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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳秀熙(HSIU-HSI CHEN) | |
dc.contributor.author | Chao-Chih Lai | en |
dc.contributor.author | 賴昭智 | zh_TW |
dc.date.accessioned | 2021-06-13T00:03:10Z | - |
dc.date.available | 2007-08-08 | |
dc.date.copyright | 2007-08-08 | |
dc.date.issued | 2007 | |
dc.date.submitted | 2007-07-30 | |
dc.identifier.citation | 1.World Health Organization. Global polio eradication initiative. [cited 2007 Jan 4]; World Health Organization [Available from: http://www.polioeradication.org.
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/28229 | - |
dc.description.abstract | 疫苗不僅能對接種疫苗者產生直接保護的作用,也對未接種疫苗者產生間接保護的作用,這就是疫苗集團免疫( herd immunity)的效應。過去很多文獻在探討疫苗的成本效益時,大多只考慮到疫苗的直接保護作用,大多忽略蜜月期、蜜月期後流行、流行期後新平衡與平均發病年齡改變等動態變化,以及這些動態變化與間接保護作用等對其成本效益所可能帶來的影響。
本研究建立了一個加入疾病症狀動態變化的傳染病模型,運用從過去小兒麻痺流行的文獻報告與由疾病管制局提供之手足口病的資料,來推估其R0值,並且比較傳統動態模型與新的症狀動態模型,並且藉此來量化集團免疫之效應。 結果新的症狀動態模型與傳統SIR模型,都能成功的估計小兒麻痺的R0值(1.71-24.17),而且結果相去不遠。可是新的症狀模型還能對臨床的併發症做預測,而且能輕易的評估疫苗與隔離等介入措施,對傳染病的影響。新的模型更能在資訊不完全下,因為加入了動態的臨床症狀之觀點,成功的推估手足口病的R0值(1.07-1.67)。而上述這些狀況都不是傳統的傳染病模型可以做到的。 總結,本研究所提出之新的症狀模型,保有傳統動態模型的所有優點,還能對臨床的併發症做預測,更能輕易的評估介入措施對傳染病的影響,並能量化集團免疫的效應。此模型對於經濟效益評估上,比傳統模型更具優勢。所以建議未來建立傳染病模型時,應將症狀的動態變化,放入評估的模型中。 | zh_TW |
dc.description.abstract | Mass vaccination can protect not only the immunized individual against infection disease but also protect the un-immunized individual. The effect of indirect protection of susceptible is termed herd immunity or herd effect. Herd immunity and herd immunity affect not only the incidence of disease but also the economic analysis of vaccination program. But the effect of herd effect in the study of economic analysis about vaccine program almost was ignored in the past.
Our modified dynamic symptom model was based on not only the dynamic infectious status but also dynamic change of disease with complications. We demonstrated it with illustrations of polio and hand-foot-mouth disease (HFMD). The effective reproductive number (R) of polio was estimated around 1.71-24.17. The effective R of HFMD was estimated around 1.07-1.67. If there are many uncertainties in emerging diseases like the HFMD with severe symptoms, the simple SIR model isn’t easily applied to this condition. But our modified dynamic symptoms model can easily handle this condition. The modified model is more easily applied to the dynamic economic analysis of the intervention program. | en |
dc.description.provenance | Made available in DSpace on 2021-06-13T00:03:10Z (GMT). No. of bitstreams: 1 ntu-96-R94846014-1.pdf: 5499055 bytes, checksum: 36bf70ae2a92d1af576b22e60a5731ae (MD5) Previous issue date: 2007 | en |
dc.description.tableofcontents | 目 錄
論文口試委員審定書……………………………………………. i 誌謝………………………………………………………………. ii 中文摘要…………………………………………………….……. iii 英文摘要…………………………………………………………… iv 第一章、研究動機與目的………………………………………. 1 第一節、研究動機………………………………………………. 1 第二節、研究目的……………………..………………………. 4 第二章、文獻回顧………………………………………………. 5 第一節、集團免疫與集團效應之文獻回顧…………….…….… 5 (一)、定義…….…………………………………………….… 5 (二)、理論…………………………………………………..… 6 1. 流行閾值理論(epidemic threshold)…………….….... 6 (1)群體作用理論(mass action principle)…………..… 6 (2) 流行閾值與基礎再生率(basic reproductive rate)….8 (3)以基礎再生率探討異質性人群之衍生方法…………….…. 9 2. 疫苗集團效應研究法設計與流行病學模型模擬估計法…….. 14 (1)疫苗集團效應研究法設計…………………………….……. 14 (2)流行病學模型模擬估計法…………………………….……. 16 3. 傳染病模型……………………………………………….……. 17 (1)靜態模型(statics)………………………………………. 18 (2)動態模型(dynamics)…………………………….………. 19 4. 二項式連鎖模型(Binominal Chain Model)……….……… 21 (三)、流行病學實例………………………………….………… 24 (四)、疫苗的成本效益評估………………………….………… 29 第二節、小兒痲痺與手足口病的文獻回顧…………….………… 31 (一)、小兒麻痺……………………………………...……..… 31 (二)、手足口病…………………………………….…..…..… 33 第三章、材料與方法…………………………………….….……..39 第一節、資料來源………………………….……………….……..39 (一)、小兒麻痺………………………………………….…..… 39 (二)、腸病毒──手足口病……………..…….…………..… 45 第二節、模型建構…………………………………………………..51 (一)建構臨床症狀的傳染病模型之步驟及要素………………..51 (二)傳染病模型建構....................................53 1.小兒麻痺……………..…………………………………..……..53 (1)簡單模型………………………………….…………………..53 (2)臨床症狀模型……………………………….………………..55 2 手足口病…………………………………………………………..59 (三)動態模型與靜態模型對傳染病介入措施效益評估之差異..63 1. 虛擬情境…………………………………………………….…..63 2. 建立介入措施成本效益評估之模型…………………….……..66 (1)固定人口單一世代…………………………………….……..66 (A)決策靜態模型……………….…………………………..…..66 (B)傳染病靜態模型………………………………….………....67 (C)動態模型…………….….…………………………………...67 (2)動態人口………………….…………………………………..67 (A)靜態模型………….….…………………..…………….…..69 (B)動態模型………….….…………………..………….……..69 (3)異質性動態人口……….………………..……….….……..70 (A)動態模型……….….……………..………………..………..70 (B) 靜態模型……….….……………..……..…………..……..72 (4) 建立評估介入措施-隔離的效益評估模型..….…..………..72 3. 模擬方法……………….….……………..…….....…….…..72 (四)模式驗證………………….….……………..…...………..77 第五章、結果………………….….……………...……..………..78 第一節、小兒麻痺R0的估計……………..…….………..………..79 (一)芝加哥地區……………..……..…………………….……..79 (二)馬歇爾群島……………..……..…………………….……..104 (三)台灣……………..……………..…………………….……..112 (四)荷蘭……………..……..…………………………….……..119 第二節、手足口病R0的估計…..………………………….……....127 第三節、集團免疫對疫苗成本效益之影響……………….……....136 (一) 參數估計…..……..……………...……...….……..136 (二) 情境一:單一出生世代………………….….….……..137 (三) 情境二:動態人群.……………………….…….……..142 (四) 情境三:動態人群……………………….……..……..150 (五) 情境四:異質性動態人群…………………….………..151 (六) 情境五:手足口病-隔離措施………….……………..156 第五章、討論…………………………………………………………157 參考文獻……………………………………………………….…..162 附錄一、小兒麻痺模型之模擬程式…………………………..… 171 附錄二、手足口病模型之模擬程式……………………………… 182 附錄三、成本效益評估模擬程式………………………………… 184 附錄四、Manuscript :Effective Reproductive Number and Herd Immunity:Applications to Poliomyelitis and Hand-foot-mouth Disease…..............................................204 | |
dc.language.iso | zh-TW | |
dc.title | 傳染病動態模型來評估集團免疫
─以小兒痲痺與手足口病為例 | zh_TW |
dc.title | Dynamic Infection model Associated with Herd Immunity ─ Illustrations of Poliomyelitis and Hand-Foot-Mouth Disease | en |
dc.type | Thesis | |
dc.date.schoolyear | 95-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 張淑惠(SHU-HUI CHANG),黃國晉,張啟明 | |
dc.subject.keyword | 集團免疫,動態模型,小兒麻痺,手足口病,基礎再生數, | zh_TW |
dc.subject.keyword | herd immunity,dynamic model,basic reproductive number,polio,hand-foot-mouth disease, | en |
dc.relation.page | 232 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2007-07-31 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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