本文選題：邊境地區(qū) + 麻疹��； 參考：《昆明醫(yī)科大學》2014年碩士論文

【摘要】：目的 通過對云南省邊境地區(qū)2013年麻疹流行病學特征和人群免疫情況的描述和分析,了解邊境地區(qū)麻疹在不同人群、地區(qū)、時間的分布情況和人群免疫狀況。通過對邊境地區(qū)麻疹的分子生物學監(jiān)測,掌握云南省邊境地區(qū)麻疹病毒株基因的型別及與代表毒株相關性,為云南省邊境地區(qū)及全省麻疹防控策略和措施的制定提供科學依據(jù),對推進全省麻疹消除進程具有重要的現(xiàn)實意義。研究方法 采用描述性流行病學方法,描述云南省邊境地區(qū)2013年麻疹流行病學特征和人群免疫情況。采用實驗流行病學方法,使用Vero/SLAM細胞(淋巴信號激活因子轉(zhuǎn)染的非洲綠猴腎細胞)進行麻疹病毒的分離培養(yǎng),用逆轉(zhuǎn)錄一聚合酶鏈反應(RT-PCR)檢測方法對病例進行確診和分離病毒的鑒定,對未分離到病毒的標本直接提取病毒核酸并進行RT-PCR和基因測序。 描述性流行病學研究的數(shù)據(jù)錄入使用Epidata3.0軟件,錄入后導出Excel后進行整理。數(shù)據(jù)分析利用SPSS17.0軟件。實驗流行病學研究的數(shù)據(jù)與WHO代表株N基因羧基末端450個核苷酸序列做比對,用MEGA5.1軟件進行序列基因親緣關系分析,做基因親緣性進化樹。 結(jié)果 云南省邊境地區(qū)2013年麻疹流行病學特征：(1)本研究共報告麻疹確診病例141例(含實驗室確診和臨床診斷)。(2)年齡分布：發(fā)病比例最高的年齡組為20-49歲成人組,占58.86%(83/141),其次是0-1.5歲兒童,占27.66%(39/141)；從年齡別發(fā)病率來看,0-1歲組的嬰兒年齡別發(fā)病率最高68.56/10萬(34/49592)。(3)男女性別比例為0.94,但1歲年齡組男女性別比為3.0。(4)各職業(yè)人群中,農(nóng)民發(fā)病52例(36.8%),散居兒童發(fā)病48例(34.04%),其他職業(yè)的發(fā)病較少。(5)發(fā)病特征：發(fā)病有明顯的季節(jié)性,春夏季為邊境地區(qū)麻疹的高發(fā)季節(jié),發(fā)病115例,占全年發(fā)病的81.56%,暴發(fā)和散發(fā)麻疹疫情均有相同的季節(jié)性規(guī)律。除瑞麗市、隴川縣和孟連縣外均有麻疹病例發(fā)生,高發(fā)區(qū)主要集中在芒市15.66/.10萬(62/395913)、臨翔區(qū)7.67/10萬(25/325945)、思茅區(qū)6.07/10萬(18/296540)、勐�？h4.84/10萬(13/268595),均高于全省發(fā)病率3.04/10萬。(6)免疫史：麻疹病例中僅有23例(16.31%)病例有確切免疫史,“0”劑次麻疹病例有70例(49.65%),免疫劑次不詳?shù)穆檎畈±?8例(34.04%)。按年齡分布情況為：8月齡18例、≥18歲88例,占75.18%(106/141),為現(xiàn)行免疫策略覆蓋外人群；8月齡-6歲共31例,為適齡接種人群,病例中有確切接種史的病例僅有13例(41.94%),“0”劑次麻疹病例有16例(51.61%),免疫史不詳2例(6.45%)。(7)麻疹疫苗接種情況：云南省邊境地區(qū)各縣(區(qū))2013年含麻疹組份疫苗的報告接種率均大于98%。 云南省邊境地區(qū)2013年麻疹病毒監(jiān)測及基因特征：(1)麻疹病毒分離：共收集到393份標本,有19份標本發(fā)生CPE,其中尿液標本13份,分離率6.84%,咽拭子標本6份,分離率2.96%。對未分離到病毒株麻疹病例標本提取核酸,共獲取30株病毒核酸。(2)RT-PCR結(jié)果：PCR產(chǎn)物純化后,經(jīng)2%瓊脂糖凝膠電泳鑒定,均在700bp處有一明顯陽性帶。(3)麻疹病毒基因型分布：19株分離到的病毒及30株病毒核酸經(jīng)基因序列測定和分析,共存在3種基因型,其中HI基因型分布于5個邊境縣(區(qū)),老撾勐賽省南磨縣及緬甸貴概；D9基因型分布于德宏州與緬甸接壤的3個縣及保山市龍陵縣和緬甸勐惹、木姐、貴概；A基因型來源于德宏州芒市。(4)基因親緣性關系分析：用MEGA5.1軟件對病毒分離物和病毒核酸做基因親緣性關系分析。結(jié)果提示,12株為H1基因型的H1a基因亞型(24.49%),36株為D9基因型(73.47%),1株為A基因型(中國滬191疫苗株、2.04%)。(5)36株D9基因型與世界衛(wèi)生組織D9基因型代表株比較：分為5個組(代表株單獨為一組)。各組間核苷酸同源性為96.0%-99.5%,氨基酸同源性為95.2%-99.3%。Custer1和Cluster2僅包含緬籍毒株,Cluster3、Cluster4均由云南省本土分離株和緬籍毒株組成(6)12株H1a亞型和世界衛(wèi)生組織H1a基因亞型和H1b基因亞型代表株比較：分為4個組(代表株各為一組)。各組間核苷酸同源性為97.1%-99.1%,氨基酸同源性為95.8%～99.3%。Cluster1僅包含1株緬籍毒株,Cluster2由云南省本土分離株和老撾籍毒株組成。(7)D9基因型麻疹疫情暴發(fā)的監(jiān)測：2013年5～8月,德宏州芒市風平鎮(zhèn)共發(fā)生麻疹暴發(fā)疫情3起,涉及病例22例,病例數(shù)在2～13例之間；3起暴發(fā)疫情共涉及13個自然村(社),其中3個村發(fā)生點狀暴發(fā)(相章村、老光村、芒賽村),采集病原學標本,分離到活病毒3株和檢測到5株病毒核酸,合計8株,均為同一起暴發(fā)疫情中分離和檢測到的D9基因型病毒株。 (8)1株A基因型和世界衛(wèi)生組織A基因型代表株比較,核苷酸同源性為99.1%,氨基酸同源性為99.3%。 結(jié)論云南省邊境地區(qū)2013年麻疹發(fā)病比例最高的年齡組為20～49歲成人組(58.86%),其次是0～1.5歲兒童(27.66%)；其中0～1歲的嬰兒年齡別發(fā)病率最高(68.56/10萬)；發(fā)病以農(nóng)民(36.88%)和散居兒童(34.04%)為主,共100例(70.92%)；冬春季為麻疹高發(fā)季節(jié)；高發(fā)區(qū)主要集中在德宏州(芒市)、臨滄市(臨翔區(qū))、普洱市(思茅區(qū))、西雙版納州(勐�？h)4個邊境州(市)所轄的4個縣(區(qū)),4個縣的發(fā)病率均高于全省發(fā)病率(3.04/10萬)；病例中僅有23例(16.31%)病例有確切免疫史,適齡接種人群病例中有確切免疫史者僅占41.94%(15例),無免疫史者(“0”劑次)占51.61%(16例)。在云南省邊境地區(qū),存在H1和D9兩種基因型麻疹病毒的循環(huán),D9基因型是由緬甸輸入的,現(xiàn)為德宏州的優(yōu)勢基因型,且該基因型在德宏州與緬甸接壤的邊境縣和緬甸相互傳播；H1基因型在老撾和云南省與老撾接壤的邊境地區(qū)相互傳播。A基因型為中國滬191疫苗株相似株。
[Abstract]:objective
Through the description and analysis of the epidemiological characteristics of measles and population immunity in the border area of Yunnan Province in 2013, the distribution of measles in the border areas, the distribution of time and the immune status of the population are understood. The molecular biological monitoring of measles in the border area and the type of the gene of measles virus in the border area of Yunnan province are grasped. It provides scientific basis for the formulation of measles prevention and control strategies and measures in Yunnan border area and province, and has important practical significance for promoting the process of measles elimination in the province.
A descriptive epidemiological method was used to describe the epidemiological characteristics of measles and the population immunity in the border area of Yunnan province in 2013. By using experimental epidemiological methods, the measles virus was isolated and cultured with Vero/SLAM cells (transfected by lymphatic signal activating factor), and a reverse transcription polymerase chain reaction (RT-PCR) was used. The detection method was used to identify and isolate the virus, and directly extract virus nucleic acid from the specimens without virus isolation, and carry out RT-PCR and gene sequencing.
Epidata3.0 software was used for data entry of descriptive epidemiological study. After the input of Excel, the data was analyzed using SPSS17.0 software. The data of the data were compared with the 450 nucleotide sequences of the carboxyl terminal of the WHO representative strain of the N gene, and the genetic relationship of the sequence genes was analyzed by MEGA5.1 software, and the gene parent was used as a gene parent. Phylogenetic tree.
Result
The epidemiological characteristics of measles in Yunnan border area in 2013: (1) 141 cases of measles confirmed cases (including laboratory diagnosis and clinical diagnosis) were reported. (2) age distribution: the age group with the highest incidence was 20-49 year old adult group, 58.86% (83/141), followed by 0-1.5 years, accounting for 27.66% (39/141); from the age incidence rate, 0-1 The age incidence rate of the age group was the highest 68.56/10 million (34/49592). (3) the sex ratio of men and women was 0.94, but among the 1 years old age group, the sex ratio of men and women was 3.0. (4), 52 cases (36.8%), 48 cases (34.04%) of scattered children, and less diseases in other occupations. (5) the onset of the disease was seasonal, and spring and summer was the border. In the area of high incidence of measles in the region, 115 cases were found, accounting for 81.56% of the annual incidence of measles. The outbreak and epidemic of measles had the same seasonal regularity. In addition to Ruili, there were measles cases in Longchuan County and Meng Lian county. The high incidence areas mainly concentrated in Manshi 15.66/.10 million (62/395913), 7.67/10 million (25/325945) in Xiang Xiang District, and 6.07/10 million (18/29654) in Simao district (18/29654) 0), 4.84/10 million (13/268595) in Menghai County, higher than the province's incidence of 3.04/10 million. (6) immunization history: only 23 cases (16.31%) of measles cases have definite immunization history, 70 cases (49.65%) with "0" dose of measles cases, 48 cases of measles (34.04%). According to age distribution, 8 month old 18 cases, 18 years 88 cases, occupy 75.18% (23). 106/141), for the current immunization strategy, 31 cases of 8 month old -6 years old, only 13 cases (41.94%) had a history of inoculation, 16 cases of measles (51.61%), 2 cases of immunization (6.45%). (7) measles vaccination: the measles group in the counties (districts) of Yunnan border area (District) in 2013 The inoculation rate of the vaccine was more than 98%.
Yunnan border area measles virus monitoring and gene characteristics in 2013: (1) measles virus isolation: a total of 393 specimens were collected, 19 specimens were CPE, including 13 urine specimens, 6.84% separation rate, 6 pharynx swabs, and isolation rate 2.96%. to extract nucleic acid from the unisolated measles case specimens. (2) RT- PCR results: after the purification of PCR products, a positive positive band was found at 700bp by 2% agarose gel electrophoresis. (3) the distribution of measles virus genotypes: 19 strains of isolated viruses and 30 strains of virus nucleic acid by gene sequencing and analysis, there were 3 genotypes, of which the HI based type was distributed in 5 border counties (regions), and South Mill County, Meng SiO Province, Laos And Burma Guizhou Province, D9 genotypes were distributed in 3 counties, Dehong and Burma, and Baoshan City, dragon Ling county and Burma Meng Provo, Mu Jie and Guizhou Province. A genotypes were derived from Manshi in Dehong. (4) genetic relationship analysis of the gene: MEGA5.1 software was used to analyze the genetic relationship between virus isolates and virus nucleic acids. The results suggested that 12 strains were H1 based The H1a gene subtype (24.49%), 36 strains were D9 genotypes (73.47%), 1 were A genotype (China Shanghai 191 vaccine strain, 2.04%). (5) 36 D9 genotypes were compared with the WHO D9 genotypes, which were divided into 5 groups (representative strains alone). The homology of nucleoside was 96.0%-99.5%, and the amino acid homology was 95.2%-99.3%.Custer1 And Cluster2 only contained Myanmar strains, Cluster3 and Cluster4 were composed of local isolates and Burmese strains in Yunnan province (6) 12 strains of H1a subtype, WHO H1a gene subtype and H1b gene subtype, which were divided into 4 groups (each group was one group). The homology of nucleoside acid was 97.1%-99.1%, and the amino acid homology was 95.8% ~ 9. 9.3%.Cluster1 contains only 1 strains of Myanmar, Cluster2 is composed of native isolates and Laotian strains in Yunnan. (7) monitoring of the outbreak of D9 genotype measles outbreak: 5~8 months of 2013, 3 cases of measles outbreak in Manshi Ping Town, Dehong, involving 22 cases, 2~13 cases, and 3 outbreaks involving 13 natural cases. The village (Society), of which 3 villages have occurred punctuate outbreaks (phase Zhang village, Lao Guang village, Muang Xay Village), collect pathogenic specimens, separate the live virus 3 strains and detect 5 strains of virus nucleic acid and total 8 strains, all of the D9 genotypic virus strains isolated and detected in the same outbreak.
(8) compared with 1 A genotype and WHO A genotype, nucleotide homology was 99.1%, amino acid homology was 99.3%.
Conclusion the highest incidence rate of measles in Yunnan border area in 2013 is 20~49 year old adult group (58.86%), followed by 0 to 1.5 year old children (27.66%); 0~1 year old infants have the highest incidence of age (68.56/10 million); the incidence of the disease is farmers (36.88%) and scattered children (34.04%), 100 cases (70.92%), and high incidence of measles in winter and spring. Season; high incidence area mainly concentrated in Dehong (Mango), Lincang City (Linxiang District), Pu'er City (Simao District), Xishuangbanna state (Menghai county) 4 border states (districts), the incidence of 4 counties is higher than the incidence of the province (3.04/10 million); only 23 cases (16.31%) cases have a definite immunization history, a case of age inoculation crowd. Only 41.94% (15 cases) with definite immunization history and 51.61% (16 cases) without immunization history ("0"). In Yunnan border area, there are two types of H1 and D9 genotypes of measles virus, the D9 genotype is imported from Burma and now the dominant genotype in Dehong, and the genotypes are in Dehong border Burma border county and Burma. Transmission; H1 genotype was transmitted in Laos and Yunnan borders with Laos;.A genotype was similar to Chinese vaccine strain 191 in Shanghai.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R511.1

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