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Article(id=1241676523132998456, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202407165, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1720713600000, receivedDateStr=2024-07-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773968352349, onlineDateStr=2026-03-20, pubDate=1731168000000, pubDateStr=2024-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773968352349, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773968352349, creator=13701087609, updateTime=1773968352349, updator=13701087609, issue=Issue{id=1241676522256388920, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='21', pageStart='3841', pageEnd='4032', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773968352140, creator=13701087609, updateTime=1773968629818, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241677686985249701, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241677686985249702, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3911, endPage=3916, ext={EN=ArticleExt(id=1241676523585983290, articleId=1241676523132998456, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Epidemiological characteristics analysis of chickenpox-related school absenteeism among primary and secondary school students in Huai’an city from 2018 to 2022, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the epidemiological characteristics of chickenpox-related absenteeism among primary and secondary school students in Huai’an city, providing reference for further improving chickenpox prevention and control in schools.

Methods

Descriptive epidemiological methods were employed to analyze data on chickenpox-related absenteeism collected from the Jiangsu Provincial Student Health Monitoring System for the 2018 to 2022 academic years. The circular distribution method was used to analyze the seasonal characteristics of absenteeism due to chickenpox.

Results

The average annual rate of chickenpox-related absenteeism among primary and secondary school students in Huai’an city from 2018 to 2022 was 26.23 per 100 000. The absenteeism rates varied between 11.96 (2021 academic year) and 70.84 (2020 academic year) (χ2=101 240.39, P < 0.01), with an average of 3.98 days absent per student. The absenteeism rate for boys was higher than that for girls (27.06 vs. 25.26, χ2=166.19, P < 0.01). Among different school types, the average absenteeism rate ranged from 4.30 (vocational high schools) to 39.97 (primary schools), with urban students exhibiting a higher average absenteeism rate compared to those in suburban areas (30.84 vs. 17.10, χ2=9 519.78, P < 0.01). A primary peak in absenteeism occurred from October to December in the first semester, while a secondary peak was observed from April to June in the second semester. Circular distribution method analysis revealed a significant seasonal concentration trend, with peak days occurring on November 26 and May 18, and peak periods spanning from October 29 to December 25 and from April 9 to June 26, respectively (Z values of 48 673.79 and 217.29, with P values < 0.01).

Conclusion

The rate of chickenpox-related absenteeism among primary and secondary school students in Huai’an city is relatively high. Monitoring should focus on boys, primary schools, urban areas, and the two peak periods (October-December and April-June). The circular distribution method for analyzing seasonal characteristics of absenteeism due to chickenpox demonstrates good practicality and can provide data support for chickenpox prevention and control in schools.

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目的

了解水痘在淮安市中小学生因病缺课中的流行病学特征，为进一步做好校园水痘防控提供参考依据。

方法

采用描述性流行病学方法对江苏省学生健康监测系统收集的2018—2022学年淮安市中小学生水痘因病缺课数据进行分析，并应用圆形分布法分析水痘因病缺课的季节性特征。

结果

2018—2022学年淮安市中小学生年均水痘因病缺课率为26.23/10万，各学年水痘因病缺课率在11.96/10万（2021学年）～70.84/10万（2020学年）之间（χ2=101 240.39，P<0.01），人均水痘因病缺课天数为3.98 d。男生年均水痘因病缺课率高于女生（27.06/10万vs. 25.26/10万，χ2=166.19，P<0.01），不同学校类型中小学生年均水痘因病缺课率在4.30/10万（职业高中）～39.97/10万（小学）之间，城区中小学生年均水痘因病缺课率高于郊县（30.84/10万vs. 17.10/10万，χ2=9 519.78，P<0.01）。水痘因病缺课率在上学期10—12月出现一个主高峰，下学期4—6月出现一个次高峰，经圆形分布法雷氏检验，水痘因病缺课存在明显的季节性集中趋势，上、下学期高峰日分别为11月26日和5月18日，高峰期分别为10月29日—12月25日和4月9日—6月26日（Z值分别为48 673.79、3 217.29，P值均<0.01）。

结论

淮安市中小学生水痘因病缺课率相对较高，水痘因病缺课监测应重点关注男生、小学、城区、两个高峰期（10—12月和4—6月）。圆形分布法分析水痘因病缺课的季节性特征具有较好的实用性，可为校园水痘防控提供数据支持。

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杨婕，E-mail:
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付瑞（1992—），男，硕士，主管医师，研究方向：儿童青少年健康和学校卫生

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付瑞（1992—），男，硕士，主管医师，研究方向：儿童青少年健康和学校卫生

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journalId=1227665162245664772, articleId=1241676523132998456, language=CN, label=图1, caption=2018—2022学年淮安市中小学生水痘因病缺课人日数和缺课率, figureFileSmall=O64DiMMf2Qr/jgfux8pBrg==, figureFileBig=InEI/mDzOGEkcHLWZpIaIA==, tableContent=null), ArticleFig(id=1241821876939456521, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676523132998456, language=EN, label=Figure 2, caption=Rate of chickenpox-induced absenteeism among primary and middle school students in Huai’an by gender during 2018—2022 academic years, figureFileSmall=xoWDCbe/agECjG7YIdY9wg==, figureFileBig=F4gkbCNjvcziTxdPmzd+4A==, tableContent=null), ArticleFig(id=1241821877052702735, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676523132998456, language=CN, label=图2, caption=2018—2022学年淮安市不同性别中小学生水痘因病缺课率, figureFileSmall=xoWDCbe/agECjG7YIdY9wg==, figureFileBig=F4gkbCNjvcziTxdPmzd+4A==, tableContent=null), ArticleFig(id=1241821877140783121, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676523132998456, language=EN, label=Figure 3, caption=Rate of chickenpox-induced absenteeism among primary and middle school students in Huai’an by type of school during 2018—2022 academic years, figureFileSmall=A5HUDLh3ysq++EN6NKXJdg==, figureFileBig=OmuB1tysw5fbTcTZzvoOOg==, tableContent=null), ArticleFig(id=1241821877245640725, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676523132998456, language=CN, label=图3, caption=2018—2022学年淮安市不同学校类型中小学生水痘因病缺课率, figureFileSmall=A5HUDLh3ysq++EN6NKXJdg==, figureFileBig=OmuB1tysw5fbTcTZzvoOOg==, tableContent=null), ArticleFig(id=1241821877325332504, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676523132998456, language=EN, label=Figure 4, caption=Regional distribution of chickenpox-induced absenteeism rate among primary and middle school students in Huai’an during 2018—2022 academic years, figureFileSmall=FFTpFtOOm9ecTQ62/xJXaw==, figureFileBig=J9rUH9y9xY8q8uOPSMOYnw==, tableContent=null), ArticleFig(id=1241821877413412893, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676523132998456, language=CN, label=图4, caption=2018—2022学年淮安市中小学生水痘因病缺课率的地区分布, figureFileSmall=FFTpFtOOm9ecTQ62/xJXaw==, figureFileBig=J9rUH9y9xY8q8uOPSMOYnw==, tableContent=null), ArticleFig(id=1241821877526659105, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676523132998456, language=EN, label=Figure 5, caption=Time series chart of the person days and rate of chickenpox-induced absenteeism among primary and middle school students in Huai’an during 2018—2022 academic years, figureFileSmall=AZi9WuI+BnKcdss5nrMJAQ==, figureFileBig=6mWlbwV13DzsEUn10QZ+iw==, tableContent=null), ArticleFig(id=1241821877618933795, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676523132998456, language=CN, label=图5, caption=2018—2022学年淮安市中小学生水痘因病缺课人日数和缺课率时间序列图, figureFileSmall=AZi9WuI+BnKcdss5nrMJAQ==, figureFileBig=6mWlbwV13DzsEUn10QZ+iw==, tableContent=null), ArticleFig(id=1241821877740568614, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676523132998456, language=EN, label=Table 1, caption=

Circular distribution results of the person days of chickenpox-induced absenteeism among primary and middle school students in Huai’an during 2018—2022 academic years

, figureFileSmall=null, figureFileBig=null, tableContent=
2018学年2019学年2020学年2021学年2022学年合计
上学期γ值0.480.630.720.490.560.63
Z值3 334.937 769.3835 964.642 049.913 896.6848 673.79
P值<0.01<0.01<0.01<0.01<0.01<0.01
188.08166.08174.46206.65134.61172.66
s69.1555.1646.0768.1061.8055.28
高峰日12月4日11月23日11月27日12月3日11月7日11月26日
高峰期10月30日—1月7日10月26日—12月20日11月4日—12月20日11月9日—1月16日10月7日—12月8日10月29日—12月25日
下学期γ值0.500.650.330.450.490.42
Z值1 046.341 124.77596.63985.49410.523 217.29
P值<0.01<0.01<0.01<0.01<0.01<0.01
146.87202.13123.01150.69164.41155.05
s67.0653.3884.7672.2067.9775.92
高峰日5月14日6月11日5月2日5月16日5月23日5月18日
高峰期4月10日—6月17日5月15日—7月9日3月20日—6月14日4月9日—6月22日4月18日—6月27日4月9日—6月26日
), ArticleFig(id=1241821877858009130, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676523132998456, language=CN, label=表1, caption=

2018—2022学年淮安市中小学生水痘因病缺课人日数圆形分布结果

, figureFileSmall=null, figureFileBig=null, tableContent=
2018学年2019学年2020学年2021学年2022学年合计
上学期γ值0.480.630.720.490.560.63
Z值3 334.937 769.3835 964.642 049.913 896.6848 673.79
P值<0.01<0.01<0.01<0.01<0.01<0.01
188.08166.08174.46206.65134.61172.66
s69.1555.1646.0768.1061.8055.28
高峰日12月4日11月23日11月27日12月3日11月7日11月26日
高峰期10月30日—1月7日10月26日—12月20日11月4日—12月20日11月9日—1月16日10月7日—12月8日10月29日—12月25日
下学期γ值0.500.650.330.450.490.42
Z值1 046.341 124.77596.63985.49410.523 217.29
P值<0.01<0.01<0.01<0.01<0.01<0.01
146.87202.13123.01150.69164.41155.05
s67.0653.3884.7672.2067.9775.92
高峰日5月14日6月11日5月2日5月16日5月23日5月18日
高峰期4月10日—6月17日5月15日—7月9日3月20日—6月14日4月9日—6月22日4月18日—6月27日4月9日—6月26日
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2018—2022学年淮安市中小学生水痘因病缺课的流行病学特征分析
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付瑞 1, 2 , 张锡彦 3, 4 , 葛恒康 1 , 骆善彩 1 , 陈俐如 1 , 杨婕 3, 4
现代预防医学 | 儿少卫生与妇幼保健 2024,51(21): 3911-3916
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现代预防医学 | 儿少卫生与妇幼保健 2024, 51(21): 3911-3916
2018—2022学年淮安市中小学生水痘因病缺课的流行病学特征分析
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付瑞1, 2, 张锡彦3, 4, 葛恒康1, 骆善彩1, 陈俐如1, 杨婕3, 4
作者信息
  • 1.淮安市疾病预防控制中心营养与食品卫生科，江苏 淮安 223001
  • 2.江苏省现场流行病学培训项目，江苏 南京 210009
  • 3.江苏省疾病预防控制中心儿童青少年健康促进所，江苏 南京 211166
  • 4.南京医科大学江苏 南京 211166

    • 付瑞（1992—），男，硕士，主管医师，研究方向：儿童青少年健康和学校卫生

通讯作者:

杨婕，E-mail:
Epidemiological characteristics analysis of chickenpox-related school absenteeism among primary and secondary school students in Huai’an city from 2018 to 2022
Rui FU1, 2, Xi-yan ZHANG3, 4, Heng-kang GE1, Shan-cai LUO1, Li-ru CHEN1, Jie YANG3, 4
Affiliations
  • Nutrition and Food Hygiene Department, Huai’an Center for Disease Control and Prevention, Huai’an, Jiangsu 223001, China
出版时间: 2024-11-10 doi: 10.20043/j.cnki.MPM.202407165
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摘要
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目的

了解水痘在淮安市中小学生因病缺课中的流行病学特征，为进一步做好校园水痘防控提供参考依据。

方法

采用描述性流行病学方法对江苏省学生健康监测系统收集的2018—2022学年淮安市中小学生水痘因病缺课数据进行分析，并应用圆形分布法分析水痘因病缺课的季节性特征。

结果

2018—2022学年淮安市中小学生年均水痘因病缺课率为26.23/10万，各学年水痘因病缺课率在11.96/10万（2021学年）～70.84/10万（2020学年）之间（χ2=101 240.39，P<0.01），人均水痘因病缺课天数为3.98 d。男生年均水痘因病缺课率高于女生（27.06/10万vs. 25.26/10万，χ2=166.19，P<0.01），不同学校类型中小学生年均水痘因病缺课率在4.30/10万（职业高中）～39.97/10万（小学）之间，城区中小学生年均水痘因病缺课率高于郊县（30.84/10万vs. 17.10/10万，χ2=9 519.78，P<0.01）。水痘因病缺课率在上学期10—12月出现一个主高峰，下学期4—6月出现一个次高峰，经圆形分布法雷氏检验，水痘因病缺课存在明显的季节性集中趋势，上、下学期高峰日分别为11月26日和5月18日，高峰期分别为10月29日—12月25日和4月9日—6月26日（Z值分别为48 673.79、3 217.29，P值均<0.01）。

结论

淮安市中小学生水痘因病缺课率相对较高，水痘因病缺课监测应重点关注男生、小学、城区、两个高峰期（10—12月和4—6月）。圆形分布法分析水痘因病缺课的季节性特征具有较好的实用性，可为校园水痘防控提供数据支持。

水痘  /  中小学生  /  因病缺课  /  流行病学特征  /  圆形分布法
Objective

To understand the epidemiological characteristics of chickenpox-related absenteeism among primary and secondary school students in Huai’an city, providing reference for further improving chickenpox prevention and control in schools.

Methods

Descriptive epidemiological methods were employed to analyze data on chickenpox-related absenteeism collected from the Jiangsu Provincial Student Health Monitoring System for the 2018 to 2022 academic years. The circular distribution method was used to analyze the seasonal characteristics of absenteeism due to chickenpox.

Results

The average annual rate of chickenpox-related absenteeism among primary and secondary school students in Huai’an city from 2018 to 2022 was 26.23 per 100 000. The absenteeism rates varied between 11.96 (2021 academic year) and 70.84 (2020 academic year) (χ2=101 240.39, P < 0.01), with an average of 3.98 days absent per student. The absenteeism rate for boys was higher than that for girls (27.06 vs. 25.26, χ2=166.19, P < 0.01). Among different school types, the average absenteeism rate ranged from 4.30 (vocational high schools) to 39.97 (primary schools), with urban students exhibiting a higher average absenteeism rate compared to those in suburban areas (30.84 vs. 17.10, χ2=9 519.78, P < 0.01). A primary peak in absenteeism occurred from October to December in the first semester, while a secondary peak was observed from April to June in the second semester. Circular distribution method analysis revealed a significant seasonal concentration trend, with peak days occurring on November 26 and May 18, and peak periods spanning from October 29 to December 25 and from April 9 to June 26, respectively (Z values of 48 673.79 and 217.29, with P values < 0.01).

Conclusion

The rate of chickenpox-related absenteeism among primary and secondary school students in Huai’an city is relatively high. Monitoring should focus on boys, primary schools, urban areas, and the two peak periods (October-December and April-June). The circular distribution method for analyzing seasonal characteristics of absenteeism due to chickenpox demonstrates good practicality and can provide data support for chickenpox prevention and control in schools.

Chickenpox  /  Primary and secondary students  /  School absenteeism  /  Epidemiological characteristics  /  Circular distribution method
付瑞, 张锡彦, 葛恒康, 骆善彩, 陈俐如, 杨婕. 2018—2022学年淮安市中小学生水痘因病缺课的流行病学特征分析. 现代预防医学, 2024 , 51 (21) : 3911 -3916 . DOI: 10.20043/j.cnki.MPM.202407165
Rui FU, Xi-yan ZHANG, Heng-kang GE, Shan-cai LUO, Li-ru CHEN, Jie YANG. Epidemiological characteristics analysis of chickenpox-related school absenteeism among primary and secondary school students in Huai’an city from 2018 to 2022[J]. Modern Preventive Medicine, 2024 , 51 (21) : 3911 -3916 . DOI: 10.20043/j.cnki.MPM.202407165
正文
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水痘是一种由水痘-带状疱疹病毒感染引起的常见呼吸道传染病，以全身同时出现丘疹、水疱及结痂为典型症状，主要经呼吸道飞沫和直接接触传播，也可通过接触被污染的物品间接传播，传染性强[1]。国内多项研究表明[2-5]，水痘多见于儿童，易在中小学校等集体单位出现聚集病例，且是中小学生因病缺课前三位病因之一，不仅对中小学生的身体健康和学习造成严重影响，也给学校的正常教学秩序和传染病防控工作带来额外压力。2013—2022年淮安市水痘年均报告发病率为70.95 /10万，职业分布以学生为最多，占总病例数的54.77%[6]。为进一步做好校园水痘防控工作并提供重要数据支撑，本研究对2018—2022学年淮安市中小学生水痘因病缺课的流行病学特征进行分析，并应用圆形分布法分析水痘因病缺课的季节性特征。
1　资料与方法
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1.1　资料来源
淮安市中小学生水痘因病缺课资料来源于江苏省学生健康监测系统中缺课监测系统（https://218.94.1.85/schoolMonitor/newPages/frame/home.jsp）。每学年中小学校缺课监测覆盖率均为100%。按照缺课日期选择2018年9月1日—2023年8月31日期间报告、地区为淮安市、学校类型为中小学、请假原因为病假、疾病类型为水痘，并经区（县）、市、省疾病预防控制中心工作人员审核核实的学生缺课信息纳入本次分析。本研究经淮安市疾病预防控制中心伦理审查委员会批准，所有监测对象及监护人在被监测前均知情同意。
1.2　方法和相关定义
将从缺课监测系统中导出的2018—2022学年淮安市中小学生水痘因病缺课数据，按性别、学校类型、地区、月份等特征汇总水痘因病缺课人日数，计算缺课率。人均水痘因病缺课天数=水痘因病缺课人日数/水痘因病缺课人次数。水痘因病缺课率(/10万)=水痘因病缺课人日数/(授课天数×学生人数)×100 000。学年是指所处年份的9月1日至下一年的8月31日。
1.3　统计学处理
采用Excel 2010软件进行数据整理，SPSS 23.0软件用于数据统计分析，组间率的比较采用χ2检验。采用圆形分布法[7-8]分析水痘因病缺课的季节性特征。所有统计检验均为双尾检验，检验水准α=0.05。
将每学年水痘因病缺课人日数数据分为上学期（9—次年2月）、下学期（3—8月），分别用Excel 2010软件进行圆形分布法分析，步骤如下：（1）将上学期181 d转换为360°（2月按28 d计），1 d相当于1.989 0°，以9月1日0时为0°，计算每月的月中位角（αi），即以每个月天数的中位值（15.5、46.0、76.5、107.0、138.0、167.5）乘以1.989 0°；将下学期184 d转换为360°，1 d相当于1.956 5°，以3月1日0时为0°，计算每月的月中位角（αi），即以每个月天数的中位值（16.0、46.5、77.0、107.5、138.0、168.0）乘以1.956 5°。上、下学期分别按下列步骤继续操作。（2）计算sinαi和cosαi的均值，分别用x和y表示。x=(∑fi-cosαi)÷n；y=(∑fisinαi)÷n；fi为月水痘因病缺课人日数，n为水痘因病缺课总人日数。（3）计算水痘因病缺课人日数的集中趋势值。（4）计算平均角和角标准差s。,；当x>0；当x<0，；。（5）平均角的假设检验。采用雷氏检验（Rayleigh test），计算雷氏Z值，Z=nγ2，查Rayleigh Z值临界值表，当Z>Z0.05，P<0.05，有统计学意义，即表示平均角存在，并有向集中的倾向。（6）计算高峰日。将乘以181 / 360（下学期为184 / 360），转换成日期即为高峰日。（7）估算高峰期。将平均角的可信区间（）转换成日期即为高峰期。
2　结果
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2.1　水痘因病缺课情况
2018—2022学年淮安市中小学生年均水痘因病缺课率为26.23/10万[11.96/10万(2021学年) ～ 70.84/10万(2020学年) ]，各学年水痘因病缺课率差异具有统计学意义（χ2=101 240.39，P<0.01），人均水痘因病缺课天数为3.98 d。各学年水痘因病缺课人日数分别占全部因病缺课人日数的17.54%、12.45%、21.84%、5.73%、4.68%。见图1。
2.2　流行病学特征
2.2.1　性别分布
2018—2022学年男、女生年均水痘因病缺课率分别为27.06 /10万、25.26 /10万，差异有统计学意义（χ2=166.19，P<0.01），男、女生水痘因病缺课率在5学年间的差异均有统计学意义(χ2=56 369.07、4 113.09，P值均<0.01）。见图2。
2.2.2　学校类型分布
2018—2022学年不同学校类型中小学生年均水痘因病缺课率在4.30/10万（职业高中）～ 39.97/10万（小学）之间，各学年不同学校类型间差异均有统计学意义（χ2=5 042.66、6 090.30、26 841.78、2 686.54、2 541.24，P值均<0.01），不同学校类型学生水痘因病缺课率在5学年间的差异均有统计学意义(χ2=82 814.98、5 141.99、12 228.86、524.90、90.79、3 183.08、1 668.21，P值均<0.01）。见图3。
2.2.3　地区分布
2018—2022学年淮安市各县区中小学生年均水痘因病缺课率在10.56/10万（盱眙县）～ 79.20/10万（开发区）之间，城区中小学生年均水痘因病缺课率高于郊县（30.84/10万vs. 17.10/10万，χ2=9 519.78，P<0.01）。见图4。
2.2.4　时间分布
2.2.4.1　月份分布
2018—2022学年中小学生水痘因病缺课率呈现明显的季节性波动，在上学期10—12月出现一个主高峰，下学期4—6月出现一个次高峰。2020学年上学期因新冠肺炎疫情影响较其他学年同期出现大幅上升，同比平均增长依次为479.43%、349.69%、815.26%、550.44%。见图5。
2.2.4.2　季节性特征
2018—2022学年上、下学期水痘因病缺课人日数的集中趋势值γ分别为0.63和0.42，经雷氏Z值检验，差异均有统计学意义（P值均<0.01）；总体平均角存在，高峰日分别为11月26日和5月18日，高峰期分别为10月29日—12月25日和4月9日—6月26日。对各学年的上、下学期水痘因病缺课人日数经雷氏Z值检验，差异均有统计学意义（P值均<0.01）；存在平均角，其中上学期高峰日有3学年在11月份，2学年在12月份，高峰期最短47 d，最长70 d，平均61 d；下学期高峰日有4学年在5月份，1学年在6月份，高峰期最短56 d，最长87 d，平均72 d。见表1。
3　讨论
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2018—2022学年淮安市中小学生年均水痘因病缺课率为26.23 /10万，高于上海市闵行区2021年[9]的监测结果（6.03 /10万），考虑可能与不同地区水痘报告发病率、疫苗接种、因病缺课上报意识等综合因素有关。2020学年水痘因病缺课率出现陡增现象，主要是受2020年初暴发的新冠肺炎疫情影响，各中小学校更加严格开展晨午检和因病缺课登记追踪工作，因病缺课监测力度和报告敏感度显著提升[4,10]。2021和2022学年水痘因病缺课率较2018和2019学年有明显下降，一方面因新冠肺炎疫情防控工作需要，中小学校多次进行了临时性的停课或线上教学安排，减少了学生间的密切接触；另一方面可能得益于新冠肺炎疫情发生后中小学校采取了更为严格的疫情防控措施，特别是开窗通风、一米线、佩戴口罩和手卫生等对水痘防控同样产生了一定积极作用[10]。与此同时，从2023年1月1日起，江苏省将水痘减毒活疫苗纳入儿童免疫规划，为适龄儿童免费接种2剂次的水痘减毒活疫苗，这一举措将进一步降低校园水痘传播和发展[11]。
本研究表明，男生水痘因病缺课率高于女生，这一点也与男生报告发病率高于女生保持一致[6]，主要与男生的活动范围和卫生习惯有关，男生相对活泼好动、户外活动较多，一旦有传染源存在，暴露机会和接触感染机会更多。水痘流行病学特征显示[12]，中国报告的水痘病例多集中在儿童，以5～9岁和10～14岁人群发病构成、年均报告发病率最高，报告发病率分别为308.14 /10万、228.31 /10万；在所有水痘突发公共卫生事件中，发生在小学的占比高达68.40%。本研究结果显示，小学是水痘因病缺课的主要场所。同时以往多项因病缺课分析[13-15]也表明，小学生总体因病缺课率均明显高于其他学段学生，可能与小学生身体机能尚处于未完善状态，对各种病原微生物的抵抗力更弱，卫生防护意识不强，同时家长对孩子健康重视程度高，一旦发生身体不适立即请病假有关。2018—2022学年淮安市城区年均水痘因病缺课率高于郊县，考虑可能与因病缺课上报的主动性和报告质量有关外，是否受当地学生体质、人口密集程度及空气质量等自然条件等因素影响需要进一步观察研究[12,16-17]。
本研究结果显示，在水痘因病缺课月份分析中，水痘因病缺课率在上学期10—12月出现一个主高峰，下学期4—6月出现一个次高峰，与水痘发病的时间分布特征基本一致[18-19]，可能与水痘-带状疱疹病毒耐冷和不耐热的病原学属性有关，同时也会受到中小学校学生因学年教学秩序安排而出现开学聚集、放假分散的周期性规律影响[20]。圆形分布法[21]分析结果表明，水痘因病缺课存在明显的季节性集中趋势，上学期高峰日为11月26日，高峰期为10月29日—12月25日；下学期高峰日为5月18日，高峰期为4月9日—6月26日。提示卫生和教育部门应在此高峰时段加强对水痘因病缺课监测，有针对性的采取多种形式的校园水痘防控措施。
水痘多为自限性疾病，发病早期以发热为主，并在1～2 d后出现皮疹，1周左右痂皮脱落愈合，整个病程10 d左右[1]。研究发现，2018—2022学年淮安市中小学生人均水痘因病缺课天数为3.98 d，提示淮安市中小学生带病上课现象可能较多，同时学校在晨午检中发现水痘早期症状方面的能力可能存在不足。有研究指出，造成学校水痘流行的原因之一就是学校对晨午检工作落实不彻底，加之缺乏有效发现手段，不易实现常规的早发现、早隔离，致使学校在防控水痘方面确实存在一定困难[22]。大多数水痘初期都伴有临床症状，最多的症状是疱疹、皮疹、发热，分别占水痘病例总数的49.59%、30.98%、26.42%[3]。提示卫生和教育部门今后应加大对中小学校水痘因病缺课的症状监测力度，并深化防控知识方面的宣传教育，引导师生及家长识别水痘早期症状体征，共同防范带病入校风险。
本研究也存在一定的局限性，未掌握水痘缺课学生的就诊信息以分析缺课日期和发病日期的关系，未对因病缺课监测系统和传染病监测报告管理系统（隶属于中国疾病预防控制信息系统）中水痘数据进行匹配分析，从而评价因病缺课系统的准确性和时效性。
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2024年第51卷第21期
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doi: 10.20043/j.cnki.MPM.202407165
  • 接收时间：2024-07-12
  • 首发时间：2026-03-20
  • 出版时间：2024-11-10
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  • 收稿日期：2024-07-12
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    1.淮安市疾病预防控制中心营养与食品卫生科，江苏 淮安 223001
    2.江苏省现场流行病学培训项目，江苏 南京 210009
    3.江苏省疾病预防控制中心儿童青少年健康促进所，江苏 南京 211166
    4.南京医科大学江苏 南京 211166

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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