本文關(guān)鍵詞： 農(nóng)村學(xué)生 麻疹 免疫現(xiàn)狀 對(duì)策研究　出處：《昆明醫(yī)學(xué)院》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的通過農(nóng)村學(xué)生麻疹免疫現(xiàn)狀調(diào)查,發(fā)現(xiàn)有效保護(hù)率低的主要原因,采取強(qiáng)化免疫及相應(yīng)干預(yù)措施,提高農(nóng)村學(xué)生麻疹免疫水平,探討控制和消除麻疹的可行性。 方法本次研究采用流行病學(xué)與實(shí)驗(yàn)室檢測(cè)相結(jié)合的方法,重點(diǎn)放在采取提高麻疹免疫水平措施后其效果評(píng)估。選取昌寧縣哽嘎鄉(xiāng)哽嘎小學(xué)(A校),施甸縣姚關(guān)鄉(xiāng)蒜園小學(xué)(B校)學(xué)生302名(采用分層隨機(jī)抽樣,按年級(jí)分層,即每校每年級(jí)隨機(jī)抽取25-30名,2校共抽取302名)；A、B兩鄉(xiāng)鎮(zhèn)教師、家長(zhǎng)(立意抽樣,教師40名,家長(zhǎng)600名),鄉(xiāng)村醫(yī)生(普查兩鄉(xiāng)鎮(zhèn)64名鄉(xiāng)村醫(yī)生)。并對(duì)302名農(nóng)村學(xué)生開展強(qiáng)化免疫,對(duì)家長(zhǎng)、教師、鄉(xiāng)村醫(yī)生進(jìn)行宣傳教育及培訓(xùn)。通過問卷、現(xiàn)場(chǎng)調(diào)查、實(shí)驗(yàn)室方法對(duì)效果進(jìn)行分析。 結(jié)果(1)實(shí)施措施前302名農(nóng)村學(xué)生免疫現(xiàn)況：麻疹疫苗第1針接種率為85.8%,第2針接種率為74.8%,2針均完成74.8%；而麻疹I(lǐng)gG抗體陽(yáng)性率、保護(hù)率分別為88.7%、51.0%,幾何平均滴度(GMT)1：551。 (2)強(qiáng)化免疫及相應(yīng)干預(yù)措施效果評(píng)估： 1)通過強(qiáng)化免疫,302名學(xué)生抗體陽(yáng)性率為100%,抗體保護(hù)率為76.9%,較強(qiáng)化免疫前的陽(yáng)性率88.7%、抗體保護(hù)率51.0%分別上升了11.3個(gè)百分點(diǎn)(x 2=36.028,P＜0.001)、25.9個(gè)百分點(diǎn)(x~2=36.028,P＜0.001)；GMT由強(qiáng)化前的1：551升至1：746(t=-2.192,P=0.0290.05)。 2)通過有效培訓(xùn),鄉(xiāng)村醫(yī)生麻疹相關(guān)防控知識(shí)得到了相應(yīng)的提高；知識(shí)得分由培訓(xùn)前的平均6.5分(總分10分)升至培訓(xùn)后的平均9.5分,提高了3分(t=-11.636,P0.001)；總的完全知曉率從培訓(xùn)前的12.5%升至60.9%,提高了48.4個(gè)百分點(diǎn)；而麻疹傳染病學(xué)、免疫程序、接種技術(shù)相關(guān)知識(shí)完全知曉率均提高了45個(gè)百分點(diǎn)。 3)通過宣傳教育,家長(zhǎng)、教師麻疹免疫規(guī)劃相關(guān)知識(shí)知曉率由宣傳教育前的10.2%、25%分別提高至98.8%(x~2=951.117,P＜0.001)、100%(x~2=95.455,P0.001),分別提高了88.6個(gè)百分點(diǎn)、75個(gè)百分點(diǎn),對(duì)麻疹免疫規(guī)劃得到了基本的認(rèn)識(shí),且均支持麻疹疫苗的免疫接種。 4)對(duì)無證或遺失證者進(jìn)行補(bǔ)證,持證率由補(bǔ)證前的67.9%升至100%,提高了32.1個(gè)百分點(diǎn)。 建議(1)加強(qiáng)科普宣傳,提高學(xué)生家長(zhǎng)和教師對(duì)接種疫苗理性認(rèn)識(shí),從而提高主動(dòng)配合意識(shí)。 (2)完善冷鏈設(shè)施和疫苗規(guī)范管理,提高疫苗接種的有效性和安全性。 (3)加強(qiáng)鄉(xiāng)村醫(yī)生專業(yè)培訓(xùn),提高業(yè)務(wù)水平,確保安全注射和接種的有效性。 (4)加強(qiáng)血清學(xué)監(jiān)測(cè),動(dòng)態(tài)掌握農(nóng)村學(xué)生實(shí)際免疫水平,為制定免疫策略提供科學(xué)依據(jù)。 (5)對(duì)麻疹發(fā)病率高于0.1/10萬地區(qū)的農(nóng)村學(xué)生開展強(qiáng)化免疫等干預(yù)措施,最大限度的減少免疫空白和低免疫人群,控制麻疹在農(nóng)村學(xué)校的流行和暴發(fā)。
[Abstract]:Objective to investigate the current situation of measles immunization among rural students and to find out the main reasons for the low effective protection rate. To improve the level of measles immunization of rural students and to explore the feasibility of controlling and eliminating measles. Methods Epidemiology and laboratory tests were used in this study. The emphasis was placed on the evaluation of the effect of measles immunization measures. 302 students (random sampling by stratification, stratified and stratified according to grade) were selected from School A of Qiuga Primary School in Chunga Township of Changning County, and School B of Guanyuan Primary School in Yaoguan Township of Shidian County. That is, a random sample of 25 to 30 teachers per school per year in two villages and towns, a total of 302 teachers from two villages and towns, parents (40 teachers, 600 parents), village doctors (64 rural doctors in two villages and towns were surveyed), and 302 rural students were immunized intensively. Education and training for parents, teachers and rural doctors. Results were analyzed by questionnaire, field investigation and laboratory methods. Results 1) the immunization status of 302 rural students before the implementation of the measures: the first vaccination rate of measles vaccine was 85.8 and the second vaccination rate was 74.80.The positive rate of measles IgG antibody was 88.7% and the protective rate was 51.0%, and the geometric average titer of GMT1: 551 was higher than that of the control group. 2. Assessment of the effectiveness of immunization enhancements and corresponding interventions:. 1) the positive rate of antibody and the protective rate of antibody were 100% and 76.9%, respectively. The positive rate of antibody was increased by 11.3 percentage points (P < 0.001 ~ 25.9%) from 1: 551 to 1: 746 t ~ (- 2) ~ 2. 192% ~ 29. 028%, P < 0. 001 ~ 25. 9% ~ 36. 028% P < 0. 0011% from 1: 551 to 1: 746 ~ 2. 192T ~ (2. 192) P ~ (29) 0.05 ~ 0. 05% respectively. 2) through effective training, rural doctors' knowledge about measles prevention and control was improved, and the average score of knowledge increased from 6.5 points (total score 10) before training to 9.5 points after training. The total total awareness rate increased from 12.5% before training to 60.9 percent, and by 48.4 percentage points, while the rate of complete knowledge of measles infectious diseases, immunization procedures and vaccination techniques were all increased by 45 percentage points. 3) through propaganda and education, the awareness rate of parents and teachers about measles immunization planning was increased from 10.2% to 98.8%, respectively, to 98.8% (P < 0.001), 95,951.117% (P < 0.001), which was increased by 88.6% and 75%, respectively. The basic knowledge of measles immunization planning was obtained. All of them supported the immunization of measles vaccine. 4) the holding rate of undocumented or lost witnesses increased from 67.9% to 100, an increase of 32.1 percentage points. It is suggested that 1) strengthen the propaganda of popularizing science, improve the students' parents and teachers' rational understanding of vaccination, and raise the awareness of active cooperation. Improve cold chain facilities and vaccine management to improve the effectiveness and safety of vaccination. Strengthen the professional training of rural doctors, improve the operational level, ensure the effectiveness of safe injection and vaccination. (4) strengthen serological monitoring and dynamically grasp the actual immunization level of rural students, and provide scientific basis for formulating immunization strategies. (5) to carry out intensive immunization and other interventions to rural students whose measles incidence is higher than 0.1 / 100 000, to minimize immunization gaps and low immunization population, and to control the prevalence and outbreak of measles in rural schools.
【學(xué)位授予單位】：昆明醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R186

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