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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 方啟泰 | |
dc.contributor.author | En-Tzu Wang | en |
dc.contributor.author | 王恩慈 | zh_TW |
dc.date.accessioned | 2021-06-15T13:33:12Z | - |
dc.date.available | 2016-02-24 | |
dc.date.copyright | 2016-02-24 | |
dc.date.issued | 2016 | |
dc.date.submitted | 2016-02-01 | |
dc.identifier.citation | 1.Hsiu-Fen Tan, Chen-Kang Chang, Hung-Fu Tseng, Wender Lin. Evaluation of the National Notifiable Disease Surveillance System in Taiwan: An example of varicella reporting. Vaccine 25 (2007) 2630-2633.
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Effectiveness of 2 doses of varicella vaccine in children. J Infect Dis. 2011 Feb; 203(3): 312-5. 34.Gould PL, Leung J, Scott C, Schmid DS, Deng H, Lopez A, et al. An outbreak of varicella in elementary school children with two-dose varicella vaccine recipients—Arkansas, 2006. Pediatr Infect Dis J. 2009 Aug; 28(8): 678-81. 35.Marin M, Meissner HC, Seward JF. Varicella prevention in the United States: a review of successes and challenges. Pediatrics. 2008; 122(3): e744-51. 36.Seward JF, Marin M, Vasquez M. Varicella vaccine effectiveness in the United States vaccination program: a review. J Infect Dis (Suppl). 2008 Mar 1; 197 Suppl 2: S82-9. 37.Kuter B, Matthews H, Shinefield H, Black S, Dennehy P, Watson B, et al. Ten year follow-up of healthy children who received one or two injections of varicella vaccine. Pediatr Infect Dis J. 2004; 23: 132-7. 38.Vázquez M, LaRussa PS, Gershon AA, Niccolai LM, Muehlenbein CE, Steinberg SP, Shapiro ED. Effectiveness over time of varicella vaccine. JAMA. 2004 Feb 18; 291(7): 851-5. 39.Johnson CE, Stancin T, Fattlar D, Rome LP, Kumar ML. A long-term prospective study of varicella vaccine in healthy children. Pediatrics. 1997; 100: 761-6. 40.Asano Y, Suga S, Yoshikawa T, Kobavashi I, Yazaki T, Shibata M, et al. Experience and reason: twenty-year follow-up of protective immunity of the Oka strain live varicella vaccine. Pediatrics. 1994; 94: 524-6. 41.US CDC, Contraindications and Precautions for Varicella Vaccination. http://www.cdc.gov/vaccines/vpd-vac/varicella/hcp-contraindications.htm. 42.WHO, Meeting of the Strategic Advisory Group of Experts on immunization, April 2014 – conclusions and recommendations. Weekly epidemiological record. No. 21, 2014, 89, 221-236. 43.Mona Marin, John X. Zhang, Jane F. Seward. Near Elimination of Varicella Deaths in the US After Implementation of the Vaccination Program. Pediatrics 2011; 214-220. 44.Po-Yuan Wu, Hong-Dar Isaac Wu, Tzu-Chieh Chou, Fung-Chang Sung. Varicella Vaccination Alters the Chronological Trends of Herpes Zoster and Varicella. PLoS ONE 2013; 8(10): e77709. 45.行政院主計總處:99年人口及住宅普查健康醫療補充報告提要分析。http://www.stat.gov.tw/public/Attachment/33298512771.pdf. 46.Ie-Bin Lian, Yu-Zen Chien, Pi-Shan Hsu, Day-Yu Chao. The changing epidemiology of varicella incidence after implementation of the one-dose varicella vaccination policy. Vaccine 29 (2011): 1448-1454. 47.Mona Marin, Dalya Güris, Sandra S. Chaves, Scott Schmid, Jane F. Seward. Prevention of Varicella- Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. June 22, 2007 / 56(RR04); 1-40. 48.Gao Z, Gidding HF, Wood JG, MacIntyre CR. Modelling the impact of one-dose vs. two-dose vaccination regimens on the epidemiology of varicella zoster virus in Australia. Epidemiol Infect 2010; 138(4): 457-68. 49.衛生福利部疾病管制署:充實國家疫苗基金及促進國民免疫力第二期計畫。http://www.cdc.gov.tw/professional/downloadfile.aspx?fid=20E761D1AC2A5657. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/51408 | - |
dc.description.abstract | 背景及目標:水痘疫苗於1997年引進臺灣,1998、1999年起分別於台北市、台中市、台中縣提供年滿1歲幼兒公費接種,2004年起擴及全國。本研究分析國內自2000至2012年的水痘流行病學趨勢、水痘相關的住院率、併發症與死亡等疾病負擔,及水痘疫苗的保護效果,並估算醫療資源與社會成本耗用情形,做為評估水痘預防接種政策的參考。
方法:自全民健康保險研究資料庫選取2000至2012年間就醫紀錄曾有與水痘相關之國際疾病分類代碼者,另自預防接種資訊系統(national immunization information system, NIIS)取得水痘病人的水痘疫苗接種資料。使用「年齡—年代—世代 ( Age-Period-Cohort, APC )」分析方法,計算水痘發生率在不同年齡、年代、世代的變化趨勢,同時分析水痘相關住院、併發症、死亡、突破感染、醫療支出及社會成本耗損情形。 結果:隨著公費水痘疫苗接種政策普及全國年滿1歲幼兒,2012年水痘發生率已較2000年大幅下降87%,發生率高峰自3到5歲延後至10到12歲,平均感染年齡由7.92歲上升至16.25歲。較早實施公費疫苗接種政策的地區(早區),其發生率在2000年已有顯著下降,晚區在實施公費疫苗接種後,趨勢與早區逐漸接近。水痘病人住院率平均每千人15.51人,以未滿1歲嬰兒、20至29歲、30至39歲及70歲以上者較高,平均住院天數為4.76天。33.47%的住院病人有併發症,以下呼吸道感染最常見。有16名水痘病人死亡,其中37.5% (6/16)有潛在疾病,81.25% (13/16)出現併發症。突破感染的平均年齡為5.28歲,1999年至2006年的出生世代,接種水痘疫苗5年後的保護效果介於82.27%至94.78%。水痘醫療支出逐年降低,以5歲病人的醫療支出占比最高,住院支出於所有醫療支出的占比逐年上升至4成,水痘相關社會成本耗損約為醫療支出的8.28倍。投資1元於疫苗,可節省2.97元的醫療支出與社會成本。 結論:公費水痘疫苗接種政策已大幅降低感染與住院,有效減少醫療支出與社會成本耗損。在第2劑水痘疫苗導入幼兒常規接種之前,有潛在疾病的兒童及不具水痘免疫力的成人,若無疫苗接種禁忌,可考慮自費接種第2劑或兩劑水痘疫苗,有助於避免嚴重併發症的發生。 | zh_TW |
dc.description.abstract | Background and purpose: The varicella vaccine has been available in Taiwan market since 1997. Taipei City and Taichung City/County started providing one free dose of varicella vaccine to 1-year-old children in 1998 and 1999, and a mass varicella immunization program was established to provide free vaccination for all 1-year-old children throughout Taiwan. This study investigated the epidemiological characteristics and disease burden of varicella from 2000 to 2012. The results will be essential to refine our immunization policy.
Method: Patients with varicella-related ICD-9-CM codes from the 2000-2012 National Health Insurance Database were included. Their immunization data was obtained from National Immunization Information System (NIIS). The Age-period-cohort (APC) analysis was used to calculate the age, period, and cohort-specific incidence of varicella. This study also investigated the geographic and seasonal distribution, hospital admission rate, breakthrough rate, vaccine effectiveness, medical costs and indirect costs from the societal perspective of varicella. Result: From 2000 to 2012, the implementation of a routine childhood varicella vaccination program has resulted in 87% decline in morbidity. The overall age-specific incidence peaked in pre-school children then shifted to teenagers, and the average age increased from 7.92 years to 16.25 years. In 2000, there was a significant decrease in incidence observed in areas implementing the free vaccination policy (early area). The deviance between early and late area had been narrowed after the implementation of the nationwide free vaccination program in 2004. The varicella-related hospital admission rate was 15.5/1000 patients. Infants younger than 1 year, adults aged from 20 to 39 years and older than 70 years had the highest admission rates. The complication rate among patients admitted to hospital was 33.47%, and the most common complication was lower respiratory tract infection. The mean duration of hospital stay was 4.76 days. 16 patients with varicella died, 37.5% had underlying disease and 81.25% had complication related to vericella. The mean age at breakthrough infection was 5.28 years. For birth cohorts 1999 to 2006, the vaccine effectiveness against varicella was 82.27% to 94.78% after five years of vaccination. The annual varicella-related medical expense declined after 2002 and the proportion of medical costs for admission has increased to 40%. The age-specific medical expenses peaked in 5-years old children. The indirect costs from the societal perspective of varicella were up to 8.28 times of medical costs. Every one dollar invested on the varicella vaccine saved 2.97 dollars of medical and social costs on average. Conclusion: The impressive decline in varicella morbidity, hospitalization, medical and social costs can be directly attributed to successful implementation of the 1-dose immunization program. A second-dose booster may be considered for children with underlying disease until the second dose introduced to routine childhood immunization program. Two-dose vaccination is also recommended for susceptible adults to prevent serious complications. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T13:33:12Z (GMT). No. of bitstreams: 1 ntu-105-R00847003-1.pdf: 1501294 bytes, checksum: bbb5aec1c26a5ad4f1c9887313e1484d (MD5) Previous issue date: 2016 | en |
dc.description.tableofcontents | 口試委員會審定書………………………………………………… i
誌謝………………………………………………………………… ii 中文摘要…………………………………………………………… iii 英文摘要…………………………………………………………… v 第一章 導論……………………………………………………… 1 第一節 實習單位簡介…………………………………………… 1 第二節 研究動機與目的………………………………………… 2 第三節 文獻探討………………………………………………… 3 第二章 研究方法………………………………………………… 7 第一節 資料收集………………………………………………… 7 第二節 分析方法………………………………………………… 8 第二節 分析項目與定義………………………………………… 9 第四節 統計分析………………………………………………… 10 第三章 結果……………………………………………………… 11 第一節 2000年至2012年國內水痘流行病學趨勢……………… 11 第二節 全面實施公費水痘疫苗接種政策前後的水痘流行病學趨勢 …… 13 第三節 早區與晚區的水痘流行病學特徵……………………… 15 第四節 水痘病人之住院率、併發症、死亡率及有無潛在疾病之差異… 17 第五節 水痘疫苗接種世代的突破感染流行病學變化情形與趨勢 ……… 20 第六節 水痘病人耗用之門急診、住院醫療費用……………… 22 第四章 討論……………………………………………………… 27 參考文獻…………………………………………………………… 35 圖 一 水痘病例數及發生率趨勢……………………………… 39 圖 二 各地區的水痘病人發生率……………………………… 40 圖 三 各月份氣溫變化與水痘病例發生情形………………… 41 圖 四 水痘病人的性別分布…………………………………… 42 圖 五 各年齡層的水痘發生率………………………………… 43 圖 六 各年齡層的水痘病例比率……………………………… 44 圖 七 早區及晚區的水痘發生率變化趨勢比較……………… 45 圖 八 各期間早區及晚區的各年齡層水痘發生率比較……… 46 圖 九 早區及晚區各出生世代於各年齡層的水痘發生率比較 ……………47 圖 十 早區及晚區各出生世代於各期間的水痘發生率比較… 48 圖十一 早區及晚區水痘發生率的年齡—年代—出生世代趨勢 49 圖十二 水痘病人的住院情形…………………………………… 50 圖十三 水痘病人的併發症種類與分布………………………… 51 圖十四 水痘病人的潛在疾病種類與分布……………………… 52 圖十五 各疫苗接種世代的突破感染發生情形………………… 53 圖十六 各疫苗接種世代的年齡別突破感染發生情形………… 54 圖十七 水痘疫苗對於各出生世代的保護力變化情形………… 55 圖十八 水痘相關醫療費用支出情形…………………………… 56 表 一 水痘疫苗對於各出生世代避免感染及住院的保護力… 57 表 二 水痘相關社會成本與醫療費用支出比較……………… 58 | |
dc.language.iso | zh-TW | |
dc.title | 2000至2012年臺灣水痘流行病學與疾病負擔 | zh_TW |
dc.title | The Epidemiological Characteristics and Disease Burden of Varicella in Taiwan from 2000 to 2012 | en |
dc.type | Thesis | |
dc.date.schoolyear | 104-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 楊靖慧,張鑾英,杜裕康 | |
dc.subject.keyword | 水痘,水痘疫苗,流行病學,突破感染,疫苗效果,疾病負擔, | zh_TW |
dc.subject.keyword | varicella,varicella vaccine,epidemiology,breakthrough infection,vaccine effectiveness,disease burden, | en |
dc.relation.page | 58 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2016-02-02 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
顯示於系所單位: | 公共衛生碩士學位學程 |
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