【摘要】：目的:了解安徽省2016年2~5月的麻疹確診病例的時(shí)空分布特征,并調(diào)查病例個(gè)案信息和感染地點(diǎn),探索病例間的流行病學(xué)關(guān)聯(lián)和影響病毒傳播的因素,為阻斷麻疹傳播提供依據(jù)。方法:收集安徽省2016年2~5月麻疹監(jiān)測(cè)數(shù)據(jù),建立地理信息(Geographic information systems,GIS)數(shù)據(jù)庫(kù)。使用Geo Da 1.4.6和Sa TScan 9.1地理信息系統(tǒng)軟件分別進(jìn)行麻疹發(fā)病率可視化展示和時(shí)空掃描統(tǒng)計(jì)分析。采用麻疹流行病學(xué)調(diào)查表,電話(huà)調(diào)查麻疹確診病例基本信息、發(fā)病前7~21天活動(dòng)史及免疫接種史等內(nèi)容。結(jié)果:1.信息系統(tǒng)報(bào)告416例麻疹確診病例,其中本省報(bào)告362例,占87.01%。在外省報(bào)告的病例以南京徐州較多。每周新發(fā)病例數(shù)波動(dòng)大,但總體處于一直上升的態(tài)勢(shì)。2.發(fā)病率圖顯示亳州譙城區(qū)、宿州碭山縣、合肥周邊地區(qū)和池州市部分地區(qū)的麻疹發(fā)病率較高,時(shí)空掃描分析顯示存在3個(gè)時(shí)空聚集性區(qū)域,分別為3月末持續(xù)至5月的亳州譙城區(qū)、3月中旬至5月中旬的合肥周邊縣區(qū)和5月中下旬的黃山市、池州市部分縣區(qū)。3.個(gè)案病例調(diào)查353例,調(diào)查完整率為84.85%,在外省感染的病例主要來(lái)自江蘇、北京、河南等地。4.15歲以下兒童麻疹病例共211例。8月齡以下的病例58例,占15歲以下兒童病例的27.49%,按時(shí)接種疫苗的病例32例,占15.17%,需要接種麻疹疫苗卻沒(méi)有按時(shí)接種的病例121例,占57.34%。病例中有5例在接種疫苗后不到15天發(fā)病。5.病例院內(nèi)感染與院外感染在性別分布上差異無(wú)統(tǒng)計(jì)學(xué)意義,在年齡結(jié)構(gòu)分布上差異有統(tǒng)計(jì)學(xué)意義,院內(nèi)感染病例在性別年齡的分布上有統(tǒng)計(jì)學(xué)差異。院內(nèi)感染主要發(fā)生在三級(jí)和二級(jí)醫(yī)院。6.調(diào)查到的麻疹病例中,能夠明確流行病學(xué)聯(lián)系的共有19起,多是與身邊人密切接觸有關(guān),包括朋友、鄰居、同事和家人。母子都感染麻疹的7起,醫(yī)務(wù)工作者感染麻疹的6起。結(jié)論:1.安徽省2016年2~5月存在空間聚集。地區(qū)發(fā)病率差距明顯。2.麻疹病例院內(nèi)感染與院外感染數(shù)量持平。3.提示院內(nèi)感染主要發(fā)生在三級(jí)醫(yī)院和二級(jí)醫(yī)院。4.小年齡組人群院內(nèi)感染多于院外感染,大年齡組人群院外感染多于院內(nèi)感染。5.小年齡組人群男性多于女性,大年齡組人群女性多于男性。6.未接種疫苗是導(dǎo)致兒童發(fā)病的最主要原因之一。7.較多病例未能在發(fā)病初期得到明確診斷,傳染源未得到有效控制。
[Abstract]:Objective: to investigate the temporal and spatial distribution of confirmed measles cases in Anhui Province from February to May 2016, and to investigate the case information and infection sites, to explore the epidemiological association between cases and the factors affecting the transmission of the virus, and to provide a basis for blocking measles transmission. Methods: measles surveillance data were collected from February to May of 2016 in Anhui Province, and geographic information (Geographic information systems,GIS database was established. The Geo Da 1.4.6 and Sa TScan 9.1 GIS software were used to visualize measles incidence and to analyze the statistics of time and space scanning respectively. The measles epidemiological questionnaire was used to investigate the basic information of confirmed measles cases by telephone, and the history of 21 days' activities and immunization before the onset of measles. The result is 1: 1. The information system reported 416 confirmed measles cases, of which 362 cases were reported in this province, accounting for 87.01%. More cases were reported in Xuzhou, Nanjing. The number of new cases per week fluctuated greatly, but the overall trend was on the rise. 2. 5%. The incidence of measles was higher in Qiaocheng District of Bozhou, Dangshan County in Suzhou, around Hefei and parts of Chizhou City. Spatio-temporal scanning analysis showed that there were three spatio-temporal clustering areas. Bozhou Qiaocheng District from the end of March to May, Hefei from mid-March to mid-May, Huangshan City from mid-to late May, and some counties from Chizhou City. A total of 353 cases were investigated, with a complete rate of 84.85. The main cases of infection in other provinces came from Jiangsu, Beijing, Henan and other places. There were 211 measles cases among children under 4.15 years of age and 58 cases under 8 months of age. Children under 15 years old accounted for 27.49% of the cases, 32 cases (15.17%) were vaccinated on time, 121 cases (57.34%) needed measles vaccine but were not vaccinated on time. Five of the cases developed less than 15 days after vaccination. There was no significant difference in sex distribution between nosocomial infection and nosocomial infection, but there was statistical difference in age structure distribution, and there was statistical difference in sex and age distribution of nosocomial infection cases. Nosocomial infection mainly occurs in level III and level II hospitals. 6. 6. A total of 19 measles cases were investigated, most of which were related to close contact with people around them, including friends, neighbors, colleagues and family. Both mothers and children were infected with measles in 7 cases, and medical workers in 6 cases. Conclusion: 1. There is a spatial aggregation in Anhui Province from February to May 2016. The regional incidence rate difference is obvious. 2. The number of nosocomial infections and nosocomial infections of measles cases was the same as that of nosocomial infections. It is suggested that nosocomial infection mainly occurs in tertiary hospitals and level II hospitals. 4. 4. Nosocomial infection was more than nosocomial infection in young age group, and nosocomial infection was more than nosocomial infection in older group. Men in the younger age group were more than women, and women in the older age group were more than men. 6. 6%. Unvaccinated is one of the leading causes of childhood morbidity. Many cases failed to get definite diagnosis in the early stage of the disease, and the source of infection was not effectively controlled.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R511.1;R181.3

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