| ObjectivesTo understand the prevalence trend and epidemical distribution of Japanese Encephalitis(JE) in Yunnan Province, and to explore the risk factors and identify the high-risk population. To evaluate the implementation of JE prevention and control measures, including JE vaccination and health education, and find out the weakness.So as to provide theoretical basis for formulation targeted prevention and control strategies and measures.Methods1. We collected the JE surveillance data during 2007 to 2016 in Yunnan Province,and analyzed the epidemiological characteristic by descriptive epidemiological method. We used Excel 2010 software to organize the data and create the relevant charts, and used the Epi infor 3.5 software to make maps.2. We investigated the JE confirmed cases from our province research sites in 2016 by case-control study, every case matched 4 controls by same community and age ± 5 years. We used unified questionnaire to conduct field investigations and collect data. Epidata 3.1 was used to establish database,enter and check data, SPSS 22.0 was used for statistical analysis, the risk factors by univariate and multivariate Logistic regression analysis.3. In research sites, all villages or communities where JE cases were reported in 2016 conducted the investigation of JE prevention and control situation. In every village or community ,we randomly selected more than 10 children under the age of 10 to do the investigation of immunization coverage rate, and the children's guardian conducted the investigation of JE awareness rate. For village vaccination workers, the JE awareness rate and the situation of health education were studied. Epidata 3.1 was used to establish database, enter and check data, SPSS 22.0 was used for statistical analysis, the rate and constituent ratio were compared by chi square test, the risk factors by univariate and multivariate Logistic regression analysis.Results1. A total of 3032 JE cases were reported in Yunnan Province during 2007 to 2016, the average annual incidence rate was 0.66/100000. 157 JE deaths were reported, the average annual mortality rate was 0.03/100000, and the fatality rate was 5.18%. The incidence of JE declined volatility. The cases mainly concentrated in Zhaotong city where was the junction of Yunnan, Guizhou and Sichuan, as well as Dehong Prefecture, Xishuangbanna Prefecture, Honghe Prefecture, Wenshan Prefecture, Puer city bordering with Burma, Laos, Vietnam. Sporadic cases were reported throughout the year. 75.23% cases concentrated during 27 to 37 weeks(June to September),the incidence showed multi peaks,and the kurtosis had been slowing year by year. The sex ratio was 1.46, the incidence of male was higher than female over the years. Most cases occurred under the age of 15, and the constituent ratio aged<15 decreased. The children aged 2 to 8 had a higher incidence, and the adult incidence increased. Most cases occurred scattered children, students, farmers.However, the constituent ratio of farmers increased.2. From the case-control study, we found a total of 16 factors were included by univariate analysis. If fixed other factors, the factors for knowing that JE vaccine can prevent JE (OR=0.49) and JE vaccination(OR=0.26) were protective factors. However,the floating population (OR=2.34), mosquito bite history (OR=2.52) were risk factors.Then we selected the people over the age of 18 for the risk factors of JE analysis. If fixed other factors, the factor that there were containers of dirty water in or around the house (OR=2.60) was risk factor.3. Among the children over the age of 2 years old, the JE vaccination rate was 89.83% and the full-course rate was 71.54%. The full-course vaccination rate strictly follow the national immunization program was 51%. The drop-out rate was 10.16%,the higher rate was in age 10 and elder than 10, migrant children and Hani children,and Honghe Prefecture, Xishuangbanna Prefecture and Zhaotong city were higher.The first dose coverage rate timely was 65.85%,Kunming(89.04%) and Pu'er(73.77%)were higher. The first dose drop-out rate was 10.98%, and Honghe Prefecture(24.39%), Xishuangbanna Prefecture( 17.31%) were higher. The second dose drop-out rate was 27.44%, and Honghe Prefecture (70.73%), Xishuangbanna Prefecture(40.38%) were higher. The household and occupation were the influence factors of JE vaccination.4. The guardian awareness rate of JE was 15.34%, the highest rate was Kunming(30.05%) and the lowest rate was Honghe(0%). The Logistic regression analysis showed that the ethnic, income and education were the influence factors. The guardians knowing JE were more likely to take prevention and control measures, such as using pesticide and mosquite net, consultation the JE vaccine. The ways of obtaining knowledge were doctors (61.59%), relatives and friends(24.13%), TV(20.63%), network (10.79%), respectively. The people which were ethnic minorities,primary school and below education, farmer and low income were mainly known by doctor. The trust ranking were doctor, TV, brochure, friend, short message service,radio, network, newspaper. Residents satisfaction with local village doctors was 84.98%, the trust was 89.98%.5. A total of 68 village vaccination staffs were included in our survey, 64.71%was no title and 72.06% was technical secondary school and below education doctors.The awareness rate was 75.00%. The awareness rate of Live attenuated JE vaccine inoculation schedule was the highest, and the awareness of AEFI and the JE sourses of infection were relatively low. The lower awareness rate was in more than 15 years length of employment doctors. 97.06% village doctors think that we need to provide propaganda education of JE. Over the past year, 16.18% village doctors provided more than 3 times related publicity, and the methods were brochures, posters and on-site publicity. Most of village doctors think that the local propaganda was on the lack of times, strength, depth and breadth. Over the past year, 29.41% village doctors did not receive any promotional materials,and 88.24% village doctors received 0 ?2 times the related training. In addition, the main knowledge sources of village doctors were books and clinicians.ConclusionsJE prevention and control work in Yunnan province had made some achievements, JE incidence rate decreased significantly. Cases distribution showed temporal aggregation and spatial clustering. The incidence of adult and farmer were on the rise. The relevant medical institutions should implement the prevention and control works before epidemic season, and encourage farmers and adult to get a vaccination.The factors of Floating population, mosquito bite history, containers of dirty water in or around the house were risk factors, and vaccination, and carrying out health education were the intervention measures. The relevant departments should strengthen the management for floating population, implement supplemental immunization and raise the vaccination rate. Besides, it is necessary to promote health education, so as to improve the awareness of the severity of JE among residents, and improve the living condition and surroundings, encourage residents to take anti mosquito measures, such as pesticide and mosquito net.There were immunization blanks in high incidence JE region, and the inoculation quality needs to be further improved. The migrant workers returning home, mobile population and childen out of birth were weak immune population, and Honghe Prefecture, Xishuangbanna Prefecture, Zhaotong city were weak immune regions. To village doctors of high-incidence area, the awareness of JE or JEV was not high, the health eduaction was on the lack of times, strength, depth and breadth, and propaganda was simple. The knowing rate of guardians about JE and JEV was low,especially the ethnic minority, low-education and low-income. The relevant departments should strengthen the management of floating population, childen out of birth and migrant workers returning home, improve the vaccination rate, while strengthen human resources construction of village doctors, and pefect the assessment and training of township to village, so as to ensure the implementation of the prevention and control measures. |
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