| 摘要註: |
背景:自1987以來,登革熱疫情成為臺灣最重要的蟲媒傳染病,中央及地方政府每年均投入大量人力、物力及財力在進行相關防治工作。2014年臺灣本土個案數甚至劇增達15,464例(以通報日計),為歷年來最高。本研究希望藉由分析臺南市2014年登革熱確診個案通報狀況,在人口學特性,如性別、年齡、居住區域類型,以及就醫習慣和居住里別的病媒蚊指數等,是否有統計上差異;統計孳生源主要種類、陽性比例及戶內外調查結果等,期能對臺南市登革熱疫情有進一步之防治建議,並做為登革熱防治的參考資料。 結果:1.臺南市2014年登革熱流行季之確診病例共153例,男性佔60.8%,年齡最高84歲,最小2歲,平均為41.9±20.1歲;居住區域類型以高度都市化市區比例最高,佔30.1%,其次是新興市區,有29.4%;發病至第一次就醫天數1-7天,平均為1.7±1.3天;2.通報個案第一次就醫就被通報比例為26.0%,就診四次以上才被通報出來的個案有14.7%;58.3%在症狀開始第一天就醫,10.6%是在症狀開始四天(含)之後才就醫。3.性別對於是否確診登革熱是有相關的(p<0.05),都市型區域比鄉村型區域確診登革熱風險較高,男性風險高於女性。4.就醫狀況部分,通報前的就醫次數,病例平均為3天,非病例是2天,具顯著差異(p<0.05)。5.病媒蚊密度調查中的布氏指數、容器指數及住宅指數,在病例及非病例區,均有顯著的差異(p<0.05)。結論:從本研究可看到,臺南市男性確診登革熱的比例高於女性,高度都市化的區域,登革熱確診比例亦高於鄉村型之區域;研究發現通報確診病例自有症狀至第一次就醫時間平均1.7±1.1天,74.5%以基層診所就醫為主,平均通報天數5.4±2.2天,48.7%為醫學中心通報,建議加強醫療院所在登革熱流行季的警覺性、鼓勵基層診所通報及快速篩檢試劑的使用協助診斷;病媒蚊密度調查的三項指數,對於是否確診為登革熱病例亦是有相關的。因此,落實病媒蚊密度調查,是重要的防疫工作項目之一。孳生源種類及陽性比例的調查,除少數容器種類外,大部分在病例及非病例區均有顯著的差異。臺南市查核的戶內容器,以桶、甕、盆、缸類容器最多,但陽性率以帆布、塑膠布最高;在戶外容器部分,一樣是桶、甕、盆、缸類容器最多,陽性率則是廢棄的馬桶水箱類最高,建議戶內外均應清除不必要之容器、廢棄物,以避免積水容器之產生。 Background: Since 1987, Dengue fever has become one of the most prevailing arthropod-borne diseases. Central and local government has been spending remarkable amount of resources for the prevention and control of the disease. However, in 2014, domestic cases drastically reached to 15,732, which was the highest of the record. The study aims to obtain the statistical variance of gender, age, type of township, medical behaviors and arbovirus vectors index of living neighborhood from the analysis of the reporting cases in Tainan City in 2014. The study also analyze the type of larval habitats, positive rate and indoors/outdoors investigation to provide recommendation to the prevention and control of the epidemic of dengue fever of Tainan City and become a reference for the countrywide Dengue fever prevention and control measures. Result: 1.In 2014,there were 153 confirmed cases in Tainan, male consists of 60.8%, oldest case is 84 years old, youngest case is two years old, the average and standard variance is 41.9±20.1. Among all type of living neighborhood, the highest is city with dense population, which is 30.1%, the second is newly developed urban area, which is 29.4%. The duration between beginning of the symptom to clinic is 1-7 days. The average and standard variance is 1.7±1.3; 2. The cases which were reported in the first clinic is 26.0%, while the case which were reported in the fourth time is 14.7%; 58.33% of the patients go to clinic in the day when the symptom began, while 10.6% go to clinic in the fourth days after the symptom began. 3. The gender is relevant to the confirmed cases(p<0.05). The risk of confirmed cases in urban type township is higher than those in rural type township, while the male is higher the female. 4. The average days before reporting to the system, the case is 3 days while non-case is 2 days. The variance is remarkable (p<0.05). 5. In the investigation of density of Dengue vectors, there is remarkable variance(p<0.05) in the Breteau index、Container index and Household index. Conclusion :From the study, male confirmed cases in Taiwan are higher than those of female; urban township higher than rural township; average duration from symptom to clinic is 1.7±1.1 days; 74.5% of the medication is at local clinic; average reporting day is 5.4±2.2; 48.7% of reporting is regional from medical center. We recommend the medical institution be alert during dengue fever epidemic, encourage local clinic report the suspected cases and use fast screening test kit to assist diagnosis. In addition, the three index of investigation of density of Dengue vectors is relevant to the confirming of dengue fever cases. Therefore, to implement investigation of density of Dengue vectors is one of the most important prevention and control measures. For the investigation of type of larval habitats and positive rate, there is significant difference in most cases in case reporting area and non-case reporting area.In the environmental surveillance of Tainan City, for containers indoors, buckets, bowels, basins and tanks are the most. But, the highest positive rate is from tarpaulin and plastic sheet; for containers outdoors, buckets, bowels, basins and tanks are also the most, while the highest positive rate is the abandoned toilet tank. Recommend to clear all wasted containers indoors and outdoors to prevent the accumulation of water. |