【作者】 牟海峰；

【导师】 姜宝法； 官友生；

【作者基本信息】 山东大学 ， 流行病与卫生统计学， 2008， 硕士

【摘要】 目的:病毒性肝炎是长期困扰人民群众身体健康的主要传染病之一,潍坊市自1992年开始使用甲、乙肝疫苗,研究1992～2006年潍坊市甲、乙肝疫苗应用后对甲肝、乙肝的发病情况的影响,提出甲、乙肝疫苗推广应用中存在的问题,为制定潍坊市甲肝、乙肝控制策略提供科学依据。方法:1.收集潍坊市疫情资料年报表、疫情资料汇编,对1992～2006年甲肝、乙肝发病情况按地区分布、年龄、性别分布、职业分布、季节分布进行统计,用Excel 2000建立数据库。用描述性分析的方法分析潍坊市1992～2006年甲肝和乙肝的流行病学特征。2.收集潍坊市1992～2006年甲肝疫苗接种统计月报表、乙肝疫苗接种统计月报表、预防接种情况统计月报表、接种率抽样调查资料,用Excel 2000建立数据库。用抽样调查的接种率来评价报告接种率是否可信,利用SPSS 13.0软件对甲、乙肝疫苗接种率与甲、乙肝发病率的关系进行相关分析。3.收集甲肝、乙肝血清学检测资料,分析甲、乙肝疫苗的免疫效果。4.甲肝与细菌性痢疾的传播途径相似,收集潍坊市1992～2006年细菌性痢疾发病资料,比较1992～2006年甲肝和细菌性痢疾的发病情况,探讨是否还有卫生状况的改变影响甲肝的发病。结果:1.潍坊市1992～2006年病毒性肝炎的发病率总体上呈下降趋势,发病率由1992年的35.90/10万下降到2002年的最低点9.92/10万,1992～1995年病毒性肝炎发病主要受甲肝的影响,且发病曲线与甲肝的发病曲线相似,1996～2006年病毒性肝炎发病主要受乙肝的影响,且发病曲线与乙肝的发病曲线相似。甲肝的发病率从1992年的26.23/10万,急剧下降到1994年的6.41/10万,1995年后下降平稳,且维持在低水平,2006年发病率最低,为0.48/10万。乙肝的发病率变化不大,1995年发病率最低,为6.81/10万,2004年出现一个小高峰,发病率为15.99/10万,并有上升趋势。2.潍坊市1992～2006年病毒性肝炎发病较高的地区有青州、寿光、临朐、高密。甲肝发病有秋季高峰,乙肝发病无明显的季节高峰,12月份甲、乙肝的发病率均为全年最低。甲、乙肝病例中,14岁以下人群发病构成比呈逐年下降的趋势。甲肝的发病以学生、农民为主,构成比分别为29.42%和28.93%;乙肝发病以农民为主,构成比为54.92%。甲、乙肝的发病率男性均高于女性,且有显著性(x_甲肝²=385.12,x_乙肝²=1896.81)。3.甲肝疫苗的接种率由1992年的0.01%上升到2006年的95.24%;乙肝疫苗的接种率由1992年的0.47%上升到2006年的99.57%。甲肝疫苗接种率与14岁以下儿童发病率呈负相关,相关系数为-0.979（P＜0.01）;甲肝疫苗接种率与全人口发病率呈也负相关,相关系数为-0.967（P＜0.01）。乙肝疫苗接种率与14岁以下儿童发病率呈负相关,相关系数为-0.861（P＜0.01）,乙肝疫苗接种率与全人口发病率相关关系并不明显（P＞0.05）。4.甲肝血清学检测调查1456名,其中有接种史1266名,无接种史190名,抗-HAV阳性率分别为88.78%和36.32%,两者有显著性差异（x²=108.62,P＜0.01）。乙肝血清学检测调查0～14岁儿童1174名,HBsAg、抗-HBs、抗-HBc阳性率分别为1.11%、71.12%、8.18%,未开展接种前的1991年抽样调查0～14岁儿童756名,HBsAg、抗-HBs、抗-HBc阳性率分别为3.17%、12.96%、10.05%,开展接种前后HBsAg、抗-HBs阳性率比较有非常显著差异(x_HBsAg²=10.52,x_抗-HBs²=624,P＜0.01)。5.甲肝和细菌性痢疾的发病率均逐年下降,甲肝的发病数由1992年的2142例下降到2006年的41例,下降了98.09%,细菌性痢疾的发病数由1992年的2931例下降到2006年的852例,下降了70.93%。从发病曲线看,甲肝和细菌性痢疾的发病从1992年到1995年为快速下降期;从1996年开始甲肝的发病率继续下降,且处于较低水平,细菌性痢疾的发病率下降不明显,提示卫生状况的改善能够降低甲肝的发病,但甲肝疫苗的接种能够将甲肝发病控制在最低水平。结论:潍坊市1992年以来甲肝疫苗的接种能够降低甲肝的发病率;乙肝疫苗的接种仅能够降低14岁以下儿童乙肝的发病率,应扩大应用范围,使总人口的发病率大幅降低。对策与建议:1.加强领导,保证资金投入潍坊市政府应建立病毒性肝炎防治研究专项基金,保障经费投入,研究当地肝炎流行特点和规律,制定适合潍坊市的肝炎防治战略规划,做好肝炎控制工作。2.加大甲、乙肝炎疫苗推广应用力度在做好14岁以下儿童免疫接种的基础上,根据甲肝的流行特征和人群免疫水平,对重点人群和重点地区开展甲肝疫苗的接种工作。除推行新生儿接种乙肝疫苗的预防策略外,还需要关注其他人群的乙肝疫苗免疫策略。3.开展宣传教育,增强防病意识应充分利用各种媒体开展多种形式的病毒性肝炎防治宣传,积极主动开展健康教育活动,使广大群众清楚地认识到病毒性肝炎对人体健康的严重危害,了解科学防治知识,增强强身健体的防病意识,消除人们恐惧感。4.加强病毒性肝炎的监测完善病毒性肝炎监测网络,积极开展病毒性肝炎发病及流行情况的监测、疫苗接种率和人群免疫水平监测,深入了解和掌握病毒性肝炎的流行特征与发病规律,为预测疾病流行趋势、制定有效预防控制措施提供科学依据。5.加强医源性感染控制工作严格执行《传染病防治法》和《献血法》等相关法律法规,加强对采供血机构和血液制品生产单位的监督,加大对血液、血制品和医疗机构消毒的监管力度,实施安全注射,防止医源性感染。更多还原

【Abstract】 Objective:Viral hepatitis is one of the major infectious diseases,and it has been affected the people’s health in a long time.Hepatitis A and B vaccine has been used in Weifang City from1992,this study researched the effect of the two vaccines on Hepatitis A and B diseases,and to put forward the questions in the utilizations of the two vaccines.We hope to provide evidence for the control of Hepatitis A and B diseases in Weifang City.Method:1.Collect the reports and data of the epidemic situation in Weifang City,to make statistics of the epidemic information on hepatitis A and B diseases from 1992 to 2006,including:distributions by people,time and place.Using Excel 2000 to build the database,and analyze the epidemic characters of hepatitis A and B diseases from 1992 to 2006 in Weifang City by descriptive study.2.Collect the monthly reports of the statistic data for hepatitis A and B vaccination statements from 1992 to 2006 in Weifang City.Using Excel 2000 to build the database.Progress the sample survey to assess the rate of vaccination coverage. Using SPSS 13.0 software to make the related analysis on the hepatitis A/B vaccination rate and the incidence of hepatitis A/B diseases.3.Collect the data of hepatitis A and B serologic test,analyze the immunity effect of hepatitis A and B vaccine.4.The transmission of Bacillary dysentery and hepatitis is similar,collecting the incidence of bacterial dysentery information from 1992 to 2006 in Weifang City, comparising the incidence of hepatitis A and bacillary dysentery from 1992 to 2006, and explore whether there are health status change affecting the incidence of hepatitis A.Results:1.The incidence of viral hepatitis from 1992 to 2006 has decreased in Weifang City,from 35.90 per 10 million in 1992 dropped to he lowest point 9.92 per 10 million in 2002.from 1992 to 1995 the incidence of virus hepatitis was mainly affected by hepatitis A virus,and the incidence curve of virus hepatitis was familiar with the incidence of hepatitis A disease,but from 1996 to 2006 the incidence of virus hepatitis was mainly affected by hepatitis B virus,and the incidence curve of virus hepatitis was familiar with the incidence of hepatitis B disease.The incidence of hepatitis A disease had a sharp drop from 26.23 per 10 million in 1992 to 6.41 per 10 million in 1994,after that,it declined steadily from 1995 to 2006,and lowest in 2006（0.48 per 10 million）.The incidence of hepatitis B disease had little changed, the lowest incidence rate for 6.81 per 10 million was in 1995,and it had emerged a small peak a in 2004（15.99 per 10 million）.2.The high incidence regions of viral hepatitis include Qingzhou,Shouguang,Linqu, Gaomi.The peak incidence of hepatitis A disease emerged in autumn,but hepatitis B disease don’t have obvious seasonal peak.The incidence rate of hepatitis A and B are the lowest in December.The trend of the incidence rate for people under the age of 14 constitutes downward.The incidence of hepatitis A disease mainly emerged in students and peasants,the ratio is separately of 29.42%and 28.93%;The incidence of hepatitis B disease mainly emerged in farmers,the ratio is 54.92%.Men are higher than women in both diseases,and it is significant(x_hb²=385.12, x_ha^x=1896.81).3.The coverage rate of hepatitis A vaccine has increased from 0.01%in 1992 to 95.24%in 2006;and hepatitis B vaccine increased from 0.47%in 1992 to 99.57%in 2006.Hepatitis A vaccination rate was negatively correlated with the incidence rate of children under the age of 14,the correlation coefficient is -0.979（P＜0.01）; hepatitis A vaccination rate and was also negatively correlated with the incidence rate of population,the correlation coefficient is -0.967（P＜0.01）.Hepatitis B vaccination rate was negatively correlated with the incidence rate of children under the age of 14,the correlation coefficient is -0.861（P＜0.01）,and hepatitis B vaccination rate has no obvious correlation with the incidence of population（P＞0.05）. 4.HAV serological detection surveys 1,456 people,including 1,266 with vaccination history and 190 without,anti-HAV positive rates were separately of 88.78%and 36.32%,there are significant differences（x²=108.62,P＜0.01）.HBV serological detection surveys 1,174 children,aged from 0 to 14,the HBsAg,anti-HBs and anti-HBc positive rates were separately of 1.11%,71.12%and 8.18%.We also survey 756 children who didn’t take immunization before 1991,the HBsAg, anti-HBs and anti-HBc positive rates were separately of 3.17%,12.96%and 10.05%, There are significant differences(x_HBsAg²=10.52,x_-HBs²=624,P＜0.01).5.The incidence rates of Bacillary dysentery and hepatitis A decreased year by year. the incidence of hepatitis A dropped from 2,142 cases to 41 in 1992～2006, decreasing 98.09%.The incidence of bacterial dysentery in 1992 dropped from 2,142 cases to 852 in 1992～2006,decreasing 70.93%.From the incidence curve, bacterial dysentery and hepatitis A diseases had a rapid decline from 1992 to 1995, then from the beginning of 1996 the incidence rate of hepatitis A continued to decline,and at a relatively low level,but the decline of bacterial dysentery was not Obviously.Countermeasures and suggestions:1.Strengthen leadership,capital investment Weifang Municipal Government should establish viral hepatitis special fund,to study the epidemic characteristics and laws of hepatitis,in order to establish stratagem and program adapt to Weifang,and control the prevalence of hepatitis.2.Promote the use on hepatitis A vaccine,and hepatitis B vaccine.On the basis of doing a good job of hepatitis A vaccine inoculation work in children under the age of 14.,make out vaccination on hepatitis A vaccine in the crowd and focus on key areas,according to the epidemiological characteristics of hepatitis A.Apart from the neonatal hepatitis B vaccine inoculation prevention strategy,but also need to pay attention to other groups of hepatitis B vaccine immunization strategy.3.Carry out publicity and education to enhance awareness of disease prevention.Make full use of various media to carry out publicity on viral hepatitis prevention, Take the initiative to conduct health education activities,in order to Know the serious harm to human health,.Enhance physical fitness awareness of disease prevention and to remove fear.4.Strengthen the monitoring of viral hepatitisPerfect hepatitis monitoring network to actively develop the incidence and prevalence of hepatitis monitoring,vaccination rates and population immunity levels,deeply understand the prevalence characteristics and the incidence of of viral hepatitis,to forecast the trend of the disease,and provide a scientific basis on develop effective prevention and control measures5.Strengthen iatrogenic infection control workStrictly implement the "Law on Prevention and Treatment of infectious diseases" and the "Blood Donation Law" and other relevant laws and regulations,and strengthen the blood collection agencies and blood products unit of production supervision,and increase their blood,blood products and medical institutions disinfection of the extent of supervision,.The implementation of a safety injection to prevent iatrogenic infection.Conclusion:in 1992 hepatitis A vaccine can reduce the incidence of hepatitis A disease in the whole population of Weifang City from 1992;The inoculation of hepatitis B vaccine can only reduced the incidence of hepatitis B disease in children under the age of 14.The government should expand the application of hepatitis B vaccine,so as to reduce the incidence of the whole population.更多还原