本文選題：甲型H1N1流感 + 抗體　； 參考：《山東大學(xué)》2011年碩士論文

【摘要】：研究背景 2009年甲型H1N1流感在我國廣泛傳播,由于甲型H1N1流感患者臨床表現(xiàn)缺乏特異性,只能通過核酸檢測和病毒分離確診,檢測費用成本高,不能廣泛應(yīng)用于臨床診斷,同時由于大量輕癥患者和隱性感染的存在,通過疾病監(jiān)測信息系統(tǒng)報告的確診病例數(shù)不能反映疫情的實際情況,因此需要了解不同時間節(jié)點我國各年齡段人群的實際感染水平,為完善疫情防控措施和應(yīng)對流感大流行提供可靠的科學(xué)依據(jù)。2009年底國家制定調(diào)查方案在全國范圍內(nèi)開展甲型H1N1流感感染狀況調(diào)查。根據(jù)方案要求,淄博市被抽取為山東省項目調(diào)查市。 研究目的 該次調(diào)查目的主要是掌握不同時期、不同地區(qū)、不同人群甲型H1N1流感感染水平；了解淄博市甲型H1N1流感病毒感染情況的動態(tài)變化趨勢,為應(yīng)對流感大流行,完善疫情防控措施提供科學(xué)依據(jù)。 資料與方法 采取多階段分層隨機(jī)抽樣方法,從淄博市9個區(qū)縣中隨機(jī)抽取2個區(qū)縣作為本次項目調(diào)查區(qū)縣,每個區(qū)縣隨機(jī)抽取2～5個街道辦事處,每個街道辦事處再隨機(jī)抽取3～5個居委會。分別于2010年1月、2010年3～4月、2010年8～9月開展三次橫斷面調(diào)查。每次調(diào)查,每個區(qū)縣按照0～5歲,6～15歲,16～24歲,25～59歲,60歲及以上5個年齡組抽取調(diào)查對象,每個年齡組在150人左右,三次橫斷面調(diào)查共抽取調(diào)查對象4500人。 對所有確定的調(diào)查對象進(jìn)行問卷調(diào)查,并采集靜脈血分離血清進(jìn)行甲型H1N1流感血凝抑制試驗,血凝抑制抗體效價≥1：40為陽性,所有調(diào)查問卷雙錄入Epidata 3.1數(shù)據(jù)庫并進(jìn)行一致性檢驗。 數(shù)據(jù)運用SPSS 13.0軟件進(jìn)行統(tǒng)計分析,率的比較采用χ2檢驗。 主要結(jié)果 1、4500名調(diào)查對象中,甲型H1N1流感病毒抗體陽性率25.60%,自然感染率21.09%,顯性感染和隱性感染比例為1.97：1。男性陽性率為27.05%,稍高于女性24.39%,不同地區(qū)間差異無統(tǒng)計學(xué)意義。 2、4500人中共有476人接種了甲型H1N1流感疫苗,占調(diào)查人數(shù)的10.58%,接種甲流疫苗者抗體陽性率42.65%,高于未接種甲流疫苗抗體陽性率23.58%。 3、全人群、接種甲型H1N1流感疫苗者和未接種甲型H1N1流感疫苗者抗體陽性率均以第一次調(diào)查為最高。接種甲流感疫苗1個月之內(nèi)抗體呈上升趨勢,15～28天抗體陽性率最高71.43%,以后隨時間推移抗體衰減,接種半年后抗體陽性率11.36%。 4、全人群甲型H1N1流感陽性率以16～24年齡組為最高33.99%,60歲以上年齡組最低14.43%。 5、全人群甲型H1N1流感陽性率以教師為最高,38.10%,學(xué)生次之,35.68%,醫(yī)務(wù)人員陽性率相對較低,19.35%。 6、至少接種1劑流感疫苗者甲型H1N1流感陽性率33.97%,高于自2007年以來未接種過流感疫苗者抗體陽性率22.54%。 7、甲型H1N1流感感染者中,發(fā)燒者占61.23%,有咳嗽癥狀者占69.70%,有咽痛癥狀者占54.80%,全部癥狀具備者所占比25.88%,感染者均為輕癥病例。 結(jié)論與建議 1、本次調(diào)查淄博市甲型H1N1流感抗體陽性率25.60%,與全國人群甲型H1N1流感病毒平均抗體陽性率一致,不同地區(qū)人群甲型H1N1流感的易感性和感染風(fēng)險是一致的。2009年甲型H1N1流感在淄博市廣泛傳播,自然感染率為21.09%,實際感染人數(shù)遠(yuǎn)遠(yuǎn)超過確診病例數(shù)。 2、甲型H1N1流感流行病學(xué)特征與季節(jié)性流感相似,一是學(xué)齡人群和年輕人群是最大的感染群體；二是在感染人群里,有一定比例的人是沒有出現(xiàn)流感樣癥狀的。 3、接種甲型H1N1流感疫苗具有良好的流行病學(xué)保護(hù)效果,接種季節(jié)性流感疫苗可能對甲型H1N1流感具有一定的交叉保護(hù)作用,特定人群中季節(jié)性H1N1流感抗體可能對甲型H1N1流感有一定程度的保護(hù)作用。 4、隨時間推移全人群、接種甲型H1N1流感疫苗者和未接種甲型H1N1流感疫苗者抗體陽性率均呈逐漸下降趨勢,以接種疫苗者抗體水平下降速率較快。 5、接種流感、甲型H1N流感疫苗可以產(chǎn)生針對性的抗體,提高人群免疫水平,由于隨著免疫后的時間推移,抗體水平有下降趨勢,建議重點人群每年接種流感疫苗。 6、擴(kuò)大流感監(jiān)測范圍,長期、連續(xù)地開展流感監(jiān)測,以便于及時、準(zhǔn)確地掌握流感活動情況,為季節(jié)性流感流行、流感大流行預(yù)警提供可靠依據(jù)。 7、定期在人群中開展流感病毒抗體監(jiān)測,可以了解人群對流感流行株的免疫保護(hù)和病毒抗原變化,為防控流感提供重要依據(jù)。
[Abstract]:Research background
Influenza A (H1N1) influenza was widely spread in China in 2009. Due to the lack of specificity in clinical manifestations of influenza A (H1N1) patients, it can only be diagnosed by nucleic acid detection and virus isolation, and the cost of detection is high. It can not be widely used in clinical diagnosis. At the same time, the disease monitoring information system has been reported for the presence of a large number of patients with mild disease and latent infection. The number of confirmed cases does not reflect the actual situation of the epidemic. Therefore, it is necessary to understand the actual infection level of the people of all ages in China at different time, and to provide a reliable scientific basis for improving the prevention and control measures and responding to the influenza pandemic in China at the end of.2009. According to the requirements of the plan, Zibo was selected as an investigation city of Shandong province.
research objective
The purpose of this survey is to grasp the level of influenza A (H1N1) infection in different periods, different regions and different populations, to understand the dynamic trend of influenza A (H1N1) virus infection in Zibo, and to provide a scientific basis for dealing with influenza pandemic and improving the prevention and control measures of the epidemic.
Information and methods
By multistage stratified random sampling, 2 districts and counties were randomly selected from 9 districts and counties in Zibo. 2~5 Street offices were randomly selected from each district and county, and 3~5 neighborhood committees were randomly selected from each street office. Three cross-sectional investigations were carried out in January 2010, 2010, 3~4 and 8~9 2010. Each district and county selected the subjects according to the 5 age groups of 0~5, 6~15, 16~24, 25~59, 60 and above, each age group of about 150 people, and three cross-sectional survey of 4500 people in each survey.
All the selected subjects were investigated by questionnaire, and the blood serum was collected for H1N1 influenza A hemagglutination inhibition test. The titer of the hemagglutination inhibition antibody was more than 1:40 as positive. All the questionnaires were recorded in the Epidata 3.1 database and tested the consistency.
Data were analyzed by SPSS 13 software, and chi square test was used to compare the rates of data. 2.
Main results
Among the 14500 subjects, the positive rate of H1N1 influenza A virus was 25.60%, the natural infection rate was 21.09%, the positive rate of dominant infection and recessive infection was 27.05%, which was slightly higher than that of female 24.39%. There was no statistical difference between different regions.
A total of 476 people were vaccinated with H1N1 influenza A (H1N1) vaccine, accounting for 10.58% of the number of people surveyed. The positive rate of antibody to the vaccine was 42.65%, which was higher than that of non immunization of 23.58%. vaccine.
3, the whole population, the positive rate of the antibody positive of the H1N1 influenza A vaccine and the uninoculated H1N1 influenza vaccine was the highest. The antibody showed an upward trend within 1 months and the positive rate of the 15~28 day antibody was 71.43%. The antibody attenuated with time and the antibody positive rate was 11.36%. after half a year.
4, the positive rate of influenza A (H1N1) in the whole population was the highest 33.99% in the 16~24 age group, and the lowest in the age group 60 and above 14.43%.
5, the positive rate of influenza A (H1N1) in the whole population was the highest among teachers, 38.10% of students, 35.68% of the students, and the positive rate of medical staff was relatively low, 19.35%.
6, the positive rate of influenza A (H1N1) is 33.97% at least 1 doses of influenza vaccine, which is higher than that of those who have not been vaccinated since 2007. The positive rate is 22.54%.
7, among those infected with influenza A (H1N1), 61.23% were fever, 69.70% with cough symptoms, 54.80% with sore throat symptoms, 25.88% of all patients with symptoms, and all cases were light cases.
Conclusions and suggestions
1, the positive rate of influenza A influenza A (H1N1) antibody in Zibo was 25.60%, which was the same as the positive rate of H1N1 influenza A virus in the whole country. The susceptibility and risk of influenza A (H1N1) influenza in different regions were consistent with the.2009 influenza A (H1N1) influenza in the city of Zibo. The natural infection rate was 21.09%, and the actual infection number was far away from the population. More than the number of confirmed cases.
2, the epidemiological characteristics of influenza A (H1N1) influenza are similar to those of seasonal influenza. One is that the school age group and the young people are the largest infected group; and the two is that in the infected people, there is a certain proportion of people who have no flu like symptoms.
3, inoculation of influenza A (H1N1) influenza vaccine has a good epidemiological protection effect. Inoculation of seasonal influenza vaccine may have a certain cross protective effect on H1N1 influenza A. The seasonal H1N1 influenza antibody in a specific population may have a certain degree of protection for a influenza A (H1N1) influenza.
4, in the whole population over time, the positive rate of antibody positive of influenza a H1N1 vaccine and non a H1N1 influenza vaccine declined gradually, and the antibody level of the vaccinated people decreased rapidly.
5, inoculation of influenza A influenza A (H1N) vaccine can produce specific antibodies to improve the immune level of the population. As the time goes on, the level of antibody decreases, and it is suggested that the key population be vaccinated every year.
6, to expand the monitoring range of influenza and to carry out continuous monitoring of influenza for a long time, so as to facilitate the timely and accurate control of influenza activity, and provide a reliable basis for the epidemic of seasonal influenza and the early warning of influenza pandemic.
7, to monitor influenza virus antibody regularly in the population, we can understand the immune protection and change of virus antigen of influenza epidemic strains, and provide important basis for preventing and controlling influenza.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R181.3

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