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系統識別號 U0026-1408201916093900
論文名稱(中文) 臺灣國際移工茲卡病毒與登革病毒之血清流行病學調查
論文名稱(英文) Seroprevalence of zika virus and dengue virus infection among foreign workers in Taiwan
校院名稱 成功大學
系所名稱(中) 公共衛生研究所碩士在職專班
系所名稱(英) Graduate Institute of Public Health(on the job class)
學年度 107
學期 2
出版年 108
研究生(中文) 李家華
研究生(英文) Chia-Hua Lee
學號 SB7051010
學位類別 碩士
語文別 中文
論文頁數 62頁
口試委員 指導教授-簡玉雯
口試委員-陳國東
口試委員-施欣怡
中文關鍵字 茲卡病毒  登革病毒  登革熱  血清流行病學  移工  東南亞  酵素連結免疫吸附法  溶斑減少中和試驗 
英文關鍵字 Zika virus  dengue virus  dengue  seroprevalence  migrant workers  Southeast Asia  Enzyme-Linked Immunosorbent Assay  Neutralization Tests 
學科別分類
中文摘要 研究背景:
臺灣目前超過70萬名的國際移工,主要來自印尼、越南、菲律賓、泰國,這些移工為臺灣的經濟發展貢獻可貴的勞動力,但這幾個國家為登革熱高度地方流行的國家,近幾年臺灣的境外移入之登革確診病例以東南亞國家為最大宗。至於茲卡病毒感染,目前全臺灣境外移入茲卡病毒確診病例累計共21例,超過一半來自於四個外勞輸出國家。
研究目的:
本研究調查剛入境臺灣的印尼、越南、菲律賓、泰國四個國際移工的血液中登革病毒與茲卡病毒IgM與IgG抗體之盛行率,以評估國際移工傳入登革病毒與茲卡病毒的風險。
研究方法:
本研究採方便取樣於2017年6月至8月收案600名來自印尼、越南、菲律賓、泰國四個國籍之國際移工血液檢體,以市售的酵素連結免疫吸附法(enzyme-linked immunosorbent assay, ELISA),檢驗登革病毒與茲卡病毒IgM與IgG抗體。針對四個國籍之國際移工,分別依年齡分層與性別,計算不同族群的茲卡病毒與登革熱病毒 IgM 與 IgG 抗體之盛行率。以費雪精確檢定(Fisher exact tests)檢定盛行率在不同性別間有無顯著差異,趨勢檢定(Cochran-Armitage)比較血清盛行率是否隨年齡有不同,研究之統計顯著P值設為0.05,資料採用SPSS22版進行統計分析。
登革病毒與茲卡病毒病毒均屬於黃病毒(flavivirus),抗體可能有部分交叉反應(cross-seroreactivity),而造成ELISA實驗結果判讀為偽陽性,溶斑減少中和試驗(Plaque reduction neutralization test, PRNT )比ELISA檢驗有更高的特異性,但耗費人力與時間,故本研究僅挑選部份檢體來做重覆確認,並依據世界衛生組織(WHO)之茲卡病毒實驗室診斷定義:茲卡病毒PRNT90效價≥20和與茲卡病毒PRNT90之效價比登革病毒PRNT90之比大於4倍,以確認是否符合近期感染茲卡病毒的實驗室病例。
結果:
本研究600位移工中有3位(0.5%)登革病毒IgM抗體陽性,其中泰國2位與菲律賓1位。茲卡病毒IgM抗體陽性有18名(3%),四個國家的茲卡病毒之IgM血清盛行率分別為:印尼(4.7%)、菲律賓(3.3%)、泰國(3.3%)和越南(0.7%),其中6名移工以PRNT90結果確診為近期感染,也就是600名國際移工中有1%(95%信賴區間0.4%-2.2%)的人,三個月內曾經感染茲卡病毒。
登革病毒IgG盛行率以菲律賓為最高(94.7%),其次為泰國(90.7%)與印尼(90.7%),而越南的移工最低(42.9%)。茲卡病毒IgG盛行率分別菲律賓(55.3%)、泰國(50.7%)與印尼(43.3%),而越南最低(6.0%),統計檢定結果只有泰國的茲卡IgM血清盛行率與登革IgG血清盛行率隨年齡增加上升。
結論:
本研究發現來自東南亞的國際移工茲卡病毒血清IgM陽性率竟然高於登革病毒血清IgM陽性率,且有1%的國際移工為近期感染茲卡病毒的確診病例,這表明該東南亞國家茲卡病毒感染的發生率可能被嚴重低估。臺灣與東南亞國家的交流往來日漸頻繁,由此區域傳入茲卡病毒的風險不可輕忽。
英文摘要 Seroprevalence and the international transmission risk of Zika virus (ZIKV) and dengue virus (DENV) infection in Southeast Asian countries remain largely unknown. The purpose of this study was to investigate the seroprevalence of IgM and IgG antibodies against DENV and ZIKV among 600 newly arrived foreign workers from Indonesia, Vietnam, the Philippines, and Thailand.
IgM against DENV was detected in only three workers, one from the Philippines (0.7%) and the other two from Thailand (1.3%). The seroprevalence of anti-ZIKV IgM was 4.7%, 3.3%, 3.3% and 0.7% in Indonesia, Philippines, Thailand, and Vietnam, respectively. Among the 600 foreign workers, 6 (1%) were further confirmed to have recent ZIKV infection by plaque reduction neutralization test. The results suggest that the incidence of Zika virus infection in this area may be seriously underestimated.
論文目次 中文摘要 I
英文摘要 III
致謝 VI
目 錄 VII
表目錄 IX
圖目錄 X
第 一 章 前言 11
1.1 研究目的 13
第 二 章 文獻探討 14
2.1 登革病毒/茲卡病毒的簡介 14
2.1.1 病毒基本結構 14
2.1.2 臨床症狀 15
(1) 登革病毒感染之臨床症狀 15
(2) 茲卡病毒感染症之臨床症狀 16
2.1.3 登革病毒/茲卡病毒之血清抗體檢驗 17
2.1.4 病毒傳染途徑 18
2.2 全球登革病毒/茲卡病毒之流行病學 19
2.2.1 登革病毒流行病學 19
2.2.2 茲卡病毒流行病學 23
2.3 臺灣登革病毒/茲卡病毒之流行病學 26
2.3.1 近年臺灣登革病毒流行病學概況 26
2.3.2 近年臺灣茲卡病毒流行病學概況 29
2.4 近年臺灣與東南亞國家勞動力交流概況 30
2.5 國際機場港埠發燒篩檢 32
2.6 文獻小結 33
第 三 章 研究方法 34
3.1 研究問題 34
3.2 資料來源 34
3.3 研究設計 34
3.4 實驗室檢驗方法 36
3.4.1 酵素連結免疫吸附法( enzyme-linked immunosorbent assay, ELISA ) 36
3.4.2 溶斑減少中和試驗(Plaque reduction neutralization test, PRNT ) 37
3.5 資料分析 40
第 四 章 結果 41
4.1 基本資料 41
4.2 ELISA登革病毒血清盛行率 43
4.3 ELISA茲卡病毒血清盛行率 45
4.4 ELISA登革病毒與茲卡病毒血清IgG及IgM交叉比較 47
4.5 PRNT登革病毒茲與卡病毒抗體檢測 48
第 五 章 討論 51
5.1 移工當地國家登革病毒流行概況與實驗結果探討 51
5.2 移工當地國家茲卡病毒流行概況與實驗結果探討 52
5.3 防疫政策建議 54
5.4 研究限制 55
第 六 章 結論 56
參考文獻 57
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