2016年安徽省麻疹空间分布特征分析和病例感染地点调查

发布时间：2018-10-24 12:59

【摘要】：目的:了解安徽省2016年2~5月的麻疹确诊病例的时空分布特征,并调查病例个案信息和感染地点,探索病例间的流行病学关联和影响病毒传播的因素,为阻断麻疹传播提供依据。方法:收集安徽省2016年2~5月麻疹监测数据,建立地理信息(Geographic information systems,GIS)数据库。使用Geo Da 1.4.6和Sa TScan 9.1地理信息系统软件分别进行麻疹发病率可视化展示和时空扫描统计分析。采用麻疹流行病学调查表,电话调查麻疹确诊病例基本信息、发病前7~21天活动史及免疫接种史等内容。结果:1.信息系统报告416例麻疹确诊病例,其中本省报告362例,占87.01%。在外省报告的病例以南京徐州较多。每周新发病例数波动大,但总体处于一直上升的态势。2.发病率图显示亳州谯城区、宿州砀山县、合肥周边地区和池州市部分地区的麻疹发病率较高,时空扫描分析显示存在3个时空聚集性区域,分别为3月末持续至5月的亳州谯城区、3月中旬至5月中旬的合肥周边县区和5月中下旬的黄山市、池州市部分县区。3.个案病例调查353例,调查完整率为84.85%,在外省感染的病例主要来自江苏、北京、河南等地。4.15岁以下儿童麻疹病例共211例。8月龄以下的病例58例,占15岁以下儿童病例的27.49%,按时接种疫苗的病例32例,占15.17%,需要接种麻疹疫苗却没有按时接种的病例121例,占57.34%。病例中有5例在接种疫苗后不到15天发病。5.病例院内感染与院外感染在性别分布上差异无统计学意义,在年龄结构分布上差异有统计学意义,院内感染病例在性别年龄的分布上有统计学差异。院内感染主要发生在三级和二级医院。6.调查到的麻疹病例中,能够明确流行病学联系的共有19起,多是与身边人密切接触有关,包括朋友、邻居、同事和家人。母子都感染麻疹的7起,医务工作者感染麻疹的6起。结论:1.安徽省2016年2~5月存在空间聚集。地区发病率差距明显。2.麻疹病例院内感染与院外感染数量持平。3.提示院内感染主要发生在三级医院和二级医院。4.小年龄组人群院内感染多于院外感染,大年龄组人群院外感染多于院内感染。5.小年龄组人群男性多于女性,大年龄组人群女性多于男性。6.未接种疫苗是导致儿童发病的最主要原因之一。7.较多病例未能在发病初期得到明确诊断,传染源未得到有效控制。
[Abstract]:Objective: to investigate the temporal and spatial distribution of confirmed measles cases in Anhui Province from February to May 2016, and to investigate the case information and infection sites, to explore the epidemiological association between cases and the factors affecting the transmission of the virus, and to provide a basis for blocking measles transmission. Methods: measles surveillance data were collected from February to May of 2016 in Anhui Province, and geographic information (Geographic information systems,GIS database was established. The Geo Da 1.4.6 and Sa TScan 9.1 GIS software were used to visualize measles incidence and to analyze the statistics of time and space scanning respectively. The measles epidemiological questionnaire was used to investigate the basic information of confirmed measles cases by telephone, and the history of 21 days' activities and immunization before the onset of measles. The result is 1: 1. The information system reported 416 confirmed measles cases, of which 362 cases were reported in this province, accounting for 87.01%. More cases were reported in Xuzhou, Nanjing. The number of new cases per week fluctuated greatly, but the overall trend was on the rise. 2. 5%. The incidence of measles was higher in Qiaocheng District of Bozhou, Dangshan County in Suzhou, around Hefei and parts of Chizhou City. Spatio-temporal scanning analysis showed that there were three spatio-temporal clustering areas. Bozhou Qiaocheng District from the end of March to May, Hefei from mid-March to mid-May, Huangshan City from mid-to late May, and some counties from Chizhou City. A total of 353 cases were investigated, with a complete rate of 84.85. The main cases of infection in other provinces came from Jiangsu, Beijing, Henan and other places. There were 211 measles cases among children under 4.15 years of age and 58 cases under 8 months of age. Children under 15 years old accounted for 27.49% of the cases, 32 cases (15.17%) were vaccinated on time, 121 cases (57.34%) needed measles vaccine but were not vaccinated on time. Five of the cases developed less than 15 days after vaccination. There was no significant difference in sex distribution between nosocomial infection and nosocomial infection, but there was statistical difference in age structure distribution, and there was statistical difference in sex and age distribution of nosocomial infection cases. Nosocomial infection mainly occurs in level III and level II hospitals. 6. 6. A total of 19 measles cases were investigated, most of which were related to close contact with people around them, including friends, neighbors, colleagues and family. Both mothers and children were infected with measles in 7 cases, and medical workers in 6 cases. Conclusion: 1. There is a spatial aggregation in Anhui Province from February to May 2016. The regional incidence rate difference is obvious. 2. The number of nosocomial infections and nosocomial infections of measles cases was the same as that of nosocomial infections. It is suggested that nosocomial infection mainly occurs in tertiary hospitals and level II hospitals. 4. 4. Nosocomial infection was more than nosocomial infection in young age group, and nosocomial infection was more than nosocomial infection in older group. Men in the younger age group were more than women, and women in the older age group were more than men. 6. 6%. Unvaccinated is one of the leading causes of childhood morbidity. Many cases failed to get definite diagnosis in the early stage of the disease, and the source of infection was not effectively controlled.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R511.1;R181.3

【参考文献】