本文選題：水痘　切入點：流行病學(xué)　出處：《復(fù)旦大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的1.了解上海市青浦區(qū)2005-2013年水痘流行病學(xué)特征。2.掌握青浦區(qū)托幼機(jī)構(gòu)兒童與小學(xué)生水痘發(fā)病特征,比較突破病例和未接種病例的疾病表現(xiàn)。3.探討疫苗接種的保護(hù)效果及水痘發(fā)病的危險因素,為有效預(yù)防控制水痘流行提供依據(jù)。方法1.收集、整理中國疾病預(yù)防控制信息系統(tǒng)關(guān)于青浦區(qū)2005-2013年水痘病例報告資料,結(jié)合青浦區(qū)統(tǒng)計局和公安分局提供的人口數(shù)據(jù),通過發(fā)病率、構(gòu)成比等指標(biāo)對青浦區(qū)水痘流行病學(xué)特征進(jìn)行描述分析。2.用1：1配對的病例對照研究方法：病例信息來源于中國疾病預(yù)防控制信息系統(tǒng),均為托幼機(jī)構(gòu)兒童與小學(xué)生,比較突破病例和未接種病例的疾病表現(xiàn)；對照為性別、班級與患者相匹配的健康人群。采用問卷形式對患者和對照在患者發(fā)病前的生活習(xí)慣、社會環(huán)境、既往病史等相關(guān)危險因素進(jìn)行調(diào)查。3.選用疫苗效率(vaccine efficacy, VE)作為疫苗保護(hù)效果的評價指標(biāo)。當(dāng)無法確切獲得人群接種率時,選用病例對照研究的公式：VE=(1-OR)X100%。4.用SPSS17.0統(tǒng)計軟件對數(shù)據(jù)進(jìn)行有關(guān)的統(tǒng)計分析,一般情況構(gòu)成分析計數(shù)資料采用χ2檢驗,計量資料采用t檢驗,各項因素進(jìn)行單因素與多因素條件Logistic回歸分析,具體采用了COX回歸模型。結(jié)果1.2005-2013年水痘流行病學(xué)特征2005-2013年青浦區(qū)共報告水痘病例數(shù)5375例,平均年發(fā)病率為61.16/10萬(14.09/10萬～113.67/10萬)。季節(jié)趨勢：11月、12月及5月、6月,形成兩個高峰,報告較少的是2月和8月。病例數(shù)報告排列前3位分別為青浦鎮(zhèn)30.77%(1716/5375)、華新鎮(zhèn)13.45%(723/5375)和徐涇鎮(zhèn)10.16%(565/5375)。15歲發(fā)病數(shù)占總發(fā)病人數(shù)的71.44%(3840/5375),性別比為1.31：1。2005～2013年共報告水痘相關(guān)突發(fā)公共衛(wèi)生事件4起,主要發(fā)生單位是小學(xué)。2.青浦區(qū)托幼機(jī)構(gòu)兒童與小學(xué)生水痘發(fā)病特征觀察托幼機(jī)構(gòu)兒童和小學(xué)生水痘高發(fā),年齡集中在4～8歲、年級集中在幼兒園中班到小學(xué)二年級。水痘突破病例發(fā)生較多,326例水痘病例中,突破病例占43.25%。突破水痘病例與未接種疫苗病例相比,在皮疹持續(xù)時間、皰疹個數(shù)、皰疹分布部位、是否伴有咽喉疼痛等的差異具有統(tǒng)計學(xué)意義(P0.05)。3.疫苗保護(hù)效果本研究中水痘疫苗總體效率(VE)為65.17%(95%CI:48.18%～76.59%)。按托幼機(jī)構(gòu)和小學(xué)分層分析,疫苗效率分別為88.37%(95%CI:73.84%～ 94.83%)、43.48%(95%CI:6.87%～65.70%)。4.危險因素的病例對照研究接觸史是水痘發(fā)病的危險因素,OR值為2.47(95% CI：1.358～4.495)。免疫史和勤洗手是水痘發(fā)病的保護(hù)因素,OR值分別為0.373(95%CI：0.241～0.578)、0.313(95%CI：0.210～0.467)。結(jié)論1.2005-2013年青浦區(qū)共報告水痘病例5375例,發(fā)病率處于較高水平。2.在兒童集體單位中水痘疫苗的保護(hù)效果總體較好,接種水痘疫苗可在一定程度上減輕感染水痘后的臨床癥狀。3.采取有效的公共衛(wèi)生措施,加強(qiáng)病例的隔離和密切接觸者觀察管理,以進(jìn)一步控制水痘疫情的暴發(fā)、流行,減輕水痘的公共衛(wèi)生危害及疾病負(fù)擔(dān)。4.建議國家或疫情高發(fā)省份可考慮將水痘疫苗納入擴(kuò)大免疫規(guī)劃；建議對疫苗保護(hù)效果的影響作進(jìn)一步研究,并由此確定第2劑次疫苗的適當(dāng)接種時間,提供兒童2劑次水痘疫苗免疫策略,建立有效的人群免疫屏障。
[Abstract]:Objective to understand the 1. Qingpu District of Shanghai city for 2005-2013 years to master the epidemiological characteristics of varicella.2. kindergarten children in Qingpu district with the primary varicella incidence characteristics, comparison of breakthrough cases and non vaccinated cases of disease.3. vaccine to investigate risk factors and protective effect of varicella disease, provide the basis for the effective prevention and control of varicella. 1. methods of collecting, sorting Chinese the disease on the Qingpu area 2005-2013 years of varicella cases report prevention and control information system, population data was provided by Qingpu area statistics bureau and Public Security Bureau, the incidence proportion on the epidemiology of varicella in Qingpu District of.2. using 1:1 matched case-control study: a case analysis method to describe information from the Chinese disease prevention and control information system, are children and pupils in kindergartens, more breakthrough cases and the unvaccinated cases of the disease The control for healthy people; gender, class and patients were matched. Using questionnaires to patients and control patients before the onset of the social environment, living habits, medical history and other related risk factors were investigated using.3. vaccine (vaccine efficacy, VE) efficiency as the evaluation indexes of vaccine protection effect. When unable to obtain the crowd vaccination rate, using case-control study formula: VE= (1-OR) X100%.4. were analyzed with SPSS17.0 statistical software for statistical data, general analysis of count data using 2 test, measurement data using t test, various factors regression analysis of single factor and multi factor Logistic, the COX regression model. Results epidemiological features of varicella 1.2005-2013 2005-2013 years in Qingpu District reported a total number of varicella cases in 5375 cases, the average annual incidence rate of 61.16/10 million (14.09/10 million to 113. 67/10 10000). Seasonal trends: November, December and May, June, the formation of the two peak, there are few reports of February and August. The number of cases report ranked the top 3 are Qingpu town 30.77% (1716/5375), 13.45% (723/5375) and Huaxin Town Xujing town 10.16% (565/5375) the total incidence of 71.44%.15 the age of incidence (3840/5375), the sex ratio of 1.31:1.2005 to 2013 reported a total of varicella related public health emergencies 4, main unit is.2. primary school kindergarten children in Qingpu district with the primary incidence features of varicella children in kindergarten and primary school students to observe the high incidence of varicella, concentrated in the age 4~8, concentrated in the kindergarten to grade the second grade primary school the varicella cases occurred in 326 cases of breakthrough, breakthrough varicella cases, cases 43.25%. breakthrough varicella cases compared with unvaccinated cases, the rash duration, the number distribution of herpes simplex, whether. The difference was statistically significant with a sore throat and protective effect of.3. vaccine (P0.05) in the study of varicella vaccine (VE) for the 65.17% overall efficiency (95%CI:48.18% ~ 76.59%). According to the analysis of kindergarten and primary school levels, vaccination rate was 88.37% (95%CI:73.84% ~ 94.83%), 43.48% (95%CI:6.87% ~ 65.70%) were risk factors of.4. the control of contact history were risk factors of incidence of varicella, OR value was 2.47 (95% CI:1.358 ~ 4.495). Immunization history and washing hands is a protective factor for the incidence of varicella, OR = 0.373 (95%CI:0.241 ~ 0.578), 0.313 (95%CI:0.210 ~ 0.467). Conclusion the 1.2005-2013 District of Qingpu reported a total of 5375 cases of varicella cases, incidence the protective effect of rate at higher levels of.2. in children with varicella vaccine in the collective unit is good as a whole, varicella vaccine can relieve the clinical symptoms of varicella infection after.3. to a certain extent, take effective Public health measures to strengthen the case isolation and close contacts to observe management, further control of varicella outbreaks, the prevalence of varicella, reduce public health risk and disease burden of.4. suggested that the state or epidemic provinces could consider varicella vaccine into immunization will expand; suggest that the effects on the protective effect of the vaccine for further study, and the second dose vaccine appropriate inoculation time, provide 2 doses of varicella vaccine immunization strategy for children, establish effective immunity barrier.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R725.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 馮冉;李印東;李長青;張松建;王鳳雙;吳殫;肖雷;;北京市順義區(qū)2006～2009年水痘流行病學(xué)分析[J];首都醫(yī)科大學(xué)學(xué)報;2010年05期

2 郭寧燕;;水痘防控[J];臨床和實驗醫(yī)學(xué)雜志;2010年06期

3 常秀蘭;陳金華;;北京市平谷區(qū)2010年水痘疫情流行病學(xué)分析[J];職業(yè)與健康;2011年18期

4 潘黎;鐘培松;費潔;;上海市嘉定區(qū)2006-2011年水痘疫情流行病學(xué)分析[J];中國初級衛(wèi)生保健;2012年07期

，

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