宁夏急性弛缓性麻痹病例监测网络评价及儿童脊髓灰质炎抗体水平调查

发布时间：2018-04-23 06:22

本文选题：脊髓灰质炎 + 抗体　；参考：《宁夏医科大学》2009年硕士论文

【摘要】： 目的通过整理和分析宁夏回族自治区2001-2007年确诊的急性弛缓性麻痹(AFP)病例个案调查表,了解宁夏回族自治区AFP病例的流行病学特征,动态掌握宁夏AFP病例发生的基本情况;分析和评价AFP病例监测系统的运行情况;同时通过随机抽样调查,检测宁夏回族自治区0-14岁健康儿童血清脊髓灰质炎抗体水平,评价人群的免疫状况,并最终为保持人群较高的免疫水平和自治区保持无脊灰状态提供依据。方法整理和分析2001-2007年宁夏回族自治区上报并按照病毒学分类标准,经AFP病例分类诊断小组讨论确诊的AFP病例的个案调查表和随访表等,分析AFP病例的流行病学特征;同时通过对2001-2007年AFP病例监测系统及时性、完整性、敏感性三个指标的分析,评价AFP监测系统的运行状况;运用随机抽样的方法,抽取银川市、中卫市、固原市0-14岁健康儿童,按0岁组、1岁组、2-4岁组、5-9岁组、10-14岁组分为5个不同年龄组,采用酶联免疫吸附试验(ELISA)检测健康儿童脊灰IgG抗体,调查了解我区健康儿童的脊灰免疫水平。结果2001-2007年宁夏回族自治区共确诊非脊灰AFP病例150例,15岁以下儿童非脊灰AFP病例年报告发病率分别为1.01/10万、1.40/10万、1.42/10万、1.58/10万、1.23/10万、1.77/10万、2.03/10万,均达到了国家卫生部规定的≥1/10万的标准;五个市均有病例报告,其中固原市15岁以下儿童非脊灰AFP病例报告发病率最高,为1.73/10万,其次是石嘴山市、中卫市、银川市和吴忠市,报告发病率分别为1.47/10万、1.44/10万、1.30/10万和1.12/10万;以县为单位,有8个县报告发病率未达到国家规定的标准;AFP发病年龄主要集中在0-5岁,占56.0%;从免疫史分析来看,“0”剂次占3.3%,1-2剂次占14.7%,≥3剂次占76.0%,不详占6.0%;AFP是一组疾病,在众多的疾病中,格林巴利综合症所占比例最大,占42.7%;所有的AFP病例均采集了粪便标本,合格粪便标本采集率为85.3%,25例粪便标本分离到肠道病毒(EV),肠道分离阳性率为16.7%,其中非脊灰肠道病毒(NPEV)18株,NPEV分离率为12.0%,脊灰病毒7例,其中脊灰病毒(PV)Ⅰ型2例,脊灰病毒(PV)Ⅱ型1例,脊灰病毒(PV)III型3例,混合型脊灰病毒1例,所有脊灰病毒(PV)经国家脊灰实验室复核均为疫苗株;以省为单位,AFP病例监测系统2001-2007年AFP病例报告后48小时调查及时率为84.2%-100%;14天内双份粪便标本采集及时率为66.7%-92.6%;粪便标本7天内送检及时率为90.5%-96.6%;分离结果28天内送达及时率为86.7%-100%;随访表75天内送达及时率为76.2%-100%;阳性标本14天送达国家及时率为均100%;银川市、固原市、中卫市403名健康儿童血清脊灰IgG抗体阳性率为99.0%,几何抗体平均滴度(GMT)为1:1567,脊灰抗体水平达到保护水平的382人,保护水平的阳性率为94.8%。结论2001-2007年宁夏AFP病例监测系统运行良好,各指标达到了国家卫生部规定的标准,同时经过多年的基础免疫、强化免疫和查漏补种等免疫策略,健康儿童脊灰抗体水平维持在较高的水平,是宁夏回族自治区多年来保持无脊灰状态强有力的保证。此外,研究也发现了在维持无脊灰过程中的一些问题,建议在今后的工作中进一步加强:1)加强薄弱地区的监测工作;2)加强小年龄组和流动儿童的管理和免疫接种,保持高水平的免疫覆盖率;3)提高AFP病例报告的特异性;4)加强健康宣传,提高人群及时就诊率;5)加强基层人员的业务素质,提高诊断水平和首诊报告率;6)提高AFP病例合格粪便标本的采集质量;7)加强AFP病例监测管理的督导,及时做好每一例AFP病例的分类诊断;8)加强全区各疾控和医疗机构之间的联系,切实做好AFP病例监测工作;9)加强村医的培训和管理,提高村医的工作条件和工资待遇;10)加强冷链体系监测,保证冷链质量。
[Abstract]:Objective to understand the epidemiological characteristics of the cases of AFP in the Ningxia Hui Autonomous Region by sorting out and analyzing the cases of acute flaccid paralysis (AFP) diagnosed in 2001-2007 years in the Ningxia Hui Autonomous Region, to dynamically grasp the basic situation of the occurrence of the AFP cases in Ningxia, and to analyze and evaluate the operation of the monitoring system for the cases of AFP disease; and by random pumping. A sample survey was conducted to detect the level of serum poliomyelitis antibody in healthy children aged 0-14 years in the Ningxia Hui Autonomous Region, to evaluate the immune status of the population, and to provide the basis for maintaining a high level of immunity in the population and keeping the polio free state of the autonomous region.
Methods to organize and analyze the the Ningxia Hui Autonomous Region report for 2001-2007 years and according to the classification criteria of Virology, the case classification and follow-up table of the confirmed AFP cases were discussed by the AFP case classification diagnosis group, and the epidemiological characteristics of the AFP cases were analyzed. At the same time, three cases of the 2001-2007 year AFP disease monitoring system were timeliness, integrity and sensitivity. The operation status of AFP monitoring system was evaluated. The 0-14 year old healthy children of Yinchuan City, Zhong Wei city and Guyuan city were selected by random sampling method. According to 0 year old group, 1 year old group, 2-4 year old group, 5-9 year old group and 10-14 year old group, 5 different age groups were divided into 5 different age groups, using enzyme linked immunosorbent assay (ELISA) to detect the polio IgG antibody in healthy children. The level of polio immunity in healthy children.
Results in 2001-2007 years, 150 cases of non polio AFP were confirmed in the Ningxia Hui Autonomous Region. The incidence rate of non polio AFP cases in children under 15 years old was 1.01/10 million, 1.40/10 million, 1.42/10 million, 1.58/10 million, 1.23/10 million, 1.77/10 million, 2.03/10 million, all reached the standard of more than 1/10 million stipulated by the Ministry of health; five cities had case reports. The incidence of non polio AFP cases of children under 15 years old in middle Guyuan was the highest incidence rate of 1.73/10 million, followed by Shizuishan, Zhong Wei City, Yinchuan city and Wuzhong City, the incidence rate was 1.47/10 million, 1.44/10 million, 1.30/10 Vanward 1.12/10 million, and the county was the unit, and the incidence of the disease was not reached the national standard; AFP was the main age of the disease. The concentration was 0-5 years, accounting for 56%. From the analysis of the history of immunization, "0" was 3.3%, 1-2 times accounted for 14.7%, more than 3 times, 76% and 6%. AFP was a group of diseases, and among the many diseases, Green Barre syndrome accounted for the largest proportion of 42.7%; all AFP cases collected fecal specimens, the collection rate of qualified fecal specimens was 85.3%, 25 cases The fecal specimens were isolated to enterovirus (EV), the positive rate of intestinal isolation was 16.7%, of which 18 were non polio enterovirus (NPEV), NPEV separation rate was 12%, polio virus 7, poliovirus (PV) type I 2, poliovirus (PV) type II 1 cases, poliovirus (PV) III type 3 cases, mixed poliovirus 1 cases, and all poliovirus (PV) through national polio The reexamination of the laboratory was all vaccine strain; with the province as a unit, the AFP case monitoring system was reported for 48 hours after 2001-2007 years of AFP case report, and the timely rate was 84.2%-100%; the timely rate of double fecal specimen collection was 66.7%-92.6% in 14 days, and the timely rate of fecal specimens was 90.5%-96.6% in 7 days; the rate of delivery in 28 days was 86.7%-100%; the follow-up table was 75. The timely delivery rate was 76.2%-100%, and the positive rate was 100% in 14 days. The positive rate of serum IgG antibody of 403 healthy children in Yinchuan, Guyuan and Zhong Wei city was 99%, the average titer of the geometric antibody (GMT) was 1:1567, and the level of polio antibody reached 382, and the positive rate of the protection level was 94.8%.
Conclusion the Ningxia AFP case monitoring system has been running well in the past 2001-2007 years. Each index has reached the standard prescribed by the national Ministry of health. At the same time, after years of basic immunization, strengthening immunity and leakage of replanting and other immunization strategies, the level of polio antibody in healthy children has been maintained at a high level. It has been strong in the Ningxia Hui Autonomous Region for years to keep the polio free state. In addition, the study also found some problems in the maintenance of polio free process and suggested further strengthening in future work: 1) strengthening monitoring in weak areas; 2) strengthening the management and immunization of small age groups and mobile children, maintaining a high level of epidemic coverage; 3) enhancing the specificity of the AFP case report; 4) strengthening Health publicity, improve the rate of timely medical treatment of the crowd; 5) strengthen the professional quality of the grass-roots personnel, improve the diagnostic level and first diagnosis report rate; 6) improve the quality of the collection of AFP cases, 7) strengthen the supervision and management of the monitoring and management of AFP cases, do a good job in the classification diagnosis of each case in time; 8) strengthen the disease control and medical institutions in the whole area. Contact, conscientiously do a good job of AFP case monitoring; 9) strengthen the training and management of village doctors, improve the working conditions and wages of village doctors; 10) strengthen the monitoring of cold chain system and ensure the quality of cold chain.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R186

【参考文献】