部队人群SARS流行规律调查研究

发布时间：2019-02-17 18:15

【摘要】：严重急性呼吸综合征(Serve Acute Respiratory Syndrome,SARS,亦称传染性非典型肺炎)是近期出现的一种新发传染病。2002年11月在我国广东佛山市出现第一例病例后,便迅速在全球蔓延,波及到全球30多个国家和地区,其中疫情以我国尤为严重。由于SARS临床症状重、传染性强,并可通过密切接触等途径造成区域性暴发,因而受到WHO和各国政府的广泛关注,我国将其纳入法定报告传染病管理。部队人群是一个特殊群体,由于部队的聚集性、流动性的特点很容易发生疫情并造成区域内的暴发、流行。因此,掌握部队人群SARS的流行规律,是防止疫情在部队蔓延的关键。本研究利用现场流行病学、血清流行病学和分子生物学技术相结合的方法,从SARS传播链分析、抗体变化规律、病原体动态监测及病毒变异等多角度对部队人群SARS流行规律进行了系统研究。首先,针对SARS病例传播快,易造成区域性聚集发病的特点,对部队3起典型聚集暴发案例进行了描述和分析。从首发病例(指征病例)入手,追踪调查所有在同一传播链中的继发病例,用SPSS、Excel等软件对病例的人群、时间、空间分布进行分析,绘制暴露关系和传播链图,探讨SARS的潜伏期、传播途径及暴发的可能原因。第二,选择部队医院临床确诊SARS病例、医护人员(高暴露人群)和正常人群(对照),应用间接免疫荧光法(IFA)和酶联免疫吸附试验(ELISA)进行血清抗SARS—CoV IgG抗体检测,探讨SARS病人发病后血清抗体产生和变化规律以及医护人员和正常人群有无隐性感染情况,从而为临床诊断和开展血清流行病学调查提供依据。第三,本研究从SARS病毒排毒角度进行以下几方面的研究:①确诊SARS患者病毒排出途径及变化规律研究,通过对不同病程SARS确诊病例的粪便、痰液、血液等标本的病原体检测,了解病毒在机体内生长与排泄的动态变化、病毒的排出途径及期限,为临床检验提供可靠数据;②病毒检测阳性病例的排毒持续时间研究,通过对病毒检测阳性病例队列进行长期追踪观察,持续检测标本以明确不同标本病毒排出持续时间,并对排毒持续时间的影响因素进行分析,为制定合理的检疫和隔离期限提供科学依据。第四,针对SARS病毒变异较多的特点,纵向上动态研究病毒变异与不同疾病流行阶段间的关系、病毒在“流行簇”病例间连续传播时发生的变异,同一病人不同发病阶
[Abstract]:Severe Acute Respiratory Syndrome (Serve Acute Respiratory Syndrome,SARS,) is a newly emerging infectious disease. After the first case occurred in Foshan City, Guangdong Province in November 2002, it spread rapidly around the world. Spread to more than 30 countries and regions, especially in China. Because of the serious clinical symptoms of SARS, strong infectivity, and the regional outbreak can be caused by close contact, WHO and the governments of various countries pay more attention to it, so our country has brought it into the management of notifiable infectious diseases. The army crowd is a special group. Because of the aggregation of troops, the characteristic of mobility is very easy to occur epidemic situation and cause the outbreak and epidemic in the region. Therefore, mastering the epidemic rule of SARS is the key to prevent the spread of SARS in the army. In this study, the methods of field epidemiology, seroepidemiology and molecular biology were used to analyze the transmission chain of SARS. The epidemic rule of SARS in army population was systematically studied from the point of view of pathogen dynamic surveillance and virus variation. Firstly, according to the characteristics of rapid transmission of SARS cases and easy to cause regional aggregation, three typical outbreak cases in army were described and analyzed. Starting with the first case (indication case), all secondary cases in the same transmission chain were tracked and investigated. The population, time and space distribution of the case were analyzed with SPSS,Excel software, and the exposure relationship and transmission chain map were drawn. To explore the latent period, transmission pathway and possible cause of SARS outbreak. Secondly, select clinical confirmed cases of SARS in military hospital, medical staff (high exposure population) and normal population (control), use indirect immunofluorescence (IFA) and Elisa (ELISA) to detect anti-SARS-CoV IgG antibody in serum. In order to provide basis for clinical diagnosis and seroepidemiology investigation, the occurrence and change of serum antibody in patients with SARS were discussed, as well as the hidden infection among medical staff and normal population. Third, from the perspective of SARS virus detoxification, the following aspects are studied: 1 the way of virus excretion and its variation in confirmed SARS patients, and the detection of pathogens in feces, sputum, blood and other samples of confirmed cases of SARS with different course of disease. To understand the dynamic changes of virus growth and excretion in the body, the route and duration of virus excretion, and to provide reliable data for clinical examination. (2) study on the duration of virus detoxification in the positive cases of virus detection, through the long-term follow-up observation of the cohort of positive cases of virus detection, the continuous detection of specimens was carried out to determine the duration of virus excretion from different specimens. The factors affecting the duration of detoxification were analyzed to provide a scientific basis for establishing a reasonable quarantine and isolation period. Fourthly, according to the characteristic of SARS virus variation, the relationship between virus variation and different disease epidemic stage is studied in longitudinal dynamic way. The variation of virus in the continuous transmission of "epidemic cluster" cases is different in the same patient.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2004
【分类号】：R82

【共引文献】