發(fā)布時間：2018-04-23 06:22

  本文選題：脊髓灰質(zhì)炎 + 抗體��； 參考：《寧夏醫(yī)科大學(xué)》2009年碩士論文

【摘要】： 目的通過整理和分析寧夏回族自治區(qū)2001-2007年確診的急性弛緩性麻痹(AFP)病例個案調(diào)查表,了解寧夏回族自治區(qū)AFP病例的流行病學(xué)特征,動態(tài)掌握寧夏AFP病例發(fā)生的基本情況;分析和評價AFP病例監(jiān)測系統(tǒng)的運(yùn)行情況;同時通過隨機(jī)抽樣調(diào)查,檢測寧夏回族自治區(qū)0-14歲健康兒童血清脊髓灰質(zhì)炎抗體水平,評價人群的免疫狀況,并最終為保持人群較高的免疫水平和自治區(qū)保持無脊灰狀態(tài)提供依據(jù)。 方法整理和分析2001-2007年寧夏回族自治區(qū)上報并按照病毒學(xué)分類標(biāo)準(zhǔn),經(jīng)AFP病例分類診斷小組討論確診的AFP病例的個案調(diào)查表和隨訪表等,分析AFP病例的流行病學(xué)特征;同時通過對2001-2007年AFP病例監(jiān)測系統(tǒng)及時性、完整性、敏感性三個指標(biāo)的分析,評價AFP監(jiān)測系統(tǒng)的運(yùn)行狀況;運(yùn)用隨機(jī)抽樣的方法,抽取銀川市、中衛(wèi)市、固原市0-14歲健康兒童,按0歲組、1歲組、2-4歲組、5-9歲組、10-14歲組分為5個不同年齡組,采用酶聯(lián)免疫吸附試驗(ELISA)檢測健康兒童脊灰IgG抗體,調(diào)查了解我區(qū)健康兒童的脊灰免疫水平。 結(jié)果2001-2007年寧夏回族自治區(qū)共確診非脊灰AFP病例150例,15歲以下兒童非脊灰AFP病例年報告發(fā)病率分別為1.01/10萬、1.40/10萬、1.42/10萬、1.58/10萬、1.23/10萬、1.77/10萬、2.03/10萬,均達(dá)到了國家衛(wèi)生部規(guī)定的≥1/10萬的標(biāo)準(zhǔn);五個市均有病例報告,其中固原市15歲以下兒童非脊灰AFP病例報告發(fā)病率最高,為1.73/10萬,其次是石嘴山市、中衛(wèi)市、銀川市和吳忠市,報告發(fā)病率分別為1.47/10萬、1.44/10萬、1.30/10萬和1.12/10萬;以縣為單位,有8個縣報告發(fā)病率未達(dá)到國家規(guī)定的標(biāo)準(zhǔn);AFP發(fā)病年齡主要集中在0-5歲,占56.0%;從免疫史分析來看,“0”劑次占3.3%,1-2劑次占14.7%,≥3劑次占76.0%,不詳占6.0%;AFP是一組疾病,在眾多的疾病中,格林巴利綜合癥所占比例最大,占42.7%;所有的AFP病例均采集了糞便標(biāo)本,合格糞便標(biāo)本采集率為85.3%,25例糞便標(biāo)本分離到腸道病毒(EV),腸道分離陽性率為16.7%,其中非脊灰腸道病毒(NPEV)18株,NPEV分離率為12.0%,脊灰病毒7例,其中脊灰病毒(PV)Ⅰ型2例,脊灰病毒(PV)Ⅱ型1例,脊灰病毒(PV)III型3例,混合型脊灰病毒1例,所有脊灰病毒(PV)經(jīng)國家脊灰實驗室復(fù)核均為疫苗株;以省為單位,AFP病例監(jiān)測系統(tǒng)2001-2007年AFP病例報告后48小時調(diào)查及時率為84.2%-100%;14天內(nèi)雙份糞便標(biāo)本采集及時率為66.7%-92.6%;糞便標(biāo)本7天內(nèi)送檢及時率為90.5%-96.6%;分離結(jié)果28天內(nèi)送達(dá)及時率為86.7%-100%;隨訪表75天內(nèi)送達(dá)及時率為76.2%-100%;陽性標(biāo)本14天送達(dá)國家及時率為均100%;銀川市、固原市、中衛(wèi)市403名健康兒童血清脊灰IgG抗體陽性率為99.0%,幾何抗體平均滴度(GMT)為1:1567,脊灰抗體水平達(dá)到保護(hù)水平的382人,保護(hù)水平的陽性率為94.8%。 結(jié)論2001-2007年寧夏AFP病例監(jiān)測系統(tǒng)運(yùn)行良好,各指標(biāo)達(dá)到了國家衛(wèi)生部規(guī)定的標(biāo)準(zhǔn),同時經(jīng)過多年的基礎(chǔ)免疫、強(qiáng)化免疫和查漏補(bǔ)種等免疫策略,健康兒童脊灰抗體水平維持在較高的水平,是寧夏回族自治區(qū)多年來保持無脊灰狀態(tài)強(qiáng)有力的保證。此外,研究也發(fā)現(xiàn)了在維持無脊灰過程中的一些問題,建議在今后的工作中進(jìn)一步加強(qiáng):1)加強(qiáng)薄弱地區(qū)的監(jiān)測工作;2)加強(qiáng)小年齡組和流動兒童的管理和免疫接種,保持高水平的免疫覆蓋率;3)提高AFP病例報告的特異性;4)加強(qiáng)健康宣傳,提高人群及時就診率;5)加強(qiáng)基層人員的業(yè)務(wù)素質(zhì),提高診斷水平和首診報告率;6)提高AFP病例合格糞便標(biāo)本的采集質(zhì)量;7)加強(qiáng)AFP病例監(jiān)測管理的督導(dǎo),及時做好每一例AFP病例的分類診斷;8)加強(qiáng)全區(qū)各疾控和醫(yī)療機(jī)構(gòu)之間的聯(lián)系,切實做好AFP病例監(jiān)測工作;9)加強(qiáng)村醫(yī)的培訓(xùn)和管理,提高村醫(yī)的工作條件和工資待遇;10)加強(qiáng)冷鏈體系監(jiān)測,保證冷鏈質(zhì)量。
[Abstract]:Objective to understand the epidemiological characteristics of the cases of AFP in the Ningxia Hui Autonomous Region by sorting out and analyzing the cases of acute flaccid paralysis (AFP) diagnosed in 2001-2007 years in the Ningxia Hui Autonomous Region, to dynamically grasp the basic situation of the occurrence of the AFP cases in Ningxia, and to analyze and evaluate the operation of the monitoring system for the cases of AFP disease; and by random pumping. A sample survey was conducted to detect the level of serum poliomyelitis antibody in healthy children aged 0-14 years in the Ningxia Hui Autonomous Region, to evaluate the immune status of the population, and to provide the basis for maintaining a high level of immunity in the population and keeping the polio free state of the autonomous region.
Methods to organize and analyze the the Ningxia Hui Autonomous Region report for 2001-2007 years and according to the classification criteria of Virology, the case classification and follow-up table of the confirmed AFP cases were discussed by the AFP case classification diagnosis group, and the epidemiological characteristics of the AFP cases were analyzed. At the same time, three cases of the 2001-2007 year AFP disease monitoring system were timeliness, integrity and sensitivity. The operation status of AFP monitoring system was evaluated. The 0-14 year old healthy children of Yinchuan City, Zhong Wei city and Guyuan city were selected by random sampling method. According to 0 year old group, 1 year old group, 2-4 year old group, 5-9 year old group and 10-14 year old group, 5 different age groups were divided into 5 different age groups, using enzyme linked immunosorbent assay (ELISA) to detect the polio IgG antibody in healthy children. The level of polio immunity in healthy children.
Results in 2001-2007 years, 150 cases of non polio AFP were confirmed in the Ningxia Hui Autonomous Region. The incidence rate of non polio AFP cases in children under 15 years old was 1.01/10 million, 1.40/10 million, 1.42/10 million, 1.58/10 million, 1.23/10 million, 1.77/10 million, 2.03/10 million, all reached the standard of more than 1/10 million stipulated by the Ministry of health; five cities had case reports. The incidence of non polio AFP cases of children under 15 years old in middle Guyuan was the highest incidence rate of 1.73/10 million, followed by Shizuishan, Zhong Wei City, Yinchuan city and Wuzhong City, the incidence rate was 1.47/10 million, 1.44/10 million, 1.30/10 Vanward 1.12/10 million, and the county was the unit, and the incidence of the disease was not reached the national standard; AFP was the main age of the disease. The concentration was 0-5 years, accounting for 56%. From the analysis of the history of immunization, "0" was 3.3%, 1-2 times accounted for 14.7%, more than 3 times, 76% and 6%. AFP was a group of diseases, and among the many diseases, Green Barre syndrome accounted for the largest proportion of 42.7%; all AFP cases collected fecal specimens, the collection rate of qualified fecal specimens was 85.3%, 25 cases The fecal specimens were isolated to enterovirus (EV), the positive rate of intestinal isolation was 16.7%, of which 18 were non polio enterovirus (NPEV), NPEV separation rate was 12%, polio virus 7, poliovirus (PV) type I 2, poliovirus (PV) type II 1 cases, poliovirus (PV) III type 3 cases, mixed poliovirus 1 cases, and all poliovirus (PV) through national polio The reexamination of the laboratory was all vaccine strain; with the province as a unit, the AFP case monitoring system was reported for 48 hours after 2001-2007 years of AFP case report, and the timely rate was 84.2%-100%; the timely rate of double fecal specimen collection was 66.7%-92.6% in 14 days, and the timely rate of fecal specimens was 90.5%-96.6% in 7 days; the rate of delivery in 28 days was 86.7%-100%; the follow-up table was 75. The timely delivery rate was 76.2%-100%, and the positive rate was 100% in 14 days. The positive rate of serum IgG antibody of 403 healthy children in Yinchuan, Guyuan and Zhong Wei city was 99%, the average titer of the geometric antibody (GMT) was 1:1567, and the level of polio antibody reached 382, and the positive rate of the protection level was 94.8%.
Conclusion the Ningxia AFP case monitoring system has been running well in the past 2001-2007 years. Each index has reached the standard prescribed by the national Ministry of health. At the same time, after years of basic immunization, strengthening immunity and leakage of replanting and other immunization strategies, the level of polio antibody in healthy children has been maintained at a high level. It has been strong in the Ningxia Hui Autonomous Region for years to keep the polio free state. In addition, the study also found some problems in the maintenance of polio free process and suggested further strengthening in future work: 1) strengthening monitoring in weak areas; 2) strengthening the management and immunization of small age groups and mobile children, maintaining a high level of epidemic coverage; 3) enhancing the specificity of the AFP case report; 4) strengthening Health publicity, improve the rate of timely medical treatment of the crowd; 5) strengthen the professional quality of the grass-roots personnel, improve the diagnostic level and first diagnosis report rate; 6) improve the quality of the collection of AFP cases, 7) strengthen the supervision and management of the monitoring and management of AFP cases, do a good job in the classification diagnosis of each case in time; 8) strengthen the disease control and medical institutions in the whole area. Contact, conscientiously do a good job of AFP case monitoring; 9) strengthen the training and management of village doctors, improve the working conditions and wages of village doctors; 10) strengthen the monitoring of cold chain system and ensure the quality of cold chain.

【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2009
【分類號】：R186

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