臺灣博碩士論文加值系統

傳染病的發生是由病原、宿主及環境三者間交互作用而成。在該模式中，如果有任何一個要素改變，破壞了原有的平衡，即會導致疾病的發生。隨著全球氣候變遷可能直接或間接的衝擊人類生存條件以及健康，其中氣候因子的改變可能會影響自然生態與環境中動、植物及微生物之繁衍生長情形、分佈及傳染途徑，傳染病的流行模式可能有所改變。腸病毒在台灣的發生情形，全年皆有病例出現，好發於夏秋季節，至今已成為台灣的地方性流行傳染病。腸病毒首次發生大流行於1998年，當時造成129,106個手足口症病患、405例重症病患、其中有78位兒童死亡，而後2000、2001、2005及2008年皆再次爆發流行。台灣目前已有許多研究發表，均偏重於探討傳染模式、病毒基因型、血清流行病學、感染後致病之機轉等研究，共推論之可能原因為（1）多為缺乏抗體之易感受性者，（2）腸病毒之病毒變異造成大流行，（3）傳染途徑的改變。經文獻回顧發現這些研究仍無法完全解釋1998年台灣為何造成腸病毒大流行。
基於上述原因，促使本研究以氣候因子來探究腸病毒重症爆發流行之可能機制，利用系統性分析腸病毒之危險因子，補足先前研究之不足。結果顯示：腸病毒重症病例發病前3-5天之平均溫度分佈於8-32℃，過去研究顯示腸病毒重症病例其感染之腸病毒型別以腸病毒71型為主，因此其8-33℃溫度範圍可能為腸病毒71型適合生長之自然環境；以1998-2008年平均來看，考量腸病毒感染之潛伏期，在平均溫度22℃時台灣之腸病毒重症病例數於開始明顯上升。腸病毒重症病例發病前3-5天之平均相對濕度分佈於45-100%，若發病前3-5天之相對濕度小於75%，隨著相對濕度增加重症病例數跟著增加，若相對濕度大於75%，重症病例隨著相對濕度增加而減少。以敏感點測試結果平均相對濕度對於腸病毒重症爆發流行未有明顯趨勢; 累積降雨量之分佈介於0-390mm範圍，其重症病例數多數分佈於累積降雨量0-50mm之間，若考量潛伏期，於發病前5天之週平均累積降雨量小於10mm時較不容易導致爆發流行，當週平均累積降雨量介於20-30mm時較容易導致爆發腸病毒重症流行。

The reason that infectious disease could take place depends on interactions between pathogen, host and environment. If any elements change, the balance was disrupted and disease progressed. With global climate change may directly or indirectly impact the micro-interaction between environmental factors, weather, including temperature and humidity, may influence the transmission mode of disease. Enteroviruses circulate in Taiwan for many years and cause epidemics in 1998. This outbreak caused 129106 hand-foot-mouth diseases, resulting 405 severe cases and 78 pediatric deaths. The following year, such as 2000, 2001, 2005 and 2008, also has smaller scale of outbreak. Summary the published literatures relating to enteroviral epidemics in Taiwan, we can infer the probable cause of unique outbreak in 1998: 1) reservoir of susceptible pediatric cases, 2) variant strain of enterovirus that never circulate in Taiwan, 3) Changes of transmission mode. All listing above cannot explain well the outbreak of 1998.
For these reasons, exploring the possibility of climate factor, such as temperature humidity and rainfall, could be the mechanisms that cause the epidemics in 1998. By incorporate the climate factor into the risk factors of enteroviral infection and analyzing systematically, we found that the average temperature falls between 8-32℃ 3-5 days ago before the onset of severe cases, which was the suitable range of temperature for the growth of enterovirus type71. Base on the average from 1998 to 2008, and time lag for incubation period of enteroviral type 71, we can conclude that severe cases started to increase when temperature average was around 22℃. If the average relative humidity3-5 days before the onset of disease were less than 75%, then case numbers was proportional to the relative humidity. If average relative humidity was greater than 75%, then severe cases decreased as the humidity increased. Consideration the influence from rainfall, the cumulative distribution of rainfall on the day of onset in severe cases was between 0-50 mmHg .Taking the incubation time together, it will lead to an outbreak when weekly cumulative rainfall was between 20-30 mmHg.

中文摘要 I
英文摘要 II
致謝 IV
目錄 V
表目錄 VI
圖目錄 VII
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機及目的 3
第二章 文獻探討 4
第一節 腸病毒特性及歷史背景之概述 4
第二節 腸病毒71型 6
第三節 腸病毒之臨床表徵與致病機制 8
第四節 以流行病學三角致病模式探討台灣腸病毒之文獻回顧 9
第三章 材料與方法 14
第一節 研究材料 14
第二節 資料之前置處理 16
第三節 腸病毒與氣候因子之相關性 17
第四節 腸病毒重症發生與氣象因子之統計檢定 18
第四章 結果 20
第一節 描述性流行病學 20
第二節 確認發爆發流行 22
第三節 平均溫度、相對濕度與腸病毒感染併發重症之分佈 22
第四節 統計分析結果 24
第四章 討論 30
第五章 結論 35
參考文獻 36

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