5岁以下儿童轮状病毒腹泻流行特征和经济负担评价分析

Analysis on Economic Burden Evaluation and Epidemiology of Rotavirus Diarrhea among Children under Five Years Old

目的了解轮状病毒在5岁以下门诊和住院腹泻儿童中的流行特征,探索建立轮状病毒腹泻经济负担的评价方法,为轮状病毒疫苗的使用和成本效益评价提供背景资料。方法收集甘肃省2012年8月—2013年7月2个轮状病毒哨点医院门诊和住院的5岁以下腹泻就诊儿童的个案信息和粪便标本,进行轮状病毒腹泻流行特征分析,对所有标本统一使用酶联免疫吸附试验方法检测轮状病毒,资料采用SPSS 17.0进行数据分析。结果共调查5岁以下腹泻就诊儿童734例,轮状病毒阳性率为41.69%,其中门诊病例的轮状病毒阳性率为30.99%,住院病例的轮状病毒阳性率为46.07%,门诊和住院轮状病毒腹泻儿童的发病年龄主要集中在2岁以下,分别占门诊和住院腹泻儿童的92.42%和97.92%,其中6月龄组的婴幼儿比例最高,分别占门诊和住院腹泻儿童的54.55%和55.42%,粪便性状主要以水样便为主,占85.80%,其次为稀便,占81.27%。5岁以下轮状病毒腹泻儿童人次均门诊直接医疗费用375.42元,人次均住院直接医疗费用2 053.91元,人次均门诊直接非医疗费用47.92元,人次均住院直接非医疗费用180.13元。人次均门诊间接费用270.45元,人次均住院间接费用721.20元。结论 2岁以下婴幼儿是轮状病毒腹泻的高发人群,针对轮状病毒腹泻对儿童健康造成的危害和经济负担,需采取措施控制轮状病毒腹泻的发病水平。

OBJECTIVE To understand the epidemiological characteristics of rotavirus among children under five years old in the outpatient and inpatient with diarrhea, establish economic burden evaluation methods of rotavirus diarrhea and provide basic information for the development and cost effectiveness evaluation of rotavirus vaccine. METHODS The individual cases information and fecal specimens were collected from children under 5 years old who were outpatient and inpatient with diarrhea in two sentinel hospitals in Gansu between August 2012 and July 2013 for rotavirus diarrhea epidemic characteristic analysis. All fecal specimens were used to detect rotavirus using Enzyme-linked immunosorbent assay. Collected data were analyzed by SPSS17.0. RESULTS A total of 734 diarrhea cases under 5 years old with rotavirus positive rate of 41.69%, including outpatient cases with rotavirus positive rate of 30.99% and inpatient cases with rotavirus positive rate of 46.07%. Most diarrhea cases with rotavirus were children under 2 years old, accounting for 92.42% of diarrhea outpatients and 97.92% of inpatients, respectively. The infants in 6 months of age group were the highest proportion of children with rotavirus diarrhea, accounting for 54.55% of diarrhea outpatients and 55.42% of inpatients, respectively. Water diarrhea was significantly character for rotavirus diarrhea, accounted for 85.80%, followed by loose stools for 81.27%. Average direct medical cost of per outpatient and per inpatient rotavirus diarrhea were 375.42 yuan and 2 053.91 yuan respectively, average direct non-medical costs of per outpatient and per inpatient with rotavirus diarrhea were 47.92 yuan and 180.13 yuan respectively, and average indirect costs of per outpatient and per inpatient were 270.45 yuan and 721.20 yuan respectively. CONCLUSION The children under 2 years old were the population at high risk of rotavirus diarrhea. The measures should be taken to control the incidence of rotavirus diarrhea against rotavirus diarrhea harm on the health of children and causing huge economic burden.