2004年台灣屏東區域登革熱流行：一家區域醫院之病例探討

An outbreak of dengue fever in Pingtung area, 2004: case series in a regional hospital

登革熱為公共衛生的重要議題。鑒於這幾年登革熱的流行，屏東都有感染案例，因此進行本研究，將屏東地區2004年的登革熱病毒感染流行病學進行分析報告。自2004年1月1日至12月31日止，屏東基督教醫院通報登革熱疑似病例共178位，經疾病管制局血清及病毒學檢驗，確認陽性個案共80例（45%），包括男性38例（47.5%），女性42例（52.5%）。確定個案平均年齡41.4 ± 18.4歲（最小4歲，最大82歲），自發病至就醫時間平均2.9 ± 2.1天（最短當天，最長10天）。病患就診科別以急診科最多（43例，53.8%），其次為感染科（17例，21.3%）與一般內科（7例，8.8%）。共有62例（77.5%）住院接受治療，平均住院天數為5.5天（最短2天，最長12天）。血清學檢驗陽性共25例，病毒學RT-PCR陽性55例，其中登革熱第一型50例，第四型5例。登革熱陽性個案的地理分佈，全市79里中有52里（65.8%）有感染個案，其中四個里同時有第一型及第四型案例。本研究中80例陽性個案的症狀排序為：發燒79例（98.8%）、厭食48例（60%）、骨關節疼痛48例（60%）、及全身無力46例（57.5%）。鑒於登革熱病患通常會先在基層醫療醫師或醫院急診處就診，因此，此類病例的發現與通報，仍有賴臨床醫師的警覺性與專業判斷，也才能進一步防堵其蔓延，並避免造成社區公共衛生及防疫方面的問題。（感控雜誌2008; 18: 341-8）。

Dengue fever is an important issue in public health. Since the epidemic of dengue fever occurred in Pingtung area in the past few years, we conducted a study to investigate the epidemiology in this area in 2004. From January to December 2004, a total of 178 cases of suspicious dengue fever managed at Pingtung Christian Hospital were reported to Center for Disease Control (CDC)Taiwan. Among them, 80 cases (45%) were subsequently confirmed by laboratory examinations performed at CDC-Taiwan and were included for analysis. There were 38 males (47.5%) and 42 females (52.5%), with a mean age of 41.4 ± 18.4 years (range, 4-82 years). The duration from the onset of fever to patient's visit to the medical station was 2.9 ± 2.1 days (range, 0-10 days). The most common symptoms were fever (98.8%), poor appetite (60%), joint pain (60%) and general malaise (57.5%). Most patients visited the emergency department (43 cases, 53.8%), the infectious disease department (17 cases, 21.3%) and the department of general internal medicine (7 cases, 8.8%). 62 (77.5%) patients were admitted to the hospital and the average of hospital stay was 5.5 days (range, 2-12 days). 25 were confirmed by the ELISA method and 55 by RT-PCR. Type I dengue virus was identified in 50 cases and type IV in 5 cases. Of the 79 districts in Pingtung city, 52 (65.8%) districts were involved, and four were found to have both type I and type IV dengue viruses circulated. Because the patients usually visit the primary care physicians or the emergency department of the hospital first, primary care physicians should be alert to this disease during the epidemic and report the case to the CDC-Taiwan once suspected. Only when the system is well established the control of dengue fever can be expected, and hence the burden of public health associated with dengue fever can be exempted. (Infect Control J 2008:18:341-8).