安徽省流行性脑脊髓膜炎流行病学特征研究
发布时间：2018-08-22 19:42
【摘要】： 流行性脑脊髓膜炎(简称流脑)是由脑膜炎双球菌引起的一种急性呼吸道传染病,是我国法定乙类传染病。安徽省历来是流脑高发地区之一,上世纪80年代后随疫苗的推广使用,流脑的发病得到有效的控制,但近年来,如一些曾经很好控制传染病死灰复燃一样,流脑发病出现迅速上升态势,伴随发病率上升,流脑的流行特征也出现明显变化。安徽省地处我国中部地区,特定的地理环境使得对安徽省相关疾病的流行特征的研究具有较普遍的外推价值,同时,作为C群流脑疫情首先发生省份之一,也为我们开展相关研究工作提供了可能。为此,我们结合对安徽省既往流脑疫情资料的回顾,开展了本课题研究工作,希望为流脑以及部分疫苗可预防疾病的预防策略及控制措施的制定、改进提供参考依据。 目的 了解安徽省流脑流行特征以及近年来出现的变化情况,为预防控制策略及措施的制定提供理论依据 材料方法 1、依托疫情报告系统收集安徽省历年流脑疫情资料。以10年为一时间段将整个研究时间分成6个年代,以淮河、长江为主要参照标记,将安徽省分成江淮、淮北和江南三个地区,比较分析了不同年代、不同地区流脑发病变化情况。对研究期间安徽省流脑发病的人群、地区、时间分布情况进行描述性分析。 2、对2003年7月到2007年6月之间合肥地区所有报告疑似流脑病例进行流脑流行病学个案调查和临床病历资料回顾性调查;2005年11月份和2006年4月份,采集不同年龄段健康人群咽拭子。根据我国在校学生年龄分布情况将所调查病例分成6个年龄组,统计时间周期以上年7月1日到第二年6月31日为一个统计年份。分年龄组、城乡地区的不同分别统计发病率和病死率,不同年龄组病例构成情况也进行描述。不同性别病例年龄中位数及死亡病例年龄中位数分别进行计算。对分类资料进行卡方检验,应用非参检验对不同性别间、死亡病例与成活病例年龄进行比较分析。应用单因素logistic将年龄、发病与就诊时间间隔及临床表现等逐个纳入分析其与病死结局关联,对其中有意义的因素,再共同纳入多因素logistic回归分析,以了解影响流脑病例死亡结局的危险因素。 结果 1951-2007年安徽省共发生流脑病例799387例,年平均发病率为28.90/10万,死亡41337例,死亡率为1.49/10万,病死率为5.17%。在此期间安徽省范围出现3次大的流行疫情:最大的一次出现在1975-1979年间,并于1977年达到此次流行年发病高峰729.25/10万;疫苗前时期,安徽省流脑疫情有8-10年流行(峰高不同)的规律,每次大流行持续时间大约为6-7年左右。上世纪80年代后随A群流脑多糖疫苗的推广使用,流脑发病率出现持续下降趋势,流脑的流行周期也越来越不明显,但仍在间隔10年左右出现发病率小幅度异常波动。2003年我省出现C群流脑局部地区爆发疫情后,全省流脑疫情呈现小幅反弹现象。安徽省流脑发病一般是从每年的10-11月份开始出现疫情上升迹象,至第二年的4-5月份达到发病高峰,与流行年份相比,散发年份发病率的季节高峰持续时间要长一个月左右时间。10或11月份发病率较前5年同月发病平均水平明显升高往往预示下年度发病上升。1994-1999年间,15岁以下占中病例的78.94%;2000-2007年间,15岁以下占中病例的17.20%,10-25岁年龄组病例占到63.03%。总的男女病例比为1.46:1,但25岁后,男女比为0.70:1。在发生全省范围的流脑流行情况下,淮北地区早于其他两地区1-2年出现疫情上升及出现发病率高峰,但2002年后的C群流脑流行先发生于江南地区。江淮、江南、淮北地区流脑发病率分别为33.20/10万、29.03/10万和30.44/10万(P = 0.000),三地区病死率分别为4.37%、4.92%和6.00%(P = 0.000)。 2003年至2007年合肥市累计发现报告流脑病例386例,年平均发病率为2.09/10万,2006/2007年度发病率达到2.86/10万。经实验室确诊病例135例,都为C群流脑。城市地区病例235例(60.88%)、农村地区病例151例(39.12%)。病例年龄中位数为15岁(最小为2个月,最大为78岁),发病率最高年龄组为12-17岁组(6.57/10万),男性病例219例,占总病例的56.7%。在小于22岁病例中,男女病例比例为1.5:1,在大于22岁病例中,男女性别比例为1:1.8。98.2%的病例发生11月份到第二年的5月份之间。临床表现:急性起病的有334例(96.53%),371例病例有发热(96.11%),其它主要症状有:有呕吐的322例(83.42%),恶心311例(80.57%),颈项强直的285例(77.9%),头痛278例(72.02)。临床分型:普通型225例(58.29%),暴发型54例(13.9%),轻型2例(0.52%)。共发生死亡病例28例,平均病死率为7.25%,死亡病例年龄中位数为10岁(2个月龄到27岁),比成活病例年龄低,成活病例年龄中位数为15岁(6个月龄到78岁),通过非参检验,两者分布差异有统计学意义(Z=2.54,P=0.01)。分析影响病例死亡的主要因素,单因素logistic回归分析结果显示:头痛、神志不清、恶心、出血点或瘀斑、瘀点数目超过3个、颈项强直、抽搐、中性粒细胞80%、克氏征阳性、布氏征阳性以及年龄小于12岁与病例死亡相关(P 0.05);将这些因素纳入logistic回归模型进行多因素分析,瘀点数目超过3个、中性粒细胞80%、布氏征阳性为病例死亡危险因素(P 0.05)。聚集性病例21起,病例年龄中位数为16岁(1岁到69岁),其中年龄在12-21岁的病例占59.31%;健康人群流脑带菌率流行期为5.99%,高于流行前期的3.05%, ,流行期B群和C群带菌率上升明显;健康人群带菌率有随年龄增加而升高的趋势。 结论 安徽省是流脑易发生地区,历史上A群流脑是本地区占绝对优势的流行菌株,A群多糖疫苗的推广使用,有效控制了安徽省流脑的发病;疫苗后时期流脑的流行周期性不再明显,但每隔10年左右仍能观察到发病率小幅度异常上升的现象;C群流脑代替了A群成为安徽省近几年的流行优势菌株,并引起流脑疫情的反弹上升,病例年龄分布出现上移趋势,但目前尚处于菌群转换的不稳定的过渡时期,需要进一步的监测研究;流脑流行优势菌群的转换反映了疫苗接种远期副(附)效应的影响,提示免疫策略及时修订变化的必要性;从病例性别构成来看,男性病例明显高于女性,该现象值得进一步关注。合肥地区针对C群流脑疫情开展的A+C群流脑群体接种效果并不明显;流脑发生季节性明显,10及11月份发病情况对下年度疫情变化有一定预示作用; C流脑病死率高于A群;瘀点数目超过3个、中性粒细胞80%、布氏征阳性等影响C群流脑病例死亡结局。
[Abstract]:Epidemic cerebrospinal meningitis (hereinafter referred to as meningomyelitis) is an acute respiratory infectious disease caused by meningococcus, is a legal class B infectious disease in China. Anhui Province has always been one of the areas with a high incidence of meningococcal meningitis. Like the resurgence of infectious diseases, the incidence of epidemic cerebrospinal meningitis is rising rapidly, and the epidemic characteristics of epidemic cerebrospinal meningitis are also changing obviously. Anhui Province is located in the central region of China. The specific geographical environment makes the study of epidemic characteristics of related diseases in Anhui Province have a widespread extrapolation value. At the same time, it is a group C epidemic situation. First of all, it is possible for us to carry out the related research work. Therefore, we carried out the research work on this subject in combination with the review of the data of epidemic situation of epidemic cerebrospinal meningitis in Anhui Province, hoping to provide a reference for the formulation and improvement of preventive strategies and control measures for epidemic diseases of epidemic cerebrospinal meningitis and some vaccines.
objective
To understand epidemiological characteristics of epidemic cerebrospinal meningitis in Anhui Province and its changes in recent years, so as to provide theoretical basis for the formulation of preventive control strategies and measures.
Material method
1. The epidemic data of epidemic encephalitis in Anhui Province over the years were collected by epidemic information reporting system. The whole research period was divided into six periods in 10 years. With Huaihe River and Yangtze River as the main reference marks, Anhui Province was divided into three regions: Jianghuai, Huaibei and Jiangnan. Descriptive analysis was conducted on the population, area and time distribution of epidemic cerebrospinal meningitis in Anhui province.
2. Epidemiological investigation and retrospective investigation of clinical data of all reported suspected cases of meningitis in Hefei area from July 2003 to June 2007 were carried out; pharyngeal swabs of healthy people of different ages were collected in November 2005 and April 2006. The cases were divided into six groups according to the age distribution of school students in China. Age group, the statistical period from July 1, last year to June 31, the second year is a statistical year. According to the age group, the incidence and mortality in urban and rural areas are calculated separately, and the composition of cases in different age groups is also described. Chi-square test was used to compare and analyze the age of death cases and survival cases among different genders and non-reference test. Age, interval between onset and treatment and clinical manifestations were included in single-factor logistic regression to analyze the correlation between age, onset and outcome of illness and death. Objective to understand the risk factors of death in patients with epidemic cerebrospinal meningitis.
Result
From 1951 to 2007, there were 799 387 cases of epidemic cerebrospinal meningitis in Anhui Province, with an average annual morbidity of 28.90/100 000, death rate of 41 337 cases, mortality rate of 1.49/100 000, fatality rate of 5.17%. During this period, there were three major epidemics in Anhui Province: the largest occurred in 1975-1979, and reached the peak of 729.25/100 000 in 1977. The epidemic of epidemic cerebrospinal meningitis in Anhui Province had an epidemic pattern of 8-10 years (with different peak heights) and the duration of each pandemic was about 6-7 years. After 1980s, with the popularization and use of group A meningitis polysaccharide vaccine, the incidence of epidemic cerebrospinal meningitis continued to decline, and the epidemic cycle of meningitis became less and less obvious, but it still appeared about 10 years apart. The incidence of epidemic cerebrospinal meningitis in Anhui Province showed a slight rebound after the outbreak of epidemic in 2003. The incidence of epidemic cerebrospinal meningitis in Anhui Province generally began from October to November of each year, and reached the peak in April to May of the second year. Compared with the epidemic year, the incidence of epidemic cerebrospinal meningitis in the sporadic year was higher. The seasonal peak duration of the rate is about a month longer. A significant increase in the average incidence in October or November from the previous five years in the same month often indicates an increase in the next year's incidence. The ratio of male to female was 1.46:1, but after 25 years old, the ratio of male to female was 0.70:1. In the case of epidemic of epidemic cerebrospinal meningitis in the whole province, the epidemic situation in Huaibei Prefecture increased 1-2 years earlier than that in the other two areas, and the incidence of group C epidemic cerebrospinal meningitis occurred in the South of the Yangtze River, the south of the Yangtze River and the north of Huaibei Prefecture in 2002. The fatality rates were 4.37%, 4.92% and 6.00% (P = 0.000), respectively.
From 2003 to 2007, a total of 386 cases of epidemic cerebrospinal meningitis were reported in Hefei, with an average annual incidence of 209/100,000 and an incidence of 286/100,000 in 2006/2007. 135 laboratory-confirmed cases were group C epidemic cerebrospinal meningitis. There were 235 cases in urban areas (60.88%) and 151 cases in rural areas (39.12%). The largest age group was 78 years old, the highest incidence was 12-17 years old group (6.57/100,000), male cases 219 cases, accounting for 56.7% of the total cases. Four cases (96.53%) had fever in 371 cases (96.11%). The other main symptoms were vomiting in 322 cases (83.42%), nausea in 311 cases (80.57%), neck stiffness in 285 cases (77.9%) and headache in 278 cases (72.02). Clinical classification: 225 cases of common type (58.29%), 54 cases of outbreak type (13.9%) and 2 cases of light type (0.52%). The median age of the patients was 10 years (2 months to 27 years), lower than that of the surviving cases. The median age of the surviving cases was 15 years (6 months to 78 years). There was a significant difference in the distribution between the two groups (Z = 2.54, P = 0.01). The main factors influencing the death of the patients were analyzed. The results of univariate logistic regression analysis showed that headache and mental retardation were the main causes. Clear, nausea, bleeding spots or ecchymosis, more than 3 blood stasis points, neck stiffness, convulsions, 80% neutrophils, positive Kirschner's sign, positive Brinell's sign and age less than 12 years were associated with death (P 0.05); these factors were included in logistic regression model for multivariate analysis, the number of blood stasis points exceeded 3, 80% neutrophils, and positive Brinell's sign (P 0.05). The median age of 21 cases was 16 years (1 to 69 years), of which 59.31% were 12-21 years old. The prevalence rate of epidemic cerebrospinal meningitis was 5.99% in healthy people, which was higher than 3.05% in pre-epidemic period. The carrier rate of B and C groups increased significantly in epidemic period. And the upward trend.
conclusion
Anhui province is an epidemic area of epidemic cerebrospinal meningitis. In history, group A epidemic cerebrospinal meningitis was the dominant strain in this area. The spread and use of group A polysaccharide vaccine effectively controlled the epidemic of epidemic cerebrospinal meningitis in Anhui province. Meningitis replaced group A as an epidemic dominant strain in Anhui Province in recent years, and caused the rebound of epidemic situation of meningitis to rise. The age distribution of cases showed a trend of upward shift. However, it is still in the unstable transition period of bacterial transformation, which needs further monitoring and research. The results suggest that it is necessary to revise the immunization strategy in time, and that male cases are significantly higher than female cases in terms of sex composition, which deserves further attention. The annual epidemic change has certain predictive effect; the mortality of group C epidemic encephalopathy is higher than that of group A; the number of blood stasis points is more than three, neutrophils are 80%, and Brinell's sign is positive.
【学位授予单位】：安徽医科大学
【学位级别】：博士
【学位授予年份】：2008
【分类号】：R181.3;R515.2
本文编号：2198120
[Abstract]:Epidemic cerebrospinal meningitis (hereinafter referred to as meningomyelitis) is an acute respiratory infectious disease caused by meningococcus, is a legal class B infectious disease in China. Anhui Province has always been one of the areas with a high incidence of meningococcal meningitis. Like the resurgence of infectious diseases, the incidence of epidemic cerebrospinal meningitis is rising rapidly, and the epidemic characteristics of epidemic cerebrospinal meningitis are also changing obviously. Anhui Province is located in the central region of China. The specific geographical environment makes the study of epidemic characteristics of related diseases in Anhui Province have a widespread extrapolation value. At the same time, it is a group C epidemic situation. First of all, it is possible for us to carry out the related research work. Therefore, we carried out the research work on this subject in combination with the review of the data of epidemic situation of epidemic cerebrospinal meningitis in Anhui Province, hoping to provide a reference for the formulation and improvement of preventive strategies and control measures for epidemic diseases of epidemic cerebrospinal meningitis and some vaccines.
objective
To understand epidemiological characteristics of epidemic cerebrospinal meningitis in Anhui Province and its changes in recent years, so as to provide theoretical basis for the formulation of preventive control strategies and measures.
Material method
1. The epidemic data of epidemic encephalitis in Anhui Province over the years were collected by epidemic information reporting system. The whole research period was divided into six periods in 10 years. With Huaihe River and Yangtze River as the main reference marks, Anhui Province was divided into three regions: Jianghuai, Huaibei and Jiangnan. Descriptive analysis was conducted on the population, area and time distribution of epidemic cerebrospinal meningitis in Anhui province.
2. Epidemiological investigation and retrospective investigation of clinical data of all reported suspected cases of meningitis in Hefei area from July 2003 to June 2007 were carried out; pharyngeal swabs of healthy people of different ages were collected in November 2005 and April 2006. The cases were divided into six groups according to the age distribution of school students in China. Age group, the statistical period from July 1, last year to June 31, the second year is a statistical year. According to the age group, the incidence and mortality in urban and rural areas are calculated separately, and the composition of cases in different age groups is also described. Chi-square test was used to compare and analyze the age of death cases and survival cases among different genders and non-reference test. Age, interval between onset and treatment and clinical manifestations were included in single-factor logistic regression to analyze the correlation between age, onset and outcome of illness and death. Objective to understand the risk factors of death in patients with epidemic cerebrospinal meningitis.
Result
From 1951 to 2007, there were 799 387 cases of epidemic cerebrospinal meningitis in Anhui Province, with an average annual morbidity of 28.90/100 000, death rate of 41 337 cases, mortality rate of 1.49/100 000, fatality rate of 5.17%. During this period, there were three major epidemics in Anhui Province: the largest occurred in 1975-1979, and reached the peak of 729.25/100 000 in 1977. The epidemic of epidemic cerebrospinal meningitis in Anhui Province had an epidemic pattern of 8-10 years (with different peak heights) and the duration of each pandemic was about 6-7 years. After 1980s, with the popularization and use of group A meningitis polysaccharide vaccine, the incidence of epidemic cerebrospinal meningitis continued to decline, and the epidemic cycle of meningitis became less and less obvious, but it still appeared about 10 years apart. The incidence of epidemic cerebrospinal meningitis in Anhui Province showed a slight rebound after the outbreak of epidemic in 2003. The incidence of epidemic cerebrospinal meningitis in Anhui Province generally began from October to November of each year, and reached the peak in April to May of the second year. Compared with the epidemic year, the incidence of epidemic cerebrospinal meningitis in the sporadic year was higher. The seasonal peak duration of the rate is about a month longer. A significant increase in the average incidence in October or November from the previous five years in the same month often indicates an increase in the next year's incidence. The ratio of male to female was 1.46:1, but after 25 years old, the ratio of male to female was 0.70:1. In the case of epidemic of epidemic cerebrospinal meningitis in the whole province, the epidemic situation in Huaibei Prefecture increased 1-2 years earlier than that in the other two areas, and the incidence of group C epidemic cerebrospinal meningitis occurred in the South of the Yangtze River, the south of the Yangtze River and the north of Huaibei Prefecture in 2002. The fatality rates were 4.37%, 4.92% and 6.00% (P = 0.000), respectively.
From 2003 to 2007, a total of 386 cases of epidemic cerebrospinal meningitis were reported in Hefei, with an average annual incidence of 209/100,000 and an incidence of 286/100,000 in 2006/2007. 135 laboratory-confirmed cases were group C epidemic cerebrospinal meningitis. There were 235 cases in urban areas (60.88%) and 151 cases in rural areas (39.12%). The largest age group was 78 years old, the highest incidence was 12-17 years old group (6.57/100,000), male cases 219 cases, accounting for 56.7% of the total cases. Four cases (96.53%) had fever in 371 cases (96.11%). The other main symptoms were vomiting in 322 cases (83.42%), nausea in 311 cases (80.57%), neck stiffness in 285 cases (77.9%) and headache in 278 cases (72.02). Clinical classification: 225 cases of common type (58.29%), 54 cases of outbreak type (13.9%) and 2 cases of light type (0.52%). The median age of the patients was 10 years (2 months to 27 years), lower than that of the surviving cases. The median age of the surviving cases was 15 years (6 months to 78 years). There was a significant difference in the distribution between the two groups (Z = 2.54, P = 0.01). The main factors influencing the death of the patients were analyzed. The results of univariate logistic regression analysis showed that headache and mental retardation were the main causes. Clear, nausea, bleeding spots or ecchymosis, more than 3 blood stasis points, neck stiffness, convulsions, 80% neutrophils, positive Kirschner's sign, positive Brinell's sign and age less than 12 years were associated with death (P 0.05); these factors were included in logistic regression model for multivariate analysis, the number of blood stasis points exceeded 3, 80% neutrophils, and positive Brinell's sign (P 0.05). The median age of 21 cases was 16 years (1 to 69 years), of which 59.31% were 12-21 years old. The prevalence rate of epidemic cerebrospinal meningitis was 5.99% in healthy people, which was higher than 3.05% in pre-epidemic period. The carrier rate of B and C groups increased significantly in epidemic period. And the upward trend.
conclusion
Anhui province is an epidemic area of epidemic cerebrospinal meningitis. In history, group A epidemic cerebrospinal meningitis was the dominant strain in this area. The spread and use of group A polysaccharide vaccine effectively controlled the epidemic of epidemic cerebrospinal meningitis in Anhui province. Meningitis replaced group A as an epidemic dominant strain in Anhui Province in recent years, and caused the rebound of epidemic situation of meningitis to rise. The age distribution of cases showed a trend of upward shift. However, it is still in the unstable transition period of bacterial transformation, which needs further monitoring and research. The results suggest that it is necessary to revise the immunization strategy in time, and that male cases are significantly higher than female cases in terms of sex composition, which deserves further attention. The annual epidemic change has certain predictive effect; the mortality of group C epidemic encephalopathy is higher than that of group A; the number of blood stasis points is more than three, neutrophils are 80%, and Brinell's sign is positive.
【学位授予单位】：安徽医科大学
【学位级别】：博士
【学位授予年份】：2008
【分类号】：R181.3;R515.2
【引证文献】
相关硕士学位论文 前1条
1 郑鑫;脑膜炎奈瑟氏菌表面蛋白NspA基因的克隆与原核表达[D];长春理工大学;2011年
，本文编号：2198120
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