本文選題：麻疹 + 血清流行病學(xué)��； 參考：《復(fù)旦大學(xué)》2011年碩士論文

【摘要】：1目的 (1)了解青浦區(qū)2001—2010年麻疹流行病學(xué)特征。 (2)掌握青浦區(qū)外來(lái)民工子弟學(xué)校新入學(xué)學(xué)生強(qiáng)化免疫前的麻疹免疫水平。 (3)掌握青浦區(qū)外來(lái)民工子弟學(xué)校新入學(xué)學(xué)生家庭基本情況及其家長(zhǎng)關(guān)于麻疹疫苗(MV)及接種等相關(guān)知識(shí)的認(rèn)知情況,了解青浦區(qū)免疫規(guī)劃工作人員對(duì)麻疹疾病、麻疹疫苗及接種相關(guān)情況的認(rèn)知情況,探討影響該人群麻疹疫苗接種率的影響因素。 2方法 (1)收集、整理上海市青浦區(qū)2001—2010年法定傳染病監(jiān)測(cè)報(bào)告系統(tǒng)和麻疹專(zhuān)病監(jiān)測(cè)系統(tǒng)資料,結(jié)合青浦區(qū)統(tǒng)計(jì)局和公安局提供的戶(hù)籍人口和非戶(hù)籍人口數(shù)據(jù),通過(guò)發(fā)病率、構(gòu)成比等指標(biāo)對(duì)青浦區(qū)麻疹流行病學(xué)特征進(jìn)行描述分析。 (2)采用多階段抽樣方法,在全區(qū)10個(gè)鎮(zhèn)(街道)抽取2個(gè)鎮(zhèn)(街道),每個(gè)鎮(zhèn)(街道)抽取4個(gè)學(xué)校,每個(gè)學(xué)校按年級(jí)、班級(jí)抽取本學(xué)期新入校學(xué)生。 (3)麻疹疫苗強(qiáng)化免疫接種前,抽取新入校學(xué)生靜脈血3ml,分離血清,采用定量酶聯(lián)免疫吸附試驗(yàn)(ELISA)測(cè)定調(diào)查對(duì)象血清中的麻疹I(lǐng)gG抗體水平,計(jì)算麻疹I(lǐng)gG抗體陽(yáng)性率、幾何平均濃度(GMC)等指標(biāo),評(píng)價(jià)新入學(xué)學(xué)生麻疹抗體水平。 (4)采用自行設(shè)計(jì)的學(xué)生家長(zhǎng)麻疹及疫苗接種相關(guān)認(rèn)知情況調(diào)查問(wèn)卷,對(duì)新入校學(xué)生家長(zhǎng)進(jìn)行問(wèn)卷調(diào)查,內(nèi)容包括學(xué)生基本情況、家庭基本情況、麻疹疫苗接種情況、相關(guān)知識(shí)知曉情況、麻疹疫苗接種意愿及相關(guān)知識(shí)獲取途徑等,計(jì)算知曉率等指標(biāo),進(jìn)行統(tǒng)計(jì)學(xué)分析。 (5)采用自行設(shè)計(jì)的免疫規(guī)劃工作人員麻疹及疫苗接種相關(guān)認(rèn)知情況調(diào)查問(wèn)卷,對(duì)青浦區(qū)疾病預(yù)防控制中心(CDC)和全區(qū)13家社區(qū)衛(wèi)生服務(wù)中心免疫規(guī)劃工作人員進(jìn)行調(diào)查,內(nèi)容包括麻疹的危害、麻疹疫苗的有效性、消除麻疹工作認(rèn)知、傳統(tǒng)麻疹疫苗強(qiáng)化免疫和麻疹疫苗查漏補(bǔ)種工作、麻疹疫苗漏種原因和提高麻疹疫苗基礎(chǔ)免疫接種率的措施等,對(duì)調(diào)查結(jié)果進(jìn)行描述性分析。 3結(jié)果 3.1青浦區(qū)2001—2010年麻疹流行病學(xué)特征(1)2001—2010年青浦區(qū)麻疹疫情以散發(fā)為主,年平均發(fā)病率為8.97/10萬(wàn)(0.10/10萬(wàn)—35.49/10萬(wàn)),可分為兩個(gè)階段：波動(dòng)期(2001—2007年)和下降期(2007—2010年),波動(dòng)期年發(fā)病率隔年起伏變化(2.23/10萬(wàn)—35.49/10萬(wàn)),下降期年發(fā)病率逐年下降(9.16/10萬(wàn)—0.10/10萬(wàn))。 (2)家庭、工廠、外來(lái)民工子弟學(xué)校為麻疹爆發(fā)疫情的主要發(fā)生場(chǎng)所,其中家庭爆發(fā)疫情以2病例為主,工廠、外來(lái)民工子弟學(xué)校為多病例爆發(fā)疫情的高危場(chǎng)所。 (3)青浦區(qū)一年四季均有麻疹發(fā)病,以春、夏季為主,4—6月病例占總發(fā)病數(shù)的55.77%。 (4)發(fā)病年齡主要集中在5歲組和中青年各年齡組(20～、25～、30～、35～40—),分別占總發(fā)病人數(shù)的35.44%和48.90%,其中8月齡病例占總發(fā)病人數(shù)的16.21%。 (5)戶(hù)籍人口與非戶(hù)籍人口病例分別占53.16%和46.84%。3.2外來(lái)民工子弟學(xué)校新入學(xué)學(xué)生強(qiáng)化免疫前的麻疹免疫水平 (1)強(qiáng)化免疫前麻疹I(lǐng)gG抗體幾何平均濃度(GMC)為998.96mIU/ml(95%CI：(912.93,1093.10)),陽(yáng)性率為96.96%。 (2)不同類(lèi)別學(xué)校(幼托、小學(xué)、初中)對(duì)象GMC差異無(wú)統(tǒng)計(jì)學(xué)意義(F=1.19,P=0.30),抗體陽(yáng)性率差異無(wú)統(tǒng)計(jì)學(xué)意義(x2=0.36,P=0.83)；不同就學(xué)史(此前無(wú)就學(xué)史、于戶(hù)籍地就學(xué)、于上海其它學(xué)校就學(xué))對(duì)象GMC差異無(wú)統(tǒng)計(jì)學(xué)意義(F=1.22,P=0.30),抗體陽(yáng)性率差異無(wú)統(tǒng)計(jì)學(xué)意義(x2=3.46,P=0.18)。 (3)38.29%調(diào)查對(duì)象無(wú)預(yù)防接種證或已經(jīng)丟失,麻疹相關(guān)疫苗接種≥2劑次者占37.95%,接種史不詳者占48.18%,不同接種史(≥2劑次、1劑次、0劑次、不詳)對(duì)象GMC差異無(wú)統(tǒng)計(jì)學(xué)意義(F=0.75,P=0.53),新入學(xué)學(xué)生麻疹相關(guān)疫苗接種劑次在新入學(xué)學(xué)生所在學(xué)校類(lèi)別、出生場(chǎng)所、新入學(xué)學(xué)生此前就學(xué)地、家庭經(jīng)濟(jì)收入、家庭孩子數(shù)、父母年齡、父母受教育年數(shù)等因素內(nèi)分布差異具有統(tǒng)計(jì)學(xué)意義。 3.3外來(lái)民工子弟學(xué)校新入學(xué)學(xué)生家長(zhǎng)相關(guān)知識(shí)認(rèn)知情況 (1)606例外來(lái)民工子弟學(xué)校新入學(xué)學(xué)生家長(zhǎng)相關(guān)認(rèn)知情況按知曉率從高到低依次為麻疹疫苗預(yù)防疾病、新入學(xué)是否查驗(yàn)預(yù)防接種證、接種麻疹疫苗是否出錢(qián)、麻疹疫苗接種起始月齡和麻疹疫苗接種劑次,其中麻疹疫苗接種起始月齡和麻疹疫苗接種劑次知曉率最低,分別為17.49%和11.39%,麻疹疫苗預(yù)防疾病答對(duì)率最高,為73.76%,各知識(shí)點(diǎn)知曉率差別有統(tǒng)計(jì)學(xué)意義(X2=685.90,P0.001)。 (2)知曉問(wèn)答平均得分2.72分(95%CI：(2.66,2.78)),得分低于3分者418例(占68.98%),父親組、母親組、祖父母等其它組平均得分差別無(wú)統(tǒng)計(jì)學(xué)意義(F=2.894,P=0.0560.05)。家長(zhǎng)麻疹疫苗接種相關(guān)知曉得分在新入學(xué)學(xué)生所在學(xué)校類(lèi)別、出生場(chǎng)所、家庭經(jīng)濟(jì)收入、家庭孩子數(shù)、父母年齡、父母受教育年數(shù)等因素內(nèi)分布差異具有統(tǒng)計(jì)學(xué)意義。 (3)外來(lái)民工子弟學(xué)校新入學(xué)學(xué)生家長(zhǎng)中認(rèn)為有必要為孩子接種麻疹疫苗的為539例(占88.94%),各組按接種愿意從高到低排序?yàn)槟赣H組(90.54%)父親組(88.89%)其它組(78.79%),差別無(wú)統(tǒng)計(jì)學(xué)意義(X2=4.04,P=0.130.05)。 (4)麻疹疫苗接種相關(guān)知識(shí)的獲取途徑按比重由大到小分別為：醫(yī)務(wù)人員、書(shū)面材料、廣播電視、其它、網(wǎng)絡(luò),其中通過(guò)醫(yī)務(wù)人員宣傳占40.10%、通過(guò)網(wǎng)絡(luò)途徑獲知占1.16%,差別有統(tǒng)計(jì)學(xué)意義(X2=359.22,P0.001)。 3.4免疫規(guī)劃工作人員相關(guān)知識(shí)認(rèn)知情況 (1)90.48%的調(diào)查者認(rèn)為現(xiàn)代醫(yī)療條件下麻疹發(fā)病后果一般或不危險(xiǎn)(不嚴(yán)重),73.02%的調(diào)查者認(rèn)為麻疹不是當(dāng)前影響人群健康的重要傳染病,88.89%的調(diào)查者認(rèn)為當(dāng)前青浦區(qū)麻疹的發(fā)病處于散發(fā)水平。 (2)23.81%的調(diào)查者認(rèn)為2012年青浦區(qū)能實(shí)現(xiàn)消除麻疹的目標(biāo),38.10%和33.33%的調(diào)查者分別覺(jué)得很難說(shuō)和不能實(shí)現(xiàn)。 (3)60.32%和30.16%的調(diào)查對(duì)象分別認(rèn)為疫苗未達(dá)到有效接種率和流動(dòng)人口增加是當(dāng)前人群麻疹發(fā)病的最主要因素；50.79%的調(diào)查對(duì)象認(rèn)為當(dāng)前適齡兒童麻疹疫苗2劑接種率有待進(jìn)一步提高,39.68%的調(diào)查對(duì)象認(rèn)為已經(jīng)達(dá)到較高水平；66.67%和26.98%的調(diào)查對(duì)象分別認(rèn)為家長(zhǎng)不重視和家長(zhǎng)未獲取足夠信息是當(dāng)前影響麻疹疫苗接種率最主要的因素；74.60%的調(diào)查對(duì)象認(rèn)為外來(lái)散居兒童是最影響麻疹疫苗接種率的人群。 (4)38.10%的調(diào)查對(duì)象覺(jué)得沒(méi)有必要開(kāi)展大范圍的麻疹疫苗強(qiáng)化免疫活動(dòng),53.97%的調(diào)查對(duì)象覺(jué)得很有必要每年定期開(kāi)展重點(diǎn)人群麻疹疫苗查漏補(bǔ)種工作,85.71%的調(diào)查對(duì)象覺(jué)得扎實(shí)基礎(chǔ)免疫、開(kāi)展查漏補(bǔ)種相對(duì)于定期開(kāi)展大范圍麻疹疫苗強(qiáng)化免疫更有針對(duì)性。 (5)74.60%和25.40%的調(diào)查對(duì)象分別認(rèn)為醫(yī)務(wù)人員面對(duì)面宣傳和宣傳手冊(cè)、宣傳單、宣傳畫(huà)報(bào)等是對(duì)兒童家長(zhǎng)最有效的宣傳方式。46.03%和36.51%的調(diào)查對(duì)象分別認(rèn)為有效擴(kuò)大相關(guān)知識(shí)宣傳和提供更便捷的預(yù)防接種服務(wù)是提高麻疹疫苗接種率的最有效措施。 4結(jié)論 (1)青浦區(qū)麻疹發(fā)病處于低發(fā)病率、散發(fā)水平,家庭、工廠、外來(lái)民工子弟學(xué)校等為麻疹多病例爆發(fā)的重點(diǎn)場(chǎng)所,低年齡、中青年人群為麻疹發(fā)病的重點(diǎn)人群。(2)青浦區(qū)外來(lái)民工子弟學(xué)校新入學(xué)學(xué)生強(qiáng)化免疫前麻疹抗體水平及抗體陽(yáng)性率均處于較高水平。(3)外來(lái)民工子弟學(xué)校新入學(xué)學(xué)生麻疹相關(guān)疫苗調(diào)查接種率不高,新入學(xué)學(xué)生所在學(xué)校類(lèi)別、出生場(chǎng)所、新入學(xué)學(xué)生此前就學(xué)地、家庭經(jīng)濟(jì)收入、家庭孩子數(shù)、父母年齡、父母受教育年數(shù)等可能是其影響因素。 (4)外來(lái)民工子弟學(xué)校新入學(xué)學(xué)生家長(zhǎng)相關(guān)知識(shí)知曉率低,且獲取相關(guān)知識(shí)途徑較為單一和傳統(tǒng),新入學(xué)學(xué)生所在學(xué)校類(lèi)別、出生場(chǎng)所、家庭經(jīng)濟(jì)收入、家庭孩子數(shù)、父母年齡、父母受教育年數(shù)等可能是其影響因素。 5建議 (1)針對(duì)性地著重控制家庭、工廠、外來(lái)民工子弟學(xué)校等重點(diǎn)場(chǎng)所和低年齡、中青年等重點(diǎn)人群的麻疹疫情發(fā)生。 (2)教育部門(mén)與衛(wèi)生部門(mén)切實(shí)加強(qiáng)預(yù)防接種證的管理和入托、入園、入學(xué)預(yù)防接種證查驗(yàn)工作。 (3)結(jié)合人群特點(diǎn),采用針對(duì)性的宣傳策略和方式,以提高人群的預(yù)防接種相關(guān)知識(shí)知曉率,以促使該人群的預(yù)防接種由被動(dòng)接種轉(zhuǎn)化為主動(dòng)接種,有效防止麻疹疫苗接種空白點(diǎn)的存在。 (4)調(diào)整相應(yīng)的免疫策略和細(xì)化工作的開(kāi)展：一方面要扎實(shí)基礎(chǔ)免疫、針對(duì)性地開(kāi)展重點(diǎn)人群的查漏補(bǔ)種和對(duì)特定人群實(shí)施合適的免疫策略,另一方面要著力加強(qiáng)硬件建設(shè)、優(yōu)化預(yù)防接種服務(wù),切實(shí)形成有效的、高水平的人群免疫屏障。
[Abstract]:1 purposes
(1) to understand the epidemiological characteristics of measles in Qingpu district from 2001 to 2010.
(2) to master the level of measles immunity before immunization for newly enrolled students of migrant workers' children in Qingpu district.
(3) master the basic situation of Qingpu migrant workers children school students and their parents about the new family of measles vaccine (MV) vaccination and cognitive knowledge, understand the Qingpu district planning staff of measles immune disease, cognition of measles vaccine and vaccination related situation, to investigate the factors influencing the coverage rate of measles vaccine the crowd.
2 method
(1) collected from 2001 to 2010, infectious disease surveillance report system and measles in Qingpu District of Shanghai City finishing special disease monitoring system, combined with the Statistics Bureau of Qingpu District Public Security Bureau and the household population and non household population data, the incidence rate, proportion of the epidemiological characteristics of measles in Qingpu district were described and analyzed.
(2) a multi stage sampling method was used to extract 2 towns (streets) in 10 towns (streets), and 4 schools were extracted from each town (street). Each school was selected by grade and class to recruit new students in this semester.
(3) immunization coverage, new students from venous blood 3ml, serum by quantitative enzyme-linked immunosorbent assay (ELISA) determination of measles IgG antibody level in the serum of subjects, calculated the positive rate of measles antibody IgG, geometric mean concentration (GMC) and other indicators, the measles antibody level of newly enrolled students evaluation.
(4) designed by the parents of measles and vaccination related cognitive questionnaire, questionnaire survey of new students parents, including the basic situation of the students, the basic family situation, vaccination of measles related knowledge, measles vaccination intention and related knowledge acquisition way, calculating the awareness rate and for statistical analysis.
(5) the self-designed immunization staff and measles vaccination related cognitive questionnaire, disease prevention and control center of Qingpu district (CDC) and the 13 community health service center of immunization staff survey, including measles harm, the effectiveness of measles vaccine, measles elimination work cognition, traditional immunization of measles vaccine and measles vaccine leak replant measles vaccine, measles vaccine leak reasons and improve the basic vaccination rate measures, descriptive analysis of survey results.
3 Results
The 3.1 District of Qingpu from 2001 to 2010, the epidemiological characteristics of measles (1) from 2001 to 2010 in Qingpu, mainly in sporadic measles outbreaks, the average annual incidence rate of 8.97/10 million (0.10/10 million 35.49/10 million), can be divided into two stages: the fluctuation period (2001 - 2007) and decline period (2007 - 2010), the following changes the fluctuation of annual incidence (2.23/10 million 35.49/10 million), the annual decline in incidence decreased year by year (9.16/10 million 0.10/10 million).
(2) families, factories and migrant workers' children schools are the main places for the outbreak of measles. Among them, 2 cases are the main causes of family outbreaks. Factories and migrant workers' children schools are high-risk places for outbreaks of many cases.
(3) there are measles all year round in Qingpu District, mainly in spring and summer, and from 4 to June, the total number of cases is 55.77%..
(4) the age of onset is mainly concentrated in the 5 years old group and the young and middle-aged age group (20 ~ 25 ~ 30 ~ 35~40), accounting for 35.44% and 48.90% of the total number, respectively. 8 month old cases account for 16.21%. of the total number.
(5) the population and non domicile cases accounted for 53.16% and 46.84%.3.2, respectively, and the level of measles immunization before the newly enrolled students in the school of migrant workers' children were strengthened.
(1) the geometric mean concentration (GMC) of IgG antibody before immunization was 998.96mIU/ml (95%CI: (912.931093.10)), and the positive rate was 96.96%.
(2) of different types of schools (kindergarten, primary school, junior high school) there was no significant difference (F=1.19, P=0.30, GMC), no statistically significant difference between the positive rate of antibody (x2=0.36, P=0.83); different school history (had no schooling in history, household education, school education in Shanghai) no significant object the difference of GMC (F=1.22, P=0.30), there was no significant difference between the positive rate of antibody (x2=3.46, P=0.18).
(3) 38.29% subjects without vaccination certificate or has been lost, measles vaccination related more than 2 doses accounted for 37.95%, with an unknown history accounted for 48.18% different vaccination history (more than 2 agents, 1 agents, 0 agents, unknown) no significant difference (F=0.75, P=0.53, GMC). New student measles vaccination related agent in the new school students school categories, birth places, new students after school, family income, family, number of children, parents' age, parents' years of schooling has statistically significant difference in distribution of factors.
3.3 the knowledge of parents' knowledge of new students' parents in the school of migrant workers' children
(1) the relevant cognitive 606 cases of migrant workers' school new students according to the awareness rate from high to low is the measles vaccine to prevent disease, whether the new entrance vaccination certificate, vaccination is money, measles vaccination starting months and measles vaccination doses, including measles vaccination starting months and measles vaccination dose lowest awareness rate were 17.49% and 11.39%, the highest correct rate of measles vaccine for disease prevention, was 73.76%, the knowledge awareness rate was statistically significant difference (X2=685.90, P0.001).
(2) knowledge quiz with an average score of 2.72 points (95%CI: (2.66,2.78)), scoring less than 3 points in 418 cases (68.98%), father, mother, grandparents and other group average scores had no significant difference (F=2.894, P=0.0560.05). The parents of measles vaccination related knowledge score of the school in the new category. The admission of students born place, family income, family, number of children, parents' age, parents' years of schooling has statistically significant difference in distribution of factors.
(3) the migrant workers children school parents newly enrolled students think it necessary for the children of measles vaccination in 539 cases (88.94%), the group were inoculated to order from high to low for the mother group (90.54%) (88.89%) father group other groups (78.79%), the difference was not statistically significant (X2=4.04, P=0.130.05).
(4) measles vaccination approaches to obtain knowledge according to the proportion from big to small are: medical personnel, written materials, radio and television and other network, which, through the propaganda of medical worker informed through the network accounted for 40.10%, accounted for 1.16%, the difference was statistically significant (X2= 359.22, P0.001).
3.4 knowledge of related knowledge of immunization program staff
(1) 90.48% of the respondents believe that the incidence of measles is generally not dangerous under modern medical conditions. 73.02% of the respondents believe that measles is not an important infectious disease affecting the health of the crowd. 88.89% of the respondents believe that the incidence of measles in Qingpu is at the sporadic level.
(2) 23.81% of the investigators believed that the Qingpu district was able to achieve the goal of eliminating measles in 2012, and 38.10% and 33.33% of the investigators found it difficult to say and failed to achieve.
(3) 60.32% of respondents and 30.16% respectively that the vaccine did not reach effective vaccination rate and the floating population is the main factor of the current measles cases; 50.79% of the respondents think that the children against measles vaccination rate of 2 agent needs to be further improved, 39.68% of the subjects that have reached a higher level; 66.67% of respondents and 26.98% are that parents and parents do not pay attention to not get enough information is the effect of measles vaccination rate is the main factor; 74.60% of the respondents think that foreign children are the most affected measles vaccination coverage.
(4) 38.10% of the respondents think there is no need to carry out large-scale measles immunization activities, 53.97% of the respondents think it is necessary to regularly focus groups carried out the measles vaccine leak replant work, 85.71% of the respondents think that the solid foundation to carry out immunization, with respect to regularly carry out large-scale leak replant measles vaccine immunization more targeted.
(5) 74.60% and 25.40% of the respondents believe that medical staff were face-to-face publicity and brochures, leaflets, posters and other subjects for parents of children is the most effective propaganda way.46.03% and 36.51% respectively that effectively expand the relevant knowledge and provide a more convenient vaccination service is the most effective way to improve measles vaccination rate.
4 Conclusion
(1) the incidence of measles in Qingpu District in the low incidence rate, emission levels, family, factory, key places, schools for migrant workers' children for measles outbreaks of low age, young people focus on measles cases. (2) of migrant workers into the new school district of Qingpu school students strengthen before immunization of measles antibody and the level of antibody positive rates were at a high level. (3) the migrant workers children school new student survey of measles related vaccine vaccination rate is not high, the freshman school type, birth place, new students after school, family income, family, number of children, parents' age, parents' years of schooling may are the influencing factors.
(4) low awareness of migrant workers' school new student related knowledge, and knowledge is relatively single and traditional way, new student school type, birth place, family income, family, number of children, parents' age, parents' years of schooling may be the influencing factors.
5 suggestion
(1) the outbreak of measles in key areas such as families, factories, migrant workers' children's schools and other key populations, such as the low age and the young and middle-aged, should be focused on the control of the family, the factory, the migrant workers' children's school and other key places.
(2) Department of education and health departments to strengthen vaccination certificate management and nursery admission, admission, vaccination certificate inspection work.
(3) combined with the characteristics of the crowd, we should use targeted publicity strategies and ways to improve the awareness rate of vaccination related knowledge in order to promote the vaccination of the population from passive vaccination to active vaccination, and effectively prevent the existence of blank points of measles vaccination.
(4) adjust the immune strategy and refinement work: on the one hand to a solid foundation to carry out targeted immunization, focus groups and the implementation of leak replant immunization strategies suitable for specific populations, on the other hand, we must focus on strengthening the hardware construction, optimization of immunization services, to form an effective, high level of population immunity barrier.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R186.3

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本文編號(hào)：1766986