【作者】 郭威；

【导师】 姜宝法；

【作者基本信息】 山东大学 ， 流行病与卫生统计学， 2009， 硕士

【摘要】 【背景】1995年以来,德州市麻疹发病率一直控制在较低水平,但2005年起发病率大幅上升,并维持在较高水平,给我省消除麻疹工作带来了严峻的挑战。2005-2007年德州市麻疹发病连续三年处于高发状态,自2005年以来德州市进入麻疹高发流行。目前,德州市免疫规划工作发展很不平衡,部分地区麻疹疫苗常规免疫存在薄弱环节,近几年我市麻疹发病年龄也出现了明显变化,发病年龄后移成人发病增多,8月龄内不可预防病例较多。为此,探讨德州市麻疹发病的影响因素,明确德州市麻疹传播的重要环节,为采取进一步的防控措施提供依据意义重大。【研究目的】了解德州市麻疹疫苗(MV)免疫效力,探讨德州市麻疹发病的影响因素,评价影响因素在人群中的分布与不同,为采取进一步的防控措施、调整控制策略提供依据。【研究方法】采用单纯随机抽样的方法,现场回顾性调查麻疹病例和对照,填写个案调查表,采集麻疹病例血清标本进行实验室检查,并查阅病人相关的病历资料。采用回顾性调查计算麻疹疫苗效力(VE)。采用1:1配比病例对照方法对德州市2008年104例麻疹患者进行发病影响因素的条件Logistic回归分析。【结果】共调查病例和对照各104人,计算MV效力(VE)为86.8%,95%可信区间为73.5%～93.4%;＜15岁年龄组MV效力(VE)为78.1%,95%可信区间为50.4%～90.3%;农村MV效力(VE)比城市要高。单因素分析结果,医疗机构暴露史、发热出疹病人接触史、外出史是发病的危险因素,有麻疹疫苗接种史是保护性因素。多因素条件Logistic回归分析结果,影响麻疹发病的因素有医疗机构暴露(OR=7.19)、与发热出疹病例接触(OR=5.21)、麻疹疫苗接种史(OR=0.15)。＜8月龄儿童麻疹发病影响因素分析显示医疗机构暴露史是其唯一的危险因素。病例组疫苗接种率明显比对照组的要低,随着免疫剂次的提高,麻疹发生的危险性要小。＜15岁年龄组病例调查显示,是否接种疫苗与儿童性别无关,而与父母文化程度、是否接到预防接种通知、父母对免疫预防基本信息的掌握情况以及胎次有关。麻疹患者中,发病前3周内57.69%(60例)有医疗机构暴露史,因病而暴露的病例中≤7岁儿童是预检分诊的重要人群。麻疹患者发病前3周内暴露于医疗机构的次数为0～7次(1.90±1.78),农村多于城市。暴露次数越多,患麻疹的危险越大。53例(占50.96%)麻疹患者首次就诊的医疗机构为私人门诊或村级卫生室。病人于麻疹发病后至最终确诊为麻疹所需时间为1～26天(5.11±4.07),农村病例要比城市所需时间要长。【结论与建议】1＜15岁年龄组MV效力(VE)不高,要进一步科学、规范开展预防接种工作。2有医疗机构暴露史、发热出疹病例接触史、未接种过麻疹疫苗的人容易发生麻疹。3当前麻疹疫苗免疫策略完全正确。4麻疹的防控,需要重视医疗机构院内感染控制工作,需要加强农村的基层医疗机构传染病防控建设。5德州市基层免疫预防工作尚需加强。更多还原

【Abstract】 [Background]Since 1995, measles incidence in Dezhou City has been at a relatively low level. However, since 2005 the incidence increased substantially, and maintained at a high level, this give the elimination of measles in our province a serious challenge. Dezhou incidence of measles in 2005-2007 was in a high occurrence status. Since 2005, Dezhou enter the high prevalence of measles.At present, the development of Dezhou programme on immunization is very uneven. Some areas of measles vaccine for routine immunization have weaknesses. In recent years, there have been significant changes in the age of measles. Adult-onset was increased. Within the 8-month-old person can not be more preventable. To this end, we explore the factors of measles incidence. Clear important aspect of measles transmission, to provide a basis for prevention and control of measles is a great significance.[Objective]To clear the vaccine efficacy of measles vaccine in dezhou; To investigate the measles prevailing factors in dezhou, evaluate the distribution and different of the prevailing factors in the population, so as to provide or adjust the strategies for measles control.[Methods]Using simple random sampling method, retrospective investigation was used and case questionnaire were filled completedly. Measles cases were collected serum samples for laboratory examination. The Patient information on medical records was searched. Retrospective investigation was used to calculate the vaccine efficacy of measles vaccine; A 1:1 pairmatched case-control study was conducted with 104 cases of measles. Multivariate conditional logistic analysis was used for data analysis. Field investigation were made for cases and controls.[Results]104 cases and 104 controls were investigated. The vaccine efficacy of measles vaccine was 86.8%(95%CI=73.5%～93.4%). The vaccine efficacy of measles vaccine of the group under the age 15 was 78.1%(95%CI=50.4%～90.3%). Rural vaccine efficacy of measles vaccine is higher than the urban people.The simple factor analysis showed that the risk of measles was related to hospital exposure, contact with patients, outgoing; measles vaccine immunization was a protective factor.Multivariate conditional logistic analysis showed that OR of hospital exposure was 7.19; OR of contact with patients was 5.21; OR of measles vaccine immunization was 0.15. Influencing factors analysis showed that exposure to the history of medical institutions is the only risk factor of children under 8 months.Vaccination rate in case group was significantly lower than the control group. With the immunization doses increase the risk of measles is to the small. <15-year-old age group investigation shows that whether a children has vaccination were unrelated to sex, but to the parents education level, whether or not received vaccination notice, the parents basic information on the immune prevention, as well as the order of born.57.69% of cases had hospital exposure.≤7-year-old children are important people for Pre-separation treatment. The number of hospital exposure was 0～7 times(1.90±1.78) during three weeks before infected with measles. The number of Rural people is more than urban. The more exposure, the greater risk of measles.50.96% of cases was treated firstly at private out-patient or village hygiene room. The time for cases diagnosed as measles finally is 1～26 (5.11±4.07) days. Cases in rural areas required longer than the city.[Conclusion and Suggestions]1 The vaccine efficacy of measles vaccine of the group under the age 15 was low. We must carry out scientific and standardized vaccination.2 Hospital exposure, contact with patients and no measles vaccine immunization make a person liable to measles. 3 The current measles vaccine immunization strategy is completely correct.4 Pay more attention to hospital infection especially in measles control is important and necessary. We need to strengthen primary health care institutions in rural areas for infectious diseases prevention and control.5 Dezhou grassroots immunization work needed to strengthen.更多还原