病为主,占总发病人数的92.7%(2387/2575)；主要发病人群为幼托(54.1%)和散居儿童(37.5%)。2009年-2011年对406例临床诊断手足口病病例开展病原学监测,阳性率为74.1%,病毒型别以EV71(34%)和CoxA16(22%)为主,存在其他肠道病毒(14%)及混合感染(0.2%)情况。EV71型所占比例逐年上升成为优势毒株,不同年份的病毒型别构成有显著差异(P0.05)。 2.2009年-2011年长宁区共报告手足口病聚集性事件117起,波及3422人,发病491例,平均罹患率为14%(4.7%-100%),报告重症病例2例；全区10个街道均有发病,主要发生在幼托机构(85%,100/117),家庭及社区发病呈上升趋势；发病高峰在4-6月、10-12月,分别占34%(40/117)、41%(48/117)；报告单位以疾控机构及社区卫生服务中心通过疫情监测发现为主(57%,67/117),疫情报告至末例发病及至疫情高峰的间隔时间≤0d的事件起数分别占51%(60/117)、95%(111/117),不同场所发生的事件报告来源、罹患率均有显著差异(均P0.05)；分析93起事件的实验室检测结果,其中由EV71和CoxA16单一病毒感染的事件分别为35起、24起,并存在EV71和CoxA16合并感染的事件(4起),涉及重症病例的事件均为感染EV71病毒；不同年份事件的病原型别构成无显著差异(P0.05),EV71型呈上升趋势。每起疫情持续时间中位数为4d(0-17d),病毒不同型别及关班与否对疫情持续时间未发现明显影响(P0.05)。 3.对367例手足口病病例的经济负担调查显示,门诊病例平均费用为396.3±153.4元(134.0-804.0元),住院病例平均费用为2905.9±741.2元(1880.0-6300.0元)。门诊总费用的影响因素中,不同性别、3岁以下儿童与3岁及以上儿童无差异(P0.05),发热儿童高于不发热儿童。住院总费用的影响因素中,不同性别、年龄及发热症状均无显著差异(P0.05)。门诊病例的直接医疗费用发热病例高于不发热病例；直接非医疗费用(包括交通费、营养费等)女性高于男性,发热病例高于不发热病例；间接损失3岁以下儿童高于3岁以上儿童(均P0.05)。伴有发热症状的住院病例直接医疗费用、直接非医疗费用高于不伴有发热的病例(均P0.05)。 4.长宁区手足口病发病以散发为主,对散发病例开展以健康教育、家访、指导消毒隔离等系列防控措施；一旦发现聚集性事件,及时核实疫情,落实消毒隔离、关班/关园等综合防控措施,117起聚集性事件仅2起达到暴发疫情级别,可见目前以病例隔离、病原检索、关班/关园、家访及健康教育为主的综合性防控措施是行之有效的。 [结论] 1.长宁区手足口病发病率逐年上升,该病无明显的地区性,呈现季节性发病趋势。 2.防控手足口病的重点场所为幼托等集体单位,防控关键时期为4-7月、10-12月,防控重点人群为0-6岁的学龄前儿童。 3.住院病例的经济负担高于门诊病例,伴有发热症状的病例疾病负担更重,早发现、早诊断、早治疗能防止住院病例和重症病例的发生,是减轻疾病负担的关键。 4.提高手足口病聚集性事件报告的及时性,是有效控制疾病蔓延的关键。 5.开展病原检索有助于防范重症手足口病的发生。 6.目前以病例隔离、病原检索、关班/关园、家访及健康教育为主的综合性防控措施是有效的。
[Abstract]:[Objective]
The epidemic characteristics of hand foot and mouth disease (HFMD) in Changning District in the past 2005-2011 years, the epidemiological characteristics of hand foot and mouth disease (HFMD) in 2009 and the results of pathogenic detection were systematically described, and the epidemiological characteristics of hand foot and mouth disease in Changning District were systematically described. A retrospective survey on the cases of Changning District management in 2010 was carried out to understand the economic burden of hand foot and mouth disease and to discuss the intervention of hand foot and mouth disease in a comprehensive way. The effect of the measures is provided to provide the basis for improving the prevention and control measures.
[method]
Using China's information system for Disease Control and prevention to collect data on the epidemic of hand foot and mouth disease (HFMD) in Changning District, Shanghai for 2005-2011 years, describe its epidemiological characteristics, collect data on the investigation and disposal of hand foot and mouth disease in Changning District for 2009-2011 years, describe its epidemiological characteristics, collect aggregated cases, and monitor the clinical diagnosis of hospitals. The specimen of pharynx swab was classified as a pathogenic type and described its pathogenic characteristics. After informed consent of the cases of hand foot and mouth disease managed in Changning District in 2010, the burden of hand foot and foot disease disease was analyzed by a well designed questionnaire to investigate the burden of hand foot and mouth disease.
[results]
In Changning District, there were 2575 cases of hand foot and mouth disease in Changning District, with an average annual incidence of 59.7/10 million. Cases occurred in 10 streets / towns in the whole region. The average annual incidence rate was the first 3 in Xin Jing Town (184.7/10 million), Zhou Qiao (64.3/10 million) and Cheng Qiao (60.9/10 million). The incidence rate of the first 3 were Tianshan (23.6/10 million), Xinhua (25.7/10 million), and Huayang (31.8/10 million). All the cases were reported in the whole year, showing obvious seasonal trend, two onset peaks in late spring and early summer (5-7 months), and 50.6% of the incidence of total disease in the end of autumn and early winter (10-12 months). 24.8%. was mainly male and male and female was 1.5:1; 0-6 year old preschool children accounted for 92.7% (2387/2575) of the total incidence. The incidence of pathogens in 406 cases of clinical diagnosis of hand foot and mouth disease (HFMD) was detected in 406 cases of children (54.1%) and scattered children (37.5%) in.2009 years. The positive rate was 74.1%, virus types were mainly EV71 (34%) and CoxA16 (22%), other enterovirus (14%) and mixed infection (0.2%) were increased year by year, and the proportion of.EV71 was increasing to become the dominant strain. There was a significant difference in viral composition between different years (P0.05).
2.2009 years, 2.2009 years -2011 reported a total of 117 cases of hand foot and mouth disease aggregated events, including 3422 people and 491 cases, with an average incidence of 14% (4.7%-100%), 2 cases of severe cases, 10 streets in the whole region, mainly in the nursery (85%, 100/117), and the incidence of family and community was on the rise; the peak of the disease was 4-6 and 10-12 months. Do not account for 34% (40/117), 41% (48/117); the reporting units were found mainly by disease control and community health service centers (57%, 67/117), and the number of events reported to the last cases and the interval of the peak of the epidemic was 51% (60/117), 95% (111/117), and the incidence of incident reports in different places were all Significant differences (all P0.05); analysis of the results of laboratory tests of 93 events, including 35 cases of EV71 and CoxA16 single virus infection, 24 cases, and EV71 and CoxA16 infection events (4), all cases involving severe cases were infected with EV71 virus, and there was no significant difference in the pathogenic type of the events in different years (P0.05 The EV71 type was on the rise. The median duration of each outbreak was 4D (0-17d). The different types of virus and whether the virus was closed or not had no significant impact on the duration of the epidemic (P0.05).
The economic burden of 3. cases of 367 cases of hand foot and mouth disease showed that the average cost of outpatient cases was 396.3 + 153.4 yuan (134.0-804.0 yuan) and the average cost of hospitalized cases was 2905.9 + 741.2 yuan (1880.0-6300.0 yuan). Among the influencing factors of outpatient total expenses, there was no difference between children under 3 years of age and children aged 3 and above (P0.05), and the fever children were higher than those of the children. Among the factors affecting the total cost of hospitalization, there were no significant differences in the gender, age and fever (P0.05). The direct medical expense fever cases in outpatients were higher than those of non fever cases; the direct non medical expenses (including transportation, nutrition, etc.) were higher in women than those of men, and the fever cases were higher than those of non fever cases; the indirect loss was 3. Children under the age of age were higher than 3 years old (all P0.05). The direct medical expenses of hospitalized cases with fever symptoms were higher than those without fever (all P0.05).
4. the incidence of hand foot and mouth disease in Changning District is mainly sporadic, and a series of prevention and control measures are carried out for sporadic cases, such as health education, home visits, and disinfection and isolation; once the aggregation events are found, the epidemic is verified in time, the disinfection and isolation, the closed class / Guan yuan and other comprehensive prevention and control measures are carried out, and only 2 of the 117 gathering events have reached the level of the outbreak, which can be seen at present. Comprehensive prevention and control measures based on case isolation, pathogen retrieval, off class / close kindergarten, family visit and health education are effective.
[Conclusion]
1. the incidence of hand foot mouth disease (HFMD) in Changning District is increasing year by year.
2. the key places for prevention and control of hand, foot and mouth disease are kindergartens and other collective units. The key period for prevention and control is 4-7 months, 10-12 months, and the key population is 0-6 years old preschool children.
3. the economic burden of hospitalized cases is higher than that of outpatient cases, and the burden of disease with fever symptoms is heavier. Early detection, early diagnosis, early treatment can prevent the occurrence of hospitalized cases and severe cases, which is the key to reduce the burden of disease.
4. to improve the timeliness of the HFMD aggregation report is the key to effective control of the spread of the disease.
5. carrying out pathogen retrieval helps prevent the occurrence of severe hand foot mouth disease.
6. currently, comprehensive prevention and control measures based on case isolation, pathogen retrieval, off class / close kindergarten, home visits and health education are effective.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.1

【参考文献】