天津市某区2010～2016年手足口病流行特征和防控策略研究

发布时间：2018-03-23 07:05

本文选题：手足口病　切入点：流行　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的手足口病作为发病率较高的肠道传染病,对天津市某区居民的健康造成较大影响,为了掌握该地区手足口病的流行规律,分析该区2010～2016年手足口病的流行特征,同时对手足口病聚集疫情、死亡病例、病原监测、EV71中和抗体监测以及EV71疫苗接种情况进行描述和分析,为今后防控手足口病提供科学的分析结论,制定科学有效的防控策略。方法对该区2010～2016年手足口病的疫情报告、病原监测、中和抗体监测和疫苗接种数据进行统计,运用描述性分析方法揭示流行规律和特征;分布资料利用卡方检验进行统计分析;对聚集性疫情的报告及时性和持续时长,利用相关分析进行统计推断分析。结果1、2010年～2016年天津市该区累计报告手足口病8431例,其中重症病例5例,死亡病例3例,共报告处置聚集疫情111起,暴发疫情1起。年发病率最高达299.17/10万,最低为118.37/10万,虽然呈下降趋势,但各年度均高于全市发病率水平。流行曲线呈现单峰或双峰流行模式,全年高峰一般在6月～7月,季节性发病特征明显。2、该区手足口病发病街区分布中金钟街、新立街、万新街占据前三位,手足口病聚集疫情主要发生在托幼机构,散居儿童出现多起重症死亡病例。发病人群集中在5岁以下儿童,发病构成占82.18%,散居儿童发病占比62.29%,男女发病性别比合计为1.5:1。死亡病例主要发生在3岁以下儿童,诊治延迟是主要原因,应加强对重症倾向早期识别和临床监护。3、该区手足口病病原监测结果显示,病毒主要构成是CVA16,EV71,CVA6和CVA10,检出阳性率分别为28.88%,24.96%,13.01%,和2.32%,CVA6在近年来的流行中所占比例较高,但是EV71还是导致重症死亡病例的主要病原体,其他肠道病毒EV还需进一步分型明确。4、该区手足口病聚集疫情主要分布在私立托幼无证托幼机构和公立幼儿园,在疫情总数中占比分别为46.85%和27.93%,托幼机构是手足口病疫情发生的重要场所,聚集疫情的发现报告及时的占比50.45%,疫情持续时间平均数为6.35天,最短为2天,最长为25天,发现报告及时性和疫情持续时间有密切相关性,报告越及时,疫情持续时间越短,r=0.885,P=0.000。5、2010～2016年该区健康人群EV71中和抗体监测结果显示,男性抗体阳性率66.12%,女性抗体阳性率76.10%,5个年龄段中阳性率最低的年龄组为1～5岁,随着年龄段增加,依次上升,16～25岁阳性率达到顶峰,26～35岁组有所下降。隐性感染率在2010年最低为7.50%,之后2014年达到最高为55.00%。累计总体中和抗体阳性率为71.79%,累计总体隐性感染率为28.21%。抗体阳性率最低的1～5岁组为易感人群,6岁及以上人群的隐性感染率较高且是重要的传染源。6、手足口病疫苗有广阔的前景,单价疫苗是一个良好的开端,安全有效且成本低廉的多价疫苗是最终目标。该区2016年共有477名适龄儿童接种EV71疫苗,经过数月观察,保护率达到100%。结论天津市该区2010～2016年手足口病发病率虽然呈现下降趋势,但是仍高于全市平均水平,托幼机构尤其是私立无证聚集疫情的主要发生地,易感人群主要是5岁及以下儿童,男性发病占明显优势,死亡病例缺乏重症倾向早期识别和临床监护。成人的EV71隐性感染率较高,儿童的中和抗体阳性率较低,缺乏保护性抗体也是儿童成为易感人群的因素。EV71疫苗上市时间较短,该区的接种数据呈现出较好的保护性,如今面对多种肠道病毒流行株共存的现状,多价手足口病疫苗是未来防控手足口病的关键。
[Abstract]:The purpose of the foot and mouth disease as intestinal infectious disease with high incidence, resulting in a greater impact on the health of residents in a district of Tianjin City, in order to grasp the epidemic regularity of HFMD in the region, analysis of the epidemic characteristics of the area 2010~2016 years of HFMD, and gathered HFMD epidemic, deaths, pathogen monitoring, description analysis of EV71 and neutralizing antibody monitoring and EV71 vaccination, provide scientific analysis for the prevention and control of hand foot and mouth disease, formulate scientific and effective prevention and control strategies. Methods of hand foot mouth disease in the 2010~2016 report of the epidemic, pathogen monitoring, neutralizing antibody monitoring and vaccination for statistical data, using descriptive analysis to reveal the regularity of epidemic and characteristics; distribution data were analyzed by chi square test; on the aggregation of the epidemic report timeliness and duration, using correlation analysis in statistical inference The analysis results in the 12010 years to 2016. Tianjin City, the District reported a total of 8431 HFMD cases, including 5 cases of severe cases and 3 death cases were reported, the disposal of aggregation of the epidemic since 111, 1 outbreaks. The annual incidence rate of up to 299.17/10 million, the lowest is 118.37/10 million, although the downward trend, but the annual incidence rate is higher than the city level. The epidemic curve is unimodal or Shuangfeng popular mode, annual peak in June to July, the seasonal incidence of obvious characteristics of.2, the incidence of HFMD block distribution in Admiralty street, new street, Wan Street to occupy the top three, gathered HFMD outbreaks occurred in kindergartens, children were more severe. The incidence of death in children under 5 years old, the incidence accounted for 82.18%, the incidence of scattered children accounted for 62.29%, the incidence ratio of male to female for a total of 1.5:1. deaths mainly occurred in children under 3 years old. The diagnosis and treatment of delayed, is the main reason, should strengthen the early recognition of severe tendency and clinical monitoring of.3, the HFMD pathogen monitoring results show that the virus is mainly composed of CVA16, EV71, CVA6 and CVA10, the positive rate was 28.88%, 24.96%, 13.01%, and 2.32%, a higher proportion of CVA6 accounted for in recent years popular, but EV71 is the main pathogen causing severe deaths, other intestinal virus EV still need further typing clear.4, the region gathered HFMD epidemic mainly in private kindergartens and nurseries without a public kindergarten, the epidemic in total accounted for 46.85% and 27.93%, kindergarten is an important place for the outbreak foot and mouth disease, the report found that the aggregation of the epidemic timely accounted for 50.45%, the average number of epidemic duration was 6.35 days, the shortest 2 days, the longest 25 days, found that the timeliness of reporting and epidemic duration are closely related The correlation of the report in a timely manner, the epidemic duration is shorter, r=0.885, P=0.000.52010 ~ EV71 healthy people 2016 the neutralizing antibody monitoring results showed that the positive rate of antibody positive rate of male 66.12%, female 5 age 76.10% antibody, the positive rate of the minimum age was 1~5 years, with the increasing of age, in order to rise, at the age of 16~25, the positive rate reached a peak of 26~35 year old group were decreased. The recessive infection rate was lowest in 2010 7.50%, in 2014 reached the highest positive rate of neutralizing antibody 55.00%. accumulative total is 71.79%, the cumulative total latent infection rate was 28.21%. the lowest antibody positive rate of 1~5 groups to the susceptible population, recessive population aged 6 and above the infection rate is high and is an important source of infection.6 HFMD vaccine has broad prospects, monovalent vaccine is a good start, multivalent vaccine is safe and effective and low cost is the ultimate goal. In 2016, a total of 477 school-age children vaccinated with EV71 vaccine, after months of observation, the protection rate of 100%. of Tianjin City, district 2010~2016 years the incidence of hand foot and mouth disease although decreased, but still higher than the average level of the city, especially in nurseries mainly private undocumented epidemic situation aggregation, susceptible population is mainly children under 5 years old, the incidence of male deaths is dominant, lack of severe tendency of early identification and clinical monitoring. Higher rate of occult EV71 infections in adults, the positive rate of neutralizing antibody in children is low, the lack of protective antibodies are children become susceptible factors of.EV71 vaccine for a short time, the vaccination data area showing a protective good, now face a variety of intestinal virus strains coexistence situation, vaccine polyvalent HFMD is key to the future of the prevention and control of hand foot and mouth disease.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.5;R181.3

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