安庆市137例发热伴血小板减少综合征流行病学调查及传播媒介蜱虫监测结果
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摘要
目的分析安庆市137例发热伴血小板减少综合征(SFTS)流行病学特征及传播媒介蜱虫监测结果,为制定该病的防控策略提供依据。方法对137例SFTS病例流行病学调查资料进行回顾性分析,采用布旗法捕获游离蜱,查体法捕捉宿主动物体表寄生蜱。结果 2011—2016年间对安庆市137例SFTS病例开展流行病学调查,其中死亡病例8例,实验室检测阳性率38.57%;病例首发症状发热99.26%,体温中位数及四分位数间距M(IQR)为39(38.8,39.5)℃;大部分病例有乏力(84.33%)、全身酸痛(62.41%)及畏寒(60.94%)等非特异性症状,消化道症状(恶心、呕吐、腹痛、腹泻等)发生率在20%～50%之间,5%～25%的病例有皮肤瘀点瘀斑、牙龈出血及结膜充血等出血症状;发病至就诊M1天,发病至住院M5天,70.63%的病例首次就诊在乡镇及以下医疗机构,平均就诊2.48次以上;74.36%的病例外周血白细胞减少,94.92%的病例血小板降低。病例主要分布在山区或丘陵(88.32%),39.13%的女性病例2周内有采茶史,发病前2周有蜱虫叮咬史的占13.14%;2017年媒介蜱虫监测安庆地区游离蜱密度29.60只/h·布旗;宿主动物羊群染蜱率为76.92%,寄生蜱密度为3.53只/宿主,蜱种鉴定长角血蜱占98.39%。结论安庆市SFTS病例分布广泛,该地区游离蜱寄生蜱密度较高,长角血蜱为优势蜱种,采茶等野外作业是高危因素。
[Objective]To analyze epidemiological characteristics of 137 cases of severe fever with thrombocytopenia syndrome(SFTS)and monitoring results of vehicle ticks in Anqing City,provide the evidence for making the prevention and controlling measures.[Methods]Descriptive study was employed to analyze the epidemiological characteristics of 137 SFTS cases,free ticks were collected with white cloth and surface parasitic ticks were collected with physical examination method from the host animals.[Results]The epidemiological investigation was performed in 137 SFTS cases in Anqing City from 2011-2016,including 8 death cases,and the positive rate of laboratory tests was 38.57%. The first symptom of the cases was fever(99.26%),with the median and interquartile range M(IQR) of body temperature was 39(38.8,39.5)℃. Most cases had the non-specific symptoms such as fatigue(84. 33 %), systemic soreness( 62. 41 %), and chills( 60. 94 %). The incidence rates of gastrointestinal symptoms(nausea,vomiting,abdominal pain,and diarrhea) were between 20%-50%,and 5%-25% of cases had the bleeding symptoms such as cutaneous ecchymosis,gingival bleeding,conjunctival congestion. The median time from onset to treatment was one day,and the median time from onset to hospitalization was five days. 70.63% of cases were first visited in the medical institutions at township level and below,with more than 2.48 times for medical treatment. 74.36% of cases had leukocyte reduction and 94.92% of cases had thrombocytopenia. 88.32% of cases were distributed in mountainous or hilly areas,39.13% of female cases had history of tea picking within two weeks,and 13.14% had history of tick bites two weeks before onset. In 2017,the monitoring of vehicle ticks in Anqing City showed that the free tick density was 29.60 ticks per hour in flags,the rate of tick infection in sheep of host animals was76.92%,density of parasitic ticks was 3.53 ticks per animal. Haemaphysalis longicornis accounted for 98.39%.[Conclusion]SFTS cases were widely distributed in Anqing City. The density of free ticks is high in this area,and Haemaphysalis longicornis dominant species. Field work is risk factor,such as tea picking.
[Objective]To analyze epidemiological characteristics of 137 cases of severe fever with thrombocytopenia syndrome(SFTS)and monitoring results of vehicle ticks in Anqing City,provide the evidence for making the prevention and controlling measures.[Methods]Descriptive study was employed to analyze the epidemiological characteristics of 137 SFTS cases,free ticks were collected with white cloth and surface parasitic ticks were collected with physical examination method from the host animals.[Results]The epidemiological investigation was performed in 137 SFTS cases in Anqing City from 2011-2016,including 8 death cases,and the positive rate of laboratory tests was 38.57%. The first symptom of the cases was fever(99.26%),with the median and interquartile range M(IQR) of body temperature was 39(38.8,39.5)℃. Most cases had the non-specific symptoms such as fatigue(84. 33 %), systemic soreness( 62. 41 %), and chills( 60. 94 %). The incidence rates of gastrointestinal symptoms(nausea,vomiting,abdominal pain,and diarrhea) were between 20%-50%,and 5%-25% of cases had the bleeding symptoms such as cutaneous ecchymosis,gingival bleeding,conjunctival congestion. The median time from onset to treatment was one day,and the median time from onset to hospitalization was five days. 70.63% of cases were first visited in the medical institutions at township level and below,with more than 2.48 times for medical treatment. 74.36% of cases had leukocyte reduction and 94.92% of cases had thrombocytopenia. 88.32% of cases were distributed in mountainous or hilly areas,39.13% of female cases had history of tea picking within two weeks,and 13.14% had history of tick bites two weeks before onset. In 2017,the monitoring of vehicle ticks in Anqing City showed that the free tick density was 29.60 ticks per hour in flags,the rate of tick infection in sheep of host animals was76.92%,density of parasitic ticks was 3.53 ticks per animal. Haemaphysalis longicornis accounted for 98.39%.[Conclusion]SFTS cases were widely distributed in Anqing City. The density of free ticks is high in this area,and Haemaphysalis longicornis dominant species. Field work is risk factor,such as tea picking.
引文
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[10]于蕾,丁鹏,肖冰,等.大连市2011—2013年发热伴血小板减少综合征布尼亚病毒监测分析[J].医学动物防制,2015,31(4):422-427.
[11]许华茹,常彩云,隋庆梅,等.济南市2011—2014年发热伴血小板减少综合征病例临床和流行病学特征分析[J].中国预防医学杂志,2017,18(1):57-59.
[12]许汴利.新布尼亚病毒感染致发热伴血小板减少综合征的发现、认识与启示[J].中华预防医学杂志,2012,46(2):99-102.
[13]吕勇,徐鹏鹏,孙婕,等.六安2011—2015年发热伴血小板减少综合征监测结果[J].中国热带医学,2017,17(8):809-812.
[14]刘勇起.气候变化对媒介生物性传染病的影响[J].中华卫生杀虫器械,2013,19(1):1-7.
[15]朱奕奕,吴寰宇,张春哲,等. 2012—2014年上海市蜱和宿主动物新型布尼亚病毒感染状初步调查[J].中国人兽共患病学报,2017,33(8):700-704.
[16]马婷,龚震宇,张严峻,等.浙江省发热伴血小板减少综合征布尼亚病毒的宿主媒介调查[J].中国媒介生物学及控制杂志,2015,26(4):353-356.
[17]张凤顺,刘晓鹏,高阳,等.本溪市地区蜱虫种群分布时空动态调查[J].中华卫生杀虫药械,2015,21(5):515-519.
[2]李德新.发热伴血小板减少综合征布尼亚病毒概述[J].中华实验和临床病毒学杂志,2011,25(2):81-84.
[3]LIU Q,HE B,HUANG SY,et al. Severe fever with thrombocytopenia syndrome,an emerging tick-borne zoonosis[J]. Lancet Infect Dis,2014,14(8):763-772.
[4]李昱,周航,牟笛,等.中国2011—2014年发热伴血小板减少综合征流行特征分析[J].中华流行病学杂志,2015,36(6):598-602.
[5]MC-MULLAN LK,FOLK SM,KELLY AJ,et al.A new phlebovirus associated with severe febrile illness in Missouri[J].N Engl J Med,2012,367(9):834-841.
[6]KIM KH,YI J,KIM G,et al.Severe fever with thrombocytopenia syndrome,South Korea,2012[J].Emerg Infect Dis,2013,19(11):1892-1894.
[7]TAKAHASHI T,MAEDA K,SUZUKI T,et al.The first identification and retrospective study of severe fever with thrombocytopenia syndrome in Japan[J].J Infect Dis,2014,209(6):816-827.
[8]汪金生,汤厚林,高伟林,等.2011—2016年安徽省安庆市发热伴血小板减少综合征监测分析[J].疾病监测,2018,33(4):324-328.
[9]曹琛,吴家兵,曹明华,等.安徽省2011—2015年发热伴血小板减少综合征流行特征分析[J].中华疾病控制杂志,2016,20(8):792-795.
[10]于蕾,丁鹏,肖冰,等.大连市2011—2013年发热伴血小板减少综合征布尼亚病毒监测分析[J].医学动物防制,2015,31(4):422-427.
[11]许华茹,常彩云,隋庆梅,等.济南市2011—2014年发热伴血小板减少综合征病例临床和流行病学特征分析[J].中国预防医学杂志,2017,18(1):57-59.
[12]许汴利.新布尼亚病毒感染致发热伴血小板减少综合征的发现、认识与启示[J].中华预防医学杂志,2012,46(2):99-102.
[13]吕勇,徐鹏鹏,孙婕,等.六安2011—2015年发热伴血小板减少综合征监测结果[J].中国热带医学,2017,17(8):809-812.
[14]刘勇起.气候变化对媒介生物性传染病的影响[J].中华卫生杀虫器械,2013,19(1):1-7.
[15]朱奕奕,吴寰宇,张春哲,等. 2012—2014年上海市蜱和宿主动物新型布尼亚病毒感染状初步调查[J].中国人兽共患病学报,2017,33(8):700-704.
[16]马婷,龚震宇,张严峻,等.浙江省发热伴血小板减少综合征布尼亚病毒的宿主媒介调查[J].中国媒介生物学及控制杂志,2015,26(4):353-356.
[17]张凤顺,刘晓鹏,高阳,等.本溪市地区蜱虫种群分布时空动态调查[J].中华卫生杀虫药械,2015,21(5):515-519.