2005-2017年甘肃省陇南市流行性乙型脑炎流行病学特征分析
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摘要
目的分析陇南市流行性乙型脑炎的流行病学特征,为制定乙脑预防控制策略和措施提供依据。方法采用描述流行病学方法对2005-2017年甘肃省陇南市乙脑资料进行分析,描述病例在时间、空间和人群分布特征。结果 2005-2017年陇南市共报告乙脑病例374例,死亡29例,病死率为7.8%,年平均报告发病率为1.1/10万(0.08～3.8/10万);病例集中在7-9月(95%),8月为发病高峰;病例集中在农村,农村病例占91%(339/374),报告病例数前五位的地区为武都区(103例)、礼县(72例)、西和县(67例)、文县(48例)和成县(28例),共占比65%(243/374);病例年龄中位数为21岁(1月龄～83岁),2005-2008年165例病例年龄中位数为12岁(3月龄～79岁),2009-2017年209例病例年龄中位数为30岁(1月龄～83岁),分布位置不同(Z=5.2,P<0.001);实施乙脑疫苗免疫接种前后14岁以下儿童病例构成比分别为59%和26%(■=17,P<0.001);病例中男性占50%(188/374),45～59岁年龄组女性发病率1.67/10万,男性年平均发病率0.77/10万(■=9.36,P<0.001);2009-2017年农民构成比为59%,高于2005-2008年的31%(■=11,P<0.001);三带喙库蚊在猪圈中的密度最高,在农户也有三带喙库蚊活动,城市居民区未监测到三带喙库蚊。结论 2008年将乙脑疫苗纳入扩大免疫规划之后,疫苗对儿童乙脑的发病起到了很好的控制作用,高发人群呈现向高年龄组推移的现象。2017年乙脑报告病例数明显升高,病例以高年龄组为主,病死率高,建议开展进一步调查以明确高发原因,重点关注成人和农村地区乙脑防控工作。
Objective To analyze the epidemiological characteristics of epidemic Japanese encephalitis in Longnan,and to provide a basis for developing prevention and control strategies of Japanese encephalitis.Methods Descriptive epidemiological method was adopted to analyze the data on the temporal,spatial and population distribution characteristics of Japanese encephalitis in Longnan from 2005 to 2017.Results A total of 374 patients with Japanese encephalitis were reported in Longnan from 2005 to 2017,29 cases were dead(7.8%).The average annual reported incidence was 1.1/100 000(0.08～3.8/100 000).The disease mainly broke out from July to September(95%) and peaked in August.The cases were concentrated on rural areas(91%,339/374).The top five regions with the highest reported cases number included Wudu(103),Lixian(72),Xihe(67),Wenxian(48) and Chengxian district(28),with a proportion of 65%(243/374).The median age of patients was 21 years(range from 1 month to 83 years),and the median age of 165 patients from 2005 to 2008 was 12 years(3 months to 79 years),whereas that of 209 patients from 2009 to 2017 was 30 years(1 month to 83 years old),depending on different distribution locations(Z=5.2,P<0.001).Constituent ratios of children aged 14 and below were 59% and 26% before and after Japanese encephalitis vaccination(■=17,P<0.001),respectively.Among all patients,there were 188 males(50%),while in the 45-59 group,the incidence of the disease was 1.67/100 000 for females and 0.77/100 000 for males(■=9.36,P<0.001).From 2009 to 2017,the constituent ratio of peasants was 59%,far higher than 31% from 2005 to 2008(■=11,P<0.001).The density of Culex tritaeniorhynchus was the highest in pigsties.C.tritaeniorhynchus was also found in peasant households but not had been monitored in urban neighbourhoods.Conclusion Since the implementation of the Expanded
Objective To analyze the epidemiological characteristics of epidemic Japanese encephalitis in Longnan,and to provide a basis for developing prevention and control strategies of Japanese encephalitis.Methods Descriptive epidemiological method was adopted to analyze the data on the temporal,spatial and population distribution characteristics of Japanese encephalitis in Longnan from 2005 to 2017.Results A total of 374 patients with Japanese encephalitis were reported in Longnan from 2005 to 2017,29 cases were dead(7.8%).The average annual reported incidence was 1.1/100 000(0.08～3.8/100 000).The disease mainly broke out from July to September(95%) and peaked in August.The cases were concentrated on rural areas(91%,339/374).The top five regions with the highest reported cases number included Wudu(103),Lixian(72),Xihe(67),Wenxian(48) and Chengxian district(28),with a proportion of 65%(243/374).The median age of patients was 21 years(range from 1 month to 83 years),and the median age of 165 patients from 2005 to 2008 was 12 years(3 months to 79 years),whereas that of 209 patients from 2009 to 2017 was 30 years(1 month to 83 years old),depending on different distribution locations(Z=5.2,P<0.001).Constituent ratios of children aged 14 and below were 59% and 26% before and after Japanese encephalitis vaccination(■=17,P<0.001),respectively.Among all patients,there were 188 males(50%),while in the 45-59 group,the incidence of the disease was 1.67/100 000 for females and 0.77/100 000 for males(■=9.36,P<0.001).From 2009 to 2017,the constituent ratio of peasants was 59%,far higher than 31% from 2005 to 2008(■=11,P<0.001).The density of Culex tritaeniorhynchus was the highest in pigsties.C.tritaeniorhynchus was also found in peasant households but not had been monitored in urban neighbourhoods.Conclusion Since the implementation of the Expanded
引文
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[2] Tiroumourougane SV,Raghava P,Srinivasan S.Japanese viral encephalitis[J].Postgraduate Medical Journal,2002,78(918):205-215.
[3] Wang P,Hu K,Luo S,et al.DC-SIGN as an attachment factor mediates Japanese encephalitis virus infection of human dendritic cells via interaction with a single high-mannose residue of viral E glycoprotein[J].Virology,2015,488:108-119.
[4] 尹遵栋,黄振水,刘桂芳,等.部分地区成人流行性乙型脑炎病例经济负担调查分析[J].中国疫苗和免疫,2013,19(4):332-335,340.
[5] Halstead SB,Thomas SJ.Japanese encephalitis:new options for active immunization[J].Clinical Infectious Diseases,2010,50(8):1155-1164.
[6] 郭绶衡,肖洁华,李光密.我国1991～2005年流行性乙型脑炎发病与死亡分析[J].中国热带医学,2006,6(12):2137-2139.
[7] 王旭霞,李艺星,梁雪枫,等.甘肃省流行性乙型脑炎地区分布特征分析[J].中国热带医学,2010,10(10):1204-1243.
[8] 吴丹,宁桂军,尹遵栋,等.中国2011-2013年流行性乙型脑炎流行病学特征分析[J].中国疫苗和免疫,2015,21(5):486-490.
[9] Arai S,Matsunaga Y,Takasaki TA,et al.Japanese encephalitis:Surveillance and elimination effort in Japan from 1982 to 2004[J].Japanese Journal of Infectious Diseases,2008,61(5):333-338.
[10] Lee DW,Choe YJ,Kim JH,et al.Epidemiology of Japanese encephalitis in South Korea,2007-2010[J].International Journal of Infectious Diseases,2012,16(6):e448-e452.
[11] 龙雪丽,王旭霞,张晓曙,等.甘肃省2004-2011年流行性乙型脑炎流行病学特征分析[J].卫生职业教育,2013,31(9):102-103.
[12] 张佳珂,唐伟,陈丹林,等.四川省流行性乙型脑炎流行特征分析[J].预防医学情报杂志,2004,20(5):526-528.
[13] 王环宇,付士红,李晓宇,等.我国首次分离到基因I型乙型脑炎病毒[J].中华微生物学和免疫学杂志,2004(11):843-849.
[14] 李晓宇,宋宏,付士红,等.中国流行性乙型脑炎病毒分子生物学特性研究[J].病毒学报,2004,20(3):200-209.
[15] 吕炜,黄谊,段丽琼,等.2007-2011年湖南省蚊媒传染病与蚊虫密度季节消长相关性分析[J].实用预防医学,2012,19(11):1662-1664.
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