$63-2013 TAP CHi PHONG C H 6 N G BgNH SOT RgTVACAC BgNH KV SINH TRONG 3 7
SANH GIA DIEN B I £ N BENH DAI TREN DIA BAN TINH SON LA 2010-2012
Nguyin Ti^n DQng', Nguyin Thj M i n h ' , Nguyen Th( San' vk CS
Tom tat
Nghien eicu tren tdt cd cdc tru&ng hpp tu vong do benh dgi, cdc truang hpp den tiem tgi 12 diem cita 11 huy^n/thdnh phd tinh San La vd phdng vdn cdc cdn bp y te, cdn bp chinh quyen dia phuang. Ket qud dieu tra cho thdy: Trong 3 ndm 2010 - 2012, ty / | ngu&i ddn bf chd dgi cdn vd tit vong do mdc dgi tdng ddn (ty le tdn cdng/100.000 ddn tuang ung: 0,0- 0,4 - 1,5). Tru&ng hap tic vong gap chu yiu & Iua tudi tren 15 (72.2%>) vd ddn tpc Thdi (77,3%). Ty I? tic vong cao a ndng ddn (59,1%) vd hpe sinh (31,8%), tuang duang & cd nam vd na, tap trung chu yeu thdng 4 vd 9 trong ndm. 100% b?nh nhdn len can dgi deu tu vong vd deu la nhimg tru&ng hop khdng tiem phdng, ly do khdng tiem phdng do chii quan ehiem 50%, do khdng hieu biet ve benh dgi chiem 36,4%, ngodi ra mdt so yeu td khde nhu den mudn, khdng cd tien di tiem phdng.
Ty le ngu&i bi chd chay rdng cdn cao nhdt (50%), chd dm (9,1%) vd eho dd len can dgi chiem 13,6% Ty le ngu&i ddn rica vet thuang vd khdng rua tuang duang (40-45%). Th&i gian ii benh tic 30- 90 ngay. Ty le tdn edng bj chd edn tiem phdng dgi ndm 2010 Id 10,4, ndm 2011 la 117,1 nhung tdng cao nhdt ndm 2012 (390,1). Nhimg thdng cd ty I? bj chd cdn nhieu: 2, 3, 5, 6, 7, 8
Tit khda: Son La; Dai.
1. D^T VAN DE
Dai la benh viem nao tiiy cip tinh do virus dai (Rabie virus, thuoc ho Rhabdo-viridae) gSy nen. Nguoi bi nhiem virus dai se len con dai va tir vong neu khong duoc xu ly dung cdch va kip thcri. 6 Vi?t Nam, cho nha la ngu6n benh dai chu yeu (khoang 97%), sau do la meo nha (2,7%). Cho dai thuong bo nha, ch^y rong va gap bat ky ai cung can.
Vai nam tro lai day, tai cdc nude chau A, ty le tu vong do benh dai dang co xu huong tang ISn. 6 Vi?t Nam, hang ndm co toi 650.000 ngucri bi sue vat cdn phai di tiem vaccin.
Trong nhung nam 1990 - 1995, Viet Nam trung binh moi ndm co tren du6i 500 ca tu vong do benh dai, ty le tu vong tren 100.000 dan la 0,43 cao nhdt trong 10 benh truySn nhilm co ty Ie tii vong cao [6]. Truoc tinh hinh nghiem trpng do, ngay 07 thang 2 ndm 1996 Thu tucmg Chinh phu da ban hanh Chi thi 92/TTg \h tdng cuomg phong chfing b?nh dai (PCBD) [2].
Bh gop phin xay dung cac giai phap hiiu hieu phong chong benh dai noi chung va ty le ngudi dan tiem phong vdc xin d^i tr6n dia ban tinh Son La n6i rieng chung toi thuc hi8n de tai ''Bdnh gid diin biin djch vd khd ndng ddp iing phong chong dfch dgi tren d^a bdn tinh San La 2010-2012" vcA muc tieu sau:.
' Trung tSm Y tl dir pii6ng tinh San La (TTYTDP Tinh Son La)
3 8 $63-2013 TAP CHi PHONG C H 6 N G BgNH SOT RiTXfa^AfcBlNriKVSlNHWNg 1. Thyc trang diln bien djch dai tiin dja bin tinh Son La nSm 2010- 2012.
2. Danh gia khd ndng ddp ung phong ch6ng dai tren d^a bdn tinh Son La tir ndm 2010 -2012, Trong bdi bao ndy chung toi chi de cdp din myc tieu (1)
2. B 6 I TlTQING VA PHlTCWG PHAP NGHIEN CCtI 2.1. Doi tirgng nghien cihi:
Ho so cdc tnrimg hgp tir vong do dai trSn dja bdn tinh Son La ndm 2010-2012.
Ho so tiem tiem vSe xin dai 3 ndm 2010-2012.
Bdo cao tiem vdc xin ph6ng dai ciJa cdc trung 1am y te huy?n
Doi tugng ph6ng v ^ sau Id cdn bg ph\i trdch cong tdc tiem phong dai tai Trung tam Y te du ph6ng, trung tdm y te cdc huy$n, Thdnh ph6 Son La.
2.2. Phirong phdp nghien cihi 2.2.1 ThM gian nghien cihi
Nghien cuu tien hdnh tir thdng 04/2012 din thdng 12/2012.
2.2.2. Dia diem nghien ciru
Nghien curu dircjc tiln hanh tai 11 huy$n/thdnh phd tinh Son La 2.2.3. Thiet ke nghidn ciru
Nghien ciiu dp dung thiit kl nghien ciiu mo td cdt ngang.
2.2.4. Chpn mau va c& mau
Todn bg ho so tiem phong dai tai 12 diem tiem phong tai 11 huy|n/thanh pho trong 3 ndm 2010- 2012. Todn bg h6 so tu vong do b?nh dai trong 3 ndm 2010- 2012 t?i 11 trung tam y tl huygn/thanhpho..
2.2.5. Nguyen lieu vd phvimg phap
- Dieu tra thu thap so hgu qua ho so benh dn - Dira vdo mau ph6ng vdn co cdu tnic dugc thiit kl sdn.
2.2.6. Xir Iy so li^u
Todn bg so ligu nhdn dugc se dugc xit ly kiem tra Iji, lam sach trudc khi dugc nhap vdo mdy tinh. S5 ligu du(?c nhap vao mdy tinh bdng chuang trinh EPIDATA. De hjn che nhirng sai sot khi nhjp s6 li$u, tdt cd philu diu dugc nh^ip 2 lin sau do sil dung chuong trinh kilm tra phdt hi?n vd siia nhitng sai sot do nhap s6 li?u. Phdn tich sl li?u bdng phdn mim SPPS 15.
S6 3-2013 TAP CHi P H 6 N G C H 6 N G BgNH S6T R&T V A CAC BgNH KY SINH TRONG 39 3. KtT QUA NGHlilN CCfU vA B A N L U ^ N
3.1. Dac diim vi^ dien bi^n dfch dai tai tmh Sou La ti^ nam 2010-2012 22/5608
• S6 khdng bjb^nhdil ns6b|b^nhd?l
Hlnk 1: S6 ngu6i mdc benh d^/T6ng s6 ngucri bi ch6 cdn glai doan 2010 - 2012 Bang 1. Phan b6 ca mdc/chlt do dai giai d o ^ 2010 - 2012
Ndm
2010 2011 2012 TSng Tylf(%)
Mic/chet Mdc (1) Chit (2) Gid tri p
0 0
5 5
17 17
22 22
100 100
>0,05 GilH
Nam(l) NQ(2) Gid trip
0 0
3 2
10 7
13 9
59,1 40,9
<0,01 Dan tQC
Kmh{l) Thdi (2) Mong (3) Khde (4) Gid trip
0 0 0 0
0 5 0 0
3 12 2 0
3 17 2 0
13,7 77,3 9,0 0,0 (2:1;3;4)<0,05
Hpc van Mucha(l) Tieu hgc (2) Trung hgc co so (3) Trang hgc ph8 thgng (4) Cao ddng/dai hgc (5) Khde (6) Gid trip
0 0 0 0 0 0
1 2 1 1 0 0
3 5 5 3 0 1
4 7 6 4 0 1
18,2 31,8 27,2 18,2 0,0 4,5 (2:1; 4; 5; 6) < 0,05, (5: 1; 2; 3; 4; 6) < 0,05 Nhgn xet: Ket qud tai Bdng 1, cho thay: Ting so ca tir vong nam 2011 va ndm 2012 Id 22 ca. So voi cac tinh miln nui thi Son La co s6 ca tit vong cao hon nhilu. Rieng ndm 2012 tinh Son La cd sd tii vong cao hon gdp 1,4 Idn so vol tinh Ha Giang, 3,7 lan so vdi tinh Dign BiSn, YSn Bdi, mgt s5 tinh khde vd la tinh co s6 ca tir vong cao nhdt trong cd nuoc [6].
40
$63-2013 TAP CHi PHONG C H 6 N G BgNH S6T RgT vA CAC BgNH K<' SINH TRONG Nam 2012 ty 1$ tii vong tdng rit cao chiim 1,5/100.000 ddn, ndm 2011 chiim ty 1^0,4/100.000 dan, nam 2010 khdng c6 tru&ng hgp tii vong. B$nh dfii c61^ 1$ tii vong cao nhat so voi cdc bSnh truyin nhiem khde tren dja bdn todn tinh trong 3 ndm qua (Ciim 0,5/100.000 ddn, ViSm ndo 0,3/100.000...).
Ty le tit vong do dai ft cd nam vd nii khong c6 s\r ch?nh l^ch nhilu, ngir6i dan t0c Thdi thi c6 ty le tir vong cao nhit (77,3%) phii hgp v6i ty-1$ ddn s6 vd phong tuc t|p qudn nu6i nhilu cho. Nhom ngufti c6 trinh dg hgc vin tieu hgc vd trung hpc co sd c6 ty 1? tii vong chiem 59,1%, nhdm nguM c6 trinh dg cao ddng /dai hgc khdng c6 tnrdmg hgp ndo dugc ghi nhdn.
Bang 2: Tinh trjing con vdt liic cdn 6 b;nh nhan tii vong Tinh tr^ng con vdt luc cdn
Binh thudng (1) Cliay rong/mat tich (2) Len con dai (3) 6m (4) Khong bilt (5) Cgng:
Gia tri p
Ndm 2010
0 0 0 0 0 0
2011 1 2 1 0 1 5
2012 4 9 2 2 0 17 (2:1; 3; 4; 5)
Tfing 5 11 3 2 1 22
<0,05
T^l?(%) 22,7 50,0 13,6 9,1 4,6 100
Nhan xet: Tinh trang con vat liic cdn chay rong chiem ty Ie cao nhat chiem 50%, cho CO bieu hien binh thuong chiem 22,7%, len con dai chiem 13,6%, cho om 9,1%, khong biet 4,6%.
Co su khac biet ve tinh trang cho chay rong/mat tich voi len con dai vdi cac tinh trang cho c6 bieu hien binh thudng chiem, cho 6m va khong biet tinh trang cua cho v6i cdc ty 1?
tuong ung: 50,0% so voi 22,7%; 13,6%; 9,1% va 4,6% vdi p < 0,01.
Bang 3. Ly do benh nhan tii vong khong tiem phong Ly do khong tiem phdng
sau khi bi sue vat cdn Chu quan (1) Khong hieu biet (2) Den muon (3) Dimg thuoc nam/dong y (4) Cpng
Nim 2010
0 0 0 0 0 Gia tri
2011 2 0 3 0 5 P
2012 9 8 0 0 17
Tong 11
8 3 0 22
Tylf(%) 50,0 36,4 13,6 0 100 (1: 2; 3; 4) < 0,01 Nh^n xet: Co sir khde bi$t ty 1? nguoi bj sue v|it cdn khong di tiem phdng la do chd quan so vcri do khong hieu bilt ve b$nh dai, do din mugn va dimg thulc nam/d6ng y, voi cdc ty le tucmg ling 50,0% so vdi 36,4%; 13,6% vd 0,0% voi p < 0,01.
S6 3-2013 TAP CHi PHONG C H 6 N G BgNH S6T RET VA CAC BgNH KY SINH TRUN6 4 1 100%) so b^nh nhan tii vong d^u khdng di ti6m ph6ng. Ly do khSng di tiem phong Id do chii quan chiem t;^ 1$ 50%), khong hiiu bilt \h bfnh dai chiim 36,4%, den mugn 13,6%. Ngoai ra c6n mpt so y6u to khde nhu kh6ng c6 du tiln dl ti6m, ddc biSt d6i vdi d6i voi mpt s6 dSn &
vi!mg sau, viing xa, viing d|c biet khd khdn khi diiu ki?n kinh tl c6n han chi, khodng cdch tir diem tiem vac xin dai din noi xa nhat cua cac dia phucmg khoang tii 60 -100 km...
3.2. ThijK tr^ng sue v$t cSn
BAng 4: Phdn b6 ngudi bi siic vat cin theo nh6m tuoi TT
Ndm 2010
t l
(%)
Ndm2011
f j
(%)
Ndm2012
H j
(%)
Tdng n chung
cpng
(%)
TuSi 1 2
<15
>15 TSng
23 89 112
20,5 79,5 100,0
685 584 1269
54,0 46,0 100,0
1.642 2.585 4227
38,8 61,2 100,0
2.450 3.258 S608
43,7 56,3 100,0 Gidi
1 2
Nam Nil
Tong Tinh tr^ng con v^
1 2 3 4 5
Binh thudng 6m Chay rdng Mdt tich Len con dai
Tong 55 57 112 t Mc cdn
70 32 7 3 0 112
49,1 50,9 100,0
62,5 28,5 6,3 2,7 0 100,0
698 571 1269
1.059 59 81 70 0 1269
55,0 45,0 100,0
83,5 4,6 6,4 5,5 0 100,0
2.294 1.933 100,0
2.927 608 423 226 43 4227
54,3 45,7 100,0
69,3 14,4 10,0 5,3 1,0 100,0
3.047 2.561 5608
4.066 699 511 299 43 S60S
54,3 45,7 100,0
72,5 12,5 9,0 5,3 0,7 100,0 Nh$n xit: Sd ngudi bi sue vat cdn d lira tudi > 15 chiim ty le 56,3 %, nam chiim ty le 54,3 %.
Tinh trang con vat luc cdn binh thudng chiim ty le 72,5%, hi dm chiim 12,5%, chay rdng 9,0%, mat tich 5,3%, len con dai 0,7%. Nhu vay nguy ca truyin benh tit cho sang ngudi la rat idn neu khdng cd cdc bi?n phap ngdn chdn kip thdi, sd ngudi tit vong tren dia ban tinh Son La trong thdi gian tdi van tilp tuc tang len bdi ngudn benh cd nguy co cao chiim tdi 27,5%.
3.4. Tinh hinh tilm phdng d^i.
HiSn nay tai 12 diem tiem tai tinh Son La chi cd diem tiem vac xin phdng dai, chua cd dilm tidm vdc xin dai vd huyet thanh khdng dai.
42 S6 3-2013 TAP CHi P H 6 N G CHgNG BgNH SgT RIT V A C A C BgNH K^ SINH TRUNG
Diem tiem
TTYTDP Mde Chdu Yen Chdu Mai Son Thanh Phi Thuan Chdu Quynh l%ai Muong La Phil Yen Bdc Yen Sdng Ma Sdp Cgp Cgng
Bang 5: Tinh hinh tidm vdcxin d^i Nim
2010 112
0 0 0 0 0 0 0 0 0 0 0 112
2011 1.233 0 0 0 0 0 36 0 0 0 0 0 1.269
2012 2012 239
45 557
0 391 422 490 49 63 65 5 4.227
Cgng
3.228 329
45 557 0 391 458 490 49 63 65 5 5.608 Nhan xet: So nguoi den tiem phong dai tai diem tiem ciia Trung tam Y tl du phong cao nhat chiem 57,5%, con Iai tiem tai cac diem tiem tai 11 huyen, thanh pho. Tuy nhien nhilu diem tiem so ngucri den tiem phong con qua it boi ddy la nhimg dilm tiem mcri triin khai.
Tiem vac xin phong dai do cho can chiem ty le cao nhdt 98,5 %>. Trong 3 ndm so ngucri tiem vac xin phong dai la 5.608, nam 2010 chi co 112 nguoi, tdng trong ndm 2011 va den ndm 2012 s6 ngucri tiem vdc xin phong dai tdng cao dpt biin len tdi 4.227 nguoi (tang gip 37,7 Idn so voi ndm 2010), chung to diln bien dich dai ngdy cdng phiic tgp, s6 nguoi hi cho cdn van tiep tuc tdng tai cac dia phuong trong toan Tinh.
4. KET LUAN
- Ty le mdc, chit do dich dai /lOO.OOO dan tai tinh Son La tdng ddn theo cac ndm 0 (2010); 0,4 (2011); 1,5(2012)
- Tu vong do benh dai chu yeu liia tu6i >15 (72,7%), va phan lon a Dan toe Thdi (773%). 6 trinh dp hpc van th^) (Trung hpc co so tro xu6ng) va d6i tupng Id nong dan t^ 1? ngucri mdc d^ cao tuong ducmg (60%)
- Phdn lon ngucri bi cdn la do cho chay rong (50%), do cho 6m 9,1%, cho len con dgi 13,6%. Chi CO 50% ngucri hi cho can la co riia sat tning vit thucmg..
Thoi gian u benh thuong tu 30 - 90 ngay (82,0%), khong co truong hpp nao du6i 30 ngay.
100% benh nhan tu vong diu khong dupc tiem phong, 100% benh nhdn hi vong khi 16n con dai.
S6 3-2013 TAP CHi P H 6 N G C H 6 N G BJNH SOT RJT VA CAC BJNH K'V' SINH TRUNG 43 - Ly do khdng di tiSm phdng chii yeu Id do chu quan (50%), khong hieu biet ve b?nh dai (36,4%), den muOn 13,6%. Nhilng ngucri din ti6m phong dgi chu yeu do chd cdn chiim 98,5%, meo 1,3% vd khde 0,2%.
T A I LIf U T H A M KHAO:
1 Bp Ndng nghiSp & Phdt trien ndng thdn (2005), Bdo cdo tdng kit 10 ndm thuc hien Chi thi 92/CT-TTg cua Thu tu&ng Chinh phu (1996 - 2005) vi Tdng cu&ng phdng chdng b$nh dgi, Hd NOi.
2 Nguyin Trdn Hiin (2009), Dich ti hpc phdn tit benh dgi & Viet Nam, D I tdi nghien cuu cdp Bp Y th, Vien Ve sinh djch tl Trung uong, Ha Noi.
3 Nguyin Trdn Hiin (2012), "Thy:c trgng tinh hinh, cdc bai hpc kinh nghi?m vd dl xuat giai phdp phdng chdng b?nh dai d Vi?t Nam", Tgp ehi Y hpe d{c phdng, Hpi Y hpc dy:
phdng Vi$t Nam, Ha Npi.
^ Dinh Thj Kim Xuyin (2000), Nghien cicu ddp itng khdng the vd dp an todn cua vdc xin phdng dgi Verorab sdn xudt tgi Phdp, theo phuang phdp tiem bdp thit vd liem trong da tren ngu&i Vi$t Nam tinh nguyen, D I tdi nghien cuu cap Bp, Vi?n V? sinh dich te Trung uong. Ha Npi.
5 Dinh Thi Kim XuyIn (2007), "Xay dung md hinh phdng chdng benh dgi d Viet nam", Tgp chi Yhoc du phdng, Hdi Y hpc du phdng Viet Nam, Sd.3, Tr.l37-I41
6 Trung tam Y tl du phdng tinh Son La (2012), Bdo cdo tinh hinh dien bien djch benh dgi & nguai ndm 2011 - 2012 vd edc bien phdp khdng che dich. Son La.
4 4 363-2013 TAP CHi PHONG C H 6 N G BgNH S6T RET vA CAC BgNH K^ SINH TRONG
A REVIEW OF RABIES IN SON LA PROVINCE 2010 - 2012 Nguyen Tien Dung', Nguyen Thi Minh',
Nguyen Thi San' etal.
Abstract;
A research was conducted by investigating all death cases due to rabies, and vaccinated cases at 12 points of 11 provinces/ cities in Son La as well as interviewing health worlcers and local government officials. The resuhs showed that: In 3 years from 2010 to 2012, the proportion of people bitten by rabid dogs and exposed to death increased (attaclt rate per 100.000 corresponding population was: 0.0 - 0.4 to 1.5). The death cases occurred in the people over 15 years old (72.2%) and Thai people (77.3%). The fatality rate was high in farmers (59.1%) and students (31.8%), similarly in both men and women, mainly occurring in April and September. 100% of the patients having seizure would be dead and they were unvaccinatcd cases. The reason of subjectiveness accounted for 50%, 36.4% due to a lack of knowledge, and there were some other reasons such as lateness, no money for shots.
Wild bites were responsible for most cases (50%), bites from sick dogs were responsible for 9.1% and 13.6% were blamed for dogs with rabies symptoms. The percentage of people who cleaned their wound and didn't were 40 and 45% respectively. The incubation period was from 30 to 90 days. Dog bites were popular in February, March, May, June, July and August.
Keywords: Son La; rabies.
Cdn b$ phdn bien:
PGS. TS Le Xuan Himg
Ngdy nhgn bdi 01/04/2013 Ngay giii phdn biin: OS/04/2013 Ngay ddng bdi: 20/05/2013