本文選題：狂犬病　切入點(diǎn)：流行特征　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1.描述分析2006-2016年廣西狂犬病流行特征2.分析廣西欽州市、防城港市動(dòng)物致傷人群流行特征和暴露后預(yù)防處置的情況3.評(píng)價(jià)廣西狂犬病防控措施的防控效果并提出狂犬病的防控策略和建議方法:1.流行特征分析:整理中國(guó)疾病預(yù)防控制信息系統(tǒng)中狂犬病報(bào)告信息,統(tǒng)計(jì)分析2006-2016年廣西狂犬病發(fā)病率、構(gòu)成比等描述性指標(biāo)和廣西狂犬病三間分布特征。2.動(dòng)物致傷人群的調(diào)查:廣西欽州市、防城港市分別選擇一所市級(jí)疾控中心的預(yù)防門診,采用描述統(tǒng)計(jì)學(xué)方法分析動(dòng)物致傷人群的三間分布的特征、致傷部位和致傷動(dòng)物特征,以及門診就診者暴露后預(yù)防處置情況。3流行病生態(tài)學(xué)研究:廣西狂犬病高、中、低發(fā)區(qū)分別抽取3個(gè)市(貴港市、玉林市和崇左市),并對(duì)其所有新農(nóng)合機(jī)構(gòu)、各級(jí)疾病預(yù)防控制中心和犬傷處理門診、農(nóng)業(yè)畜牧獸醫(yī)部門進(jìn)行問卷調(diào)查。研究指標(biāo)包括狂犬病疫苗、被動(dòng)免疫制劑報(bào)銷的金額以及報(bào)銷人次數(shù)、狂犬病疫苗和狂犬病被動(dòng)免疫制劑的使用量、犬傷處理門診就診人次數(shù)、犬只的免疫密度、獸用疫苗使用量。分析三市狂犬病發(fā)病率與相關(guān)因素的相關(guān)性,采用雙變量的相關(guān)分析狂犬病發(fā)病率與各個(gè)變量間的關(guān)系。對(duì)雙變量均屬于正態(tài)分布,采用pearson相關(guān)分析,對(duì)于變量不符合正態(tài)分布,采選用spearman秩相關(guān)分析。結(jié)果:1.總發(fā)病情況及構(gòu)成。2006-2016年廣西壯族自治區(qū)狂犬病各年報(bào)告的總發(fā)病人數(shù)分別為518例、493例、372例、324例、303例、286例、227例、163例、125例、111例、56例。年發(fā)病率分別為1.112/10萬、1.045/10萬、0.780/10萬、0.673/10萬、0.624/10萬、0.621/10萬、0.488/10萬、0.348/10萬、0.265/10萬、0.234/10萬、0.117/10萬。11年間共報(bào)告狂犬病2978例,占所有法定傳染病的比重為0.07%,占乙類傳染病的比重為0.17%。死亡2975例,病死率為99.96%。2.三間分布情況。從時(shí)間分布看,2006-2016年,廣西狂犬病全年均有發(fā)病報(bào)告,呈現(xiàn)逐年下降的趨勢(shì)。尤其是2013年廣西將狂犬病暴露后處置費(fèi)用納入新農(nóng)合后,2013-2016年狂犬病發(fā)病數(shù)比2009-2012年下降60.94%。7-10月為發(fā)病高峰期。從地區(qū)分布看,狂犬病的流行地區(qū)明顯縮小,有狂犬病報(bào)告的縣(區(qū))數(shù)逐年明顯下降,廣西狂犬病高發(fā)區(qū)流行強(qiáng)度不斷下降。以玉林市、柳州市、崇左市降幅較大。從人群分布看,男女發(fā)病性別比例為2.61:1,農(nóng)民、學(xué)生和散居兒童是狂犬病高發(fā)人群。3.2016年欽州、防城港市動(dòng)物致傷人群流行特征及犬傷門診暴露后處置情況。時(shí)間分布均呈現(xiàn)夏秋季高發(fā)。人群分布以青壯年和嬰幼兒發(fā)生的例數(shù)較高,且男性遠(yuǎn)高于女性。致傷的部位主要下肢為主,其次為手部,與狂犬病的發(fā)病特征一致。防城港市就診者暴露分級(jí)主要以Ⅱ度為主,欽州市以Ⅲ度為主,防城港市疫苗全程接種的水平高于欽州(χ2=33.06,p0.05),2016年兩市Ⅲ度暴露被動(dòng)免疫制劑注射率在70%-80%。4.廣西狂犬病防控效果分析。對(duì)貴港市、玉林市和崇左市的流行病生態(tài)學(xué)研究顯示:自2013年狂犬病暴露暴后處置費(fèi)用納入新農(nóng)合,狂犬病報(bào)銷金額、犬傷門診就診人次和狂犬病疫苗的使用量都有大幅提升。其中崇左市疫苗使用率和被動(dòng)制劑使用率明顯高于貴港市和玉林市(χ2=12.45,p0.05;χ2=8.67,p0.05),并與狂犬病發(fā)病負(fù)相關(guān)(r=-0.624,p0.05)。11年間崇左市犬免疫密度為92.56%,欽州市和貴港市犬免疫密度分別為66.56%、65.39%。5.狂犬病相關(guān)因素。本研究對(duì)2009-2016年貴港市、玉林市和崇左市狂犬病發(fā)病率與相關(guān)因素的多重線性回歸分析,狂犬病疫苗的使用率和犬只免疫密度與狂犬病發(fā)病率成負(fù)相關(guān)。結(jié)論:1.2006-2016年,廣西狂犬病發(fā)病率從1.114/10萬下降到0.117/10萬。尤其是狂犬病疫苗納入新農(nóng)合后,狂犬病的發(fā)病率下降明顯,狂犬病流行區(qū)域也明顯縮小�？袢“l(fā)病有明顯的季節(jié)性,每年7-10月份發(fā)病高峰期�？袢「呶Ｂ殬I(yè)人群為散居兒童和青壯年,且男性發(fā)病高于女性。2.廣西犬只免疫率已逐漸達(dá)到或接近70%免疫屏障水平,提高犬只免疫水平是預(yù)防狂犬病根本措施,可以有效遏制廣西人間狂犬病的流行。3.狂犬病疫苗的使用率和犬只的免疫密度與狂犬病發(fā)病率成負(fù)相關(guān)。4.結(jié)合本研究結(jié)果及廣西實(shí)際情況提出以下防控策略:(1)加強(qiáng)犬類管理,提高犬只免疫密度;(2)提高暴露后及時(shí)正確處置率和免疫接種水平;(3)完善聯(lián)防聯(lián)控機(jī)制,建議廣西建立多部門參與的狂犬病防控聯(lián)席會(huì)議制度,強(qiáng)化信息溝通機(jī)制,提高各部門防控水平,不斷使聯(lián)防聯(lián)控機(jī)制高效化和長(zhǎng)效化。
[Abstract]:Objective: to describe the epidemiological characteristics of rabies in Guangxi 1. 2006-2016 2. year analysis of Guangxi Qinzhou City, Fangchenggang City, the epidemic characteristics of injury caused by animal population and prevention treatment after exposure of 3. Guangxi rabies prevention and control measures of the evaluation of control effect and proposed control strategies and suggestions: 1. analysis methods of rabies epidemic characteristics: Chinese disease prevention and control of rabies consolidation report information in information system, statistical analysis of 2006-2016 years the incidence of rabies in Guangxi, which hurt the crowd caused Descriptive Index and distribution characteristics of rabies in Guangxi three.2. animal investigation ratio: Guangxi Qinzhou City, prevention clinic in Fangchenggang city were selected in a municipal CDC, used to describe the distribution of three statistical methods to analyze the injury characteristics of the animal population, injury and injury characteristics of animal, and outpatient post exposure preventive treatment of.3 epidemic ecology Study on rabies in Guangxi: high, low incidence areas were selected in 3 cities (Guigang City, Yulin city and Chongzuo city), and all of its medical institutions at all levels of the Centers for Disease Control and prevention and treatment of dog injury clinic, animal husbandry and Veterinary Department of agriculture conducted a questionnaire survey. The indicators included rabies vaccine, passive immunization reimbursement the amount of reimbursement and the number of people, use of rabies vaccine and rabies passive immunization, treatment clinic number of injured dogs, dogs immune density, veterinary vaccine usage. Correlation analysis of three rabies incidence rate and related factors, correlation analysis using bivariate relationship between the variables and the incidence of rabies. For two variables belong to normal distribution, using Pearson correlation analysis, the variables do not accord with normal distribution, mining using Spearman rank correlation analysis. Results: the total incidence of 1. and.2006-2016 The total incidence of rabies in the Guangxi Zhuang Autonomous Region each year report were 518 cases, 493 cases, 372 cases, 324 cases, 303 cases, 286 cases, 227 cases, 163 cases, 125 cases, 111 cases, 56 cases. The annual incidence rate was 1.112/10 million, 1.045/10 million, 0.780/10 million, 0.673/10 million, 0.624/10 million, 0.621/10 million, 0.488/10 million, 0.348/10 million, 0.265/10 million, 0.234/10 million, 0.117/10 million.11 total of 2978 cases of rabies, accounting for the proportion of all infectious diseases was 0.07%, 2975 cases of class B infectious diseases accounted for 0.17%. of death, the mortality rate was three. The distribution of 99.96%.2., distribution from time 2006-2016 in Guangxi, the incidence of rabies throughout the year, showing a declining trend. Especially in 2013 Guangxi will post exposure treatment costs included in the new rural cooperative after 2013-2016 years the incidence of rabies ratio declined for 2009-2012 years in 60.94%.7-10 months is the peak incidence. From the perspective of regional distribution. The dog disease epidemic area was significantly reduced, there are reports of rabies county (District) number decreased year, a high incidence of rabies epidemic in Guangxi. Strength decreases in Yulin City, Liuzhou City, Chongzuo City, a larger decline. From the view of the distribution of population, the proportion of men and women of sex is 2.61:1, farmers, students and children is the high incidence of rabies Qinzhou.3.2016, Fangchenggang city animal injury population and epidemic characteristics of rabies clinics after exposure to disposal. Time distribution showed a higher incidence in summer and autumn. The population distribution in young infants and the number of cases is higher, and the male is much higher than that of women. The main parts of lower limb injury, followed by hand, consistent with the onset of the characteristics of rabies. Fangchenggang city were exposed to graded mainly in the second degree, Qinzhou city in Fangchenggang city of the main vaccine vaccination levels higher than Qinzhou (2=33.06, P0.05), in 2016 two, III The degree of exposure to passive immunization injection rate analysis of 70%-80%.4. in Guangxi. The effect of rabies prevention and control in Guigang City, epidemic ecological research on Yulin city and Chongzuo city shows that since the storm after the disposal expenses included in the new rural cooperative medical exposure to rabies in 2013, rabies outpatient reimbursement amount, amount of dog injury attendances and rabies vaccines have increased dramatically. The use of Chongzuo City, the vaccine rate and passive preparation was significantly higher than that of Guigang City and Yulin city (x 2=12.45, P0.05; X 2=8.67, P0.05), and the incidence of rabies negative correlation (r=-0.624, P0.05).11 Chongzuo from canine immune density was 92.56%, the city of Qinzhou and Guigang City dogs immune density were 66.56%, 65.39%.5. related factors rabies. This study of Guigang City, 2009-2016 years, multiple linear and related factors in Yulin city and Chongzuo City, the incidence of rabies regression analysis, rabies vaccine usage and dogs The immune density and the incidence of rabies was negatively correlated. Conclusion: 1.2006-2016 years, Guangxi rabies incidence decreased from 1.114/10 to 0.117/10 million million. Especially the rabies vaccine included in the new rural cooperative, rabies incidence rate decreased significantly, the rabies epidemic region is also significantly reduced. Rabies incidence has obvious seasonal, annual 7-10 month peak incidence. Rabies occupation high risk population for children and young adults, and the incidence was higher in male than female.2. Guangxi dog immunization rate has gradually reached 70% immune barrier, improve immunity level is the fundamental measures for the prevention of canine rabies, can effectively curb the epidemic of human rabies in Guangxi.3. rabies vaccine usage and dog immune density and the incidence of rabies.4. was negatively correlated with the results of this study and the actual situation of Guangxi and put forward the following strategy: (1) to strengthen the dog management. High density dog immunization; (2) increase after exposure to timely and correct disposal rate and immunization level; (3) improve the joint prevention and control mechanism, establish multi sectoral joint meeting system of rabies prevention and control in Guangxi, strengthen the information communication mechanism, improve the level of prevention and control departments, joint prevention and control mechanism, and long-term..

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.99;R181.3

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