| 摘要: | 目的: 本研究的主旨是欲瞭解流行性感冒於流行季節期間學童受到流感侵襲的狀況，並且探討在控制年齡、性別、同住家人數目和居住的城鄉別下，學童的社會生活中的家庭、學校和社交生活的各類社會接觸程度與感染流感之關係。
方法: 採縱貫性之研究設計，研究對象為為台中市及南投縣願意參與計畫的某六所國小學童，經家長同意後透過結構式的問卷及血液樣本的採集方式蒐集相關資料，自2009年9月初於流感季節前追踪至2010年7月初即流感季節後，剔除血液檢體不完整的樣本，本研究的有效樣本為187位。
結果: 整體兒童H1N1新型流感的侵襲率為27.78%，而季節性H3N2流感的侵襲率為24.17%，兒童H1N1新型流感的侵襲率在城鄉間不具差異但季節性H3N2流感的侵襲率卻是都會區顯著高於鄉鎮區(41.43%>18.8%
，P=0.013)。經複邏輯斯迴歸分析後，結果發現顯著影響H1N1新型流感的因素是同住家人數目和社交生活的平日交談之接觸程度；即同住家人數4-5人較2-3人不易感染(OR=0.04，95% CI=0.14-0.84)、社交生活中的平日交談接觸密度會愈高則愈易感染(OR=1.02，95%
CI=1.00-1.04)。在感染季節性H3N2流感的相關因素是城鄉別、年齡和社交生活的平日遊戲之接觸程度，即都會區學童較鄉鎮區學童容易感染季節性H3N2流感(OR=3.1，95% CI=1.05-9.13)、年齡愈高愈易感染(OR=1.44，95% CI=1.08-1.93)、社交生活中的平日遊戲接觸密度愈高愈易感染(OR=1.05，95% CI=1.01-1.09)。
結論: 季節性H3N2流感的侵襲率具城鄉差異，居住於都市的兒童較鄉鎮兒童容易受到侵襲，此型流感對於國小兒童而言，年級較大者反易被感染；然而H1N1新型流感侵襲率情形反未見上述結果。不過同住家人人數較少較易感染，透露了在家庭中人數較少反會因彼此接觸機會可能較大而有較易感染的情形。總之，本研究結果發現不論季節性H3
N2流感或H1N1新型流感的感染皆與兒童在社交生活中的平日與他人接觸之程有關，學童與他人交談或遊戲的接觸愈頻繁愈易感染。因此本研究結果可提供相關單位參考，特別是在流行性感冒季節要來臨時，
應加強都會區的防治工作，小家庭成員間要注意避免較親密的接觸，
也要注意學童在家庭和學校生活以外的社交生活之接觸情形，儘量避免學童與他人有密切的近距離接觸。
Objective: The aim of this study was to examine the
relationships between social contact and the infection of seasonal influenza H3N2 and pandemic H1N1 as well in school children.
Methods: A longitudinal study design was adopted, and study subjects were children from six elementary schools in both urban and rural areas, located in Mid-Taiwan. Data were collected from the home-interviews with children’s
caregivers by administering structured-questionnaire surveys and from children’s blood specimen. After obtaining the informed consents from parents,
the study subjects were followed up from the early September, 2009 to early July, 2010. This study excluded incomplete information and obtained a final analytic sample of 187 children.
Results: The overall attack rates of pandemic H1N1 and seasonal H3N2 influenza were 27.78% and 24.17%,respectively
. No difference in the attack rates of pandemic H1N1 influenza found between the urbanized city and the rural
town; but it was not the case for seasonal H3N2 influenza. The attack rate of 41.43% in the city was significantly higher than that of 18.8% in the rural town. The results of multiple logistic regression models revealed that among
children aged 6 to 12 years, the risk factors for pandemic H1N1 infection were household size and the contact density of daily talking in social life, with the odds of 4-5 persons in a house were lower than those of 2-3 persons (OR=0.04, P=0.018) and the odds increasing 1.02 times by one-unit increase in the contact density (P=0.047) .Three risk factors for seasonal H3N2 influenza infection
were found—living area, age and the contact density of daily playing games in social life. The odds of children living in the urban city were higher than their counterparts in the rural town (OR=3.1, P=0.04), the odds increased 1.44 times with one-year increase in age (OR=1.44, P=0.014) and the odds increased 1.05 times with one-unit increase in the contact density (P=0.02).
Conclusions: The attack rate of seasonal H3N2 influenza was higher in city than that in rural area, but it was not the case for pandemic H1N1influenza. Household size, living areas, age and the contact density of talking and playing
games with others in children’s daily social life were significant risk factors for influenza infections, although the four risk factors were varied by virus types.
However, results suggested that parents and school teachers need to pay more attentions on children’s social life and prevent them from close contact with others during the influenza epidemic periods. |
