本文選題：手足口病　切入點(diǎn)：流行　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的手足口病作為發(fā)病率較高的腸道傳染病,對(duì)天津市某區(qū)居民的健康造成較大影響,為了掌握該地區(qū)手足口病的流行規(guī)律,分析該區(qū)2010～2016年手足口病的流行特征,同時(shí)對(duì)手足口病聚集疫情、死亡病例、病原監(jiān)測、EV71中和抗體監(jiān)測以及EV71疫苗接種情況進(jìn)行描述和分析,為今后防控手足口病提供科學(xué)的分析結(jié)論,制定科學(xué)有效的防控策略。方法對(duì)該區(qū)2010～2016年手足口病的疫情報(bào)告、病原監(jiān)測、中和抗體監(jiān)測和疫苗接種數(shù)據(jù)進(jìn)行統(tǒng)計(jì),運(yùn)用描述性分析方法揭示流行規(guī)律和特征;分布資料利用卡方檢驗(yàn)進(jìn)行統(tǒng)計(jì)分析;對(duì)聚集性疫情的報(bào)告及時(shí)性和持續(xù)時(shí)長,利用相關(guān)分析進(jìn)行統(tǒng)計(jì)推斷分析。結(jié)果1、2010年～2016年天津市該區(qū)累計(jì)報(bào)告手足口病8431例,其中重癥病例5例,死亡病例3例,共報(bào)告處置聚集疫情111起,暴發(fā)疫情1起。年發(fā)病率最高達(dá)299.17/10萬,最低為118.37/10萬,雖然呈下降趨勢(shì),但各年度均高于全市發(fā)病率水平。流行曲線呈現(xiàn)單峰或雙峰流行模式,全年高峰一般在6月～7月,季節(jié)性發(fā)病特征明顯。2、該區(qū)手足口病發(fā)病街區(qū)分布中金鐘街、新立街、萬新街占據(jù)前三位,手足口病聚集疫情主要發(fā)生在托幼機(jī)構(gòu),散居兒童出現(xiàn)多起重癥死亡病例。發(fā)病人群集中在5歲以下兒童,發(fā)病構(gòu)成占82.18%,散居兒童發(fā)病占比62.29%,男女發(fā)病性別比合計(jì)為1.5:1。死亡病例主要發(fā)生在3歲以下兒童,診治延遲是主要原因,應(yīng)加強(qiáng)對(duì)重癥傾向早期識(shí)別和臨床監(jiān)護(hù)。3、該區(qū)手足口病病原監(jiān)測結(jié)果顯示,病毒主要構(gòu)成是CVA16,EV71,CVA6和CVA10,檢出陽性率分別為28.88%,24.96%,13.01%,和2.32%,CVA6在近年來的流行中所占比例較高,但是EV71還是導(dǎo)致重癥死亡病例的主要病原體,其他腸道病毒EV還需進(jìn)一步分型明確。4、該區(qū)手足口病聚集疫情主要分布在私立托幼無證托幼機(jī)構(gòu)和公立幼兒園,在疫情總數(shù)中占比分別為46.85%和27.93%,托幼機(jī)構(gòu)是手足口病疫情發(fā)生的重要場所,聚集疫情的發(fā)現(xiàn)報(bào)告及時(shí)的占比50.45%,疫情持續(xù)時(shí)間平均數(shù)為6.35天,最短為2天,最長為25天,發(fā)現(xiàn)報(bào)告及時(shí)性和疫情持續(xù)時(shí)間有密切相關(guān)性,報(bào)告越及時(shí),疫情持續(xù)時(shí)間越短,r=0.885,P=0.000。5、2010～2016年該區(qū)健康人群EV71中和抗體監(jiān)測結(jié)果顯示,男性抗體陽性率66.12%,女性抗體陽性率76.10%,5個(gè)年齡段中陽性率最低的年齡組為1～5歲,隨著年齡段增加,依次上升,16～25歲陽性率達(dá)到頂峰,26～35歲組有所下降。隱性感染率在2010年最低為7.50%,之后2014年達(dá)到最高為55.00%。累計(jì)總體中和抗體陽性率為71.79%,累計(jì)總體隱性感染率為28.21%�？贵w陽性率最低的1～5歲組為易感人群,6歲及以上人群的隱性感染率較高且是重要的傳染源。6、手足口病疫苗有廣闊的前景,單價(jià)疫苗是一個(gè)良好的開端,安全有效且成本低廉的多價(jià)疫苗是最終目標(biāo)。該區(qū)2016年共有477名適齡兒童接種EV71疫苗,經(jīng)過數(shù)月觀察,保護(hù)率達(dá)到100%。結(jié)論天津市該區(qū)2010～2016年手足口病發(fā)病率雖然呈現(xiàn)下降趨勢(shì),但是仍高于全市平均水平,托幼機(jī)構(gòu)尤其是私立無證聚集疫情的主要發(fā)生地,易感人群主要是5歲及以下兒童,男性發(fā)病占明顯優(yōu)勢(shì),死亡病例缺乏重癥傾向早期識(shí)別和臨床監(jiān)護(hù)。成人的EV71隱性感染率較高,兒童的中和抗體陽性率較低,缺乏保護(hù)性抗體也是兒童成為易感人群的因素。EV71疫苗上市時(shí)間較短,該區(qū)的接種數(shù)據(jù)呈現(xiàn)出較好的保護(hù)性,如今面對(duì)多種腸道病毒流行株共存的現(xiàn)狀,多價(jià)手足口病疫苗是未來防控手足口病的關(guān)鍵。
[Abstract]:The purpose of the foot and mouth disease as intestinal infectious disease with high incidence, resulting in a greater impact on the health of residents in a district of Tianjin City, in order to grasp the epidemic regularity of HFMD in the region, analysis of the epidemic characteristics of the area 2010~2016 years of HFMD, and gathered HFMD epidemic, deaths, pathogen monitoring, description analysis of EV71 and neutralizing antibody monitoring and EV71 vaccination, provide scientific analysis for the prevention and control of hand foot and mouth disease, formulate scientific and effective prevention and control strategies. Methods of hand foot mouth disease in the 2010~2016 report of the epidemic, pathogen monitoring, neutralizing antibody monitoring and vaccination for statistical data, using descriptive analysis to reveal the regularity of epidemic and characteristics; distribution data were analyzed by chi square test; on the aggregation of the epidemic report timeliness and duration, using correlation analysis in statistical inference The analysis results in the 12010 years to 2016. Tianjin City, the District reported a total of 8431 HFMD cases, including 5 cases of severe cases and 3 death cases were reported, the disposal of aggregation of the epidemic since 111, 1 outbreaks. The annual incidence rate of up to 299.17/10 million, the lowest is 118.37/10 million, although the downward trend, but the annual incidence rate is higher than the city level. The epidemic curve is unimodal or Shuangfeng popular mode, annual peak in June to July, the seasonal incidence of obvious characteristics of.2, the incidence of HFMD block distribution in Admiralty street, new street, Wan Street to occupy the top three, gathered HFMD outbreaks occurred in kindergartens, children were more severe. The incidence of death in children under 5 years old, the incidence accounted for 82.18%, the incidence of scattered children accounted for 62.29%, the incidence ratio of male to female for a total of 1.5:1. deaths mainly occurred in children under 3 years old. The diagnosis and treatment of delayed, is the main reason, should strengthen the early recognition of severe tendency and clinical monitoring of.3, the HFMD pathogen monitoring results show that the virus is mainly composed of CVA16, EV71, CVA6 and CVA10, the positive rate was 28.88%, 24.96%, 13.01%, and 2.32%, a higher proportion of CVA6 accounted for in recent years popular, but EV71 is the main pathogen causing severe deaths, other intestinal virus EV still need further typing clear.4, the region gathered HFMD epidemic mainly in private kindergartens and nurseries without a public kindergarten, the epidemic in total accounted for 46.85% and 27.93%, kindergarten is an important place for the outbreak foot and mouth disease, the report found that the aggregation of the epidemic timely accounted for 50.45%, the average number of epidemic duration was 6.35 days, the shortest 2 days, the longest 25 days, found that the timeliness of reporting and epidemic duration are closely related The correlation of the report in a timely manner, the epidemic duration is shorter, r=0.885, P=0.000.52010 ~ EV71 healthy people 2016 the neutralizing antibody monitoring results showed that the positive rate of antibody positive rate of male 66.12%, female 5 age 76.10% antibody, the positive rate of the minimum age was 1~5 years, with the increasing of age, in order to rise, at the age of 16~25, the positive rate reached a peak of 26~35 year old group were decreased. The recessive infection rate was lowest in 2010 7.50%, in 2014 reached the highest positive rate of neutralizing antibody 55.00%. accumulative total is 71.79%, the cumulative total latent infection rate was 28.21%. the lowest antibody positive rate of 1~5 groups to the susceptible population, recessive population aged 6 and above the infection rate is high and is an important source of infection.6 HFMD vaccine has broad prospects, monovalent vaccine is a good start, multivalent vaccine is safe and effective and low cost is the ultimate goal. In 2016, a total of 477 school-age children vaccinated with EV71 vaccine, after months of observation, the protection rate of 100%. of Tianjin City, district 2010~2016 years the incidence of hand foot and mouth disease although decreased, but still higher than the average level of the city, especially in nurseries mainly private undocumented epidemic situation aggregation, susceptible population is mainly children under 5 years old, the incidence of male deaths is dominant, lack of severe tendency of early identification and clinical monitoring. Higher rate of occult EV71 infections in adults, the positive rate of neutralizing antibody in children is low, the lack of protective antibodies are children become susceptible factors of.EV71 vaccine for a short time, the vaccination data area showing a protective good, now face a variety of intestinal virus strains coexistence situation, vaccine polyvalent HFMD is key to the future of the prevention and control of hand foot and mouth disease.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.5;R181.3

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