發(fā)布時間：2018-05-10 14:50

  本文選題：水痘 + 流行病學(xué)特征��； 參考：《中國疾病預(yù)防控制中心》2017年碩士論文

【摘要】：背景:水痘是由水痘-帶狀皰疹病毒經(jīng)初次感染引起的一種急性、高傳染性的病毒性疾病。人類是其唯一的傳染宿主,主要通過接觸病變皮膚水皰液中的病毒或經(jīng)飛沫或氣溶膠傳播從而造成傳染,一旦易感人群中出現(xiàn)病例,就難以預(yù)防爆發(fā)流行的出現(xiàn)。如何有效控制水痘爆發(fā)流行,已成為公共衛(wèi)生領(lǐng)域不可忽視的重要問題之一。衛(wèi)生實(shí)踐證明大范圍接種水痘疫苗是預(yù)防水痘流行的有效措施之一�？死斠朗兴荒昃鶊蟾姘l(fā)病率和水痘突發(fā)公共衛(wèi)生事件的發(fā)生情況來看,水痘成為學(xué)校(幼兒園)相關(guān)突發(fā)公共衛(wèi)生事件中問題較為突出的傳染病之一。開展克拉瑪依市水痘流行病學(xué)和疾病負(fù)擔(dān)調(diào)查研究,將為進(jìn)一步完善克拉瑪依水痘疫苗免疫策略提供相關(guān)證據(jù)。目的:通過研究克拉瑪依市水痘流行病學(xué)特征、水痘疫情報告質(zhì)量和漏報情況、水痘醫(yī)療費(fèi)用負(fù)擔(dān)和水痘疫苗納入兒童免疫規(guī)劃的效果,為進(jìn)一步完善免疫策略提供依據(jù)。研究方法:利用中國疾病預(yù)防控制信息系統(tǒng)收集克拉瑪依市水痘疫情監(jiān)測資料,采用描述流行病學(xué)方法分析水痘流行病學(xué)分布特征和免疫策略實(shí)施前后流行病學(xué)特征變化情況、水痘疫情報告質(zhì)量采用回顧性調(diào)查方法,對4個幼兒園所有3-6歲兒童水痘患病情況進(jìn)行調(diào)查,進(jìn)行水痘漏報率分析;收集轄區(qū)內(nèi)二級甲等及以上醫(yī)院4家水痘病例的醫(yī)療費(fèi)用相關(guān)信息,分析水痘患者診治費(fèi)用。結(jié)果:2006-2016年全市共報告水痘病例5682例,年均報告發(fā)病率130.70/10萬,全市水痘發(fā)病呈現(xiàn)季節(jié)性和地區(qū)性、人群差異,實(shí)施免疫規(guī)劃后全人群水痘發(fā)病率略有下降,疫苗使用前為179.53/10萬,納入免疫規(guī)劃后為146.11/10萬,其中,未使用疫苗1歲組,由502.66/10萬升至687.15/10萬;1-4歲組發(fā)病率由749.81/10萬,下降到513.99/10萬。2013-2015年克拉瑪依市水痘病例通過疫情監(jiān)測平均報告及時率為94.07%,重卡率為1.62%,錯誤卡率為0.17%、必填項(xiàng)完整率100%。通過對4所幼兒園回顧性調(diào)查:有水痘患病史的是14例,其中11例在傳染病報告疫情中有記錄,有3例未報告,水痘病例未報率為21.43%(3/14)。水痘疫苗接種率為79.19%,曾患水痘14名,其中沒有在門診或住院治療3人,未經(jīng)網(wǎng)絡(luò)報告3人。14名病例中,自述接種水痘疫苗11人,占78.57%,其中患病前接種2人,占14.28%。水痘病例醫(yī)療費(fèi)用調(diào)查顯示:2013-2015年全市水痘門診病例1969人,門診費(fèi)用386874.25元,人均門診用費(fèi)196.48元,其中藥費(fèi)347749.27元,占89.89%;住院病例78人,住院費(fèi)用245370.93元,人均醫(yī)療費(fèi)用3145.76元,其中藥費(fèi)169672.17元,占69.15%。初步推算克拉瑪依2013-2015年水痘病例醫(yī)療費(fèi)用767510.16元�？死斠朗�2013-2015年水痘疫苗接種費(fèi)用近160萬元,而水痘疫苗接種總收益為3314214.27元,水痘疫苗接種成本:收益=1:2.1。結(jié)論:2006-2016年期間,克拉瑪依市水痘疫情呈現(xiàn)周期性,但兒童水痘疫情呈下降趨勢,尤其是2013年水痘疫苗納入兒童免疫規(guī)劃以來下降更明顯。2013-2015年克拉瑪依市水痘醫(yī)療費(fèi)用767510.16元。在補(bǔ)充調(diào)查中的水痘病例中,有2例患者患病前接種了水痘疫苗,提示適齡兒童接種2劑次水痘疫苗更能有效預(yù)防水痘。通過該研究,初步掌握克拉瑪依市水痘流行規(guī)律和2013-2015年水痘產(chǎn)生的醫(yī)療費(fèi)用負(fù)擔(dān),分析1劑次水痘疫苗納入免疫規(guī)劃后的效果,同時也為克拉瑪依市即將開展水痘疫苗2劑次的免疫接種方案提供支撐數(shù)據(jù)。
[Abstract]:Background: chickenpox is an acute, highly contagious viral disease caused by the initial infection of varicella zoster virus. Human is the only infectious host. It is transmitted by exposure to viruses in the blister fluid or by droplets or aerosols, and it is difficult to prevent detonation once the susceptible population appears. How to effectively control the outbreak of chickenpox has become one of the important issues that can not be ignored in the public health field. The health practice has proved that the vaccination of chickenpox in a wide range is one of the effective measures to prevent the epidemic of chickenpox. The annual reported incidence of varicella in Karamay and the occurrence of public health emergencies of chickenpox To see, chickenpox is one of the most prominent infectious diseases in public health emergencies in schools (kindergartens). The investigation of the epidemiology and disease burden of chickenpox in Karamay will provide relevant evidence for further improving the immunization strategy of Karamay varicella vaccine. The purpose of this study is to study the epidemiology of varicella in Karamay. Characteristics, the quality of the report of chicken pox and the leakage of the report, the cost burden of varicella and the effect of varicella vaccine into the children's immunization program, and provide the basis for further improving the immunization strategy. The research method: using the information system of China's disease prevention and control to collect the surveillance data of the Karamay varicella epidemic situation and the descriptive epidemiological methods. The epidemiological characteristics of chickenpox and the changes of epidemiological characteristics before and after the implementation of immunization strategies were analyzed. The quality of the report of varicella was reviewed by a retrospective survey. The prevalence of varicella in all 3-6 year old children in 4 kindergartens was investigated, the rate of varicella leakage was analyzed, and 4 chickenpox cases in the hospital were collected and above two levels in the hospital. Results: 5682 cases of chickenpox were reported in the whole city in 2006-2016 years. The annual reported incidence of chicken pox was 130.70/10 million. The incidence of chickenpox in the city was seasonal and regional, the population was different. The incidence of varicella in the whole population decreased slightly after the implementation of the immunization program, and the vaccine was 179.53/10 million before the vaccine was used. The immunization program was 146.11/10 million, of which the 1 year old group was not used, from 502.66/10 million to 687.15/10 million; the incidence rate of 1-4 year old group was from 749.81/10 million to 513.99/10 ten thousand.2013-2015 years, the average report rate of Karamay varicella cases through surveillance of epidemic situation was 94.07%, the rate of heavy card was 1.62%, the rate of error card was 0.17%, and the complete rate was 100. Through a retrospective survey of 4 kindergartens, 14 cases had a history of varicella disease, of which 11 were recorded in the epidemic report, 3 were not reported, the rate of varicella cases was 21.43% (3/14). The vaccination rate of varicella was 79.19%, and 14 chickenpox had been developed, of which 3 were not admitted to the door or in the hospital, without the network report of the 3 people.14 cases. 11 people were vaccinated against chickenpox, accounting for 78.57%. Among them, 2 people were inoculated before the disease, accounting for the medical costs of 14.28%. varicella cases, accounting for 1969 people in the city of chickenpox in 2013-2015 years, 386874.25 yuan for out-patient expenses and 196.48 yuan per capita for outpatient expenses, including 347749.27 yuan and 89.89%, 78 hospitalized cases, hospitalized expenses 245370.93, per capita medical treatment. The cost of treatment was 3145.76 yuan, of which the charge of medicine was 169672.17 yuan, accounting for 767510.16 yuan in Karamay's 2013-2015 year medical cost of varicella in Karamay. The cost of vaccinating vaccine for chickenpox was nearly 1 million 600 thousand yuan for 2013-2015 years in Karamay, and the total income of varicella vaccine was 3314214.27 yuan, and the cost of vaccinating vaccine was =1:2.1. conclusion: 2006-2016 years. In Karamay, the epidemic of chickenpox in Karamay was cyclical, but the epidemic of chickenpox in children was declining. Especially in 2013, the drop of varicella vaccine in children's immunization program decreased more obviously in the year of.2013-2015 in Karamay. 2 cases of chickenpox were inoculated with varicella vaccine in the case of chickenpox in the supplementary investigation. It is suggested that the vaccination of 2 doses of varicella vaccine for children of the age is more effective to prevent chickenpox. Through this study, the law of the epidemic of chickenpox in Karamay and the medical cost burden of 2013-2015 year's chickenpox are mastered. The effect of the 1 doses of varicella vaccine into the immunization program is analyzed, and the 2 doses of the chickenpox vaccine are also forthcoming in Karamay. The vaccination program provides support data.

【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R511.5;R181.3

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