DANH GIA MOT SO OAC DIEM DJCH T£, LAM SANG vy DJCH CUM A / H I N I TA , I N H QUANG TRj NAM 2009
Tran Kim Phung
, Sff Y te Qudng Tri " , T O M T A T , . - : . ^ ; . . . . • .
Mot nghien cifu h6i CLPU cac tru'wng hap benh nhan co trieu chCeng lam sang nghi ngcc trong thai gian co dich cunn A(H1N1) den kham, dilu tri va du'O'c ISy m i u xet nghiem tai cac co'sec yte trong toan tinh Quang Tri. Ket qua cho thiy trong s6 191 tru'dng hap nghi nga cum A(H1N1) du-ac lly m i u xet nghiem co 75 truang hgp du'ang tinh. Lua tudi tCf 10-19 tu6i co ty le m i c cao nhit (46,6%). Co mot tru'dng hap tLP vong.
Ty le xet nghiem du'ang tinh trong so trudng hgp nghi ngd la 39,2%. Ty le m i c toan tinh la 0,012%, ty le chet/mac la 1,33%. Cac trieu chipng lam sang chinh bao g6m: s6t (98,7%), ho khan, co ddm (93,3%), dau hgng (81,3%), dau d i u (89,3%), dau ca xu'ang khdp (73,3%). Trieu chifng cua benh thu'dng nhe, cac d i u hieu lam sang tu'ang du'ang d hai nhom benh nhan xet nghiem du'ang tinh va nhom benh nhan nghi ngd trong vu dich. Ket qua xet nghiem du'ang tinh co m6i tu'ang quan vdi vung c6 djch va khong co djch, vdi cac trieu chieng s6t, dau d i u , dau hong, ho, dau ca dau khdp.
TiK khoa: Benh nhan nghi ngd, trieu chCeng, du'ang tinh, y i u to lien quan. i
L D A T V A N D E
Cinn A(H IN 1) la mot benh truyen nhiem duoc gay ra boi virus co bo gene la RNA, thuoc hp Orthomyxoviridae. frong cac trudng hop nang, ciim gay nen viem phoi, day la trieu chung CO the gay tir vong.
Tai Viet Nam den ngay 20/1/2010 c6 11.166 truong hop mac va 56 ca tu vong do cum A ( H l N l ) [1]. Rieng a khu virc mien Trung, tinh den ngay 20/5/2010, toan khu vuc ghi nhan 1.299 truong hop mac, tu vong 8 truong hop. Dich da xay ra 11/11 tinh [2].
Trong nam 2009 tinh Quang Tri da xay ra dich ciun A(H IN 1) tai 9/9 huyen/ thanh, thj.
Co 191 truong hop nghi ngo dugc ghi nhan, trong do CO 75 truong hop xet nghiem duong tinh, CO 1 truong hop tu' vong. Nham tim hieu cac ySu to nguy co va de xuat cac bien phap
kiem soat, khong che khong de djch lan rong.
Chiing toi tien hanh de tai nghien ctiu "Bdnh gid nipt so dgc diem dich te, lam sdng vu dich cumA(HlNI) tai tinh Quang Tri niim 2009".
Muc tieu nghien cuu:
Mo ta dac diem djch te hoc cua cac trudng hop nghi ngd va xac djnh Ciun A H IN 1 trong thdi gian thang 8 - 12/2009.
Mo ta dac diem lam sang cac trudng hgp nay.
Mo ta cac yeu to lien quan den xet nghiem diro'ng tinh.
II. PHLTONG PHAP NGHIEN ClTU Nghien cuu dugc tien hanh d toan bg 9 huyen, thi xa, thanh pho ciia tinh Quang Tri.
Thdi gian nghien cuu: Tir 04/8/2009 den 31/12/2009.
Ten tac gia; Tran Kim Phung Dia chi: Sd Y te tinh Quang Tri Oien ' ai:091 3456 818
g.p- rankimphungl95@gmail.com
Tap chi Y hoc dir phong. Tap XX, sd 7 (115)
Doi tucrng nghien ciru: Tat ca nhijng ngudi bi mac benh. c6 den co sd y te cac tuyen va dugc dieu tra theo mau phieu ciia Bo Y te va cd lay mau benh pham de xet nghiem.
Thiet ke nghien cuu: Nghien cuu md ta hdi cuu cac trudng hgp cd trieu chung lam sang nghi ngd va cac trirdng hgp xet nghiem duong tinh.
Mau nghien ciiu: Vi nghien cuu tien hanh tren nhung ngudi cd trieu chung lam sang nghi nhieiii ciim den co' sd y te trong thdi gian 5 thang nen khdng chgn trudc quan the nghien ciru. Tdng ddi tugng nghien ciiu trong 5 thang ghi nhan dirge: 191 ca benh, cd 74 ca dirong tinh, 1 ca tu vong.
Cdng CU thu thap thdng tin:
- Phieu dieu tra ca benh Cum A (HIN 1) theo mau cua Bd Y te.
- Phieu lay mau va tra ldi ket qua xet nghiem Cdc bien so vd chi so:
- Md ta dac diem djch te hgc Cum A(H IN 1) tir thang 8-12/2009: Tudi, gidi, nghd nghiep, thanh thj, ndng thdn, thdi gian.
- Cac trieu chiing lam sang: sdt, dau hgng, ho, khd thd. ia chay, buon ndn va ndn, dau dau dau co khdp.
- Md ta cac yeu td lien quan den xet nghiem duong tinh trong cac trudng hgp nghi ngd: Phoi nhiem (cd ti6p xuc benh nhan duong tinh vdi H l N l ) , vao vung dich trong vdng 7 ngay, cac benh man tinh: (ung thu. tieu dudng, suy giam mien djch, benh tim, benh phdi, suy dinh dudng, cd thai).
III. K E T QUA
3.1. Diem djch te hoc cua cac trurong hop nghi ngd va xac djnh cum A (HlNl)
Tinh den ngay 31/12/2009, toan tinh ghi nhan 75 trudng hgp duang tinh trong sd 191 trudng hgp nghi ngd. Ty le xet nghiem duong tinh trong sd trudng hgp nghi ngd la 39,2%. Trong dd cd 1 trirdng hgp tir vong tai huyen VTnh Linh. Neu dan sd ciia Quang Trj la 631.191 ngirdi thi ty le mac toan tinh dugc tinh la 0,012%. Ty le chSt/mk la 1,33%.
Thang 8 Thang 9 Thang 10 Thang 1 Thang 12 Nghi nga -* Duang tfnh
Bleu do 1. Diln bien ca benh theo thang va ket qua xet nghiem
Trong 5 thang dich xay ra tu thang 8 d8n thang 12. Thang 10 dugc ghi nhan sd ca benh nghi ngd cung nhu sd trudng hgp xet nghiem duong tinh cao nhat (129/51).
B a n g 1 . Phan b6 ca benh theo tu6i:
Tuoi £)6i tu-ong XN (+ ) Ty le %
0-9 15 1 6,7 10-19 i f 47 52,8 20-29 4i 18 39,1 30-39 16 5 31,3 40-49 6 0 0 Tren 50 19 4 20,1
Do tudi mac trung binh 23,8 gap nhieu nhat d lira tudi 10-29, thap nhat liia tuoi 0-9.
3.2. Mo ta cac dac diem lam sang va xet nghiem
Bang 2. Cac dac d i l m lam sang lien quan den ket qua xet nghiem
Dau hieu lam sang
S6t tren 38°C Bau hong
Ho khan hoac c6 ddm Kho thd
(a chay Budn non, non Dau diu
Dau ca, dau khdp
Doi tu'O'ng N=116
106
gs
S2 ' 42 1§
29
92
76
XN(-) Ty le %
91,6 76,7 79,3 35,2 12,9 25,0 79,3 65,5
Doi N=75
74 61 70 22 9 19 67 55
tu'O'ng XN (+) Ty le %
98,7 81,3 93,3 29,3 12,0 25,3 89,3 73,3
Trong 106 trudng hgp xet nghiem am 75 trudng hgp duong tinh, dau hieu sdt cd ty le tinh, gap nhieu nhat la dau hieu sdt (91,6%), cao nhat (98,7%), thap nhat dau hieu tieu chay it gap nhat dau hieu tieu chay (12,9% ). Trong (12,0%).
Tap chi Y hoc du phong. Tap XX, sd 7 (115)
3.3. Xac djnh cac yeu to lien quan den xet nghiem du-ffng tinh
Bang 3. Cac y i u to co m6i lien quan K i t qua XN
Dac diem OR
(^0 (0
Co 38 45
7 ngay trLPOc khi khoi phat ~ 1,62 Khong 37 71
0 6 67 92
Dau d i u 2,0 Khong 8 22
0 6 61 89
Dau hong 1,32 Khong ' 14 27
0 6 70 92
Ho 3,65 Khong 5 24
0 6 19 29
Buon non/non 1,01 Khong 56 87
Thanh thi 33 44
Dja dilm -. 1,28 Nong thon 42 72
Nam 43 65
Gioi tinh 1,05 Nu 32 51
Bang 4. Cac y i u t6 chu'a tim thay moi lien quan
Dac diem
Ket qua XN
OR
Benh man tinh
Lam trong co' s o y t l ,, . .
Kho tho
Dau CO khop
Tieu chay
06 Khong Co Khong Co Khong Co Khong 0 6 Khong
(+) 10 65 1 74 22 53 22 53 9 66
(-)
21 95 5 111
42 74 42 74 15 101
0,69
0,3
0,73
0,73
0,91
IV. BAN LUAN "'"'' '''^'-"'
Ty le mac toan tinh 0,012%, ty le chet/
mac la 1,33%. Theo udc tinh nguy co sd ngudi mac cum A/H IN 1 ciia cac chuyen gia y te cd khoang T0% dan sd bi mac ciim, trong do cd 0,10-0,35% tii- vong [3] thi ty le mSc ciim A/
HlNl tinh Quang Trj thap hon nhieu so vdi udc tinh. Tuy nhien sd ngudi mac ciim tren thuc te cd the cao hon nhieu so vdi sd dugc bao cao do han che viec chi dinh xet nghiem (chi xet nghiem d nhung ddi tugng cd nguy co' cao va dang dieu tri tai benh vien). Ty le chet/
mac cao hon 3,8 lan so vdi ty le udc tinh (0,1- 0,35%). Trudng hgp tu vong ciim A/H IN 1 tinh Quang Tri xay ra vao thang 12/2009 tai huyen Vinh Linh tren ddi tirgng tre tudi (26 tudi), cd nguy CO cao (cd thai 6 thang).
Trong sd 191 trudng hgp. trong dd nam gidi la 108 trudng hgp, chiem ty le 56,6%, nQ- oidi 83 trudng hgp chiem ly le 43,4%. Tuy nlv y le xet nghiem duong tinh giira nam
gidi va nu' gidi la tuong duong. Sd duong tinh d nam 43 chiem ty le 39,8%. Sd duong tinh d niT32,chi6m tyle 38,5%.
Do tudi mac tap trung cao d nhdm tudi 10-19 (46,6%) va 20-29 (24,%). Ty le nay tuong ddng vdi ty le cua WHO (phan tich dir lieu tir cac nudc lien minh chau Au, Nhat Ban. Me-hi- cd) 36% d do tuoi 10-19. 17% do tuoi 20-29.
Do tudi mac trung binh 23,8 (nhdm ngudi tre hgc sinh, sinh vien va khde manh ), khac vdi Clim mua (nhdm ngudi nhiem thudng tap trung d tre em va ngudi gia )|4|. Vi vay, neu dai djch Clim A/H IN 1 xay ra thi cac trudng hoc. la noi cd sd mac cao nhat. Cac nha djch te hoc udc tinh ty le tan cdng ciia dich ciim A/H IN 1 la 1,4-1,6 (cd nghTa la tir 10 ngirdi nhiem virus Clim A/H IN 1 ban dau thi se lay lan va tao ra sd mac mdi tir 14-16 ngudi tiep theo. nhu vay tinh lay truyen ciia virus ciim A/H INI cao hon dang ke so vdi virus ciim miia.
Thdi gian mac dugc ghi nhan tap trung tu thang 9 den thang 11 (miia thu ddng). thdi Tap chi Y hoc du phong. Tap XX, sd 7 (115)
tiet mat, am thuan Igi cho virus ndi chung va virus HlNl ndi rieng phat trien.
Vk cac dku hieu lam sang, trong nghien cuu chung tdi phan ra h'ai nhdm. nhdm cd xet nghiem duong tinh va nhdm cd xet nghiem am tinh. Kk qua cho thay t>'' le cac dau hieu lam sang d ca 2 nhdm tuong ddng nhau. ty le cao gap d cac dau hieu nhu sdt, ho khan hoac cd ddm. dau dau. dau hong, dau co' xuong khdp.
Trong nghien ciru ty le cac dau hieu lam sang cua Benh vien nhiet ddi trung uong cho thay sot (100%), ho khan (50%), dau hong (30,8%). dau d^u. met mdi (42,3%), dau ca xuong khdp (23.1%)[5| . So sanh vdi ket qua nghien cuu cua chiing tdi d nhdm benh nhan cd ket qua xet nghiem duong tinh cho thay cac dau hieu sdt (98.7%), ho khan, cd ddm (93,3%). dau hong (81,3%), dau dku (89.3%), dau CO xuang khdp (73,3%) la tuong duong.
lYieu chirng khd thd trong nghien ciru ciia chiing tdi chiem t\ le thap 29,3%, khdng cd dau hieu dau tue nguc, khac vdi ciim A/H5N1 dau hieu khd thd, thd nhanh, dau tue ngiic dien bien nhanh va chiem ly lc cao (tieu chuan chan doan ve lam sang).
Cd mdi lien quan giua ket qua xet nghiem duong tinh vdi viing cd djch va khdng cd dich (OR- 1,62), vdi trieu chirng dau dau (0R=2).
vdi dau hieu dau hong (OR==l,32), vdi trieu chiing ho (OR=3.65), vdi trieu chiing dau co dau khdp (OR'-1,37) vdi dia ban thanh thi.
Khdng tim tha> mdi lien quan giua ket qua xel nghiem duong linh vdi cac benh man linh, lam trong cac co sd y le, chiing khd thd, trieu chirng tieu chay, trieu chiing ndn va budn ndn, nam va nu.
V . K E T L L A N • " • " " • Vu dich Clim A/H IN 1 xay ra tren dia ban
linh Quang Trj c6 mot sd dac diem nhu sau:
- Djch xay ra trong miia Ddng Xuan, keo dai 5 thang, cd tdc do lay lan nhanh, cao diem vao giua thang 10. Tudi mJc chii y^u la lira tudi hgc dudng, dac biel lira tudi lir 10-19 ludi cd l>' le mic 46,6%.
- Ty le mac loan linh 0.012%, ty le chet/
mac la 1,33%.
- Cac trieu chirng thudng gap dien hinh cho nhiem virus ciim. Cac dau hieu lam sang tren tuong dirong d hai nhdm benh nhan xel nghiem duong tinh va nhdm benh nhan nghi ngd trong vu dich.
- Ket qua xet nghiem duong tinh cd mdi luong quan vdi viing cd dich va khdng cd djch, vdi cac trieu chung lam sang, vdi dia ban thanh thi. Khdng tim thay mdi lien quan giua ket qua xet nghiem duong tinh vdi cac benh man tinh, chirng khd thd. Iricu chiing lieu chay, trieu chiing ndn va budn ndn, nam va nir.
TAI LIEU T H A M KIIAO:
1. Cue Y le du phdng va Mdi Trudng Bo Y te. Bao cao tinh hinh ciim A(HINI) nam 2010.
2. Vien Pasteur Nha Trang. Thdng tin Y le du phdng sd 23 nam 2010.
3. Bd Y tS. Phdng chdng dich ciun A (H5N1) lay sang ngudi - Nha xuat ban Y hoc Ha Ndi -2006.
4. Ban chi dao phdng chdng dai djch ciim d ngudi. Ke hoach hanh ddng phdng chdng dai djch Clim A(IIINI) lai Viet Nam. Ha Ngi nam 2009.
5. Benh vien nhiet ddi Trung uong. Ket qua phdng chong dai djch cum A/H 1N 1. nam 2009.
t -UATION OF EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS O NFLUENZA A(H1N1) OUTBREAK IN QUANG TRI PROVINCE, 2009
Tran Kim Pliung ; - Quang Tri Health Department
A retrospective study was conducted from 4"' August 2009 to 31^' December 2009 on those patients who have suspected or/and lab-confirmed with Influenza A(HINI) virus infection. All patients suspected with Influenza A(IIINI) symptoms and sampled for Influensa A(I1 IN 1) lab-confirmation during the outbreak period. The results showed that: 75 lab-confir- mation positive with Influenza A(HINI) virus infections among 191 suspected patients were recorded during study period. The prevalent age group was from 10-19 years old account- ing for 46.6%. The positive rate among sus- pected patients was 39.2%. The morbidity rale in the whole province was found to be 0.012%.
The death rate/morbidity rate was 1.33%. The
main clinical characteristics/symptoms were as follows: 98.7% with fever; 93.3% with cough with nasal secretions; 81.3% with sore throats; 89.3% with headache; 73.3% with muscle and joint pain. The present outbreak of lnfluenzaA(HlN]) virus infection in Quang Iri occurred for five months during the winter - spring season with high spread. The prevalent age group was from 10-19 years old. There was no significant difference in clinical symp- toms between the lab-confirmed patient group and the suspected patient group. Main clinical symptoms were found to be fever, cough, sore throat, headache, muscle and joint pain.
Keywords: Suspected patients, symp- toms, positive, related factors
Tap chi Y hgc du phdng. Tap XX, sd 7 (115) II
