山东省平邑县、莒南县肾综合征出血热流行病学研究

发布时间：2018-05-13 23:29

本文选题：肾综合征出血热 + 流行特征　；参考：《山东大学》2008年硕士论文

【摘要】： 肾综合征出血热(Hemorrhagic Fever with Renal Syndrome,HFRS)是一种自然疫源性疾病,该病以亚洲、欧洲大陆多发。其中流行性出血热(EHF,HFRS的一种)主要流行于亚洲地区,而发病最多的是中国。HFRS是由汉滩病毒引起的,经研究证实分为9个血清型,我国主要是汉坦型和汉城型流行。目前该病在我国流行仍十分严重,并且出现了新的流行特征:①发病例数上升明显;②现有疫区范围不断扩大,新疫区时有出现;③大中城市流行强度上升,疫情向大中城市蔓延;④流行的季节性发生变化,除冬季外,其它季节的月发病差异不明显。研究目的:莒南县以低海拔的平原、丘陵为主,境内河流密布;平邑县是典型的山区地形,海拔较高,河流较少。两县相距100余公里,但地理生态环境相差大,且两县HFRS发病率都较高,都是我国HFRS监测点。本研究利用两县历年HFRS发病资料、宿主动物监测资料等,应用描述流行病学研究方法,探讨具有不同地理特征与生态环境HFRS疫源地的异质性及其影响因素,以便为在不同地理特征与生态环境的疫区进行HFRS的预防和控制提供科学的理论依据。本研究结果表明: 1.莒南县1975年9月1日～2005年12月1日共发生HFRS病例16118例,平均发病率58.61/10万,累计病死203例,平均病死率1.26%。其中男性占67.24%,15～64岁占总发病数88.05%,农民占总病例的88.92%;平邑县1980年12月～2005年12月,累计发生HFRS病例9384例,平均发病率29.48/10万,死亡265例,平均病死率2.82%。男性占64.96%,35～45岁人群发病所占比例最高(33.23%);农民占88.99%。 2、两县HFRS的年发病水平呈周期性变化,平邑县流行周期约3～5年,莒南县约5～7年;两县均经历了秋冬季的单峰型→以秋冬峰为主的双峰型→以春峰为主的双峰型的季节性波动;总体上,两县HFRS秋冬季病死率大于春季,病死率总的趋势随时间在下降。 3、两县疫源地先后经历了由姬鼠型散发阶段→姬鼠型暴发流行阶段→家鼠、姬鼠混合型散发流行阶段→家鼠型为主的混合型暴发→家鼠型为主的混合型散发阶段的变化过程,到2005年12月两县仍处在家鼠型为主的混合型散发阶段。鼠密度高峰在第三季度,鼠带毒率第4季度最高。 4、HFRS病例的分布在两县乡镇有明显的聚集性。高发区多位于地势低洼,易受内涝及河水流过的平原地带;中发病区,主要分布在干旱丘陵地区和低山林区;低发病区域多分布在较高海拔的干旱山区,两县HFRS的发病也有一定的家庭聚集现象。结论: (1)平邑县和莒南县HFRS的流行都经历了以下5个过程:散发→局部流行→暴发→广泛流行→散发阶段,但莒南县有一个HFRS的持续高发流行阶段(1990～1994年)。两县疫源地都经历了由HTN型→HTN型为主的混合型→SEO型为主的混合型的疫源地演变过程;两县病死率总的趋势在下降,秋冬季病死率明显高于春季病死率。 (2)两县的年发病率、病死率、流行周期存在差异。莒南县的年发病率明显高于平邑县的年发病率,平邑县病死率则高于莒南县病死率。平邑县流行周期约为3～5年,莒南县HFRS流行周期约为5～7年, (3)HFRS发病率随地形地貌、生态景观等空间环境的改变而发生变化。HFRS疫区有从莒南县所在的东南平原河网地区向西北部山区丘陵地带迁移的趋势。
[Abstract]:Hemorrhagic Fever with Renal Syndrome (HFRS) is a natural epidemic disease, which is widely distributed in Asia and Europe, among which epidemic hemorrhagic fever (one of EHF, HFRS) is mainly prevalent in Asia, and the most prevalent is that Chinese.HFRS is caused by Hantaan virus. It has been confirmed to be divided into 9 serotypes by study. Our country is mainly the Hantaan type and Seoul type popular. At present, the epidemic in China is still very serious, and there are new epidemic characteristics: (1) the number of cases is rising obviously; (2) the scope of the epidemic area is expanding, the new epidemic area has appeared; (3) the epidemic intensity of the large and middle cities is rising, the epidemic situation spreads to the large and medium cities; (4) the seasonal change of epidemic situation has changed. Except for winter, there was no significant difference in the incidence of other seasons.
Research purposes: Junan county is a low altitude plain, mainly hilly, and the inland river is densely distributed; Pingyi county is a typical mountainous terrain, high altitude, and less rivers. Two counties are more than 100 kilometers apart, but the geographical and ecological environment is different, and the incidence of HFRS in two counties is high, all of which are HFRS monitoring points in China. This study uses the data of the incidence of HFRS in two counties for the year. In order to provide scientific theoretical basis for the prevention and control of HFRS in the epidemic areas of different geographical features and ecological environment, the heterogeneity and its influencing factors with different geographical features and ecological environment HFRS foci are discussed by descriptive epidemiological methods.
The results of this study show that:
1. Junan county from September 1, 1975 to 1 December 2005, there were 16118 cases of HFRS cases, the average incidence of 58.61/10 million, the cumulative mortality of 203 cases, the average fatality rate of 1.26%. is 67.24%, 15~64 years old accounted for 88.05%, the farmers accounted for 88.92% of the total cases, and Pingyi County December 1980 to December 2005, the cumulative incidence of 9384 cases of HFRS, the average hair The morbidity rate was 29.48/10 million, 265 cases died, the average mortality rate was 2.82%., the male accounted for 64.96%, the proportion of the 35~45 year old population was the highest (33.23%), and the farmers accounted for 88.99%.
2, the annual incidence of HFRS in two counties showed periodic changes, the epidemic period of Pingyi county was about 3~5 years, and Junan county was about 5~7 years. The two counties all experienced the seasonal fluctuation of the single peak type of autumn winter and the Shuangfeng type to the spring peak dominated by the autumn winter peak. In general, the mortality rate of the two counties was greater than that in spring, and the total trend of mortality was the following. Time is falling.
3, the two county foci have experienced the change process of the mixed sporadic phase from the stage of the Apodemus type to the outbreak stage of the Apodemus type, the rat, the mixed type of the Apodemus, the mixed type of the rat type and the rat type, and the mixed sporadic phase of the rat type. In December 2005, the two counties are still in the mixed type of the rat type. The peak rate in the third quarter was highest in the fourth quarter.
4, the distribution of HFRS cases in the two counties and towns has obvious aggregation. The high incidence area is located in the low lying land, easily subject to the waterlogging and river flowing through the plain area; the middle incidence area is mainly distributed in the arid hilly area and the low mountain forest area; the low incidence area is mostly distributed in the high altitude arid mountain area, and the incidence of the two county HFRS is also a certain family gathering now. Elephant.
Conclusion:
(1) the epidemic of HFRS in Pingyi and Junan counties all experienced the following 5 processes: sporadic, local epidemic, outbreak, widespread epidemic and sporadic phase, but Junan county has a continuous high epidemic stage of HFRS (1990~1994 years). All two county foci have experienced a mixed type of mixed type of type of type HTN to SEO mainly of type to HTN type. The overall trend of mortality in two counties is decreasing, and the mortality in autumn and winter is significantly higher than that in spring.
(2) the annual incidence, fatality rate and epidemic cycle of the two counties were different. The annual incidence of Junan county was obviously higher than the annual incidence of Pingyi County, and the fatality rate in Pingyi county was higher than that of Junan county. The epidemic cycle of Pingyi county was about 3~5 years, and the epidemic cycle of HFRS in Junan county was about 5~7 years.
(3) the incidence of HFRS changes with the change of the spatial environment, such as landform, landform, landscape, ecological landscape, and so on. The.HFRS epidemic area has a tendency to migrate from the river network area of the southeast plain to the mountainous and hilly areas of the northwest of Junan.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R181.3

【参考文献】