本文選題：麻疹疫苗 + 短期效果��； 參考：《浙江大學》2007年碩士論文

【摘要】： 目的隨著麻疹疫苗的大規(guī)模接種,麻疹發(fā)病有顯著的下降,但近幾年麻疹疫情形勢依然嚴峻,發(fā)病數(shù)居高不下,正常的季節(jié)分布被打破,嚴重的不良反應時有發(fā)生。不少專家和領導關注現(xiàn)階段麻疹疫苗接種是否能消除或控制麻疹,接種成本和效益比較是否經(jīng)濟合理。為進一步有效控制麻疹的發(fā)病,評價現(xiàn)階段接種麻疹疫苗的衛(wèi)生經(jīng)濟學指標,特組織此次研究。方法抽取每個縣區(qū)選取3家接種單位和市縣疾控中心為調查對象,調查2006年疫苗使用成本、冷鏈設備價值折舊等八個方面。調查覆蓋的疫苗品種為國家和省免疫規(guī)劃的七種疫苗。調查了321例2006年麻疹的治療費用和陪護人工損失和每日交通費用情況,病例覆蓋了2006年杭州市麻疹發(fā)病的所有病例(除部分調查中失訪的病例)。分析杭州市連續(xù)15年八月齡兒童麻疹疫苗基礎免疫效果數(shù)據(jù),列舉了其它同類研究HI檢測麻疹疫苗初免前后血凝抑制抗體水平結果,分析了免前抗體滴度與免后抗體滴度的相關關系,免前滴度與陽轉率、免后保護率的相關性關系,并對免前滴度與抗體滴度增長倍數(shù)兩者的關系進行了曲線擬合,以求出麻疹疫苗免疫后短期效果。以杭州市1950～2006年疫情資料為基礎,分別用“指數(shù)平滑法”(EXSMOOTH)、“易感人群減少法”和“中位數(shù)法”來預測麻疹發(fā)病數(shù),計算減少發(fā)病例數(shù)。以統(tǒng)計局公布的國民生產(chǎn)總值、人均國民收入、城鄉(xiāng)居民人均消費支出計算避免陪護誤工而創(chuàng)造的產(chǎn)值和減少死亡所能創(chuàng)造的產(chǎn)值。結果根據(jù)成本費用調查結果,2006年麻疹疫苗預防接種成本費用共需6132091元,其中疫苗成本為431925元,家長陪護損失工時費3527437元。匯總15年1027對免疫效果監(jiān)測數(shù)據(jù)得出,麻疹接種后一個月后達到1:2保護水平的有93.48%;文件檢索后同類研究的免后平均保護率達到96.60%,將免前滴度作對數(shù)轉換,用X表示log10(免前滴度),再用變量Z表示免疫接種前后抗體滴度之比,最后用變量X和Z分別做直線方程、對數(shù)方程、等比級數(shù)曲線模型和指數(shù)方程,發(fā)現(xiàn)指數(shù)曲線的擬合優(yōu)度相對較好,并有統(tǒng)計學意義,指數(shù)方程為Z=14.1087X-0.8837。分別用不同方法推算麻疹疫苗接種后病例減少數(shù),用simple法推算年均減少發(fā)病17002.70例;用holt法推算1年均減少發(fā)病9337.59例。用易感人群減少法推算麻疹發(fā)病減少數(shù)5090人。以大規(guī)模按月接種麻疹疫苗前的1951年到1983年的發(fā)病率中位數(shù)235.04/十萬來推算,在接下來的23年平均每年減少發(fā)病13357人。直接經(jīng)濟效益計算,根據(jù)調查結果平均每例麻疹的治療費用和易感人群減少法推算的減少發(fā)病數(shù)得出減少直接治療費用損失9482670元。陪護誤工損失費2809720.5元,養(yǎng)育損失費6200元,治療過程中的交通損失費用681554.3元。匯總得出直接效益12980145元。間接經(jīng)濟效益,根據(jù)治療費用調查結果,避免陪護誤工能創(chuàng)造的產(chǎn)值6721595.5元,減少死亡所能創(chuàng)造產(chǎn)值4720342.1元,以上2項合計避免間接經(jīng)濟損失11441937.6元�？傂б�,①凈效益=直接收益+間接收益-成本=12980145+11441937.6-6132091=18289992元②成本與總效益比值=成本/總效益=6132091/18289992=1/2.98。結論在現(xiàn)階段接種麻疹疫苗仍有較好的衛(wèi)生經(jīng)濟學效益。
[Abstract]:Objective with the large-scale vaccination of measles vaccine, the incidence of measles has decreased significantly, but in recent years the situation of measles epidemic situation is still severe, the incidence of the disease is still high, the normal seasonal distribution is broken and the serious adverse reaction occurs. Many experts and leaders pay attention to the current stage of measles vaccination to eliminate or control measles and inoculate In order to further effectively control the incidence of measles, to evaluate the health economic indicators of measles vaccine at the present stage, this study is a special organization. Methods 3 inoculation units and city and county CDC in each county were selected to investigate the cost of vaccine use in 2006, the depreciation of cold chain equipment, and so on. Eight. The survey covered seven vaccines for national and provincial immunization programs. 321 cases of measles treatment costs, artificial loss and daily traffic cost in 2006 were investigated. All cases of measles in Hangzhou were covered by all cases in 2006 (except for cases lost in some surveys). The analysis of Hangzhou city for 15 years eight consecutive years. The results of the basic immunization effect of measles vaccine in children of the month of age were given, and the results of the blood coagulation inhibition antibody level before and after the detection of measles vaccine before and after HI were enumerated, and the correlation between the titer of the pre free antibody and the titer of the post immune antibody, the correlation between the pre free titer and the positive conversion rate, the post free protection rate, and the increase of the titer and the titer of the antibody were also analyzed. The relationship between the long multiple of the two was fitted to the short-term effect of the measles vaccine. Based on the data of the 1950~2006 year epidemic situation in Hangzhou, the number of measles was predicted by the "exponential smoothing method" (EXSMOOTH), the method of "susceptible population reduction" and "median method", and the number of cases was reduced. Gross national product (GNP), per capita national income, and per capita consumption expenditure of urban and rural residents can be calculated to avoid the output value created by escort, and to reduce the output value created by death. Results according to the cost and cost survey results, the cost and cost of measles vaccine inoculation needed 6132091 yuan in 2006, and the cost of the vaccine was 431925 yuan. 3527437 yuan ($3527437). A total of 15 years of immunization monitoring data were collected. 93.48% of the 1:2 protection level was reached one month after the measles inoculation. The average post free protection rate of the similar study after the file retrieval was 96.60%, the pre free titer was used as the logarithmic conversion, the log10 was expressed with X, and the variable Z was used to indicate the titer of antibody before and after immunization. In the end, the linear equation, the logarithm equation, the equivalent series curve model and the exponential equation are used respectively with variable X and Z. The goodness of fit of the exponential curve is found to be relatively good and has statistical significance. The exponential equation is used to calculate the number of cases after measles vaccine inoculation by different methods, and the average annual decrease is calculated by simple method. The incidence of 17002.70 cases was calculated by Holt method, and 9337.59 cases were reduced in 1 years. The incidence of measles was reduced by 5090. The median rate of 235.04/ one hundred thousand from 1951 to 1983 before the measles vaccination was calculated, and 13357 people were reduced annually for the next 23 years. Direct economic benefits were reduced. Calculation, according to the results of the investigation, the average cost of each case of measles and the reduction of the incidence of susceptible population reduction were 9482670 yuan to reduce the cost of direct treatment, 2809720.5 yuan for the loss of escort, 6200 yuan for the cost of breeding and 681554.3 yuan for the loss of traffic in the treatment process. The direct benefit was 12980145 yuan. Economic benefits, according to the results of the treatment cost survey, avoid the output value created by escort workers 6721595.5 yuan, reduce death to create output value of 4720342.1 yuan, the above 2 total to avoid indirect economic losses of 11441937.6 yuan. Total benefits, (1) net benefit = direct income + indirect income - the cost of =12980145+11441937.6-6132091=18289992 yuan (2) cost Compared with the total benefit ratio = cost / total benefit =6132091/18289992=1/2.98. conclusion the measles vaccine still has better health economics benefits at this stage.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2007
【分類號】：R186

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