2011-2017年福建省输入性疟疾流行态势及防控策略
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摘要
目的分析福建省2011-2017年输入性疟疾流行特征,为福建省顺利实现消除疟疾提供科学依据。方法收集2011-2017年福建省输入性疟疾流行病学调查资料,运用SPSS 18.0软件对输入性疟疾的虫种、输入来源以及三间分布进行统计分析;对输入性疟疾首诊确诊的影响因素进行多因素logistic回归分析。结果 2011-2017年福建省共报告输入性疟疾病例632例,以恶性疟为主,占总病例数的67.6%(427/632)。输入来源地主要为非洲,占总比例数的85.1%(533/632);病例主要分布在福州,占总病例数的50.6%(320/632),其余地区散在分布。发病时间无明显季节性,全年均有输入性病例报告;发病人群多为青壮年,约占总病例的85.1%(533/632),男女性别比例为9.2∶1(570/62)。从发病到确诊的时间大多在10 d以内,占总病例数的82.9%(524/632);首诊确诊455例,约占总比例的72%.首诊确诊的影响因素中,患者就诊前服用抗疟药物与首诊确诊率呈负相关[OR=0.175,95%CI(0.061～0.509)],就诊前告知去过疟区[OR=132.964,95%CI(41.601～424.973)]及首诊机构为县级以上医疗机构[OR=27.951,95%CI(13.285～58.806)]这两个因素与首诊确诊率呈正相关;就诊前是否患过疟疾对首诊确诊率无影响(OR=1.496,95%CI(0.735～3.044))结论为适应我省目前的疟疾流行态势,制定了相应的防控策略:做好传染源的管理和控制,加强外出务工人员的疟疾防治知识健康教育,提高基层首诊医生对疟区回国人员的疟疾诊断意识,做到早发现、早诊断、早治疗。最大限度降低继发性传播风险,确保我省消除疟疾目标的顺利实现。
We analyzed the epidemic characteristics of imported malaria in order to provide scientific evidences for eliminating malaria in Fujian Province. We collected the epidemiological data of imported malaria from 2011 to 2017, the SPSS software was used to analyzedthe species of malaria,source of infection and the Three Intervals distribution. At the same time, we did the multivariate Logistic Regression analysis on influence factors of cases identified by initial diagnosis of imported malaria. The results showed that a total of 632 imported malaria cases were reported from 2011 to 2017,and the main type of these cases were P. falciparum, accounting for 67.6%(427/632). All of the cases were imported,85.1%(533/632) were imported from Africa;50.6%(320/632) were mainly distributed in Fuzhou,the rest were scattered;the cases were reported the whole year, the onset time showed no significant seasonal variation; 85.1%(533/632)of the incidence of crowd were male young,males more than females,the sex ratio was 9.2∶1(570/62); 82.9%(524/632) of the interval from onset to final diagnosis was in 10 days mostly; 72%(455/632) of the cases were identified by initial diagnosis. Among the influence factors of cases identified by initial diagnosis,there was a negative correlation between the rate of first diagnosis and the rate of taking antimalarial drugs before treatment(OR=0.175, 95%CI 0.061-0.509); two influence factors, which were informing doctor about the situation of malaria epidemic and initial diagnosis above the county level, were positive associated with the rate of first diagnosis(OR were 132.964 and 27.951, 95%CI were 41.601-424.973 and 13.285-58.806, respectively). The influence factor of occurrence of malaria was no reflection on the rate of first diagnosis(OR=1.496, 95%CI: 0.735-3.044).In order to adapt the epidemic situation of malaria at present in Fujian Province, the following control strategy was set up, control infection source, the health education of malaria knowledge for migrant workers must be strengthened,at the same time,in order to ensure the realization of the goal of eliminating malaria,the initial clinician on primary level should improve the diagnosis consciousness and diagnosis level for malaria. Early detection,early diagnosis and early treatment are important to minimize the occurrence of secondary transmission risk.
We analyzed the epidemic characteristics of imported malaria in order to provide scientific evidences for eliminating malaria in Fujian Province. We collected the epidemiological data of imported malaria from 2011 to 2017, the SPSS software was used to analyzedthe species of malaria,source of infection and the Three Intervals distribution. At the same time, we did the multivariate Logistic Regression analysis on influence factors of cases identified by initial diagnosis of imported malaria. The results showed that a total of 632 imported malaria cases were reported from 2011 to 2017,and the main type of these cases were P. falciparum, accounting for 67.6%(427/632). All of the cases were imported,85.1%(533/632) were imported from Africa;50.6%(320/632) were mainly distributed in Fuzhou,the rest were scattered;the cases were reported the whole year, the onset time showed no significant seasonal variation; 85.1%(533/632)of the incidence of crowd were male young,males more than females,the sex ratio was 9.2∶1(570/62); 82.9%(524/632) of the interval from onset to final diagnosis was in 10 days mostly; 72%(455/632) of the cases were identified by initial diagnosis. Among the influence factors of cases identified by initial diagnosis,there was a negative correlation between the rate of first diagnosis and the rate of taking antimalarial drugs before treatment(OR=0.175, 95%CI 0.061-0.509); two influence factors, which were informing doctor about the situation of malaria epidemic and initial diagnosis above the county level, were positive associated with the rate of first diagnosis(OR were 132.964 and 27.951, 95%CI were 41.601-424.973 and 13.285-58.806, respectively). The influence factor of occurrence of malaria was no reflection on the rate of first diagnosis(OR=1.496, 95%CI: 0.735-3.044).In order to adapt the epidemic situation of malaria at present in Fujian Province, the following control strategy was set up, control infection source, the health education of malaria knowledge for migrant workers must be strengthened,at the same time,in order to ensure the realization of the goal of eliminating malaria,the initial clinician on primary level should improve the diagnosis consciousness and diagnosis level for malaria. Early detection,early diagnosis and early treatment are important to minimize the occurrence of secondary transmission risk.
引文
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[5] 黄光全,袁方玉,林文等.湖北省20052009年输入性疟疾发病态势分析[J].公共卫生与预防医学,2012 21(6):25-27.
[6] 买买提江·吾买尔,伊斯拉音·乌斯曼,阿迪力·司马义,等.2004-2015年新疆输入性疟疾疫情分析[J].中国寄生虫学与寄生虫病杂志,2016,4 (2):128-132.
[7] 刘颖,周瑞敏,苏云普.河南省2011年疟疾疫情分析[J].现代预防医学,2013,40(15):2900-2901.
[8] 汤林华,中国消除疟疾的目标、策略与路径[J].中国热带医学,2016 16(4):301-304.
[9] 陈国伟,王军,黄兴周,等.云南省8个边境州市19 个口岸入境者疟疾血清学检测[J].中国寄生虫学与寄生虫病杂志,2010,8(1):54-57.
[10] Wang DQ,Li SG,Cheng Z,et al.Transmission risk from imported Plasmodium vivax malaria in the China-Myanmar border region [J].Emerg Infect Dis,2015,21 (10):1861-1864.DOI:10.3201/eid2110.150679
[2] 汤林华.输入性疟疾的诊治与管理[M].上海:上海科学技术出版社,2010:6
[3] 中华人民共和国卫生部.《中国消除疟疾行动计划(2010-2020年)》[Z].2010.
[4] 王晓欢,张山鹰.福建省消除疟疾地区重新流行风险指示体系的构建[J].中国人兽共患病学报,2015 31(11):1081-1085.DOI:10.3969/j.issn.1002—2694.2015.11.020
[5] 黄光全,袁方玉,林文等.湖北省20052009年输入性疟疾发病态势分析[J].公共卫生与预防医学,2012 21(6):25-27.
[6] 买买提江·吾买尔,伊斯拉音·乌斯曼,阿迪力·司马义,等.2004-2015年新疆输入性疟疾疫情分析[J].中国寄生虫学与寄生虫病杂志,2016,4 (2):128-132.
[7] 刘颖,周瑞敏,苏云普.河南省2011年疟疾疫情分析[J].现代预防医学,2013,40(15):2900-2901.
[8] 汤林华,中国消除疟疾的目标、策略与路径[J].中国热带医学,2016 16(4):301-304.
[9] 陈国伟,王军,黄兴周,等.云南省8个边境州市19 个口岸入境者疟疾血清学检测[J].中国寄生虫学与寄生虫病杂志,2010,8(1):54-57.
[10] Wang DQ,Li SG,Cheng Z,et al.Transmission risk from imported Plasmodium vivax malaria in the China-Myanmar border region [J].Emerg Infect Dis,2015,21 (10):1861-1864.DOI:10.3201/eid2110.150679