2011—2017年武汉市输入性非恶性疟流行特征分析
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摘要
目的分析武汉市境外输入性非恶性疟的流行特征,探讨其流行规律,为今后武汉市非恶性疟的诊断与防控提供依据。方法收集2011—2017年武汉市网络报告的输入性非恶性疟疫情数据资料,并进行统计分析。结果 2011—2017年武汉市报告输入性非恶性疟92例,其中间日疟46例,卵形疟31例,三日疟7例,混合感染8例,均为实验室确诊病例。输入病例以男性青壮年为主,其中男性占97.83%,年龄的P_(50)为36岁;职业以干部职员和农民工为主,干部职员占52.17%,农民工占29.35%。发病时间无明显季节性,从回国发病到确诊入院耗时P_(50)为5d。输入性非恶性疟病例中来自撒哈拉以北的国家和地区占16.30%,来自撒哈拉以南的占52.17%,来自东南亚国家占31.52%,三种非恶性疟感染类型在这三个地区的分布差异有统计学意义(χ~2=60.999,P<0.001),且非洲撒哈拉以北以输入性间日疟为主,撒哈拉以南以输入性卵形疟和三日疟为主,差异统计学意义(χ~2=25.949,P<0.001<0.017)。结论近年来该市输入性非恶性疟诊断时效性较差,首诊医生应根据疟疾输入地以及患者发病特征及早开具疟原虫镜检单,提高对输入性疟疾的早发现、早诊断和早治疗的水平。
Objective To analyze the epidemiological characteristics of imported non-falciparum malaria in Wuhan and discuss its epidemic rules to provide epidemiological basis for the diagnosis and prevention of non-falciparum malaria in Wuhan. Methods The data of reported non-falciparum malaria in Wuhan from 2011 to 2017 were collected and statistically analyzed. Results From 2011 to 2017, Wuhan reported 92 cases of imported non-falciparum malaria, including 46 cases of plasmodium vivax, 31 cases of plasmodium ovale, 7 cases of plasmodium malariae, 8 cases of mixed infection, all of which were laboratory confirmed cases. Males accounted for 97.83%(90/92) of the imported cases, and the P_(50) of their age was 36, cadres and staff accounted for 52.17%(48/92), and the migrant workers accounted for 29.35%(27/92). There was no seasonal fluctuation in the onset time. The median time from onset to diagnosis after returning to the country was 5 days. 16.3%(15/92)of the cases came from countries and regions in north of the Sahara. 52.17%(48/92)of the cases came from countries and regions in sub-Saharan, and 31.52%(29/92)of the cases came from Southeast Asian countries. There were statistically significant differences in the infection status of the three nonmalignant malaria infections in the three regions(χ~2=60.999,P<0.001). The north of Sahara was mainly imported plasmodium vivax, and the sub-Saharan region was mainly imported plasmodium ovale and plasmodium malariae. The differences were significant(χ~2=25.949,P<0.001<0.017). Conclusion In recent years, the diagnostic timeliness of the nonmalignant malaria is poor. The first-time doctors should improve the level of early detection, early diagnosis and early treatment of nonmalignant malaria based on the malaria input site and the characteristics of the patient′s disease and order an early screening of the plasmodium.
Objective To analyze the epidemiological characteristics of imported non-falciparum malaria in Wuhan and discuss its epidemic rules to provide epidemiological basis for the diagnosis and prevention of non-falciparum malaria in Wuhan. Methods The data of reported non-falciparum malaria in Wuhan from 2011 to 2017 were collected and statistically analyzed. Results From 2011 to 2017, Wuhan reported 92 cases of imported non-falciparum malaria, including 46 cases of plasmodium vivax, 31 cases of plasmodium ovale, 7 cases of plasmodium malariae, 8 cases of mixed infection, all of which were laboratory confirmed cases. Males accounted for 97.83%(90/92) of the imported cases, and the P_(50) of their age was 36, cadres and staff accounted for 52.17%(48/92), and the migrant workers accounted for 29.35%(27/92). There was no seasonal fluctuation in the onset time. The median time from onset to diagnosis after returning to the country was 5 days. 16.3%(15/92)of the cases came from countries and regions in north of the Sahara. 52.17%(48/92)of the cases came from countries and regions in sub-Saharan, and 31.52%(29/92)of the cases came from Southeast Asian countries. There were statistically significant differences in the infection status of the three nonmalignant malaria infections in the three regions(χ~2=60.999,P<0.001). The north of Sahara was mainly imported plasmodium vivax, and the sub-Saharan region was mainly imported plasmodium ovale and plasmodium malariae. The differences were significant(χ~2=25.949,P<0.001<0.017). Conclusion In recent years, the diagnostic timeliness of the nonmalignant malaria is poor. The first-time doctors should improve the level of early detection, early diagnosis and early treatment of nonmalignant malaria based on the malaria input site and the characteristics of the patient′s disease and order an early screening of the plasmodium.
引文
[1] 曹俊,刘耀宝,曹园园,等.中国消除疟疾的持续挑战:输入性疟疾[J].中国寄生虫学与寄生虫病杂志,2018,36(2):93-96.
[2] 范久波,李保安,刘海菊. 湖北襄阳市输入性卵形疟1例[J]. 中国寄生虫学与寄生虫病杂志,2017,35(4):312.
[3] 吴凯,陈芳,徐明星,等.2008—2017年武汉市境外输入性疟疾疫情及诊断能力分析[J].中国血吸虫病防治杂志,2018,30(3):289-294.
[4] 陈光裕. 疟疾复发的机理[J]. 国外医学(寄生虫病分册),1982(4):145-148.
[5] 燕贺,夏志贵,丰俊,等. 2011—2013全国输入性三日疟与卵形疟疫情分析[J]. 国际医学寄生虫病杂志,2015,42(1):14-17,21.
[6] 孙凌聪,吴冬妮,张华勋,等.湖北省首例输入性疟疾混合感染的实验室诊断分析[J]. 公共卫生与预防医学,2017,28(2):131-133.
[7] 马斌荣,医学统计学[M].5版,北京:人民卫生出版社,2011:74.
[8] Collins,William E,Geoffrey M,et al.Plasmodium Ovale: Parasite and Disease[J].Clinical Microbiology Reviews,2005(18): 570-581.
[9] 吴凯,王重新,陈野,等. 武汉市流动人口输入性疟疾管理效果评价[J]. 中国病原生物学杂志,2012,7(1):53-55.
[10] Doderer-Lang.The Ears of the African Elephant: Unexpected High Seroprevalence ofPlasmodium Ovale and Plasmodium Malariae in Healthy Populations in Western Africa[J].Malaria Journal,2014(13):240.
[11] BETSON, MARTHA.Detection of PersistentPlasmodium Spp. Infections in Ugandan Children after Artemether-Lumefantrine Treatment[J].Ed Russell Stothard Parasitology,2014(141):1880–1890.
[12] Chew, Ching Hoong.Hexaplex PCR Detection System for Identification of Five Human Plasmodium Species with an Internal Control[J].Journal of Clinical Microbiology,2012,50(12):4012- 4019.
[13] Bialasiewicz, Seweryn.Impact of Competitive Inhibition and Sequence Variation upon the Sensitivity of Malaria PCR[J].Journal of Clinical Microbiology,2007,45(5):1621–1623.
[14] Steenkeste, Nicolas.Sub-Microscopic Malaria Cases and Mixed Malaria Infection in a Remote Area of High Malaria Endemicity in Rattanakiri Province, Cambodia: Implication for Malaria Elimination[J].Malaria Journal,2010(9):108.
[15] Manning, Laurens.Features and Prognosis of Severe Malaria Caused byPlasmodium Falciparum, Plasmodium Vivax and Mixed Plasmodium Species in Papua New Guinean Children[J].PLoS ONE,2011,6(12):29203.
[16] TURKI, Habibollah.Efficiency of Nested-PCR in Detecting Asymptomatic Cases toward Malaria Elimination Program in an Endemic Area of Iran[J].Iranian Journal of Parasitology,2015,10(1):39-45.
[17] 王忠磊,付婷霞,胡颖欣,等.山东省输入性疟疾流行病学及临床特点分析[J].公共卫生与预防医学,2016,27(1):16-19.
[18] 张丽,丰俊,张少森,等.2016年全国疟疾疫情分析[J].中国寄生虫学与寄生虫病杂志,2017,35(6):515-519.
[2] 范久波,李保安,刘海菊. 湖北襄阳市输入性卵形疟1例[J]. 中国寄生虫学与寄生虫病杂志,2017,35(4):312.
[3] 吴凯,陈芳,徐明星,等.2008—2017年武汉市境外输入性疟疾疫情及诊断能力分析[J].中国血吸虫病防治杂志,2018,30(3):289-294.
[4] 陈光裕. 疟疾复发的机理[J]. 国外医学(寄生虫病分册),1982(4):145-148.
[5] 燕贺,夏志贵,丰俊,等. 2011—2013全国输入性三日疟与卵形疟疫情分析[J]. 国际医学寄生虫病杂志,2015,42(1):14-17,21.
[6] 孙凌聪,吴冬妮,张华勋,等.湖北省首例输入性疟疾混合感染的实验室诊断分析[J]. 公共卫生与预防医学,2017,28(2):131-133.
[7] 马斌荣,医学统计学[M].5版,北京:人民卫生出版社,2011:74.
[8] Collins,William E,Geoffrey M,et al.Plasmodium Ovale: Parasite and Disease[J].Clinical Microbiology Reviews,2005(18): 570-581.
[9] 吴凯,王重新,陈野,等. 武汉市流动人口输入性疟疾管理效果评价[J]. 中国病原生物学杂志,2012,7(1):53-55.
[10] Doderer-Lang.The Ears of the African Elephant: Unexpected High Seroprevalence ofPlasmodium Ovale and Plasmodium Malariae in Healthy Populations in Western Africa[J].Malaria Journal,2014(13):240.
[11] BETSON, MARTHA.Detection of PersistentPlasmodium Spp. Infections in Ugandan Children after Artemether-Lumefantrine Treatment[J].Ed Russell Stothard Parasitology,2014(141):1880–1890.
[12] Chew, Ching Hoong.Hexaplex PCR Detection System for Identification of Five Human Plasmodium Species with an Internal Control[J].Journal of Clinical Microbiology,2012,50(12):4012- 4019.
[13] Bialasiewicz, Seweryn.Impact of Competitive Inhibition and Sequence Variation upon the Sensitivity of Malaria PCR[J].Journal of Clinical Microbiology,2007,45(5):1621–1623.
[14] Steenkeste, Nicolas.Sub-Microscopic Malaria Cases and Mixed Malaria Infection in a Remote Area of High Malaria Endemicity in Rattanakiri Province, Cambodia: Implication for Malaria Elimination[J].Malaria Journal,2010(9):108.
[15] Manning, Laurens.Features and Prognosis of Severe Malaria Caused byPlasmodium Falciparum, Plasmodium Vivax and Mixed Plasmodium Species in Papua New Guinean Children[J].PLoS ONE,2011,6(12):29203.
[16] TURKI, Habibollah.Efficiency of Nested-PCR in Detecting Asymptomatic Cases toward Malaria Elimination Program in an Endemic Area of Iran[J].Iranian Journal of Parasitology,2015,10(1):39-45.
[17] 王忠磊,付婷霞,胡颖欣,等.山东省输入性疟疾流行病学及临床特点分析[J].公共卫生与预防医学,2016,27(1):16-19.
[18] 张丽,丰俊,张少森,等.2016年全国疟疾疫情分析[J].中国寄生虫学与寄生虫病杂志,2017,35(6):515-519.