【作者】 甘秀敏；

【导师】 聂绍发；

【作者基本信息】 华中科技大学 ， 流行病与卫生统计学， 2011， 博士

【摘要】 目的：1、评价以控制传染源为主的血吸虫病综合防治策略的近期效果,为进一步制订和调整血吸虫病防治的目标和重点提供理论依据；2、分析居民血吸虫感染率的短期变化趋势,为血吸虫感染率短期预测提供简便易行的方法学依据；3、构建血吸虫病疫情监测与预警指标体系,为我国血吸虫病疫情监测和预警系统的建设提供参考；4、探讨提高血吸虫病疫情监测与预警水平的策略和措施,为我国血吸虫病防治工作提供策略支持。方法：1、应用描述流行病学方法,分析湖北省潜江市2005-2010年和阳新县2000-2009年两个国家级血吸虫病监测点血吸虫病的流行情况；2、应用时间序列ARIMA模型和灰色预测模型对潜江市1956-2010年居民血吸虫感染率进行拟合,预测居民血吸虫感染率短期变化趋势；3、通过文献学习和资料查阅,形成专家咨询表,收集专家意见,应用Delphi法和层次分析法,筛选指标并确定其内部权重；4、应用SWOT法分析血吸虫病疫情监测与预警工作所处的内部和外部环境,并提出相应的策略和措施。结果：1、潜江市和阳新县监测点居民血吸虫感染率已分别降至0.41%和2.18%,粪检阳性率有逐年降低的趋势,其中农民和男性仍然是血吸虫感染的高危人群；两监测点耕牛血吸虫感染率已分别降至1.96%和1.67%,但家畜敞放的情况仍普遍存在；两监测点钉螺感染率已分别降至0.00%和0.24%,但有螺面积压缩不明显。2、所构建的时间序列ARIMA(1,1,0)模型和灰色预测模型拟合效果较好,预测精度较高,血吸虫感染率实际值均在预测值的95%可信区间内；两模型短期预测结果均显示未来两年潜江市居民血吸虫感染率将略有降低。3、血吸虫病疫情监测与预警指标体系包括5个一级指标、15个二级指标和48个三级指标。其中“血防干预措施”一级指标权重最大,组合权重系数排在前列的指标分别为人群感染率、上年急感人数及耕牛感染率所属的传染源疫情影响因素指标以及疫情发生及报告的疫情动态指标,与实际情况相符。协调系数检验结果显示所建立的指标体系有较高的权威性和可靠性。4、我国血吸虫病疫情监测与预警工作所面临的优势和机会分别为监测力度大和国家重视,所面临的劣势和威胁分别为无完善的监测与预警体系和当前严峻的血防形势。结论：1、湖北省血吸虫病疫情得到有效控制,以控制传染源为主的血吸虫病综合防治策略效果明显；2、时间序列ARIMA模型和灰色预测模型预测精度较好,可应用于血吸虫感染率的短期预测分析中；3、所构建的血吸虫病疫情监测与预警指标体系可在进一步实证分析和修订后应用于我国血吸虫病疫情监测与预警工作中；4、我国血吸虫病疫情监测与预警水平仍有待进一步提高,我国血防工作者应审时度势、把握机会、扬长避短,提高我国血防工作能力。创新点：1、首次应用时间序列和灰色预测模型对湖北省血吸虫病疫情进行了预测分析,为湖北省今后血防工作重点的确定和策略的调整提供科学依据；2、在国内首次构建了血吸虫病疫情监测与预警指标体系,为国家或地区血吸虫病暴发或流行的定量风险评估打下基础；3、将SWOT分析法首次应用于提高我国血吸虫病监测与预警水平的策略探讨中,为我国实现消灭血吸虫病的最终目标提供策略支持。更多还原

【Abstract】 Objectives1. To evaluate the epidemic situation of schistosomiasis and the recent effect of the comprehensive schistosomiasis control program focusing on the main transmission cycles and reservoirs in order to further adjust the targets for schistosomiasis control and provide the theoretical basis for future schistosomiasis control strategies in China.2. To analysis the short-term change trend of the residents’ infection rates of schistosomiasis so as to provide the methodological basis for short-term forecasting the infection rates of schistosomiasis.3. To establish the indicator system for schistosomiasis monitoring and early warning in order to put forward the effective references for the implementation of schistosomiasis monitoring and early warning system in China.4. To explore the strategies and intervention measures for improving the ability of schistosomiasis monitoring and early warning so as to provide the strategic support for schistosomiasis control in China.Methods1. Using descriptive epidemiological methods to analysis the longitudinal surveillance data of two national schistosomiasis surveillance sites, including Qianjiang City from 2005 to 2010 and Yangxin County from 2000 to 2009.2. Time series ARIMA model and grey model (1,1) were constructed to forecast the short-term change trend of the residents’infection rates of schistosomiasis using the annual report data from 1956 to 2010 in Qianjiang City.3. Literature review and data collection were used to form the questionnaire for expert consulting and opinion collection, then the methods of Delphi and the Analytic Hierarchy Process (AHP) were applied to screen the indicators and determine their internal weights for establishing schistosomiasis monitoring and early warning indicator system.4. SWOT analysis was used to explore the internal and external impact factors for improving the ability of schistosomiasis monitoring and early warning in China and putting forward corresponding strategies and intervention measures.Results1. The residents’infection rates of schistosomiasis in Qianjiang City and Yangxin County had decreased to 0.41% and 2.18%, respectively. The residents’ parasitological prevalence of schistosomiasis decreased year by year (P for Cochran-Armitage trendχ2test was less than 0.05) and the farmers and males were still at high risk of schistosomiasis infection. The prevalence of cattle in two national surveillance sites of Qianjiang City and Yangxin County also decreased to 1.96% and 1.67%, respectively, but the situation of gracing of cattle in the grasslands was still very widespread. Additionally, the percentage of infected snails in two national surveillance sites of Qianjiang City and Yangxin County had dropped to 0.00% and 0.24%, respectively, whereas the total area of snail habitats was not obviously and effectively compressed.2. Time series ARIMA (1,1,0) model and grey prediction model were well fitted to the data of schistosomiasis infection. These two models were proved to be reasonable models with relatively high prediction accuracy. The actual values of schistosomiasis infection rates were all in the 95% confidence interval of the predictive values. The prediction results showed that the residents’schistosomiasis infection rates in Qianjiang City would continue to decrease slightly in the next two years.3. The indicator system for schistosomiasis epidemic situation monitoring and early warning included 5 first-level indicators,15 second-level indicators and 48 third-level indicators. Among these indicators, the first-level indicator of "schistosomiasis intervention measures" had the largest weight. The most important indicators in this indicator system included the impact factors of epidemic situation, such as the schistosomiasis infection rates of humans, the number of acute schistosomiasis infection last year and the schistosomiasis infection rates of cattle, and indicators of schistosomiasis epidemic situation outbreak and report, which were in accordance with the actual situation. The results of coordination coefficient test showed that the indicator system we established had high quality of authority and reliability.4. The advantages and opportunites for improving the ability of schistosomiasis monitoring and early warning in China were greater efforts on monitoring and the whole nation’s attention, whereas no comprehensive monitoring and early warning system for schistosomiasis and the current severe situation of schistosomiasis in China were still the shortages and threats that we must face.Conclusions1. An integrated schistosomiasis control strategy focusing on the main transmission cycles and reservoirs which combines with chemotherapy, infrastructure interventions, health education and robust surveillance is feasible for effectively controlling schistosomiasis in China.2. Time series ARIMA model and grey model have showed high quality prediction accuracy. We can choose proper model for short-term forecasting of schistosomiasis according to the actual needs in the daily work of schistosomiasis control.3. The indicator system for schistosomiasis epidemic situation monitoring and early warning we have established could be used in the actual daily work after further verifying and amending.4. The ability of schistosomiasis monitoring and early warning in China still need to be improved and the workers of schistosomiasis control must judge the hour and size up the situation, seize the opportunies, adopt the good points and avoid the shortages so as to enhance the capacity of schistosomiasis control in China.Innovations1. Time series ARIMA model and grey prediction model were first applied to forecast the short-term change trend of the residents’infection rates of schistosomiasis in Qianjiang City of Hubei Province, which could provide the scientific basis for determining the priorities adjusting the targets for schistosomiasis control and provide the theoretical basis for future schistosomiasis control strategies in Hubei Province. 2. The indicator system was first established for schistosomiasis monitoring and early warning, which could provide a solid basis for the quantitative risk assessment of regional schistosomiasis outbreak or epidemic in China.3. A SWOT analysis was first used in the dicussion of strategies for improving the ability of schistosomiasis monitoring and early warning, which could provide strategic support for achieving the ultimate goal of schistosomiasis elimination in China.更多还原