广州市2004-2010年新生儿破伤风流行病学分析

目的了解广州市新生儿破伤风（NT）发病情况,确定高危人群,为消除NT策略与措施的调整提供依据。方法对广州市2004-2010年NT监测系统数据进行描述流行病学分析。结果广州市2004-2010年共报告NT病例365例,发病率为0.96‰,发病率呈逐年下降趋势,男女性别比为1.57∶1;死亡40例,病死率为10.96%,发病时间越短,病死率越高;病例主要为流动人口,特别是外省流动人口所占比例较大;全年均有病例发生,6-8月发病较多;发病时间集中在2～10d之间,4～8d为发病高峰;病例以在家由未经培训人员或家人接生为主,大部分为计划外生育,母亲均未接种过破伤风类毒素,只有少数做过产前检查。结论广州市消除NT的重点在于流动人口,要采取加强宣传教育、倡导住院分娩、提倡育龄期妇女接种破伤风类毒素、完善NT监测系统等综合防控措施,并将计划生育和消除NT的行动计划有机结合起来。

Analysis on epidemiological characteristic of neonatal tetanus in Guangzhou from 2004 to 2010

Objective To provide the basis for the strategy of elimination of neonatal tetanus （NT） by analyzing the data collected from NT surveillance system. Methods The data of NT in Guangzhou during 2004 and 2010 was analyzed and described. Results 365 cases were reported in Guangzhou from 2004-2010. The total incidence rate was 0.96‰ and the annual incidence rates decreased yearly. The sex ratio of male to female of the infected people was 1.57∶1. 40 dead cases were reported and the fatality rate was 10.96% which was decreased with the onset time. The cases mainly occurred in migrant children, particularly in children from other provinces. There were cases all the year. A seasonal peak was found from June to August. The onset time was during 2～10 days after birth and peaked in 4～8 days. Most of cases were delivered at home by untrained midwives or relatives and belonged to over quota children. All mothers of the cases had never received the tetanus toxoid vaccination. Only a few of them had received prenatal examination. Conclusion The strategy of elimination NT in Guangzhou should focus on immigrant population. Comprehensive measures should be adopted which include reinforcing propaganda and education, giving birth in hospital, immunizing women of child-bearing age with tetanus toxoid routinely and improving NT surveillance system. It is also very important to combine NT elimination and family planning closely.