云南省保山市农村学生麻疹免疫现状分析及对策研究

发布时间：2018-03-01 19:43

本文关键词： 农村学生麻疹免疫现状对策研究　出处：《昆明医学院》2010年硕士论文　论文类型：学位论文

【摘要】： 目的通过农村学生麻疹免疫现状调查,发现有效保护率低的主要原因,采取强化免疫及相应干预措施,提高农村学生麻疹免疫水平,探讨控制和消除麻疹的可行性。方法本次研究采用流行病学与实验室检测相结合的方法,重点放在采取提高麻疹免疫水平措施后其效果评估。选取昌宁县哽嘎乡哽嘎小学(A校),施甸县姚关乡蒜园小学(B校)学生302名(采用分层随机抽样,按年级分层,即每校每年级随机抽取25-30名,2校共抽取302名)；A、B两乡镇教师、家长(立意抽样,教师40名,家长600名),乡村医生(普查两乡镇64名乡村医生)。并对302名农村学生开展强化免疫,对家长、教师、乡村医生进行宣传教育及培训。通过问卷、现场调查、实验室方法对效果进行分析。结果(1)实施措施前302名农村学生免疫现况：麻疹疫苗第1针接种率为85.8%,第2针接种率为74.8%,2针均完成74.8%；而麻疹IgG抗体阳性率、保护率分别为88.7%、51.0%,几何平均滴度(GMT)1：551。 (2)强化免疫及相应干预措施效果评估： 1)通过强化免疫,302名学生抗体阳性率为100%,抗体保护率为76.9%,较强化免疫前的阳性率88.7%、抗体保护率51.0%分别上升了11.3个百分点(x 2=36.028,P＜0.001)、25.9个百分点(x~2=36.028,P＜0.001)；GMT由强化前的1：551升至1：746(t=-2.192,P=0.0290.05)。 2)通过有效培训,乡村医生麻疹相关防控知识得到了相应的提高；知识得分由培训前的平均6.5分(总分10分)升至培训后的平均9.5分,提高了3分(t=-11.636,P0.001)；总的完全知晓率从培训前的12.5%升至60.9%,提高了48.4个百分点；而麻疹传染病学、免疫程序、接种技术相关知识完全知晓率均提高了45个百分点。 3)通过宣传教育,家长、教师麻疹免疫规划相关知识知晓率由宣传教育前的10.2%、25%分别提高至98.8%(x~2=951.117,P＜0.001)、100%(x~2=95.455,P0.001),分别提高了88.6个百分点、75个百分点,对麻疹免疫规划得到了基本的认识,且均支持麻疹疫苗的免疫接种。 4)对无证或遗失证者进行补证,持证率由补证前的67.9%升至100%,提高了32.1个百分点。建议(1)加强科普宣传,提高学生家长和教师对接种疫苗理性认识,从而提高主动配合意识。 (2)完善冷链设施和疫苗规范管理,提高疫苗接种的有效性和安全性。 (3)加强乡村医生专业培训,提高业务水平,确保安全注射和接种的有效性。 (4)加强血清学监测,动态掌握农村学生实际免疫水平,为制定免疫策略提供科学依据。 (5)对麻疹发病率高于0.1/10万地区的农村学生开展强化免疫等干预措施,最大限度的减少免疫空白和低免疫人群,控制麻疹在农村学校的流行和暴发。
[Abstract]:Objective to investigate the current situation of measles immunization among rural students and to find out the main reasons for the low effective protection rate. To improve the level of measles immunization of rural students and to explore the feasibility of controlling and eliminating measles. Methods Epidemiology and laboratory tests were used in this study. The emphasis was placed on the evaluation of the effect of measles immunization measures. 302 students (random sampling by stratification, stratified and stratified according to grade) were selected from School A of Qiuga Primary School in Chunga Township of Changning County, and School B of Guanyuan Primary School in Yaoguan Township of Shidian County. That is, a random sample of 25 to 30 teachers per school per year in two villages and towns, a total of 302 teachers from two villages and towns, parents (40 teachers, 600 parents), village doctors (64 rural doctors in two villages and towns were surveyed), and 302 rural students were immunized intensively. Education and training for parents, teachers and rural doctors. Results were analyzed by questionnaire, field investigation and laboratory methods. Results 1) the immunization status of 302 rural students before the implementation of the measures: the first vaccination rate of measles vaccine was 85.8 and the second vaccination rate was 74.80.The positive rate of measles IgG antibody was 88.7% and the protective rate was 51.0%, and the geometric average titer of GMT1: 551 was higher than that of the control group. 2. Assessment of the effectiveness of immunization enhancements and corresponding interventions:. 1) the positive rate of antibody and the protective rate of antibody were 100% and 76.9%, respectively. The positive rate of antibody was increased by 11.3 percentage points (P < 0.001 ~ 25.9%) from 1: 551 to 1: 746 t ~ (- 2) ~ 2. 192% ~ 29. 028%, P < 0. 001 ~ 25. 9% ~ 36. 028% P < 0. 0011% from 1: 551 to 1: 746 ~ 2. 192T ~ (2. 192) P ~ (29) 0.05 ~ 0. 05% respectively. 2) through effective training, rural doctors' knowledge about measles prevention and control was improved, and the average score of knowledge increased from 6.5 points (total score 10) before training to 9.5 points after training. The total total awareness rate increased from 12.5% before training to 60.9 percent, and by 48.4 percentage points, while the rate of complete knowledge of measles infectious diseases, immunization procedures and vaccination techniques were all increased by 45 percentage points. 3) through propaganda and education, the awareness rate of parents and teachers about measles immunization planning was increased from 10.2% to 98.8%, respectively, to 98.8% (P < 0.001), 95,951.117% (P < 0.001), which was increased by 88.6% and 75%, respectively. The basic knowledge of measles immunization planning was obtained. All of them supported the immunization of measles vaccine. 4) the holding rate of undocumented or lost witnesses increased from 67.9% to 100, an increase of 32.1 percentage points. It is suggested that 1) strengthen the propaganda of popularizing science, improve the students' parents and teachers' rational understanding of vaccination, and raise the awareness of active cooperation. Improve cold chain facilities and vaccine management to improve the effectiveness and safety of vaccination. Strengthen the professional training of rural doctors, improve the operational level, ensure the effectiveness of safe injection and vaccination. (4) strengthen serological monitoring and dynamically grasp the actual immunization level of rural students, and provide scientific basis for formulating immunization strategies. (5) to carry out intensive immunization and other interventions to rural students whose measles incidence is higher than 0.1 / 100 000, to minimize immunization gaps and low immunization population, and to control the prevalence and outbreak of measles in rural schools.
【学位授予单位】：昆明医学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R186

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