影響腸病毒感染重症通報確診病例之因子 ---以法定傳染病通報系統為例

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影響腸病毒感染重症通報確診病例之因子 ---以法定傳染病通報系統為例

Factors of Influence for Confirming Severe Enterovirus Infection in the Reporting System ─ The Example of Mandatory Communicable Disease Reporting System

曾筑君 , Masters　　Advisor：楊哲銘　　

繁體中文

腸病毒感染重症；確診；醫師看診行為；醫院層級；疾病特性； severe enterovirus infection ； confirming ； physician’s behavior for treatment ； hospital ； disease characters

Abstract │ Reference (35) │ Altmetrics

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Background: Since the 1998 outbreak of Enterovirus 71 type infection in Taiwan, a large-scale pandemic would take place between early March and the beginning of autumn every year, which was causing panic all over Taiwan. The children under five years old have become the most vulnerable ones infected with severe complications such like aseptic meningitis, pulmonary edema and acute myocarditis, which even caused approximately 10% to 25.7% of those infected children died. Not only in Taiwan, but seventeen countries including U.S.A, France and Australia have severe enterovirus infection outbreak. The Centers of Disease Control, Taiwan has listed the severe enterovirus infection as the secondary mandatory communicable disease and established an instant notification system for tracing the epidemic situation; the doctors who found the infected case have to inform, report, confirm the case and trace the situation in order to prevent the epidemic of enterovirus infection. This research focuses on what factors in Mandatory Communicable Disease Reporting System could help doctors confirm who the real case is for severe enterovirus infection. 
Methods: Secondary data was used in this research. Variables analyzed included patient characters, hospital level, physician’s behavior for treatment, and disease characters from 1999~2008 Mandatory Communicable Disease Reporting System Database. There are 2611 suspected cases in the reporting system. Descriptine analysis, chi-square test, and logistic regression were applied to explore relationships between independent variables and confirmed cases of severe enterovirus infection. 
Results:There are 1503 confirmed cases of severe enterovirus infection and 1084 non-severe enterovirus infection cases according to the reporting system. We found the diagnosis accuracy rate is 58.1%. After calculating the diagnosis accuracy rate each year, the proportion has the tendency to rise gradually every year. In comparing with all variables, there is a significant difference among hospital levels (P<0.01), especially medical center has a higher accuracy rate then local hospital (45.1% vs. 1.4%, OR=1.4). Physician’s behavior is also significant. The other results show that season and the county where patients lived are both positively related to the rate of confirmed cases of severe enterovirus infection cases. Conclusions: These results should be taken into account when the public health policies are reviewed. The research shows the part of factors in Mandatory Communicable Disease Reporting System could do preliminary confirming, and it can also monitor the epidemic tendency effectively.

Reference ( 35 ) 〈TOP〉

王珠鳳(2005)。南台灣近二十年來腸病毒之分子流行病學暨單株抗體的製備與特性分析。高雄醫學大學基礎醫學研究所碩士論文，高雄。
連結：
江大雄(2005)。台北市某市立醫院腸病毒住院病人之流行病學研究。疫情報導，21(2)，80-95。
連結：
林翠莉、陳國東、王恩慈、李宜學、黃教威、徐秋菊、吳和生(2007)。1998~2006年台灣地區腸病毒重症個案血清型之分析探討與警愓。疫情報導，23(9)，514-530。
連結：
涂醒哲(2001)。傳染病症狀群通報的重要性。疫情報導，17(2)，66-72。
連結：
張鑾英(2002)。腸病毒71型臨床、重症危險因子、致病機轉及流行病學研究。長庚大學臨床醫學研究所博士論文，台北。
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