| ObjectivesTo analyze the epidemiological characteristics of reported cases of pertussis in Yunnan Province from 2009 to 2018,and carry out investigations on the status of diagnosis and reporting of pertussis among doctors in Kunming and Zhaotong.Grasp the epidemiological characteristics of pertussis in Yunnan Province and the familiarity of doctor with pertussis related knowledge.Explore the factors that influence doctors'familiarity with pertussis.Provide a theoretical basis for improving the sensitivity of monitoring and reporting of pertussis in Yunnan Province,and effectively preventing and controlling pertussis.Methods1.Epidemiological characteristics analysis:using descriptive epidemiological methods.Collect 2009-2018 reported cases of pertussis in Yunnan Province,use Microsoft Excel 2016 software and map software to compile data and make charts,analyze and discuss the characteristics of pertussis in Yunnan include the spatial,temporal and population distribution?immunization history?diagnosis and report;2.Investigation of the status of infectious disease reports in medical institutions:A self-designed questionnaire is used to investigate the settings,organization and management of infectious disease reports in various hospitals,and information construction;3.Investigation on the status of pertussis diagnosis report of doctor:by stratified random sampling method,some public medical institutions in Kunming and Zhaotong were selected,and the doctor in the departments related to pertussis diagnosis and report were investigated on the spot with self-designed questionnaire.To collect the basic information of doctor,their knowledge of basic knowledge,clinical diagnosis,laboratory examination,treatment and prevention of pertussis,their experience in diagnosis and treatment of pertussis and their personal attitude.Through single factor and multi factor analysis,the related factors influencing the doctor's knowledge of pertussis were analyzedResults1.In 2009-2018,Yunnan Province reported a total of 429 cases of whooping cough with no deaths.The average annual reported incidence rate was 0.09/100,000.The number of reported cases and the incidence rate in each year ranged from 21 cases,0.04 per 100,000(2014)to 88 cases,and 0.19 per 100,000(2018).There was an upward trend in 2014-2018.The top three cities with the highest number of reported cases were Zhaotong City(168 cases),Xishuangbanna Prefecture(89 cases),Wenshan Prefecture and Honghe Prefecture(both 49 cases),accounting for 71.33%of the total reported cases;the average annual incidence rate The top three cities are Xishuangbanna(0.78/100,000),Zhaotong(0.31/100,000),and Nujiang(0.19/100,000);the incidence shows a "double peak" seasonal distribution,with peaks concentrated in 5 In May and August,the number of cases from May to August accounted for 46.15%of the total number of cases;the ratio of the number of male and female cases was 1.07:1,and the incidence rate of male and female was the same 0.09/100,000;the cases were mainly scattered children,accounting for the total 89.04%of the cases(382 cases),cases under 5 years old accounted for 91.83%of the total number of cases,the 0-year-old group showed an upward trend;274 cases had a definite history of DTP immunization.The number of DTP vaccinated at 0,1,2,3,and 4 doses was 142(51.82%),49(17.88%),29(10.58%),and 41 cases,respectively.Among the 429 cases,there were 385 clinically diagnosed cases(89.74%)and 44 laboratory confirmed cases(10.26%).Among the clinically diagnosed cases,the Xishuangbanna People's Hospital reported the most cases(86 cases,22.34%).Among the confirmed cases,the Children's Hospital Affiliated to Chongqing Medical University reported the most cases(31 cases,70.45%).The local counties and districts,other counties and districts of this city,other prefectures and provinces of this province,other provinces,and foreign(Burmese)reported cases were 157(36.60%),128(29.84%),6(1.40%),134 Cases(31.24%),4 cases(0.93%).84,09%of laboratory confirmed cases were diagnosed and reported by hospitals outside the province;24.68%of clinically diagnosed cases were diagnosed and reported by hospitals outside the province.2.Basic situation of the questionnaire survey:732 valid questionnaires,716 questionnaires for doctors and 16 questionnaires for medical institutions were collected 9 hospitals in Kunming,7 in Zhaotong;3 hospitals at the provincial level,6 at the municipal level,and 7 at the district level;The most professional among doctors is clinical medicine(85.75%),the degree is mainly undergraduate(65.78%),the title is mainly elementary and below(68.16%),the most is physicians(42.74%),mainly full-time doctors(59.64%);The overall accuracy rate of 716 doctors' pertussis related knowledge was 45.60%,the single-select question correct rate is 63.41%,the multiple-select correct rate is 27.79%,the qualified rate of pertussis knowledge was 58.24%,and the pertussis familiarity rate is 41.48%;There are 46 doctors in charge of epidemic management and review in all hospitals,78.26%are full-time staff,63.04%are nursing majors,preventive medicine accounts for only 8.70%,and professional education and bachelor degree account for almost half of each.The degree of professionalism and education of the doctors are not high,and the work of the departments is complicated;all hospitals use information management software,and the information construction is the best at the provincial level.3.The analysis results of the influencing factors of the doctor's familiarity with pertussis showed:13 variables:hospital level,gender,age,education,job title,department,job attributes,medical industry working hours,current department working hours,familiarity with diagnostic criteria,long-term cough diagnosis and treatment experience for unknown reasons,pertussis diagnosis experience,and the need for monitoring is the influencing factor of doctor's familiarity with pertussis,among them,women,provincial hospitals,bachelor degree and above,intermediate and above titles,pediatrics,infections,prevention and protection,full-time doctors,medical industry working hours 11-15 years,current department working hours>20 years,general and above familiar with diagnosis The standard,with long-term experience in the diagnosis and treatment of coughs of unknown origin,considers the need to carry out pertussis monitoring,doctors with these characteristics are more familiar with pertussis.ConclusionsPertussis was prevalent at a low level in Yunnan Province from 2009 to 2018,but the number of reported cases and the incidence rate have shown an upward trend since 2014;The cases were mainly infants and young children,and the proportion of the 0-year-old group increased year by year,Most cases of infants and young children are those who have not started the DTP immunization program,delayed vaccination,and missed the vaccination.Infants and young children are still at high risk of pertussis;There are fewer cases of adolescents and adults,only 2 adult cases are reported.against the background that adolescents and adults are the main source of infection for infants and young children,adult cases do not show the same signs of growth as infant and child cases,which indicates that the diagnosis may be missed;The cases reported in Yunnan Province are mainly based on clinical diagnosis,and most of the laboratory confirmed cases are reported by medical institutions outside the province,indicating that our province's pertussis laboratory has weak detection capabilities;The areas with higher reported incidences are located at the provincial borders and border areas in eastern Yunnan and western Yunnan.Yunnan province has the risk of pertussis cross-border and cross-provincial transmission;Doctors surveyed in Kunming and Zhaotong have a pass rate of 58.24%,and a familiarity rate of 41.48%in the answers to pertussis-related knowledge.Doctors are less familiar with pertussis;Doctors in the two cities have a high rate of wrong selection and missing selection of the source of infection,susceptible people,diagnostic criteria,case classification,differential diagnosis,and whether they can be immune for life,and the medical institutions surveyed by the two cities failed to carry out laboratory tests specific to pertussis(ELISA and PCR):Analysis of influencing factors shows that doctors with characteristics of provincial hospitals,pediatrics,women,bachelor degree and above,intermediate and above titles,medical industry work 11-15 years,current department work for more than 20 years,full-time doctors,etc.are more familiar with pertussis,doctor who are more familiar with the diagnostic criteria for pertussis,or have the experience in the diagnosis and treatment of unexplained long-term cough,or who believe it is necessary to carry out pertussis monitoring are more familiar with pertussisBased on the above conclusions,it is recommended that Yunnan Province continue to increase the DTP vaccination rate,regularly carry out DTP leak detection and replanting work,formulate pertussis monitoring programs according to local conditions,set up pertussis monitoring points in key regional hospitals,improve laboratory testing capabilities,encourage medical institutions to add testing projects,promote more sensitive,reliable and fast PCR detection methods.Carry out training and evaluation of doctors on the diagnosis and reporting of pertussis,and conduct targeted training for doctors of different levels of hospitals and departments according to the analysis of influencing factors,so as to improve the diagnosis report level of whooping cough in Yunnan Province.In this paper,the epidemiological characteristics of reported cases of pertussis in Yunnan Province in the past 10 years and the current research on the familiarity of pertussis of doctor in some areas are analyzed for the first time,which can provide reference for pertussis monitoring and prevention and control in Yunnan Province,but also has limitations.It is suggested that more pertussis related research should be carried out in Yunnan Province to provide more theory for pertussis prevention and control policy Support. |
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