江滩工业开发阻断血吸虫病传播措施及其效果评价
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摘要
目的评价江滩型流行区实施江滩工业开发为主措施阻断血吸虫病传播的效果,为江滩地区阻断和消除血吸虫病提供有效对策。方法采用前瞻性现场研究的方法,选择一个江滩型血吸虫病流行区县,对圩外江滩环境实施以工业开发为主的综合治理。连续开展居民病情、家畜病情和环境螺情调查,并收集综合开发措施实施情况。分析比较实施综合开发前后血吸虫病疫情变化状况,综合评价阻断血吸虫病传播的效果。结果 2001-2015年项目区共开发江滩面积496.34hm~2,占江滩总面积的90.16%。其中,工业开发江滩面积411.80hm~2,占74.81%;农业开发江滩面积84.55hm~2,占15.36%。共对6条通江河道进行混凝土护坡4.87km,改造涵闸与建造沉螺池9座。实施工业开发为主措施后,项目区钉螺和感染性钉螺面积呈快速下降态势,2001-2007年钉螺面积下降了80.55%,年均下降13.43%,到2012年消灭了钉螺;2002-2005年查出感染性钉螺面积占97.92%(50.29/51.36),到2007年消灭了感染性钉螺。2001-2004年(开发初期)查出病人占总数的88.77%(245/276),居民感染率在0.14%-0.51%之间,期间发生急性感染病人122例;2005-2011年(开发中期)查出病人占总数的11.23%(31/276),居民感染率在0.01%~0.03%之间;2012-2015年(开发后期)未查到粪阳病人,居民感染率已降为0。15年间仅在开发前期的2003年查到粪检阳性家畜13头,当年家畜感染率为1.32%。结论江滩地区实施沿江工业开发是阻断血吸虫病传播与促进当地经济发展的共赢之策,但在实施工业开发的前期要重点加强人群感染防护,并加强家畜放牧管理,防止突发疫情的发生。
Objective To evaluate the effectiveness with which industrial development-based interventions interrupt the transmission of schistosomiasis in marshland regions in order to formulate effective strategies for interruption of schistosomiasis transmission and schistosomiasis elimination in marshland regions. Methods A prospective field study was designed.A marshland region where schistosomiasis is endemic was selected,and industrial development-based comprehensive control was implemented outside that region.The schistosomiasis morbidity in humans and livestock and snail survey were continuously performed,and the implementation of the comprehensive control interventions was investigated.Changes in the prevalence of schistosomiasis were compared before and after the implementation of industrial developmentbased comprehensive control to evaluate the effectiveness with which the transmission of schistosomiasis was interrupted. Results From 2001 to 2015,a total of 496.34hm~2 of marshland was reclaimed in the studied region,accounting for90.16% of the total marshland area.A total of 411.80hm~2 of former marshland(74.81%)was used for industrial development and 84.55hm~2 of former marshland(15.36%)was used for agricultural development.Concrete revetments were constructed on the banks of 6tributaries to the Yangtze River,and 9sluices/settling basins for snails were modified or built.After the implementation of industrial development-based comprehensive control,a dramatic decline in the area ofsnail habitats and areas with infected snails was observed,and the area of snail habitats decreased by 80.55%in 2007 relative to the area in 2001,with an annual decrease of 13.43%.All snails were eliminated in 2012.In 2007,infected snails had been eliminated from 97.92%(50.29hm~2/51.36hm~2)of the area where infected snails were detected between 2002 and 2005.Eighty-eight-point-seventy-seven percent(245/276)of patients with schistosomiasis were detected in the early stage of development(2001to 2004),and 122 cases of acute schistosomiasis were noted.The rate of human infection ranged from 0.14%to 0.51%.Eleven-point-twenty-three percent(31/276)of patients with schistosomiasis were detected in the middle stage of development(2005to 2011),and the rate of human infection ranged from 0.01% to 0.03%.No patients with schistosomiasis were detected in the late stage of development(2012to 2015),and the rate of human infection decreased to 0%.During the 15 years of development,only 13 heads of infected livestock were detected in 2003,with an infection rate of 1.32%in 2003. Conclusion Industrial development is a win-win strategy to interrupt schistosomiasis transmission and promote local economic development in marshland regions;however,schistosomiasis control and management of livestock grazing need to be enhanced to prevent sudden outbreaks.
Objective To evaluate the effectiveness with which industrial development-based interventions interrupt the transmission of schistosomiasis in marshland regions in order to formulate effective strategies for interruption of schistosomiasis transmission and schistosomiasis elimination in marshland regions. Methods A prospective field study was designed.A marshland region where schistosomiasis is endemic was selected,and industrial development-based comprehensive control was implemented outside that region.The schistosomiasis morbidity in humans and livestock and snail survey were continuously performed,and the implementation of the comprehensive control interventions was investigated.Changes in the prevalence of schistosomiasis were compared before and after the implementation of industrial developmentbased comprehensive control to evaluate the effectiveness with which the transmission of schistosomiasis was interrupted. Results From 2001 to 2015,a total of 496.34hm~2 of marshland was reclaimed in the studied region,accounting for90.16% of the total marshland area.A total of 411.80hm~2 of former marshland(74.81%)was used for industrial development and 84.55hm~2 of former marshland(15.36%)was used for agricultural development.Concrete revetments were constructed on the banks of 6tributaries to the Yangtze River,and 9sluices/settling basins for snails were modified or built.After the implementation of industrial development-based comprehensive control,a dramatic decline in the area ofsnail habitats and areas with infected snails was observed,and the area of snail habitats decreased by 80.55%in 2007 relative to the area in 2001,with an annual decrease of 13.43%.All snails were eliminated in 2012.In 2007,infected snails had been eliminated from 97.92%(50.29hm~2/51.36hm~2)of the area where infected snails were detected between 2002 and 2005.Eighty-eight-point-seventy-seven percent(245/276)of patients with schistosomiasis were detected in the early stage of development(2001to 2004),and 122 cases of acute schistosomiasis were noted.The rate of human infection ranged from 0.14%to 0.51%.Eleven-point-twenty-three percent(31/276)of patients with schistosomiasis were detected in the middle stage of development(2005to 2011),and the rate of human infection ranged from 0.01% to 0.03%.No patients with schistosomiasis were detected in the late stage of development(2012to 2015),and the rate of human infection decreased to 0%.During the 15 years of development,only 13 heads of infected livestock were detected in 2003,with an infection rate of 1.32%in 2003. Conclusion Industrial development is a win-win strategy to interrupt schistosomiasis transmission and promote local economic development in marshland regions;however,schistosomiasis control and management of livestock grazing need to be enhanced to prevent sudden outbreaks.
引文
[1]雷正龙,张利娟,徐志敏,等.2014年全国血吸虫病疫情通报[J]中国血吸虫病防治杂志,2014,27(6):563-9.
[2]毛守白.血吸虫生物学与血吸虫病的防治[M].北京:人民卫生出版社,1990,643-5.
[3]周晓农.我国血吸虫病流行病学特点与科防治研究重点[J].中华地方病学杂志,2006,25(5):473-4.
[4]郝阳,吴晓华,夏刚,等.2004年全国血吸虫病疫情通报[J].中国血吸虫病防治杂志,2005,17(6):401-4.
[5]Zhou XN,Guo JG,Wu XH,el al.Epidemiology of schistosomiasis in the People's Republic of China,2004[J].Emerg Infect Dis,2007,13(10):1470-6.
[6]陈红根,谢曙英,曾小军,等.当前我国湖区血吸虫病流行特征与防治策略[J].中国血吸虫病防治杂志,2011,23(1):3-9.
[7]周晓农,汪天平,王立英,等.中国血吸虫病流行现状分析[J].中华流行病学杂志,2004(25):546-7.
[8]孙乐平,梁幼生,戴建荣,等.江苏省血吸虫病监测预警关键技术研究与集成示范Ⅰ:监测预警示范点布局与效果[J].中国血吸虫病防治杂志2015,27(3):221-8.
[9]高扬,孙乐平,左引萍,等.流动渔船民血吸虫病防治措施的研究Ⅲ船员区域联动查治病机制的构建与应用[J].中国血吸虫病防治杂志2011,23(5):535-40.
[10]雷正龙,周晓农.消除血吸虫病-我国血吸虫病防治工作的新目标与新任务[J].中国血吸虫病防治杂志2015,27(1):1-4.
[11]孙乐平,赵贤贵,周晓农,等.江堤水泥板护坡和沿堤挖池养鱼控制血吸虫病流行的效果观察[J].中国血吸虫病防治杂志1996,8(3):153-5.
[12]洪青标,黄轶昕,周晓农,等.江苏省江滩地区血吸虫病流行状况及防治效果的纵向观察[J].中国血吸虫病防治杂志2001,13(3):132-6.
[13]曹奇,顾伯良,吴中兴,等.江滩地区3个村血吸虫病优化防治对策的研究[J].中国血吸虫病防治杂志,1998,10(6):349-50.
[14]宋鸿涛,张家楷,李龙根,等.江滩综合开发控制沿江血吸虫病流行的研究[J].中国血吸虫病防治杂志,1994,6(4):203-6.
[15]田斌,张正球,陈前,等.仪征市江滩综合治理控制血吸虫病效果观察[J].中国寄生虫病防治杂志,2005,18(5):附2-3.
[16]郭家钢.中国血吸虫病综合治理的历史与现状[J].中华预防医学杂志,2006,40(4):225-8.
[17]黄轶昕,蔡刚,吴锋,等.江苏省沿江5市江滩滩情螺情现状调查和钉螺控制策略的研究[J].中国血吸虫病防治杂志,2000,12(2):86-90.
[18]陶恒业,夏爱,赵亚明,等.镇江市焦北滩翻耕种植灭螺效果及费用-效益评价[J].中国血吸虫病防治杂志,2012,24(5):576-8.
[19]Zhou XN,Wang LY,Chen MG,et al.The public health significance and control of schistosomiasis in China-then and now[J].Acta Trop,2005,96(2/3):97-105.
[20]Wang LD,Utzinger J,Zhou XN.Schistosomiasis control:experiences and lesson from China[J].Lancet,2008,372(9652):1793-5.
[21]周晓农,姜庆五,郭家钢,等.我国血吸虫病传播阻断实现路径的探讨[J].中国血吸虫病防治杂志,2012,24(1):1-4.
[22]洪青标,闻礼永,钟波,等.适宜技术:消除血吸虫病进程中的推进器-2015年首届中国血吸虫病防治论坛述评[J].中国血吸虫病防治杂志,2015,27(5):447-50.
[23]王福彪,马玉才,孙乐平,等.江苏省血吸虫病监测预警关键技术研究与集成示范Ⅲ:机械化清障自动投药灭螺一体机的研制[J].中国血吸虫病防治杂志,2016,28(1):5-10.
[24]周晓农,林丹丹,汪天平,等.我国"十二五"期间血吸虫病防治策略与工作重点[J].中国血吸虫病防治杂志,2011,23(1):1-4.
[25]王加松,何亮才,荣先兵,等.荆岑DY-1型血防灭螺药液专用喷洒机研制与应用[J].中国血吸虫病防治杂志,2016,28(1):75-8.
[26]Li SZ,Zheng H,Abe EM,et al.Reduction patterns of acute schistosomiasis in the People`s Republic of China[J].PLoS Negl Trop Dis,2014,8(5):e2849.
[27]周晓农.开展精准防控实现消除血吸虫病的目标[J].中国血吸虫病防治杂志,2016,28(1):1-4.
[28]严俊,胡桃,雷正龙.全国重点寄生虫病的防控形势与挑战[J].中国寄生虫学与寄生虫病杂志,2015,33(6):412-7.
[29]孙乐平,周晓农,洪青标,等.长江下游江滩地区血吸虫病再流行规律的研究Ⅰ:钉螺的迁入与消长[J].中国血吸虫病防治杂志,2001,13(4):213-5.
[30]Yang GJ,Zhou XN,Sun LP,et al.Compensatory density feedback of Oncomelania hupensis populations in two different environmental settings in China[J].Parasit Vectors,2011(4):133.
[31]许静,杨坤,李石柱,等.我国血吸虫病传播控制后的监测体系[J].中国血吸虫病防治杂志,2014,26(1):1-5.
[32]左引萍,朱道建,杜广林,等.江苏省血吸虫病疫情监测与风险评估系统的研究Ⅲ:扬州市沿江地区血吸虫病传播风险监测评估[J].中国血吸虫病防治杂志,2016,28(4):353-7.
[2]毛守白.血吸虫生物学与血吸虫病的防治[M].北京:人民卫生出版社,1990,643-5.
[3]周晓农.我国血吸虫病流行病学特点与科防治研究重点[J].中华地方病学杂志,2006,25(5):473-4.
[4]郝阳,吴晓华,夏刚,等.2004年全国血吸虫病疫情通报[J].中国血吸虫病防治杂志,2005,17(6):401-4.
[5]Zhou XN,Guo JG,Wu XH,el al.Epidemiology of schistosomiasis in the People's Republic of China,2004[J].Emerg Infect Dis,2007,13(10):1470-6.
[6]陈红根,谢曙英,曾小军,等.当前我国湖区血吸虫病流行特征与防治策略[J].中国血吸虫病防治杂志,2011,23(1):3-9.
[7]周晓农,汪天平,王立英,等.中国血吸虫病流行现状分析[J].中华流行病学杂志,2004(25):546-7.
[8]孙乐平,梁幼生,戴建荣,等.江苏省血吸虫病监测预警关键技术研究与集成示范Ⅰ:监测预警示范点布局与效果[J].中国血吸虫病防治杂志2015,27(3):221-8.
[9]高扬,孙乐平,左引萍,等.流动渔船民血吸虫病防治措施的研究Ⅲ船员区域联动查治病机制的构建与应用[J].中国血吸虫病防治杂志2011,23(5):535-40.
[10]雷正龙,周晓农.消除血吸虫病-我国血吸虫病防治工作的新目标与新任务[J].中国血吸虫病防治杂志2015,27(1):1-4.
[11]孙乐平,赵贤贵,周晓农,等.江堤水泥板护坡和沿堤挖池养鱼控制血吸虫病流行的效果观察[J].中国血吸虫病防治杂志1996,8(3):153-5.
[12]洪青标,黄轶昕,周晓农,等.江苏省江滩地区血吸虫病流行状况及防治效果的纵向观察[J].中国血吸虫病防治杂志2001,13(3):132-6.
[13]曹奇,顾伯良,吴中兴,等.江滩地区3个村血吸虫病优化防治对策的研究[J].中国血吸虫病防治杂志,1998,10(6):349-50.
[14]宋鸿涛,张家楷,李龙根,等.江滩综合开发控制沿江血吸虫病流行的研究[J].中国血吸虫病防治杂志,1994,6(4):203-6.
[15]田斌,张正球,陈前,等.仪征市江滩综合治理控制血吸虫病效果观察[J].中国寄生虫病防治杂志,2005,18(5):附2-3.
[16]郭家钢.中国血吸虫病综合治理的历史与现状[J].中华预防医学杂志,2006,40(4):225-8.
[17]黄轶昕,蔡刚,吴锋,等.江苏省沿江5市江滩滩情螺情现状调查和钉螺控制策略的研究[J].中国血吸虫病防治杂志,2000,12(2):86-90.
[18]陶恒业,夏爱,赵亚明,等.镇江市焦北滩翻耕种植灭螺效果及费用-效益评价[J].中国血吸虫病防治杂志,2012,24(5):576-8.
[19]Zhou XN,Wang LY,Chen MG,et al.The public health significance and control of schistosomiasis in China-then and now[J].Acta Trop,2005,96(2/3):97-105.
[20]Wang LD,Utzinger J,Zhou XN.Schistosomiasis control:experiences and lesson from China[J].Lancet,2008,372(9652):1793-5.
[21]周晓农,姜庆五,郭家钢,等.我国血吸虫病传播阻断实现路径的探讨[J].中国血吸虫病防治杂志,2012,24(1):1-4.
[22]洪青标,闻礼永,钟波,等.适宜技术:消除血吸虫病进程中的推进器-2015年首届中国血吸虫病防治论坛述评[J].中国血吸虫病防治杂志,2015,27(5):447-50.
[23]王福彪,马玉才,孙乐平,等.江苏省血吸虫病监测预警关键技术研究与集成示范Ⅲ:机械化清障自动投药灭螺一体机的研制[J].中国血吸虫病防治杂志,2016,28(1):5-10.
[24]周晓农,林丹丹,汪天平,等.我国"十二五"期间血吸虫病防治策略与工作重点[J].中国血吸虫病防治杂志,2011,23(1):1-4.
[25]王加松,何亮才,荣先兵,等.荆岑DY-1型血防灭螺药液专用喷洒机研制与应用[J].中国血吸虫病防治杂志,2016,28(1):75-8.
[26]Li SZ,Zheng H,Abe EM,et al.Reduction patterns of acute schistosomiasis in the People`s Republic of China[J].PLoS Negl Trop Dis,2014,8(5):e2849.
[27]周晓农.开展精准防控实现消除血吸虫病的目标[J].中国血吸虫病防治杂志,2016,28(1):1-4.
[28]严俊,胡桃,雷正龙.全国重点寄生虫病的防控形势与挑战[J].中国寄生虫学与寄生虫病杂志,2015,33(6):412-7.
[29]孙乐平,周晓农,洪青标,等.长江下游江滩地区血吸虫病再流行规律的研究Ⅰ:钉螺的迁入与消长[J].中国血吸虫病防治杂志,2001,13(4):213-5.
[30]Yang GJ,Zhou XN,Sun LP,et al.Compensatory density feedback of Oncomelania hupensis populations in two different environmental settings in China[J].Parasit Vectors,2011(4):133.
[31]许静,杨坤,李石柱,等.我国血吸虫病传播控制后的监测体系[J].中国血吸虫病防治杂志,2014,26(1):1-5.
[32]左引萍,朱道建,杜广林,等.江苏省血吸虫病疫情监测与风险评估系统的研究Ⅲ:扬州市沿江地区血吸虫病传播风险监测评估[J].中国血吸虫病防治杂志,2016,28(4):353-7.