Epidemiological characteristics and related factors of varicella public health emergency events in primary schools of Nanning City from 2014 to 2023
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摘要:
目的 分析2014―2023年南宁市小学水痘突发公共卫生事件(public health emergency events, PHEEs)的流行病学特征和影响因素，为开展小学水痘疫情防控工作提供科学参考。 方法 通过中国疾病预防控制信息系统收集2014―2023年南宁市水痘发病资料和小学水痘突发公共卫生事件信息，采用移动平均预警方法识别水痘流行期，运用描述性流行病学方法分析小学水痘PHEEs疫情特征，采用逐步法建立多重线性回归模型，分别分析水痘突发疫情持续时间和各流行期内PHEEs起数和疫情总病例数的相关因素。 结果 2014―2023年南宁市共报告116起小学水痘突发公共卫生事件，疫情主要发生在冬春季流行期(66.38%)，不同流行期水痘突发公共卫生事件的中位持续时间(H=1.62, P=0.204)和疫情中位病例数(H=1.69, P=0.194)差异无统计学意义。农村小学总发病率(5.82%)高于其他类型学校(χ2 =646.04, P＜0.001)；县镇小学的疫情持续时间(F=4.02, P=0.021)、疫情平均病例数(F=4.54, P=0.013)、涉及班级数(F=9.36, P＜0.001)最高；城市小学疫情涉及人数(F=28.06, P＜0.001)最高。疫情首次报告病例数(β=0.84, P=0.006)、单起疫情病例数(β=0.16, P=0.048)和涉及班级数(β=1.21, P=0.004)是小学水痘突发公共卫生事件持续时间的影响因素；流行期内疫情总起数及疫情病例总数与首起疫情持续时间呈正相关(疫情总起数: β=0.08, P=0.029; 疫情病例总数: β=6.16, P=0.001)，与流行期内疫情平均时间间隔呈负相关(疫情总起数: β=-0.21, P＜0.001; 疫情病例总数: β=-8.14, P=0.001)。 结论 在水痘流行期应重视小学水痘疫情的防控，提高对校园水痘聚集疫情监测的敏感度，减少班级间传播可缩短突发公共卫生事件持续时间，同时应加强流行期异常信号识别(首起疫情持续时间、疫情间隔时间)，以及时评估整体暴发水平。 Abstract:Objective This study aimed to analyze the epidemiological characteristics and related factors of varicella public health emergency events (PHEEs) in primary schools in Nanning City from 2014 to 2023, offering scientific insights for the prevention and control of varicella outbreaks in schools. Methods Utilizing the China information system for disease control and prevention, we collected data on varicella cases and PHEEs in primary schools. The moving average warning method identified varicella epidemic periods. Descriptive epidemiology was applied to characterize these PHEEs. We employed stepwise approaches to construct multiple linear regression models, focusing on the factors associated with the duration of varicella outbreaks, the frequency of PHEEs, and the total number of cases during each epidemic period. Results Between 2014 and 2023, Nanning City reported 116 varicella PHEEs in primary schools, predominantly occurring during the winter and spring epidemic periods (66.38%). No significant differences were observed in the median duration (H=1.62, P=0.204) and case numbers across various epidemic periods(H=1.69, P=0.194). The overall incidence rate in rural primary schools was significantly higher at 5.82%, compared to other school types (χ2 =646.04, P < 0.001). County-town primary schools experienced the longest epidemic duration (F=4.02, P=0.021), highest average number of cases per outbreak (F=4.54, P=0.013), and the greatest involvement of classes (F=9.36, P < 0.001). Urban primary schools had the highest number of people affected (F=28.06, P < 0.001). The duration of varicella PHEEs was significantly influenced by the initial case numbers reported (β=0.84, P=0.006), the number of cases per outbreak (β=0.16, P=0.048), and the number of classes involved (β=1.21, P=0.004). Furthermore, the total number of PHEEs and total case numbers during an epidemic period were positively associated with the duration of the first outbreak (β=0.08, P=0.029; β=6.16, P=0.001) and negatively with the average interval time between outbreaks (β=-0.21, P < 0.001; β=-8.14, P=0.001). Conclusions Heightened focus on varicella prevention and control in primary schools is essential, especially during epidemic periods. Enhancing the sensitivity of school-based varicella outbreak monitoring and reducing transmission between classes can shorten the duration of PHEEs. Strengthening the recognition of abnormal signals during the epidemic, such as the duration of the first outbreak and the interval between outbreaks, is crucial for the timely assessment of the overall outbreak level. -
Key words:
- Varicella /
- Primary school /
- Public health emergency event /
- Epidemic period
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表 1 南宁市2014―2023年流行期小学水痘PHEEs疫情特征
Table 1. Characteristics of varicella PHEEs epidemics in primary schools in Nanning City, 2014―2023
特征
Characteristic冬春季流行期
Winter and spring epidemic periods① (n=10)夏季流行期
Summer epidemic periods① (n=8)合计
Total①t/χ2值value P值
value累计疫情起数 Total number of PHEEs 77(67.54) 37(32.46) 114(100.00) 流行期疫情起数 Number of PHEEs 7.00(4.00, 8.00) 3.50(1.50, 8.00) 6.50(3.00, 8.00) 1.68 0.194 流行期平均持续时间 Average duration of epidemic period/d 130.30±19.40 130.00±11.82 130.17±16.03 0.04 0.970 流行期内各起疫情持续时间
Duration of PHEEs within the epidemic period34.00(23.00, 53.50) 29.00(20.00, 46.25) 33.00(21.00, 49.00) 1.62 0.204 流行期内各起疫情平均间隔时间
Average interval time between PHEEs within the epidemic period /d17.99±6.64 33.92±22.12 25.07±17.06 -2.17 0.045 疫情病例总数 Total number of outbreak cases 3 308(71.20) 1 338(28.80) 4 646(100.00) 流行期内各起疫情的病例数
Number of cases per outbreak during the epidemic period34.00(23.00, 52.25) 26.00(20.75, 45.00) 32.00(22.00, 49.00) 1.69 0.194 流行期南宁市平均报告病例数
Average reported cases in Nanning City during the epidemic period4 373.70±2 263.33 2 943.25±1 317.31 3 737.94±1 990.35 1.58 0.134 流行期距学期开始时间间隔
Average interval time between epidemics within the epidemic period/d25.50(17.00, 28.00) 17.50(15.50, 23.00) 20.00(16.00, 28.00) 1.44 0.229 注：PHEEs，突发公共卫生事件。
①以人数(占比/%)或M(P25, P75)或x±s表示。
Note: PHEEs, public health emergency events.
① Number of people (proportion/%) or M(P25, P75) or x±s.
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表 2 2014―2023年南宁市不同类型小学水痘PHEEs流行病学特征
Table 2. Epidemiological characteristics of varicella PHEEs in different types of primary schools in Nanning City, 2014―2023
特征
Characteristic农村小学
Rural primary schools① (n=41)县镇小学
County town primary schools① (n=36)城市小学
Urban primary schools① (n=39)合计
Total① (n=116)χ2/F值
valueP值
value总发病率 Overall incidence rate/% 5.82(1 325/22 768) 3.39 (1 943/57 347) 2.36 (1 514/64 078) 3.32 (4 782/144 193) 646.04 < 0.001 学生发病率 Student incidence rate/% 6.13(1 321/21 541) 3.57 (1 938/54 343) 2.51 (1 508/60 152) 3.50 (4 767/136 036) 617.58 < 0.001 教职员工发病率 Incidence rate among faculty and staff/% 0.33(4/1 227) 0.17(5/3 004) 0.15(6/3 926) 0.18(15/8 157) 1.61 0.448 涉及人数 Number of people affected 555.32±431.97 1 592.97±848.63 1 643.03±855.53 1 243.04±887.22 28.06 < 0.001 疫情持续时间 Duration of epidemic outbreaks/d 31.56±21.24 45.58±26.84 35.49±17.92 37.23±22.73 4.02 0.021 疫情首次报告病例数
Number of Initial cases reported per epidemic outbreak15.59±6.13 17.00±6.79 15.44±4.75 15.97±5.92 0.79 0.457 疫情平均病例数 Average number of cases per epidemic outbreak 32.32±18.43 53.94±47.81 38.85±24.11 41.22±32.97 4.54 0.013 男性 Male 54.26 (719/1 325) 60.52 (1 176/1 943) 56.27 (852/1 514) 57.44 (2 747/4 782) 13.87 0.001 涉及班级数 Number of affected classrooms 7.20±4.03 12.72±6.42 11.08±6.69 10.22±6.21 9.36 ＜0.001 配备校医 Equipped with school doctor 14.63(6/41) 19.44(7/36) 89.74(35/39) 41.38(48/116) 58.84 ＜0.001 有内宿 Has boarding facilities 17.07(7/41) 55.56(20/36) 61.54(24/39) 35.34(41/116) 18.89 ＜0.001 有校外午托 With off-campus lunch care 2.44(1/41) 13.89(5/36) 28.21(11/39) 14.66(17/116) 10.63 0.005 采取停课措施 Class suspension 26.83(11/41) 13.89(5/36) 12.82(5/39) 18.10(21/116) 3.27 0.195 冬春流行期 Winter and spring epidemic periods 63.41(26/41) 72.22(26/36) 64.10(25/39) 66.38(77/116) 2.09 0.719 夏季流行期 Summer epidemic periods 34.15(14/41) 25.00(9/36) 35.90(14/39) 31.90(37/116) 非流行期 Outside of epidemic periods 2.44(1/41) 2.78(1/36) 0 1.72(2/116) 注：PHEEs，突发公共卫生事件。
①以构成比/%或x±s表示。
Note: PHEEs, public health emergency events.
① Composition ratio/% or x±s.
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表 3 南宁市2014―2023年小学水痘PHEEs持续时间相关因素分析
Table 3. Analysis of factors related to the duration of varicella PHEEs in primary schools in Nanning City, 2014―2023
因素
Factor单因素分析 Univariate analysis 多因素分析 Multivariate analysis β值value sx值
valuet值
valueP值
valueβ值
valuesx值
valuet值
valueP值
value学校类型 School type① 农村小学 Rural primary school -3.93 4.95 -0.79 0.430 县镇小学 County town primary school 10.10 5.12 1.97 0.051 首次报告病例数 Number of initial case reported 1.51 0.33 4.56 ＜0.001 0.84 0.30 2.80 0.006 单起疫情病例数 Number of case in a single epidemic outbreak 0.38 0.05 6.96 ＜0.001 0.16 0.08 2.00 0.048 涉及班级数 Number of affected classroom 2.09 0.28 7.42 ＜0.001 1.21 0.41 2.93 0.004 流行季节 Epidemic periods② 冬春流行期 Winter and spring epidemic periods 17.36 16.29 1.07 0.289 夏季流行期 Summer epidemic periods 13.20 16.51 0.80 0.426 无教职员工病例 No cases among faculty and staff -2.98 6.49 -0.46 0.650 无校医 No school doctor 1.21 4.30 0.28 0.778 无内宿 No boarding facilities -2.45 4.26 -0.58 0.566 无校外午托 No off-campus lunch care -9.72 5.92 1.64 0.103 未采取停课措施 Class suspension measures not implemented -8.15 5.45 -1.49 0.138 注：1. PHEEs，突发公共卫生事件。
2. 采用线性回归分析，以水痘PHEEs持续时间作为因变量(n=116)。
①以城市小学为对照; ②以非流行期为对照，全部变量进入多因素模型，采用逐步法筛选变量。
Note: 1. PHEEs, public health emergency events.
2. A generalized linear model was used for analysis, with the duration of varicella PHEEs as the dependent variable (n=116).
① Using urban primary schools as the control; ② Using the non-epidemic period as the control. Incorporating all variables into a multi-factor model and a stepwise method was employed to select variables.
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表 4 南宁市2014―2023年流行期小学水痘PHEEs总起数相关因素分析
Table 4. Analysis of factors related to the total number of varicella PHEEs in primary schools during the epidemic period in Nanning City, 2014―2023
变量
Variable单因素分析 Univariate analysis 多因素分析 Multivariate analysis β值value sx值value t值value P值value β值value sx值value t值value P值value 首起疫情距流行期起始时间 Time from the start of the epidemic period to the first outbreak/d -0.13 0.06 -2.10 0.052 首起疫情持续时间 Duration of the first outbreak/d 0.06 0.05 1.09 0.290 0.08 0.03 2.42 0.029 首起疫情病例数 Number of cases in the first outbreak -0.02 0.03 -0.79 0.441 流行期南宁市总报告病例数
Total reported cases in Nanning City during the epidemic period0 0 -1.01 0.314 流行期持续时间 Duration of the epidemic period/d 0.09 0.07 1.25 0.230 流行期内平均疫情间隔时间
Average interval time between epidemics within the epidemic period/d-0.20 0.05 -3.87 0.001 -0.21 0.05 -4.75 ＜0.001 流行期距学期开始时间间隔
Time interval between the start of the epidemic period and the beginning of the school term/d-0.08 0.13 -0.57 0.580 注：1. PHEEs，突发公共卫生事件。
2. 采用线性回归分析，以18个流行期内PHEEs起数为因变量，全部变量进入多因素模型，采用逐步法筛选变量。
Note: 1. PHEEs, public health emergency events.
2. Linear regression analysis was utilized, with the number of PHEEs within 18 epidemic periods as the dependent variable, and multivariate analysis employed a stepwise method for variable selection.
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表 5 南宁市2014―2023年流行期小学水痘PHEEs病例总数相关因素分析
Table 5. Analysis of factors associated with the total number of varicella PHEEs cases in primary schools during epidemic periods in Nanning City, 2014―2023
变量
Variable单因素分析 Univariate analysis 多因素分析 Multivariate analysis β值value sx值value t值value P值value β值value sx值value t值value P值value 首起疫情距流行期起始时间 Time from the start of the epidemic period to the first outbreak/d -4.85 2.94 -1.65 0.118 首起疫情持续时间 Duration of the first outbreak /d 5.16 2.06 2.51 0.023 6.16 1.44 4.29 0.001 首起疫情病例数 Number of cases in the first outbreak 0.71 1.13 0.63 0.537 流行期南宁市总报告病例数
Total reported cases in Nanning City during the epidemic period0.07 0.02 3.06 0.007 流行期持续时间 Duration of the epidemic period /d 3.79 3.25 1.16 0.261 流行期内平均疫情间隔时间
Average interval time between epidemics within the epidemic period/d-6.84 2.68 -2.55 0.022 -8.14 1.88 -4.32 0.001 流行期距学期开始时间间隔
Time interval between the start of the epidemic period and the beginning of the school term/d2.51 6.04 0.42 0.683 注：1. PHEEs，突发公共卫生事件。
2. 采用线性回归分析，以18个流行期内PHEEs起数为因变量，全部变量进入多因素模型，采用逐步法筛选变量。
Note: 1. PHEEs, public health emergency events.
2. Linear regression analysis was utilized, with the number of PHEEs within 18 epidemic periods as the dependent variable, and multivariate analysis employed a stepwise method for variable selection.
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