【摘要】： 目的:病毒性肝炎是長(zhǎng)期困擾人民群眾身體健康的主要傳染病之一,濰坊市自1992年開(kāi)始使用甲、乙肝疫苗,研究1992～2006年濰坊市甲、乙肝疫苗應(yīng)用后對(duì)甲肝、乙肝的發(fā)病情況的影響,提出甲、乙肝疫苗推廣應(yīng)用中存在的問(wèn)題,為制定濰坊市甲肝、乙肝控制策略提供科學(xué)依據(jù)。 方法:1.收集濰坊市疫情資料年報(bào)表、疫情資料匯編,對(duì)1992～2006年甲肝、乙肝發(fā)病情況按地區(qū)分布、年齡、性別分布、職業(yè)分布、季節(jié)分布進(jìn)行統(tǒng)計(jì),用Excel 2000建立數(shù)據(jù)庫(kù)。用描述性分析的方法分析濰坊市1992～2006年甲肝和乙肝的流行病學(xué)特征。 2.收集濰坊市1992～2006年甲肝疫苗接種統(tǒng)計(jì)月報(bào)表、乙肝疫苗接種統(tǒng)計(jì)月報(bào)表、預(yù)防接種情況統(tǒng)計(jì)月報(bào)表、接種率抽樣調(diào)查資料,用Excel 2000建立數(shù)據(jù)庫(kù)。用抽樣調(diào)查的接種率來(lái)評(píng)價(jià)報(bào)告接種率是否可信,利用SPSS 13.0軟件對(duì)甲、乙肝疫苗接種率與甲、乙肝發(fā)病率的關(guān)系進(jìn)行相關(guān)分析。 3.收集甲肝、乙肝血清學(xué)檢測(cè)資料,分析甲、乙肝疫苗的免疫效果。 4.甲肝與細(xì)菌性痢疾的傳播途徑相似,收集濰坊市1992～2006年細(xì)菌性痢疾發(fā)病資料,比較1992～2006年甲肝和細(xì)菌性痢疾的發(fā)病情況,探討是否還有衛(wèi)生狀況的改變影響甲肝的發(fā)病。 結(jié)果:1.濰坊市1992～2006年病毒性肝炎的發(fā)病率總體上呈下降趨勢(shì),發(fā)病率由1992年的35.90/10萬(wàn)下降到2002年的最低點(diǎn)9.92/10萬(wàn),1992～1995年病毒性肝炎發(fā)病主要受甲肝的影響,且發(fā)病曲線與甲肝的發(fā)病曲線相似,1996～2006年病毒性肝炎發(fā)病主要受乙肝的影響,且發(fā)病曲線與乙肝的發(fā)病曲線相似。甲肝的發(fā)病率從1992年的26.23/10萬(wàn),急劇下降到1994年的6.41/10萬(wàn),1995年后下降平穩(wěn),且維持在低水平,2006年發(fā)病率最低,為0.48/10萬(wàn)。乙肝的發(fā)病率變化不大,1995年發(fā)病率最低,為6.81/10萬(wàn),2004年出現(xiàn)一個(gè)小高峰,發(fā)病率為15.99/10萬(wàn),并有上升趨勢(shì)。 2.濰坊市1992～2006年病毒性肝炎發(fā)病較高的地區(qū)有青州、壽光、臨朐、高密。甲肝發(fā)病有秋季高峰,乙肝發(fā)病無(wú)明顯的季節(jié)高峰,12月份甲、乙肝的發(fā)病率均為全年最低。甲、乙肝病例中,14歲以下人群發(fā)病構(gòu)成比呈逐年下降的趨勢(shì)。甲肝的發(fā)病以學(xué)生、農(nóng)民為主,構(gòu)成比分別為29.42%和28.93%;乙肝發(fā)病以農(nóng)民為主,構(gòu)成比為54.92%。甲、乙肝的發(fā)病率男性均高于女性,且有顯著性(x_(甲肝)~2=385.12,x_(乙肝)~2=1896.81)。 3.甲肝疫苗的接種率由1992年的0.01%上升到2006年的95.24%;乙肝疫苗的接種率由1992年的0.47%上升到2006年的99.57%。甲肝疫苗接種率與14歲以下兒童發(fā)病率呈負(fù)相關(guān),相關(guān)系數(shù)為-0.979(P＜0.01);甲肝疫苗接種率與全人口發(fā)病率呈也負(fù)相關(guān),相關(guān)系數(shù)為-0.967(P＜0.01)。乙肝疫苗接種率與14歲以下兒童發(fā)病率呈負(fù)相關(guān),相關(guān)系數(shù)為-0.861(P＜0.01),乙肝疫苗接種率與全人口發(fā)病率相關(guān)關(guān)系并不明顯(P＞0.05)。 4.甲肝血清學(xué)檢測(cè)調(diào)查1456名,其中有接種史1266名,無(wú)接種史190名,抗-HAV陽(yáng)性率分別為88.78%和36.32%,兩者有顯著性差異(x~2=108.62,P＜0.01)。乙肝血清學(xué)檢測(cè)調(diào)查0～14歲兒童1174名,HBsAg、抗-HBs、抗-HBc陽(yáng)性率分別為1.11%、71.12%、8.18%,未開(kāi)展接種前的1991年抽樣調(diào)查0～14歲兒童756名,HBsAg、抗-HBs、抗-HBc陽(yáng)性率分別為3.17%、12.96%、10.05%,開(kāi)展接種前后HBsAg、抗-HBs陽(yáng)性率比較有非常顯著差異(x_(HBsAg)~2=10.52,x_(抗-HBs)~2=624,P＜0.01)。 5.甲肝和細(xì)菌性痢疾的發(fā)病率均逐年下降,甲肝的發(fā)病數(shù)由1992年的2142例下降到2006年的41例,下降了98.09%,細(xì)菌性痢疾的發(fā)病數(shù)由1992年的2931例下降到2006年的852例,下降了70.93%。從發(fā)病曲線看,甲肝和細(xì)菌性痢疾的發(fā)病從1992年到1995年為快速下降期;從1996年開(kāi)始甲肝的發(fā)病率繼續(xù)下降,且處于較低水平,細(xì)菌性痢疾的發(fā)病率下降不明顯,提示衛(wèi)生狀況的改善能夠降低甲肝的發(fā)病,但甲肝疫苗的接種能夠?qū)⒓赘伟l(fā)病控制在最低水平。 結(jié)論:濰坊市1992年以來(lái)甲肝疫苗的接種能夠降低甲肝的發(fā)病率;乙肝疫苗的接種僅能夠降低14歲以下兒童乙肝的發(fā)病率,應(yīng)擴(kuò)大應(yīng)用范圍,使總?cè)丝诘陌l(fā)病率大幅降低。 對(duì)策與建議:1.加強(qiáng)領(lǐng)導(dǎo),保證資金投入 濰坊市政府應(yīng)建立病毒性肝炎防治研究專項(xiàng)基金,保障經(jīng)費(fèi)投入,研究當(dāng)?shù)馗窝琢餍刑攸c(diǎn)和規(guī)律,制定適合濰坊市的肝炎防治戰(zhàn)略規(guī)劃,做好肝炎控制工作。 2.加大甲、乙肝炎疫苗推廣應(yīng)用力度 在做好14歲以下兒童免疫接種的基礎(chǔ)上,根據(jù)甲肝的流行特征和人群免疫水平,對(duì)重點(diǎn)人群和重點(diǎn)地區(qū)開(kāi)展甲肝疫苗的接種工作。除推行新生兒接種乙肝疫苗的預(yù)防策略外,還需要關(guān)注其他人群的乙肝疫苗免疫策略。 3.開(kāi)展宣傳教育,增強(qiáng)防病意識(shí) 應(yīng)充分利用各種媒體開(kāi)展多種形式的病毒性肝炎防治宣傳,積極主動(dòng)開(kāi)展健康教育活動(dòng),使廣大群眾清楚地認(rèn)識(shí)到病毒性肝炎對(duì)人體健康的嚴(yán)重危害,了解科學(xué)防治知識(shí),增強(qiáng)強(qiáng)身健體的防病意識(shí),消除人們恐懼感。 4.加強(qiáng)病毒性肝炎的監(jiān)測(cè) 完善病毒性肝炎監(jiān)測(cè)網(wǎng)絡(luò),積極開(kāi)展病毒性肝炎發(fā)病及流行情況的監(jiān)測(cè)、疫苗接種率和人群免疫水平監(jiān)測(cè),深入了解和掌握病毒性肝炎的流行特征與發(fā)病規(guī)律,為預(yù)測(cè)疾病流行趨勢(shì)、制定有效預(yù)防控制措施提供科學(xué)依據(jù)。 5.加強(qiáng)醫(yī)源性感染控制工作 嚴(yán)格執(zhí)行《傳染病防治法》和《獻(xiàn)血法》等相關(guān)法律法規(guī),加強(qiáng)對(duì)采供血機(jī)構(gòu)和血液制品生產(chǎn)單位的監(jiān)督,加大對(duì)血液、血制品和醫(yī)療機(jī)構(gòu)消毒的監(jiān)管力度,實(shí)施安全注射,防止醫(yī)源性感染。
[Abstract]:Objective: To study the effect of hepatitis A and hepatitis B vaccine on the incidence of hepatitis A and hepatitis B after the application of hepatitis A and hepatitis B vaccine from 1992 to 2006. The existing problems in the promotion and application of hepatitis B vaccine provide a scientific basis for the development of the control strategy of hepatitis A and hepatitis B in the city. The method 1. Collect the annual report and epidemic information of the epidemic information of the Fangfang City, and make statistics on the incidence of hepatitis A and hepatitis B from 1992 to 2006 according to the regional distribution, age, sex distribution, occupational distribution and seasonal distribution, and set up the number with Excel 2000. Analysis of the epidemiology of hepatitis A and hepatitis B from 1992 to 2006 in Fangfang City by means of descriptive analysis Characteristics.2. Collect the monthly report of the vaccination statistics of the hepatitis A vaccine from 1992 to 2006, the monthly report of the hepatitis B vaccine, the monthly report of the monthly vaccination, the data on the sampling survey of the vaccination rate, and use Excel 2000. To establish a database. The rate of vaccination with a sample survey was used to evaluate the reliability of the reported vaccination rate. The relationship between the rate of hepatitis B and the incidence of hepatitis A and hepatitis B was measured by using the SPSS 13.0 software. Line-related analysis.3. Collection of serologic test data of hepatitis A and hepatitis B, and analysis of A and B The immune effect of the liver vaccine was similar to that of the bacillary dysentery. The incidence of bacillary dysentery from 1992 to 2006 was collected from 1992 to 2006, and the incidence of hepatitis A and bacillary dysentery in 1992 to 2006 was compared. the change of the condition The incidence of viral hepatitis was decreased from 35.90 per 100,000 in 1992 to 9.92 per 100,000 in 2002, and the incidence of viral hepatitis in 1992 to 1995 was mainly affected by alpha-liver. The incidence of viral hepatitis was mainly affected by hepatitis B during the period from 1996 to 2006, and the incidence of viral hepatitis in 1996-2006 was mainly affected by hepatitis B. The incidence of hepatitis A was similar to that of hepatitis B. The incidence of hepatitis A decreased from 26.23/1 million in 1992 to 6.41/10 million in 1994, decreased steadily after 1995, and maintained at a low level. The lowest rate of incidence of hepatitis B was 0.48/ 100,000. The incidence of hepatitis B was low, with the lowest incidence in 1995, which was 6.81/ 100,000, a small peak in 2004, with a prevalence of 15. .99/ 100,000, and there is a rising trend.2. The incidence of viral hepatitis from 1992 to 2006 in the Fangfang City. The higher area has Qingzhou, Shouguang, Linyi, and Gaomi. The onset of hepatitis A has a peak in autumn, and there is no obvious seasonal peak in the incidence of hepatitis B.1 In February, the incidence of hepatitis B was the lowest in the whole year. In case of hepatitis A and hepatitis B, the incidence of hepatitis B was 14 years. The incidence of hepatitis A in the following population is decreasing year by year. The incidence of hepatitis A is mainly based on students and farmers. The composition ratio is 29.42% and 28.93%, respectively. The rate of incidence of hepatitis A and hepatitis B was higher than that of female, and there was significant difference (x _ (liver) ~ 2 = 385.12. The coverage rate of hepatitis B vaccine increased from 0.01% in 1992 to 95.24% in 2006, and the vaccination rate of hepatitis B vaccine was increased by 1992 0.47% increased to 99.57% in 2006. The rate of hepatitis A vaccine was negatively correlated with the incidence of children under 14 years of age. The correlation coefficient was-0.979 (P <0.01), and the rate of hepatitis A vaccine was negatively correlated with the incidence of whole population. And the correlation coefficient was-0.967 (P <0.01). The vaccination rate of hepatitis B vaccine was negatively correlated with the incidence of children under 14 years of age, the correlation coefficient was-0.861 (P <0.01), and the vaccination rate of hepatitis B vaccine was similar to that of the whole population. The incidence of the incidence of hepatitis A was not significant (P> 0.05).4. The serologic test of the hepatitis A was 1456, including 1266 of the history of inoculation,190 without the history of inoculation, 88.78% of the anti-HAV positive rate and 36.32% of the anti-HAV, respectively. The positive rates of HBsAg, anti-HBs and anti-HBc were 1.11%, 71.12% and 8.18%, respectively. The positive rates of anti-HBc were 1.11%, 71.12% and 8.18%, respectively. The rate of anti-HBs was 3.17%, 12.96% and 10.05%, respectively. The positive rate of HBsAg and anti-HBs was significantly different before and after inoculation (x _ (HBsAg) ~ 2 = 10.52. The incidence of hepatitis A and bacillary dysentery decreased year by year. The incidence of alpha-liver decreased from 2142 in 1992 to 41 in 2006, and the incidence of bacillary dysentery decreased by 98.09%, and the number of bacillary dysentery was 29 in 1992. From the onset of the disease, the incidence of alpha-and bacillary dysentery was from 1992 to 1995. The incidence of alpha-and bacillary dysentery began to decline from 1992 to 1995, and the incidence of alpha-and bacillary dysentery began to decrease from 1992 to 1995, and the incidence of bacillary dysentery was low. It is not obvious that the improvement of the sanitary condition can reduce the hepatitis A. The infection of hepatitis A vaccine can be controlled at the lowest level. Conclusion: The vaccination of hepatitis A vaccine since 1992 can reduce the incidence of hepatitis A. The inoculation of hepatitis B vaccine can only be reduced below 14 years of age. The incidence of hepatitis B in children The application scope should be expanded to make the total The incidence of the population is significantly reduced. Countermeasures and suggestions:1. Strengthen the leadership and ensure that the government of the city and the city should set up a special fund for the prevention and control of viral hepatitis, to guarantee the input of the funds and to study the local area The characteristics and laws of the epidemic of hepatitis are formulated to be suitable for the city. the prevention and control strategic planning of hepatitis and the control of the hepatitis.2. The promotion and application of the hepatitis A and the hepatitis B vaccine are carried out to the basis of the immunization of children under the age of 14 On the basis of the prevalence of the hepatitis A and the level of immunization of the population, the joint of the hepatitis A vaccine was carried out on the key population and the key areas. work. In addition to the introduction of a neonatal inoculation of hepatitis B In addition to the prevention strategy of the vaccine, it is also necessary to pay attention to the immunization strategy of the hepatitis B vaccine of other people.3. Carry out the publicity and education, strengthen the disease prevention consciousness, and take full advantage of various media to carry out various forms of virus To promote the prevention and control of hepatitis, to actively carry out the activities of health education, to make the broad masses clear Recognition of viral hepatitis on human body To improve the monitoring network of viral hepatitis and to actively carry out the development of the monitoring network of viral hepatitis. Surveillance of the incidence and prevalence of viral hepatitis, the vaccination rate and the population's immune water Level monitoring, in-depth understanding and mastery of the virus To strengthen the control of iatrogenic infection, the prevention and control of infectious diseases and the blood donation should be strictly implemented. Law> and other relevant legal methods
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類(lèi)號(hào)】：R186

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