背景： 每年登革熱在全世界造成五千萬到一億人口的感染，死亡率介於3.5 到 5%間。由於合適的地理及人文環境，登革熱一直是台灣所面臨的重要傳染病課題。如何以臨床症狀正確地診斷出疑似病例並提高早期通報率，以協助疫情的控制實為重要的研究議題。本研究運用高雄市登革熱確診病例調查表，分析人口統計資料、出現症狀、初診醫院層級以及是否第一次就診即被通報，藉以了解各臨床表現與登革熱診斷的相關性，以及影響第一次就診通報與否之相關因素。
設計：以高雄市經血清確診為登革熱之病人為研究對象，採用2006 年1 月1 日至2006 年12 月31 日之高雄市「登革熱病例調查表」進行分析，研究對象共計593 例。
結果：確診個案的平均年齡為46.45±19.06歲﹙年齡分布為2至89歲﹚。出現症狀排名依序為發燒﹙97.3%﹚、疼痛（75.2%）、腸胃症狀（74.7%）、紅疹（49.2%）
以及口乾舌燥（49.1%）。卡方檢定結果發現與初診通報有顯著相關性之因素包括：性別、年齡分組、病毒類型、是否為登革出血熱、初診醫院層級、疼痛及腸胃症狀。邏輯斯迴歸分析發現性別、年齡分組、病毒類型、初診醫院層級、腸胃症狀及無力為初診通報與否的預測因子。
結論：登革熱的初診通報與否受到了臨床症狀及病人初次就診醫院層級的影響。醫院層級愈高，初診通報率越高。醫療從業人員可善用繼續教育的機會，於登革熱流行期間再度加強登革熱好發症狀等的專業知識，以提高早期診斷率。此外，衛生主管機關亦可以由傳染病警示及通報系統著手，減少因醫師個人因素所造成的通報疏漏，提高初診通報率，以早期偵測疫情，及早做出防疫決策，避免造成暴發性的流行。

Objective: Globally, about 50 to 100 million patients are infected with dengue fever per year and the average mortality rate is about 3.5 to 5% in Asia. Because of appropriate geographic location and cultural factors, dengue fever has been the important subject of infectious disease that Taiwan faces. In order to control and prevent the spread of dengue fever effectively, how to diagnose the suspected case correctly by the clinical symptoms and to improve the early reporting rates become critical research questions. The purpose of this study is to explore the correlation between clinical symptoms and diagnosis of dengue fever, and the factors associated with being reported at the first outpatient visit among confirmed case by using Dengue Fever Survey Form, which including demographics, clinical symptoms, level of the first outpatient visit and whether the patient is reported at the first outpatient visit.
Design: 593 virologically confirmed cases during 2006 Dengue endemics in Kaohsiung city were studied. The data were from Dengue Fever Survey Form, which were collected from January 1 to December 31,2006.
Result: The mean age of cases was 46.45±19.06 years (range 2 years to 89 years). The most common symptoms were fever (97.3%), pain (75.2%), GI symptoms (74.7%), skin rash (49.2%), and thirsty/dry mouth (49.1%). Chi-square tests showed gender, age in group, viral type, whether dengue hemorrhagic fever or not, level of the first outpatient visit, pain and gastrointestinal symptoms were significantly associated with being reported at the first outpatient visit. The result of the analysis of logistic regression indicated that the significant predictors of being reported at the first outpatient visit were gender, age in group, viral type, level of the first outpatient visit, gastrointestinal symptoms and fatigue.
Conclusion: Reporting of infectious disease is essential to detection of outbreaks, planning of control program and provision of appropriate treatment. Clinical symptoms of dengue fever and the level of the first outpatient visit will influence rates of being reported at the first outpatient visit. All medical providers involved in diagnosis and treatment of dengue fever should strengthen their knowledge by continuing learning in order to improve early identification rates. In addition, health department could try to improve the detection and reporting systems to make the reporting steps more convenient and advance early reporting rates.

第一章 緒論.........................................................................1
第一節 研究背景與動機.................................................1
第二節 研究目的.............................................................3
第二章 文獻探討.................................................................4
第一節 登革熱簡介.........................................................4
第二節 登革熱臨床症狀相關研究...............................12
第三節 影響傳染病通報的因素...................................15
第三章 研究設計與方法...................................................18
第一節 研究架構...........................................................18
第二節 研究問題與假設...............................................18
第三節 研究資料來源...................................................19
第四節 研究變項與操作型定義...................................19
第五節 資料處理與分析方法.......................................21
第四章 研究結果...............................................................22
第一節 描述性統計.......................................................22
第二節 推論性分析.......................................................27
一、差異檢定............................................................27
二、迴歸分析............................................................33
第五章 研究討論...............................................................35
第一節 人口學特性、病毒種類及罹病嚴重度、就醫狀
況之討論...........................................................35
第二節 好發症狀及其與年齡之關係 ..........................36
第三節 臨床症狀與初診通報與否之關係...................37
第四節 人口學特性、病毒種類及罹病嚴重度、就醫狀
況與初診通報與否之關係...............................37
第五章 結論與建議...........................................................39
第一節 結論.......................................................................39
第二節 研究建議...............................................................40
第三節 研究限制及給未來研究者的建議.......................41
參考資料............................................................................42

Ahmed, S., Ali, N., Ashraf, S., Ilyas, M., Tariq, W. U., & Chotani, R. A. (2008).Dengue fever outbreak: A clinical management experience. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 18(1), 8-12.
Allen, C. J., & Ferson, M. J. (2000). Notification of infectious diseases by general practitioners: A quantitative and qualitative study. The Medical Journal of Australia, 172(7), 325-328.
Center for Disease Control. Mandatory reporting of infectious diseases by clinicians.MMWR 1990;39(RR-9): 1-11,16-17 Retrived 2009/4/15, from http://www.cdc.gov/mmwr/preview/mmwrhtml/00001665.htm
Center for Disease Control. Fact Sheet: Dengue and Dengue Hemorrhagic Fever.Retrived 2009/4/15,from http://www.cdc.gov/ncidod/dvbid/dengue/facts.htm
Curtis, A. B., McCray, E., McKenna, M., & Onorato, I. M. (2001). Completeness and timeliness of tuberculosis case reporting. A multistate study. American Journal of
Preventive Medicine, 20(2), 108-112.
Dato, V., Wagner, M. M., & Fapohunda, A. (2004). How outbreaks of infectious disease are detected: A review of surveillance systems and outbreaks. Public Health Reports (Washington, D.C.: 1974), 119(5), 464-471.
Doyle, T. J., Glynn, M. K., & Groseclose, S. L. (2002). Completeness of notifiable infectious disease reporting in the united states: An analytical literature review. American Journal of Epidemiology, 155(9), 866-874.
Friedman, S. M., Sommersall, L. A., Gardam, M., & Arenovich, T. (2006). Suboptimal reporting of notifiable diseases in canadian emergency departments: A survey of emergency physician knowledge, practices, and perceived barriers. Canada Communicable Disease Report, 32(17), 187-198.
Geneva: World Health Organization. (1997). Dengue hemorrhagic fever: diagnosis, treatment, prevention and control, 2nd edn.
Gibbons, R. V., & Vaughn, D. W. (2002). Dengue: An escalating problem. BMJ (Clinical Research Ed.), 324(7353), 1563-1566.
Gubler, D. J. (2004). The changing epidemiology of yellow fever and dengue, 1900 to 2003: Full circle? Comparative Immunology, Microbiology and Infectious
Diseases, 27(5), 319-330.
Guzman, M. G., & Kouri, G. (2002). Dengue: An update. The Lancet Infectious Diseases, 2(1), 33-42.
Harris, E., Videa, E., Perez, L., Sandoval, E., Tellez, Y., Perez, M. L., et al. (2000). Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in
Nicaragua. The American Journal of Tropical Medicine and Hygiene, 63(1-2), 5-11.
Itoda, I., Masuda, G., Suganuma, A., Imamura, A., Ajisawa, A., Yamada, K., et al. (2006). Clinical features of 62 imported cases of dengue fever in japan. The
American Journal of Tropical Medicine and Hygiene, 75(3), 470-474.
Jones, J. L., Meyer, P., Garrison, C., Kettinger, L., & Hermann, P. (1992). Physician and infection control practitioner HIV/AIDS reporting characteristics. American Journal of Public Health, 82(6), 889-891.
Lee, M. S., Hwang, K. P., Chen, T. C., Lu, P. L., & Chen, T. P. (2006a). Clinical characteristics of dengue and dengue hemorrhagic fever in a medical center of
southern taiwan during the 2002 epidemic. Journal of Microbiology, Immunology, and Infection, 39(2), 121-129.
Pinheiro, F. P., & Corber, S. J. (1997). Global situation of dengue and dengue haemorrhagic fever, and its emergence in the americas. World Health Statistics
Quarterly.Rapport Trimestriel De Statistiques Sanitaires Mondiales, 50(3-4), 161-169.
Schramm, M. M., Vogt, R. L., & Mamolen, M. (1991). The surveillance of communicable disease in vermont: Who reports? Public Health Reports(Washington, D.C.: 1974), 106(1), 95-97.
Singh, N. P., Jhamb, R., Agarwal, S. K., Gaiha, M., Dewan, R., Daga, M. K., et al. (2005). The 2003 outbreak of dengue fever in Delhi, India. The Southeast Asian Journal of Tropical Medicine and Public Health, 36(5), 1174-1178.
Sung, V., O'Brien, D. P., Matchett, E., Brown, G. V., & Torresi, J. (2003). Dengue fever in travelers returning from southeast asia. Journal of Travel Medicine : Official Publication of the International Society of Travel Medicine and the Asia Pacific Travel Health Association, 10(4), 208-213.
Tassniyom, S., Vasanawathana, S., Chirawatkul, A., & Rojanasuphot, S. (1993). Failure of high-dose methylprednisolone in established dengue shock syndrome: A placebo-controlled, double-blind study. Pediatrics, 92(1), 111-115.
李允吉, 劉建衛, & 黃高彬. (2007/10/01). 登革熱與登革出血熱. 感染控制雜誌, 17(5), 307-315.
段延昌, 洪敏南, 陳美珠, 邱鴻英, 黃啓泉, 林建州, et al. (2008/01/25). 2006 年高高屏本土性登革熱疫情因應與結果. 疫情報導, 24(1), 3-21.
鍾兆麟. (2006/09/25). 漫談登革熱防治. 疫情報導, 22(9), 589-596.
行政院衛生署疾病管制局-2007 登革熱防治工作指引