本文選題：手足口病 + 聚集性事件��； 參考：《復旦大學》2012年碩士論文

【摘要】：[目的] 分析長寧區(qū)2005-2011年手足口病疫情、2009年-2011年手足口病聚集性事件的流行特征和病原學檢測結果,系統(tǒng)描述長寧區(qū)手足口病流行特征；對2010年長寧區(qū)管理的病例開展回顧性調(diào)查,了解手足口病的經(jīng)濟負擔;綜合探討手足口病的干預措施效果,為改進防控措施提供依據(jù)。 [方法] 利用中國疾病預防控制信息系統(tǒng)收集上海市長寧區(qū)2005-2011年的手足口病疫情資料,描述其流行病學特征；收集2009-2011年長寧區(qū)手足口病聚集性事件調(diào)查處置資料,描述其流行病學特征；采集聚集性病例、監(jiān)測點醫(yī)院臨床診斷病例的咽拭子標本進行病原學分型,描述其病原學特征；對2010年長寧區(qū)管理的手足口病病例,經(jīng)知情同意后,通過設計好的調(diào)查問卷進行經(jīng)濟負擔調(diào)查,分析手足口病疾病負擔。 [結果] 1.2005-2011年長寧區(qū)共發(fā)生手足口病2575例,年平均發(fā)病率59.7/10萬。全區(qū)10個街道/鎮(zhèn)均有病例發(fā)生,年平均發(fā)病率居前3位的是新涇鎮(zhèn)(184.7/10萬)、周橋(64.3/10萬)、程橋(60.9/10萬),發(fā)病率居后3位的是天山(23.6/10萬)、新華(25.7/10萬)、華陽(31.8/10萬)街道。全年均有病例報告,呈現(xiàn)明顯的季節(jié)性發(fā)病趨勢,春末夏初(5-7月)、秋末冬初(10-12月)兩個發(fā)病高峰,分別占總發(fā)病數(shù)的50.6%、24.8%。以男性發(fā)病為主,男女比例為1.5：1；0-6歲的學齡前兒童發(fā)病為主,占總發(fā)病人數(shù)的92.7%(2387/2575)；主要發(fā)病人群為幼托(54.1%)和散居兒童(37.5%)。2009年-2011年對406例臨床診斷手足口病病例開展病原學監(jiān)測,陽性率為74.1%,病毒型別以EV71(34%)和CoxA16(22%)為主,存在其他腸道病毒(14%)及混合感染(0.2%)情況。EV71型所占比例逐年上升成為優(yōu)勢毒株,不同年份的病毒型別構成有顯著差異(P0.05)。 2.2009年-2011年長寧區(qū)共報告手足口病聚集性事件117起,波及3422人,發(fā)病491例,平均罹患率為14%(4.7%-100%),報告重癥病例2例；全區(qū)10個街道均有發(fā)病,主要發(fā)生在幼托機構(85%,100/117),家庭及社區(qū)發(fā)病呈上升趨勢；發(fā)病高峰在4-6月、10-12月,分別占34%(40/117)、41%(48/117)；報告單位以疾控機構及社區(qū)衛(wèi)生服務中心通過疫情監(jiān)測發(fā)現(xiàn)為主(57%,67/117),疫情報告至末例發(fā)病及至疫情高峰的間隔時間≤0d的事件起數(shù)分別占51%(60/117)、95%(111/117),不同場所發(fā)生的事件報告來源、罹患率均有顯著差異(均P0.05)；分析93起事件的實驗室檢測結果,其中由EV71和CoxA16單一病毒感染的事件分別為35起、24起,并存在EV71和CoxA16合并感染的事件(4起),涉及重癥病例的事件均為感染EV71病毒；不同年份事件的病原型別構成無顯著差異(P0.05),EV71型呈上升趨勢。每起疫情持續(xù)時間中位數(shù)為4d(0-17d),病毒不同型別及關班與否對疫情持續(xù)時間未發(fā)現(xiàn)明顯影響(P0.05)。 3.對367例手足口病病例的經(jīng)濟負擔調(diào)查顯示,門診病例平均費用為396.3±153.4元(134.0-804.0元),住院病例平均費用為2905.9±741.2元(1880.0-6300.0元)。門診總費用的影響因素中,不同性別、3歲以下兒童與3歲及以上兒童無差異(P0.05),發(fā)熱兒童高于不發(fā)熱兒童。住院總費用的影響因素中,不同性別、年齡及發(fā)熱癥狀均無顯著差異(P0.05)。門診病例的直接醫(yī)療費用發(fā)熱病例高于不發(fā)熱病例；直接非醫(yī)療費用(包括交通費、營養(yǎng)費等)女性高于男性,發(fā)熱病例高于不發(fā)熱病例；間接損失3歲以下兒童高于3歲以上兒童(均P0.05)。伴有發(fā)熱癥狀的住院病例直接醫(yī)療費用、直接非醫(yī)療費用高于不伴有發(fā)熱的病例(均P0.05)。 4.長寧區(qū)手足口病發(fā)病以散發(fā)為主,對散發(fā)病例開展以健康教育、家訪、指導消毒隔離等系列防控措施；一旦發(fā)現(xiàn)聚集性事件,及時核實疫情,落實消毒隔離、關班/關園等綜合防控措施,117起聚集性事件僅2起達到暴發(fā)疫情級別,可見目前以病例隔離、病原檢索、關班/關園、家訪及健康教育為主的綜合性防控措施是行之有效的。 [結論] 1.長寧區(qū)手足口病發(fā)病率逐年上升,該病無明顯的地區(qū)性,呈現(xiàn)季節(jié)性發(fā)病趨勢。 2.防控手足口病的重點場所為幼托等集體單位,防控關鍵時期為4-7月、10-12月,防控重點人群為0-6歲的學齡前兒童。 3.住院病例的經(jīng)濟負擔高于門診病例,伴有發(fā)熱癥狀的病例疾病負擔更重,早發(fā)現(xiàn)、早診斷、早治療能防止住院病例和重癥病例的發(fā)生,是減輕疾病負擔的關鍵。 4.提高手足口病聚集性事件報告的及時性,是有效控制疾病蔓延的關鍵。 5.開展病原檢索有助于防范重癥手足口病的發(fā)生。 6.目前以病例隔離、病原檢索、關班/關園、家訪及健康教育為主的綜合性防控措施是有效的。
[Abstract]:[Objective]
The epidemic characteristics of hand foot and mouth disease (HFMD) in Changning District in the past 2005-2011 years, the epidemiological characteristics of hand foot and mouth disease (HFMD) in 2009 and the results of pathogenic detection were systematically described, and the epidemiological characteristics of hand foot and mouth disease in Changning District were systematically described. A retrospective survey on the cases of Changning District management in 2010 was carried out to understand the economic burden of hand foot and mouth disease and to discuss the intervention of hand foot and mouth disease in a comprehensive way. The effect of the measures is provided to provide the basis for improving the prevention and control measures.
[method]
Using China's information system for Disease Control and prevention to collect data on the epidemic of hand foot and mouth disease (HFMD) in Changning District, Shanghai for 2005-2011 years, describe its epidemiological characteristics, collect data on the investigation and disposal of hand foot and mouth disease in Changning District for 2009-2011 years, describe its epidemiological characteristics, collect aggregated cases, and monitor the clinical diagnosis of hospitals. The specimen of pharynx swab was classified as a pathogenic type and described its pathogenic characteristics. After informed consent of the cases of hand foot and mouth disease managed in Changning District in 2010, the burden of hand foot and foot disease disease was analyzed by a well designed questionnaire to investigate the burden of hand foot and mouth disease.
[results]
In Changning District, there were 2575 cases of hand foot and mouth disease in Changning District, with an average annual incidence of 59.7/10 million. Cases occurred in 10 streets / towns in the whole region. The average annual incidence rate was the first 3 in Xin Jing Town (184.7/10 million), Zhou Qiao (64.3/10 million) and Cheng Qiao (60.9/10 million). The incidence rate of the first 3 were Tianshan (23.6/10 million), Xinhua (25.7/10 million), and Huayang (31.8/10 million). All the cases were reported in the whole year, showing obvious seasonal trend, two onset peaks in late spring and early summer (5-7 months), and 50.6% of the incidence of total disease in the end of autumn and early winter (10-12 months). 24.8%. was mainly male and male and female was 1.5:1; 0-6 year old preschool children accounted for 92.7% (2387/2575) of the total incidence. The incidence of pathogens in 406 cases of clinical diagnosis of hand foot and mouth disease (HFMD) was detected in 406 cases of children (54.1%) and scattered children (37.5%) in.2009 years. The positive rate was 74.1%, virus types were mainly EV71 (34%) and CoxA16 (22%), other enterovirus (14%) and mixed infection (0.2%) were increased year by year, and the proportion of.EV71 was increasing to become the dominant strain. There was a significant difference in viral composition between different years (P0.05).
2.2009 years, 2.2009 years -2011 reported a total of 117 cases of hand foot and mouth disease aggregated events, including 3422 people and 491 cases, with an average incidence of 14% (4.7%-100%), 2 cases of severe cases, 10 streets in the whole region, mainly in the nursery (85%, 100/117), and the incidence of family and community was on the rise; the peak of the disease was 4-6 and 10-12 months. Do not account for 34% (40/117), 41% (48/117); the reporting units were found mainly by disease control and community health service centers (57%, 67/117), and the number of events reported to the last cases and the interval of the peak of the epidemic was 51% (60/117), 95% (111/117), and the incidence of incident reports in different places were all Significant differences (all P0.05); analysis of the results of laboratory tests of 93 events, including 35 cases of EV71 and CoxA16 single virus infection, 24 cases, and EV71 and CoxA16 infection events (4), all cases involving severe cases were infected with EV71 virus, and there was no significant difference in the pathogenic type of the events in different years (P0.05 The EV71 type was on the rise. The median duration of each outbreak was 4D (0-17d). The different types of virus and whether the virus was closed or not had no significant impact on the duration of the epidemic (P0.05).
The economic burden of 3. cases of 367 cases of hand foot and mouth disease showed that the average cost of outpatient cases was 396.3 + 153.4 yuan (134.0-804.0 yuan) and the average cost of hospitalized cases was 2905.9 + 741.2 yuan (1880.0-6300.0 yuan). Among the influencing factors of outpatient total expenses, there was no difference between children under 3 years of age and children aged 3 and above (P0.05), and the fever children were higher than those of the children. Among the factors affecting the total cost of hospitalization, there were no significant differences in the gender, age and fever (P0.05). The direct medical expense fever cases in outpatients were higher than those of non fever cases; the direct non medical expenses (including transportation, nutrition, etc.) were higher in women than those of men, and the fever cases were higher than those of non fever cases; the indirect loss was 3. Children under the age of age were higher than 3 years old (all P0.05). The direct medical expenses of hospitalized cases with fever symptoms were higher than those without fever (all P0.05).
4. the incidence of hand foot and mouth disease in Changning District is mainly sporadic, and a series of prevention and control measures are carried out for sporadic cases, such as health education, home visits, and disinfection and isolation; once the aggregation events are found, the epidemic is verified in time, the disinfection and isolation, the closed class / Guan yuan and other comprehensive prevention and control measures are carried out, and only 2 of the 117 gathering events have reached the level of the outbreak, which can be seen at present. Comprehensive prevention and control measures based on case isolation, pathogen retrieval, off class / close kindergarten, family visit and health education are effective.
[Conclusion]
1. the incidence of hand foot mouth disease (HFMD) in Changning District is increasing year by year.
2. the key places for prevention and control of hand, foot and mouth disease are kindergartens and other collective units. The key period for prevention and control is 4-7 months, 10-12 months, and the key population is 0-6 years old preschool children.
3. the economic burden of hospitalized cases is higher than that of outpatient cases, and the burden of disease with fever symptoms is heavier. Early detection, early diagnosis, early treatment can prevent the occurrence of hospitalized cases and severe cases, which is the key to reduce the burden of disease.
4. to improve the timeliness of the HFMD aggregation report is the key to effective control of the spread of the disease.
5. carrying out pathogen retrieval helps prevent the occurrence of severe hand foot mouth disease.
6. currently, comprehensive prevention and control measures based on case isolation, pathogen retrieval, off class / close kindergarten, home visits and health education are effective.
【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R725.1

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本文編號：1985059