民工子弟学校新生强化免疫前麻疹血清流行病学及影响因素研究

发布时间：2018-04-18 05:23

本文选题：麻疹 + 血清流行病学　；参考：《复旦大学》2011年硕士论文

【摘要】：1目的 (1)了解青浦区2001—2010年麻疹流行病学特征。 (2)掌握青浦区外来民工子弟学校新入学学生强化免疫前的麻疹免疫水平。 (3)掌握青浦区外来民工子弟学校新入学学生家庭基本情况及其家长关于麻疹疫苗(MV)及接种等相关知识的认知情况,了解青浦区免疫规划工作人员对麻疹疾病、麻疹疫苗及接种相关情况的认知情况,探讨影响该人群麻疹疫苗接种率的影响因素。 2方法 (1)收集、整理上海市青浦区2001—2010年法定传染病监测报告系统和麻疹专病监测系统资料,结合青浦区统计局和公安局提供的户籍人口和非户籍人口数据,通过发病率、构成比等指标对青浦区麻疹流行病学特征进行描述分析。 (2)采用多阶段抽样方法,在全区10个镇(街道)抽取2个镇(街道),每个镇(街道)抽取4个学校,每个学校按年级、班级抽取本学期新入校学生。 (3)麻疹疫苗强化免疫接种前,抽取新入校学生静脉血3ml,分离血清,采用定量酶联免疫吸附试验(ELISA)测定调查对象血清中的麻疹IgG抗体水平,计算麻疹IgG抗体阳性率、几何平均浓度(GMC)等指标,评价新入学学生麻疹抗体水平。 (4)采用自行设计的学生家长麻疹及疫苗接种相关认知情况调查问卷,对新入校学生家长进行问卷调查,内容包括学生基本情况、家庭基本情况、麻疹疫苗接种情况、相关知识知晓情况、麻疹疫苗接种意愿及相关知识获取途径等,计算知晓率等指标,进行统计学分析。 (5)采用自行设计的免疫规划工作人员麻疹及疫苗接种相关认知情况调查问卷,对青浦区疾病预防控制中心(CDC)和全区13家社区卫生服务中心免疫规划工作人员进行调查,内容包括麻疹的危害、麻疹疫苗的有效性、消除麻疹工作认知、传统麻疹疫苗强化免疫和麻疹疫苗查漏补种工作、麻疹疫苗漏种原因和提高麻疹疫苗基础免疫接种率的措施等,对调查结果进行描述性分析。 3结果 3.1青浦区2001—2010年麻疹流行病学特征(1)2001—2010年青浦区麻疹疫情以散发为主,年平均发病率为8.97/10万(0.10/10万—35.49/10万),可分为两个阶段：波动期(2001—2007年)和下降期(2007—2010年),波动期年发病率隔年起伏变化(2.23/10万—35.49/10万),下降期年发病率逐年下降(9.16/10万—0.10/10万)。 (2)家庭、工厂、外来民工子弟学校为麻疹爆发疫情的主要发生场所,其中家庭爆发疫情以2病例为主,工厂、外来民工子弟学校为多病例爆发疫情的高危场所。 (3)青浦区一年四季均有麻疹发病,以春、夏季为主,4—6月病例占总发病数的55.77%。 (4)发病年龄主要集中在5岁组和中青年各年龄组(20～、25～、30～、35～40—),分别占总发病人数的35.44%和48.90%,其中8月龄病例占总发病人数的16.21%。 (5)户籍人口与非户籍人口病例分别占53.16%和46.84%。3.2外来民工子弟学校新入学学生强化免疫前的麻疹免疫水平 (1)强化免疫前麻疹IgG抗体几何平均浓度(GMC)为998.96mIU/ml(95%CI：(912.93,1093.10)),阳性率为96.96%。 (2)不同类别学校(幼托、小学、初中)对象GMC差异无统计学意义(F=1.19,P=0.30),抗体阳性率差异无统计学意义(x2=0.36,P=0.83)；不同就学史(此前无就学史、于户籍地就学、于上海其它学校就学)对象GMC差异无统计学意义(F=1.22,P=0.30),抗体阳性率差异无统计学意义(x2=3.46,P=0.18)。 (3)38.29%调查对象无预防接种证或已经丢失,麻疹相关疫苗接种≥2剂次者占37.95%,接种史不详者占48.18%,不同接种史(≥2剂次、1剂次、0剂次、不详)对象GMC差异无统计学意义(F=0.75,P=0.53),新入学学生麻疹相关疫苗接种剂次在新入学学生所在学校类别、出生场所、新入学学生此前就学地、家庭经济收入、家庭孩子数、父母年龄、父母受教育年数等因素内分布差异具有统计学意义。 3.3外来民工子弟学校新入学学生家长相关知识认知情况 (1)606例外来民工子弟学校新入学学生家长相关认知情况按知晓率从高到低依次为麻疹疫苗预防疾病、新入学是否查验预防接种证、接种麻疹疫苗是否出钱、麻疹疫苗接种起始月龄和麻疹疫苗接种剂次,其中麻疹疫苗接种起始月龄和麻疹疫苗接种剂次知晓率最低,分别为17.49%和11.39%,麻疹疫苗预防疾病答对率最高,为73.76%,各知识点知晓率差别有统计学意义(X2=685.90,P0.001)。 (2)知晓问答平均得分2.72分(95%CI：(2.66,2.78)),得分低于3分者418例(占68.98%),父亲组、母亲组、祖父母等其它组平均得分差别无统计学意义(F=2.894,P=0.0560.05)。家长麻疹疫苗接种相关知晓得分在新入学学生所在学校类别、出生场所、家庭经济收入、家庭孩子数、父母年龄、父母受教育年数等因素内分布差异具有统计学意义。 (3)外来民工子弟学校新入学学生家长中认为有必要为孩子接种麻疹疫苗的为539例(占88.94%),各组按接种愿意从高到低排序为母亲组(90.54%)父亲组(88.89%)其它组(78.79%),差别无统计学意义(X2=4.04,P=0.130.05)。 (4)麻疹疫苗接种相关知识的获取途径按比重由大到小分别为：医务人员、书面材料、广播电视、其它、网络,其中通过医务人员宣传占40.10%、通过网络途径获知占1.16%,差别有统计学意义(X2=359.22,P0.001)。 3.4免疫规划工作人员相关知识认知情况 (1)90.48%的调查者认为现代医疗条件下麻疹发病后果一般或不危险(不严重),73.02%的调查者认为麻疹不是当前影响人群健康的重要传染病,88.89%的调查者认为当前青浦区麻疹的发病处于散发水平。 (2)23.81%的调查者认为2012年青浦区能实现消除麻疹的目标,38.10%和33.33%的调查者分别觉得很难说和不能实现。 (3)60.32%和30.16%的调查对象分别认为疫苗未达到有效接种率和流动人口增加是当前人群麻疹发病的最主要因素；50.79%的调查对象认为当前适龄儿童麻疹疫苗2剂接种率有待进一步提高,39.68%的调查对象认为已经达到较高水平；66.67%和26.98%的调查对象分别认为家长不重视和家长未获取足够信息是当前影响麻疹疫苗接种率最主要的因素；74.60%的调查对象认为外来散居儿童是最影响麻疹疫苗接种率的人群。 (4)38.10%的调查对象觉得没有必要开展大范围的麻疹疫苗强化免疫活动,53.97%的调查对象觉得很有必要每年定期开展重点人群麻疹疫苗查漏补种工作,85.71%的调查对象觉得扎实基础免疫、开展查漏补种相对于定期开展大范围麻疹疫苗强化免疫更有针对性。 (5)74.60%和25.40%的调查对象分别认为医务人员面对面宣传和宣传手册、宣传单、宣传画报等是对儿童家长最有效的宣传方式。46.03%和36.51%的调查对象分别认为有效扩大相关知识宣传和提供更便捷的预防接种服务是提高麻疹疫苗接种率的最有效措施。 4结论 (1)青浦区麻疹发病处于低发病率、散发水平,家庭、工厂、外来民工子弟学校等为麻疹多病例爆发的重点场所,低年龄、中青年人群为麻疹发病的重点人群。(2)青浦区外来民工子弟学校新入学学生强化免疫前麻疹抗体水平及抗体阳性率均处于较高水平。(3)外来民工子弟学校新入学学生麻疹相关疫苗调查接种率不高,新入学学生所在学校类别、出生场所、新入学学生此前就学地、家庭经济收入、家庭孩子数、父母年龄、父母受教育年数等可能是其影响因素。 (4)外来民工子弟学校新入学学生家长相关知识知晓率低,且获取相关知识途径较为单一和传统,新入学学生所在学校类别、出生场所、家庭经济收入、家庭孩子数、父母年龄、父母受教育年数等可能是其影响因素。 5建议 (1)针对性地着重控制家庭、工厂、外来民工子弟学校等重点场所和低年龄、中青年等重点人群的麻疹疫情发生。 (2)教育部门与卫生部门切实加强预防接种证的管理和入托、入园、入学预防接种证查验工作。 (3)结合人群特点,采用针对性的宣传策略和方式,以提高人群的预防接种相关知识知晓率,以促使该人群的预防接种由被动接种转化为主动接种,有效防止麻疹疫苗接种空白点的存在。 (4)调整相应的免疫策略和细化工作的开展：一方面要扎实基础免疫、针对性地开展重点人群的查漏补种和对特定人群实施合适的免疫策略,另一方面要着力加强硬件建设、优化预防接种服务,切实形成有效的、高水平的人群免疫屏障。
[Abstract]:1 purposes
(1) to understand the epidemiological characteristics of measles in Qingpu district from 2001 to 2010.
(2) to master the level of measles immunity before immunization for newly enrolled students of migrant workers' children in Qingpu district.
(3) master the basic situation of Qingpu migrant workers children school students and their parents about the new family of measles vaccine (MV) vaccination and cognitive knowledge, understand the Qingpu district planning staff of measles immune disease, cognition of measles vaccine and vaccination related situation, to investigate the factors influencing the coverage rate of measles vaccine the crowd.
2 method
(1) collected from 2001 to 2010, infectious disease surveillance report system and measles in Qingpu District of Shanghai City finishing special disease monitoring system, combined with the Statistics Bureau of Qingpu District Public Security Bureau and the household population and non household population data, the incidence rate, proportion of the epidemiological characteristics of measles in Qingpu district were described and analyzed.
(2) a multi stage sampling method was used to extract 2 towns (streets) in 10 towns (streets), and 4 schools were extracted from each town (street). Each school was selected by grade and class to recruit new students in this semester.
(3) immunization coverage, new students from venous blood 3ml, serum by quantitative enzyme-linked immunosorbent assay (ELISA) determination of measles IgG antibody level in the serum of subjects, calculated the positive rate of measles antibody IgG, geometric mean concentration (GMC) and other indicators, the measles antibody level of newly enrolled students evaluation.
(4) designed by the parents of measles and vaccination related cognitive questionnaire, questionnaire survey of new students parents, including the basic situation of the students, the basic family situation, vaccination of measles related knowledge, measles vaccination intention and related knowledge acquisition way, calculating the awareness rate and for statistical analysis.
(5) the self-designed immunization staff and measles vaccination related cognitive questionnaire, disease prevention and control center of Qingpu district (CDC) and the 13 community health service center of immunization staff survey, including measles harm, the effectiveness of measles vaccine, measles elimination work cognition, traditional immunization of measles vaccine and measles vaccine leak replant measles vaccine, measles vaccine leak reasons and improve the basic vaccination rate measures, descriptive analysis of survey results.
3 Results
The 3.1 District of Qingpu from 2001 to 2010, the epidemiological characteristics of measles (1) from 2001 to 2010 in Qingpu, mainly in sporadic measles outbreaks, the average annual incidence rate of 8.97/10 million (0.10/10 million 35.49/10 million), can be divided into two stages: the fluctuation period (2001 - 2007) and decline period (2007 - 2010), the following changes the fluctuation of annual incidence (2.23/10 million 35.49/10 million), the annual decline in incidence decreased year by year (9.16/10 million 0.10/10 million).
(2) families, factories and migrant workers' children schools are the main places for the outbreak of measles. Among them, 2 cases are the main causes of family outbreaks. Factories and migrant workers' children schools are high-risk places for outbreaks of many cases.
(3) there are measles all year round in Qingpu District, mainly in spring and summer, and from 4 to June, the total number of cases is 55.77%..
(4) the age of onset is mainly concentrated in the 5 years old group and the young and middle-aged age group (20 ~ 25 ~ 30 ~ 35~40), accounting for 35.44% and 48.90% of the total number, respectively. 8 month old cases account for 16.21%. of the total number.
(5) the population and non domicile cases accounted for 53.16% and 46.84%.3.2, respectively, and the level of measles immunization before the newly enrolled students in the school of migrant workers' children were strengthened.
(1) the geometric mean concentration (GMC) of IgG antibody before immunization was 998.96mIU/ml (95%CI: (912.931093.10)), and the positive rate was 96.96%.
(2) of different types of schools (kindergarten, primary school, junior high school) there was no significant difference (F=1.19, P=0.30, GMC), no statistically significant difference between the positive rate of antibody (x2=0.36, P=0.83); different school history (had no schooling in history, household education, school education in Shanghai) no significant object the difference of GMC (F=1.22, P=0.30), there was no significant difference between the positive rate of antibody (x2=3.46, P=0.18).
(3) 38.29% subjects without vaccination certificate or has been lost, measles vaccination related more than 2 doses accounted for 37.95%, with an unknown history accounted for 48.18% different vaccination history (more than 2 agents, 1 agents, 0 agents, unknown) no significant difference (F=0.75, P=0.53, GMC). New student measles vaccination related agent in the new school students school categories, birth places, new students after school, family income, family, number of children, parents' age, parents' years of schooling has statistically significant difference in distribution of factors.
3.3 the knowledge of parents' knowledge of new students' parents in the school of migrant workers' children
(1) the relevant cognitive 606 cases of migrant workers' school new students according to the awareness rate from high to low is the measles vaccine to prevent disease, whether the new entrance vaccination certificate, vaccination is money, measles vaccination starting months and measles vaccination doses, including measles vaccination starting months and measles vaccination dose lowest awareness rate were 17.49% and 11.39%, the highest correct rate of measles vaccine for disease prevention, was 73.76%, the knowledge awareness rate was statistically significant difference (X2=685.90, P0.001).
(2) knowledge quiz with an average score of 2.72 points (95%CI: (2.66,2.78)), scoring less than 3 points in 418 cases (68.98%), father, mother, grandparents and other group average scores had no significant difference (F=2.894, P=0.0560.05). The parents of measles vaccination related knowledge score of the school in the new category. The admission of students born place, family income, family, number of children, parents' age, parents' years of schooling has statistically significant difference in distribution of factors.
(3) the migrant workers children school parents newly enrolled students think it necessary for the children of measles vaccination in 539 cases (88.94%), the group were inoculated to order from high to low for the mother group (90.54%) (88.89%) father group other groups (78.79%), the difference was not statistically significant (X2=4.04, P=0.130.05).
(4) measles vaccination approaches to obtain knowledge according to the proportion from big to small are: medical personnel, written materials, radio and television and other network, which, through the propaganda of medical worker informed through the network accounted for 40.10%, accounted for 1.16%, the difference was statistically significant (X2= 359.22, P0.001).
3.4 knowledge of related knowledge of immunization program staff
(1) 90.48% of the respondents believe that the incidence of measles is generally not dangerous under modern medical conditions. 73.02% of the respondents believe that measles is not an important infectious disease affecting the health of the crowd. 88.89% of the respondents believe that the incidence of measles in Qingpu is at the sporadic level.
(2) 23.81% of the investigators believed that the Qingpu district was able to achieve the goal of eliminating measles in 2012, and 38.10% and 33.33% of the investigators found it difficult to say and failed to achieve.
(3) 60.32% of respondents and 30.16% respectively that the vaccine did not reach effective vaccination rate and the floating population is the main factor of the current measles cases; 50.79% of the respondents think that the children against measles vaccination rate of 2 agent needs to be further improved, 39.68% of the subjects that have reached a higher level; 66.67% of respondents and 26.98% are that parents and parents do not pay attention to not get enough information is the effect of measles vaccination rate is the main factor; 74.60% of the respondents think that foreign children are the most affected measles vaccination coverage.
(4) 38.10% of the respondents think there is no need to carry out large-scale measles immunization activities, 53.97% of the respondents think it is necessary to regularly focus groups carried out the measles vaccine leak replant work, 85.71% of the respondents think that the solid foundation to carry out immunization, with respect to regularly carry out large-scale leak replant measles vaccine immunization more targeted.
(5) 74.60% and 25.40% of the respondents believe that medical staff were face-to-face publicity and brochures, leaflets, posters and other subjects for parents of children is the most effective propaganda way.46.03% and 36.51% respectively that effectively expand the relevant knowledge and provide a more convenient vaccination service is the most effective way to improve measles vaccination rate.
4 Conclusion
(1) the incidence of measles in Qingpu District in the low incidence rate, emission levels, family, factory, key places, schools for migrant workers' children for measles outbreaks of low age, young people focus on measles cases. (2) of migrant workers into the new school district of Qingpu school students strengthen before immunization of measles antibody and the level of antibody positive rates were at a high level. (3) the migrant workers children school new student survey of measles related vaccine vaccination rate is not high, the freshman school type, birth place, new students after school, family income, family, number of children, parents' age, parents' years of schooling may are the influencing factors.
(4) low awareness of migrant workers' school new student related knowledge, and knowledge is relatively single and traditional way, new student school type, birth place, family income, family, number of children, parents' age, parents' years of schooling may be the influencing factors.
5 suggestion
(1) the outbreak of measles in key areas such as families, factories, migrant workers' children's schools and other key populations, such as the low age and the young and middle-aged, should be focused on the control of the family, the factory, the migrant workers' children's school and other key places.
(2) Department of education and health departments to strengthen vaccination certificate management and nursery admission, admission, vaccination certificate inspection work.
(3) combined with the characteristics of the crowd, we should use targeted publicity strategies and ways to improve the awareness rate of vaccination related knowledge in order to promote the vaccination of the population from passive vaccination to active vaccination, and effectively prevent the existence of blank points of measles vaccination.
(4) adjust the immune strategy and refinement work: on the one hand to a solid foundation to carry out targeted immunization, focus groups and the implementation of leak replant immunization strategies suitable for specific populations, on the other hand, we must focus on strengthening the hardware construction, optimization of immunization services, to form an effective, high level of population immunity barrier.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R186.3

【参考文献】