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麻疹流行特征防控策略及研究新进展课件

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麻疹 流行 特征 策略 研究 进展 课件
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As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 麻疹流行特征 防控策略 及研究新进进展 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 疫情概况 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 全国麻疹疫情特征 16年6年 保持22年 在10 10万左右波动 3年 开始 应用MV 开始 计划免疫 开始 消除麻疹 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 2010年全国开 展强化免疫活动 2003 2009年27省份以省为单位开展 补充免疫活动 2013 2014年 麻疹疫情回升 近年麻疹发发病显显著下降 但2013 2014年回升 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 全国2015年麻疹疫情继续继续 上升 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 各省呈交替高发的态势 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 1988 2014年 不同年龄组 病例占比变化 u 1岁组 从15 升至50 u2 4岁 从20 降至 10 u5 19岁 从60 降至 5 u 20岁组 从10 升至35 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year u 8月龄 8 23月龄最高 u2 4岁其次 u20 39岁组已超过5 19岁组 u 40岁组快速上升 2005 2014年不同年龄组发病率 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 2014年全国麻疹病例的年龄龄分布 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 2014年全国病例出生队列分布 成人 60年代末 90年代初出生 均匀分布在各出生队列中 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 2013年 2014年各省麻疹病例年龄特征 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 2014年各省麻疹病例居住状态 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 浙江省麻疹疫情 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 浙江麻疹 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 提醒 2015年两起暴发 杭州萧山区乐荣电线电器有限公司麻疹暴发疫情 报告麻 疹确诊病例5例 疑似病例4例 5例麻疹确诊病例均为女 性 年龄在17 26周岁 均为四川凉山彝族自治州美姑县 人 否认有麻疹相关疫苗免疫史 发病日期为12月26 31 日之间 离开四川时间在12月5日左右 来萧山时间为12 月12日 28日之间 病例症状典型 症状较重 舟山市定海区小沙街道麻疹暴发疫情 发病3人 最后1例 为1月13日报告 其中2例为6月龄和2岁儿童 1例为44 岁女性 否认有麻疹相关疫苗免疫史 病例间有亲属关系 均来自四川省凉山彝族自治州喜德县 12月10日左右离 开四川 12月28日到1月8号发病 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 麻疹流行特征小结 麻疹发病水平已大幅降低 且大年龄儿童 青少年 发病极少 体现了既往消除麻疹措施的效果 流行周期性未打破 随着易感者积累 已再度回升 本土H1基因型绝对优势 97 4 发病年龄组变化 与人群免疫力估计相符的 常规 免疫是核心 8 23月龄 及时接种关键 成人发病相对凸显 部分地区更明显 发病率虽然比以前高 仍远低于儿童 主要是比重相对增加 医院内感染与传播难以阻断 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 2014年 成人传播疫情案例 传播方向 传播对 数 比例 成人 成人2480 成人 适龄儿童 413 成人 婴幼儿13 3 婴幼儿 成人13 3 合计30100 续发传播主要发生在成人之间 30对有明确传播关系 麻疹病例之间传播链 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year Vaccine 2012 30 3996 4001 医院内传播 挑战中国的一个高危因素 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 防控策略 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 已消除麻疹国家 地区的经验 与策略 美国 三次消除麻疹的努力 1966 1978 1993三次设立目标 经过35年努力 2000年实 现 策略 2剂MCV常规免疫高接种率 查验接种证 WHO美洲区 1994年设立目标 2002年实现 策略 一次初始SIA MCV1高接种率 周期性后续SIA 澳大利亚 新西兰 韩国 2006年宣布实现 2014年 WHO 证实 策略 一次初始SIA 常规免疫2剂MCV高接种率 日本 正在申请消除麻疹证实 前期背景 1995 2006仅1剂程序 低接种率 2007 08大规 模暴发 策略 初一高三滚动式SIA 常规免疫2剂MCV高接种率 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 我国消除麻疹的综合策略 一次初始SIA 两剂次常规免疫高接种率 免疫预防 常规免疫 8月龄 18月龄两剂MCV 强化免疫 SIA 查验接种证 入学查验是否接种 2剂MCV 加强监测 暴发控制 医院感染控制 风疹控制 宣传动员 见 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 2004 2009 以省为单位开展SIA 27个省完成8月 14岁 1 86亿儿童接种 2010 全国统一组织开展 1995 2009出生队列 1 03亿人次 2011 2013 以县为单位风险评估 选择性 非选择性SIA 消除麻疹免疫策略 群体性补补充免疫 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 2005年开始实施 非强制性 2013年纳入基本 公共卫生服务考 核 消除麻疹免疫策略 入托 学查验查验 接种证证 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 消除麻疹策略 监测工作 开展以个案为 基础监测 1999 2004 2009 2014 麻疹监测方案第一版 麻疹监测方案第二版 更新实施 全国麻疹监测方案 进一步升级 提出分类要求 开展个案监测 将风疹监测纳入 实验室网络2002 2012 建立地市级及以上网络 地市级开展RT PCR检测 80 with blood specimen 2009 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 消除麻疹策略 暴发疫情控制 暴发界定 报告 调查 风险评估 处置 应急接种 浙江省疾病预防控制中心 浙江省麻疹疫情调查与处置技术指南 2014版 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 消除麻疹策略 风疹控制 2007年 含风疹成分疫苗纳入常规免疫 2015年 风疹个案监测 要素包括 采用包含麻疹和风疹的病例定义 将麻疹和风疹病例纳入常规报告 整合麻疹和风疹个案调查表 同步进行麻疹和风疹血清学检测 监测病例分类应同时包括麻疹和风疹 省卫计卫计委 浙江省麻疹风风疹监测监测方案 浙卫办卫办 疾控 2014 1号 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 我国消除麻疹的疑惑 麻疹的策略足以消除麻疹 超过25年有效疫苗的2剂次免疫程序 广泛开展麻疹强化免疫 实行入学查验接种证的政策 高质量的麻疹实验室和监测 足够高的报告接种率可以达到消除麻疹的目标 国家和省级多年超过95 的2剂次接种率 但中国本土的H1基因型仍然在几乎所有省份循环 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 人群 免疫空白 在哪里 儿童实际接种率可能比报告的结果低 当调查时 可发现低接种率 流动人口对以行政为单位的接种率报告方式的挑战 在偏远和少数民族地区存在难以覆盖的儿童 一些青年人可能没有完成免疫 一些儿童可能在第一剂次时没有成功 又未接种第二剂次 第1剂接种月龄较小 8月龄 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 需要 新的知识和加强免疫规划工作 免疫规划实施的测量手段 真实的接种率 有效的接种率评估可以识别免疫空白 并在没有疾病的情况 下有助于保持高覆盖率 可以帮助理解疫苗接种的障碍所在 通过以证据为基础的干预措施来提高接种率 需要有效策略来免疫青年人 应对所有的麻疹暴发 协同麻疹和风疹 通过沟通的策略来维持信心 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 麻疹发病与疫苗免疫策略 巴西圣保罗州 1980 2011 Note Includes notified cases 1980 1992 and only laboratory confirmed cases after 1992 Measles catch up campaign 9 months 14 years Campaign MMR 9 months 10 years Outbreak control follow up MR 6 months 5 years follow up MMR 1 4 years MR campaign Women 20 29 years MR campaign 20 39 years MMR follow up 1 4 years follow up MR 9 months 4 years As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 成人接种 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 思考 基本策略几乎没有差异 南美 如巴西的人口密度很高 也需要高的 疫苗接种率 中国在消灭脊灰工作的策略方面基本上是借 鉴南美的经验 取得了显著的成效 中国目前消除麻疹的策略需要进一步借鉴和 强化落实南美一些国家的经验 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 差距 到底差在何处 需要政府高度的政治承诺 消除麻疹是否是优 先的工作目标 技术措施需要实实在在地落实 完善的常规免疫和补充免疫策略 要真 高 大年龄组人群欠账何时还 敏感的疾病监测系统 要真 灵 高质量的实验室支持网络 要真 准 广泛的社会动员 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 医疗机构在消除麻疹中的职责 u医疗机构负责就诊的麻疹监测病例报告 保证报告信息的完 整性和准确性 户籍地与现住址 联系电话 u采集就诊病例的血标本和病原学标本 完成标本运送并协助 病例流行病学调查工作 u医疗机构负责开展主动监测 医疗单位应每周开展相关科室 主动监测 了解医生诊断为麻疹 风疹病例病例的报告情况 u经认证考核的实验室可开展监测病例的血清学检测 u对本单位有关医护人员进行培训 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 考核指标 u疑似病例报告率 医疗机构麻疹 风疹病例报告率100 报告的麻疹 风疹病 例数 所有诊断为麻疹 风疹的病例 100 u医疗机构麻疹病例标本采集率和送检及时率 医疗机构麻疹病例血标本采集率达到95 以上 按照要求 采集血标本的麻疹病例数 所有报告的麻疹病例 100 医疗机构血标本采集后3日内送达网络实验室的比例达到 90 以上 按时送达血标本的麻疹病例数 采集标本的麻疹 病例 100 省卫生计生委 医疗机构公共卫生工作规范 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 主要问题 医院内感染 论文数据 医院成为主要感染场所 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 特别是在8月龄之前尚未达到麻疹疫苗接种年龄 对于一般医院 病例的预检分诊 病例隔离及其保护性 措施未常规开展 医院感染在麻疹传播中扮演重要角色医院感染在麻疹传播中扮演重要角色 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 麻疹的医院传播特点 原因 麻疹病毒的高传播力 病毒在空气中可存活2小时 病例早期尚未表现出麻疹特异性症状 特征 通常比社区获得的麻疹更严重 暴发迅速播散 高危地点 输液室 急诊部 侯诊室 在接近消除或消除后阶段的重要性 美国麻疹消除以后20 的暴发为医院感染 WHO的暴发分析中 22 的麻疹病例为医院感染 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 麻疹医院传播的防控建议 预防 确保医院的医务人员有免疫力 医务人员或新进人员强制开展麻疹疫苗的接种 提高工作人员对于麻疹的意识 呼吸道疾病院感的防控 分诊 个人防护 宣传 高发季节降低门诊病人的输液比例 减少传播机会 发热出疹性病人确立预检分诊和专门诊治流程 在医疗机构发生的每一例病例 立即对发热出疹性患者实施呼吸道预防措施 报告疑似病例 对所有可能的麻疹病例接触者都要立即应急接种 无免疫力的卫生工作者停止治疗患者 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 主要问题 成人发病 9101112131415161718192021222328 33 38 东 中 西部地区1 59岁人群麻疹抗体阳性率曲线图 成人易感者比例较大 可能是今后流行主体 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 主要问题 疫情报告 暴发漏报 省份 发发病率 10万 暴发统计时发统计时 段 估算暴发发起 数 实际实际报报告起 数 占报报告率 北京10 671 7月655076 92 天津19 391 3月11686 5 辽辽宁18 671 2月6868 22 估算北京 天津 辽宁麻疹暴发疫情报告情况 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 主要问题 疫情处置 调查 处置不及时 暴发处置不到位 搜索 接种率评估 应 急免疫 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 下一步 针对 不同出生队列 分类考虑 8月龄 1 降低全 人群发病率 2 减少接 触 8 23月龄 1 及时接种率 2 2剂次全程 95 3 减少接触 5 19岁 1 既往SIA已覆 盖 发病极少 2 在校生查验 接种证 补种 MR MMR 3 降低全人群发 病率 减少接触 20岁 尤其1978 1993队 列 1 疫苗时代出生 接种率 低 2 近年强化免疫未覆盖 3 数量大 活跃 易感者 均匀分散 SIA必要 可行性小 4 策略 重点人群接种 医务 大学 外来务工 疫情时应急接种 鼓励接种 减少接触 2 4岁 1 风险评 估 补充免疫 3 入托查验 入学查验 3 减少接触 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 研究新进展 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 消除麻疹定义演变 无本土传播 vs 1 100万 2004年西太区 消除麻疹现场指南 定义 在具有一定数量人口的较大地理区域内 无本土 麻疹病毒传播 输入麻疹病毒也不引起持续传播 所有 的散在病例和传播链都与输入病例有关 具体操作层面上的临时标准和指标为 年报告确诊病例发病率在1 100万以下 不包括输入病例 具有高质量运转的发热出疹性疾病监测系统 每个出生队列人群麻疹免疫力在95 以上 2010年WHO总部WER 在有运行良好的监测系统存在的前提下 某特定地理区 域 如 某区域 内 12个月未出现本土麻疹传播 2012年8月WHO西太区进一步明确了消除麻疹目标 在监测系统高质量运转的前提下 特定区域内无本土麻 疹病毒传播超过12个月以上 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 消除麻疹和消除麻疹和风风疹疹地区目地区目标标 Decade of Vaccines goal Decade of Vaccines goal Meet Meet vaccination vaccination coverage targets in every coverage targets in every region country and region country and communitycommunity 全球疫苗行动计划全球疫苗行动计划 到到 2015 2015年 年 WHO 6WHO 6大区大区 中至少中至少4 4个区实现消除麻疹 至少个区实现消除麻疹 至少2 2个区实现消除消除风疹个区实现消除消除风疹 到到 2020 2020年 至少年 至少5 5个区实现消除麻疹和风疹 个区实现消除麻疹和风疹 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 我国消除麻疹目标演变 2006年卫生部制发 2006 2012年全国消除麻疹行动计划 到2012年 全省麻疹发病率控制在1 100万以下 不包括输入病例 无 本土麻疹病毒传播 通过消除麻疹工作促进免疫规划工作全面发展 2010年卫生部制发 2010 2012年全国消除麻疹行动方案 总目标 2012年 力争全国麻疹发病率控制在1 100万以下 不包括输入病例 无本土麻疹病毒传播 分年度目标 2010年全国麻疹发病率控制在25 30 100万以下 2011年全国麻疹发病率控制在5 10 100万以下 2012年全国麻疹发病率控制在1 100万以下 达到消除麻疹目标 国务院卫生事业 十二五 发展规划 在监测系统高质量运转的前提下 特定区域内无本土麻疹病毒传播超过12 个月以上 目标 努力实现消除麻疹 国家卫生计生委即将制发 2015 年 全国消除麻疹行动方案 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 全球麻疹和风疹战略计划2012 2020 GLOBAL MEASLES AND RUBELLA STRATEGIC PLAN 2012 2020 愿景 通过强有力的合作 资源和政治承诺 可以并将一定 共同努力 实现并保持全球消除麻疹 风疹和先天性 风疹综合征 CRS 的目标 目标 到2015年 全球麻疹死亡率较2000年至少降低95 在WHO实现区域性消除麻疹和风疹 CRS的目标 到2020年 至少在WHO的5个区域实现实现消除麻疹和风风疹的目标标 Margaret Chan DG WHO Anthony
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