本文選題：麻疹　切入點：流行趨勢　出處：《蘇州大學》2013年碩士論文

【摘要】：研究背景 中國消除麻疹采取的綜合性措施已取得重大成績，麻疹疫情大幅度回落，但局部地區(qū)仍存在麻疹病毒持續(xù)傳播，特別是對小月齡和成人麻疹感染易感性及其在麻疹傳播動力學中所起的作用等消除麻疹的技術(shù)問題目前仍沒有定論。 研究目的 弄清不同年齡段人群中麻疹易感因素，探索可能對成人采取的免疫措施效果及麻疹初免月齡的調(diào)整對小月齡發(fā)病的影響等內(nèi)容，對目前消除麻疹進程中出現(xiàn)的麻疹流行態(tài)勢及控制策略的研究提供可靠的理論和實踐支持，從而達到降低麻疹發(fā)病率和死亡率的最終目的。 研究方法 根據(jù)《全國麻疹監(jiān)測方案》要求，調(diào)查全市范圍內(nèi)在2009年～2013年發(fā)病的麻疹實驗室確診病例，按照1：2的比例，在每一名麻疹實驗室確診病例現(xiàn)住村（社區(qū)）選擇2名年齡組匹配的對照，就病例和對照的發(fā)病與就診情況、可能的暴露史、居住地和旅行史、既往麻疹患病史和疫苗接種史、衛(wèi)生服務情況、社會人口學和經(jīng)濟學信息等內(nèi)容進行入戶個案訪談調(diào)查。本次調(diào)查采用Epidata軟件建立調(diào)查數(shù)據(jù)庫，嚴格按照雙錄入的要求進行錄入，數(shù)據(jù)分析采用SAS9.1統(tǒng)計軟件包完成。根據(jù)研究目的，不同年齡組病例與對照分析不同內(nèi)容，分別進行單因素和多因素分析，結(jié)果中的圖表使用Microsoft Excel2003完成。 研究結(jié)果 2004～2012年九年內(nèi)天寧區(qū)、鐘樓區(qū)、武進區(qū)的年平均發(fā)病率居前三位，分別為20.50/10萬，13.94/10萬，13.20/10萬，以上地區(qū)屬于經(jīng)濟較活躍地區(qū)，流動人口遷徙頻繁。麻疹發(fā)病存在季節(jié)性升高的特點，3～5月份的發(fā)病數(shù)占總病例數(shù)的70.01%，雖然6月份開始出現(xiàn)發(fā)病下降趨勢，但是流行持續(xù)時間較長，超過3個月。九年內(nèi)總體高發(fā)年齡分布呈現(xiàn)“三峰”現(xiàn)象，分別集中在0～1歲，5～10歲和20歲以上年齡段，，但是2009～2012年的四年內(nèi)各年齡段發(fā)病率較前五年呈現(xiàn)下降趨勢，1歲以下年齡段發(fā)病數(shù)占該四年發(fā)病總數(shù)的29.67%，15歲以上年齡段發(fā)病數(shù)達四年發(fā)病總數(shù)的47.69%，呈現(xiàn)明顯“雙向移位”。2004～2012年病例主要集中在散居兒童(1475例，42.67％)和學生(445例,占12.87％)，工人居第三位（376例，10.88％）。2004～2012年所有麻疹調(diào)查病例中常住人口（戶籍在居住地縣區(qū)）1603例，占47.44%，流動人口（戶籍不在居住地縣區(qū)）1855例，占54.90%。麻疹病例以未免疫為主（65.61%）。 病例對照研究顯示，以父母為主的看護方式、外來流動人口、發(fā)病前7～21天的麻疹病人接觸史和醫(yī)院暴露史是＜8月齡嬰兒麻疹發(fā)病的危險因素。對8月齡～14歲年齡段單因素分析顯示1胎、家長對預防接種態(tài)度積極和有麻疹疫苗接種史是麻疹發(fā)病的保護性因素，隨著接種次數(shù)的增加麻疹發(fā)病的危險性減小，父親初高中及以下文化程度、母親初高中及以下文化程度、外來流動人口、發(fā)病前7～21天的麻疹病人接觸史和醫(yī)院暴露史是該年齡段麻疹發(fā)病的危險因素；多因素分析則顯示，家長對預防接種的態(tài)度積極、有麻疹疫苗接種史是8月齡～14歲兒童麻疹發(fā)病的保護因素，麻疹發(fā)病的危險因素有外來流動人口、發(fā)病前7～21天醫(yī)院暴露史和接種次數(shù)較少。對＞14歲年齡段單因素分析顯示外來流動人口、發(fā)病前7～21天的麻疹病人接觸史和醫(yī)院暴露史是該年齡段麻疹發(fā)病的危險因素；多因素分析則顯示，麻疹發(fā)病的危險因素有外來流動人口、發(fā)病前7～21天醫(yī)院暴露史。 結(jié)論 2009年和2010年麻疹疫苗強化免疫效果顯著。傳染源管理不嚴，“新”易感者流入，家長對接種麻疹疫苗的認識不夠是麻疹發(fā)病的重要因素。開展高質(zhì)量的麻疹疫苗常規(guī)免疫和強化免疫活動，特別是加強流動人口的接種管理，提高易感人群麻疹疫苗接種率，通過健康教育提高家長麻疹相關知識的認知和自我防護意識，加強傳染源的管理是消除麻疹的有效手段。
[Abstract]:Research background
China take comprehensive measures to eliminate measles has made significant achievements, the measles epidemic fell sharply, but the local area still exists in the continuous spread of measles virus, especially on the susceptibility of adult measles infection and young age and played in the role of measles transmission dynamics of measles elimination technology is still inconclusive.
research objective
Understand the different age groups in measles susceptible factors, explore the immune effect and measures on adult measles can take months beginning from the adjustment effect on young age onset, support the theory and practice of the reliable elimination of measles epidemic situation and control strategy of measles in the process, so as to achieve the ultimate objective to reduce the incidence and mortality of measles.
research method
According to the national measles surveillance program "requirements, investigation within the city from 2009 to 2013 the incidence of measles laboratory confirmed cases, according to the proportion of 1:2 in each case confirmed measles laboratory now living village (community) in 2 age groups, according to the case, and the possible pathogenesis and treatment, exposure history, residence and travel history, history of disease and measles vaccination history, health services, social demography and economics information for the home interview survey. The Epidata software to establish the survey database used in this survey, in strict accordance with the double entry entry requirements, data analysis using statistical software SAS9.1. According to the study to patients in different age groups and different contents were comparative analysis, single factor and multi factor analysis, the results of using Microsoft Excel2003 to complete the chart.
Research results
Zhonglou District 2004~2012 years within nine years, Wujin Tianning District, the average annual incidence rate in the top three, respectively 20.50/10 million, 13.94/10 million, 13.20/10 million, more than the area belongs to the economically active regions, floating population migration frequently. The incidence of measles are characteristic of the seasonal rise, the total number of cases of incidence of 3~5 months the 70.01%, although the June onset decline, but the epidemic continues for a long time, more than 3 months. Presents "three peaks" phenomenon in the overall age distribution within nine years, were concentrated in 0~1 years old, 5~10 years old and over the age of 20 years old, but four years 2009~2012 years in each age the rate of the previous five years showed a downward trend, the four years accounted for 29.67% of the total incidence of age 1 years of age the incidence, over 15 years of age four years amounted to 47.69% of the total incidence, showed the "two-way shift".2004 ~ 2012 case Mainly in scattered children (1475 cases, 42.67%) and students (445 cases, 12.87%), the worker ranks third (376 cases, 10.88%).2004 to 2012 all measles cases of resident population (registered residence in 1603 cases, accounting for 47.44% of the county), floating population (domicile is not in residence district) 1855 cases 54.90%., accounting for measles cases in an immune response (65.61%).
The case-control study showed that parents care in the way of floating population, before the onset of contact history and hospital 7~21 days of exposure to measles patients is less than 8 month old risk factors. The incidence of measles in infants of single factor of 8 month old to 14 years of age analysis showed that the 1 child, parents of the pre vaccination measles vaccine and a positive attitude vaccination is a protective factor for the incidence of measles, with increased risk of measles vaccination times reduced, junior high school and the culture level of father, mother of junior and senior high school education level and below, the floating population, before the onset of contact history and 7~21 days of hospital patients with measles exposure history are the risk factors of the age of measles; multivariate analysis showed that parents' attitudes to vaccination have positive measles vaccination history was a protective factor of 8 month old ~ 14 years old children measles, measles incidence due to danger Known as the floating population, exposure to 7~21 days before the onset of a smaller number of hospital history and inoculation. In 14 years of age, single factor analysis showed that the floating population, before the onset of contact history and 7~21 days of hospital patients with measles exposure history are the risk factors of the age of measles; multivariate analysis showed that the risk of measles there are factors of floating population, 7~21 days before the onset of hospital exposure history.
conclusion
In 2009 and 2010 measles masscampaign significantly. The source of infection management is not strict, the "new" susceptible inflows, enough parents' understanding of measles vaccination is an important factor in the incidence of measles. Carry out high quality measles vaccine routine immunization and immunization activities, in particular to strengthen the vaccination management of floating population, improve the susceptibility the measles vaccination rate, improve parents measles related knowledge awareness and self-protection awareness through health education, strengthen the management of infectious sources is an effective means of eliminating measles.

【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R511.1

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