NHAN XET v e DjCH
S 6 T X U A T H U Y 6 TDENGUE TAI
HAIPHONG NAM 2009
Do Manh Cuo-ng, Le Thj Song Huang, Nguyin Thu Hanh Trung tdmy te di^ phong thdnh phd Hdi Phong
TOM TAT
Tir nam 1998, Du'^n phdng chong Sot xuat huylt Dengue (SXHD) da dupe trien khai d Hai Phong. So lu'png b§nh nhan(b/n) da giam din theo cac nam. Dac biet ttr nam 2004-2008 kh6ng co djch xay ra tren dja ban thanh pho. Nam 2009 Hai Phong c6 su biing phat trd lai cua djch SXHD voi 272 truPng hp'p mac benh. Vu djch nay c6 mpt so diem kh^c bipt so voi cac vg djch truPc. Bang phuong phap nghien cii'u h6i ciru, tdt da tien hanh nghien CLCU vu djch SXHD cua Hai Phdng nam 2009 va co mpt so nh$n x6t sau: - Thai gian djch: Bit diu tir thang 7, ket thuc vao thang 12, tap trung a lipa tuoi lan. 20-24 tuoi T6ng so b/n: 272, trong do 53 ca (+). -Pham vi dich: Dich xay ra tren pham vi rpng vpi 14/15 quan huyen va 80/226 xa phudng. - Dich phat triln manh a huyen dao Cat Ba.Ty le mic/100.000 dan: 14,8. Dich mang tinh xSm nhSp
I. DAT VAN DE
Sdt xuat huyet Dengue la benh truyen nhiim gay djch do vi rut Dengue gay nen. Benh hien luu hanh d tren 100 nudc thupc cac khu vuc cd khi hau nhiet ddi va a nhiet ddi viing Ddng Nam A va Tay Thai Binh Duong.
Benh SXHD lin diu tien xuit hien d Viet Nam vao cudi nhirng nam 1950, den nay da trd thanh benh djch luu hanh tai nudc ta.Tai Viet Nam, SXHD la mdt trong mudi benh truyin nhiim cd ty le tu vong cao nh at trong 10 nam trd lai day ( 1994-2003).
Nam 2009 tinh hinh benh SXHD diln biln phiic tap va nguy hilm, benh nhan chii yeu tap trung tai cac tinh/thanh pho la Ha Ndi, Nghe An,Bic Giang, Quang Ninh, Thanh Hoa.
Tai Hai Phdng, tir nam 1999 din 2009, dv an phdng chong SXHD da dugc triln khai Tac gia: Dd Manh Cudng
Dja chi: Trung tam Y tl Du phdng Hai phdng Di?n thoai: 0313.842879. 0912.518.372 Email: [email protected]
tren tat ca cac quan, huyen, thj xa. Sd lugng benh nhan da giam dan theo cac nam tir 1998 din 2008. Giai doan tir nam 1998-2003 so lugng benh nhan tap trung chii yeu d 3 quan ndi thanh la Ngd QuyIn, Hong Bang va Le Chan. Quy md djch tai cac xa phudng cung chi d mire do vira va nhd. Giai doan tir 2004-2008 khdng cd djch tren dja ban thanh phd.Den nam 2009 so lugng benh nhan SXHD tang vpt so vdi nhung nam lien ke trudc dd vdi 272 trudng hop trong dd 53 ca (+) tinh..
Qua theo ddi vu dich SXHD d Hai Phdng nam 2009 tdi thay cd 1 sd diem dac biet ve djch te hpc so vdi nhieu nam trudc dd nhu: dja ly, khdi cam thu, quy md djch...
Xuit phat tir nhan djnh dd nen tdi tien hanh nghien cuu de tai "Nhan xet ve djch te hpc vu djch Sdt xuat huyet Dengue tai Hai Phdng nam 2009"
Tap chi Y hpc du phong, Tap XXI, sd 4 (122) 103
Muc tiiu: nhan dugc chin doan Iam sang SXHD dugc Tim hieu ve dac diem djch te cua vu dilu trj tai cac benh vien trong thanh pho hoac djch. tai cdng ddng da dugc nhan vien y te du phdng
- D I xuit cac bien phap can thiep nhim dilu tra theo miu 1 ciia Bg Y tl.
nang cao chit lugng cua cdng tac phdng 2.2. Phuotig phap nghien cuu:
chdng dich. Nghien cuu md ta ket hgp vdi hdi ciru
^_^ , /> , ^ Xir ly sd lieu theo phuong phap thdng II. PHU^ONG PHAP NGHIEN CUU . . . ^
ke y hpc.
2.1.Ddi tugng nghien ciru: Tat ca cac benh HI. KET QUA VA BAN LUAN
3.1. Phan bo benh nhan SXHD:
Bang 1. S6 benh nhan SXHD theo lu'a tudi
Lu'a tudi Sd b/n Ty I p %
0-4 7 2.57 5-9 12 4.41 10-14 17 6.25 15-19 68 25,0 20-24 82 30.15 25-29 31 11.40 30-34 18 6.62 35-39 11 4.04 40-44 6 2.21 45-49 11 4.04 50-54 4 1.47 55-59 4 1.47
> 60 1 2,57 Cpng 272 100
Sd benh nhan SXHD nam 2009 chu ylu Nguyin Van Hiiu [1] nam 1969, 1975,1991 va la d dp tudi tir 20 den 24, chiem 30,15 %. Benh cua Thac sy Pham Qudc Vinh [ 2 ] giai doan nhan nhd tudi nhit la 1 tudi. Benh nhan cao 1979-1993 thi ty le mic SXHD d lua tudi ldn
Bang 2. S6 lupng b/n SXHD theo gio-i tinh
Gim
Nam NO' Tong
Sd m i c 152 120 272
Ty le % 55,88 44,12 100
Nghien cuu tren 272 mau phieu dieu tra cho thiy nam gidi mic vdi ty le cao han nir, chilm 55,88% (152 trudng hgp).
Bang 3. Sd lupng b/n SXHD theo quan, huypn
TT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Quan/huypn Ngd Quyen Hdng Bang Le Chan Kiln An An Lao Do Son Kien Thuy Hai An Vinh Bao Tien Lang Thuy Nguyen Cat Hai An Duong Duong Kinh Bgch Long VI
Tong sd
Sd ca 29 11 38 4 8 4 2 9 8 6 11 127
9 2 0
272
Ty le % 10,66
4,04 13,97
1,47 2,94 1,47 0,74 3,31 2,94 2,21 4,04 46,69
3,31 0,74 0
Sd dan 158.977 106.486 207.000 83.191 124.592
51.417 126.041
74.734 188.653 152.208 295.319 28.118 139.683
50.051 258
1.837.302
Ty le mic/10.000 dan 1,824
1,03 1,836 0,48 0,64 0,78 0,16 1,20 0,42 0,39 0,37 45,17
0,64 0,40 0
Ty le mSc chung ciia thanh phd/100.000 dan = 14,8
Tap chi Y hpc dir phong. Tap XXI, sd 4 (122) 105
Nhan xet: Nam 2009 la nam xuit hien so ca benh ldn nhat trong vdng 5 nam trd lai <tir 2004-2008). Qua bang tren cho thiy djch ldn xay ra tren dja ban ciia thj tran Cat Ba thudc huyen dao Cat Hai vdi 127 ca (chiem ty le 46,69 %), ty le mic /10.000 dan = 45,16 cao nhat toan thanh pho.
Nhu vay, so vdi nhieu nam lien ke trudc 3.2. Thdi gian xuat hien djch:
dd dja du ciia djch da cd sir chuyin ddi tir khu vuc cac quan ndi thanh vdi mat do dan cu ddng diic sang khu vuc huyen dao Cat Ba la khu du Ijch thu hiit nhilu khach tir cac nai tren toan qudc, ddng thdi cung la khu vuc dang tren da do thj hoa nhanh chdng nen da hinh thanh nen mdi trudng thuan Igi cho mudi truyin benh SXHD phat triln.
Bang 4. Sd lugng b/n SXHD theo tho'i gian trong nam
Thang So benh nhan Ty le %
1 0 0
2 1 0,36
3 0 0
4 0 0
5 0 0
6 0 0
7 3 1,1
8 20 0,73
9 58 21,32
10 88 32.35
11 64 23,53
12 38 13,97
Tong 272 100
Qua bang tren cho thay b/n xuat hien chu yeu vao cac thang 8-12, trong dd dinh diem la tap trung vao thang 10 (88 b/n = 32,35 %)
Vu djch bat dau xuat hien tir cudi thang 7 vdi 03 ca benh ddng thdi ciing la 3 ca (-I-) tinh. Ca benh dau tien la 1 b/n d quan Le Chan, cd yeu td djch te la di vao vimg dang cd djch SXHD (Ha Ndi) trong vdng < 14 ngay. Chi 1 tuan sau, bat dau xuat hien cac ca benh va ca
(+) tinh tai phudng khac ciia quan Le Chan ddng thdi sang cac quan huyen khac nhu Thuy Nguyen va Cat Ba.
Thdi gian vu djch keo dai tir thang 7-12, trong do dinh diem la tap trung vao thang 10 vdi 88 trudng hgp ( chiem 32,3 %). Dieu nay phii hgp vdi cac nghien ciru trudc day ciia Nguyen Van Hieu [1]
3.3. Quy mo dich:
Bang 5. Quy md vu djch SXHD
Ten den vj
NQ HB LC KA VB TL AL AD TN Ds KT HA CH DK BLV Th^nh pho
Xa phirvng c6 Tong
djch sd xa phuo'ng
11/13 6/11 13/15
3/10 6/30 5/23 7/17 5/16 10/37
2/8 2/18
5/8 3/13
2/6 0/1 80/226
Ty le % XIP CO djch
84.62 54,55 86,67 30 20 21,74 41,18 31,25 27,03 25 11,11 62,50 23,08 33,33
0
Mire dp djch quy mo xa phuo'ng
Nhd Nho Nhd Nhd Nhd Nhd Nhd Nhd Nho Nhd Nhd Nho Ldn Nho
14/15 Quan huypn CO djch
Mii'c dp djch quy md quan huypn
Ldn Ldn Ldn Trung binh Trung binh Trung binh Trung binh Trung binh Trung binh Trung binh
Nho Ldn Trung binh Trung binh Khong co b/n
Djch xay ra tren pham vLrdng vdi 14/15 va- Hai An da xay ra djch Idn vdi > 50 % sd quan huyen trong thanh pho cd benh nhan. Xet phudng cd b/n. Day la dilu rat can thiet cho ve quy md xa phudng thi djch ldn da xay ra d cdng tac giam sat chii ddng nham phat hien Cat Ba. Xet vl quy md quan huyen thi 4 quan sdm ca benh de xii' ly kjp thdi.
npi thanh la Le Chan, Hong Bang, Ngd QuyIn
Tap chi Y hpc dir phong. Tap XXI, sd 4 (122) 107
3.4. Yeu to dich te:
Bang 6. Ylu td djch t l cua b/n SXHD nam 2009
STT 1
2
3 4
Y I U td djch t l
Sinh vien hpc d Ha Npi Oi Ha Npi trong vdng 1 tuin Bi Thanh phd HCM ve Lai xe tuydn HN-HP Tdng sd
Sdb/n 61 12 1 3 77
Ty le % 22.43
4.41 0.37 1.10 28,31
Ghi chii
Trong sd nay cd ca benh (va cung la b/n duong tinh) d§u tien cua Hai Phdng
Ca benh dau tierrva cung la ca (+) tinh dau tien cua thanh phd Hai Phdng cd yeu td djch te la di tir viing cd djch. Va cung tuang tu nhu vay ddi vdi huyen dao Cat Ba, do la nhan vien cua 1 cdng ty tai Ha Ngi. Bang 7 cho thay cd tdi 77 b/n ( 28,31 %>) cd ylu to DT trd vl tir
vimg cd djch.
Dieu nay cd the ndi rang nguyen nhan cua vu djch SD/SXHD nam 2009 d Hai Phdng van la do djch xam nhap tii' tinh. Dieu nay phii hgp vdi cac nghien ciru tnrdc day ciia Gs Nguyen Van Hieu.[ 1 ]
3.5. Dac diem ve lam sang:
Bang 7. Cac tripu chirng cua b/n SXHD nam 2009
Tripu chu'ng
S6b/n Ty lp %
S6t
272 100
Day that (+) 231 84,93
XH tu nhien
233 85,66
Tieu ciu
< 50 G/l 40 14,71
Tieu ciu tu'51-<100
114 41,91
Tieu ciu
>100 118 43,98
Nhan xet: Trieu chirng sdt gap d 100 % cac trudng hgp. Cd 233 ca ( chiem 85.66 %>) cd XH tu nhien d cac mii'c do khac nhau. Sd lugng TC < 100 G/l gap d 154 ca benh chiem 56,62 %
V. KET LUAN
Bac diem dich te, hlnh thdi, cudng dp vd tinh chdt vu dich:
15-24(150ca = 55,15%)
Tyle mic/100.000 dan: 14,8.
Thdi gian djch : Tir thang 7-12, cao nhat vao thang 10-
Hinh thai dich : xay ra tren dien rdng o 14/15 quan huyen va 80/226 xa phudng.Quy md cip quan/huyen d 4 quan ngi thanh LC. NQ.
HB, HA va quy md cip xa phudng d Cat Ba.
YIU td djch tl: Dilu tra vl djch tl cho
TAI LIEU THAM KHAO
1. Nguyen Van Hieu- Mdt sd dac diem djch te hgc benh Dengue xuat huy It Dengue tai khu vuc Hai Phdng nam 1991 .Tap chi Y hgc Hai Phdng nam 1993, tap 1, trang 55-57
2. Pham Qudc Vinh ( 1997)Mdt sd dac dilm
djch te hpc benh sdt xuit hu It Dengue d Hai Phdng 1979-1993. Ky ylu cdng trinh khoa hpc cdng nghe 1994-1997, trang 303-310 Dengue Newsletter (1991), WORLD HEALTH ORGANIZATION, volume 16, page: 1-18
REMARKS ON DENGUE PETECHIAL FEVER IN HAI PHONG IN 2009
Do Manh Cuong, Le Thi Song Huong, Nguyen Thu HanhHai Phong Centre of Preventive Medicine Since 1998, the Dengue Petechial Fever Prevention Project (SXHD) has been implemented in Hai Phong.
' Number of patients has been reduced every year. Particularly, there was not any outbreak during 2004-2008 period in the city. In 2009, there was an outbreak of degue petechial fever in the city with 272 cases. This outbreak had several differences from the previous ones. By restrospective study, we have studied the outbreak in 2009 and followings are some remarks:
Outbreak duration: started in July and ended in December, mainly on adolescent age from 20 to 24 years old.
Total number of patients: 272, including 53 positive cases (+).
- Scale ofthe outbreak: the outbreak was in a large area of 14/15 districts and 80/226 communes.
The outbreak was serious in Cat Ba island district. The infection rate per 100000 people was 14.8. The outbreak was agressive.
Tap chi Y hpc du phong. Tap XXI, sd 4 (122)