基于人群抗体水平的湖北省血吸虫病传播风险分析

doi:10.12140/j.issn.1000-7423.2021.05.003

中国寄生虫学与寄生虫病杂志 ›› 2021, Vol. 39 ›› Issue (5): 578-584.doi: 10.12140/j.issn.1000-7423.2021.05.003

• 湖北省寄生虫病防治经验专题报道 • 上一篇下一篇

基于人群抗体水平的湖北省血吸虫病传播风险分析

吴家利(), 李博, 刘斯, 涂祖武, 唐丽, 涂珍, 周晓蓉, 孙凌聪, 肖瑛, 朱红^*()

湖北省疾病预防控制中心,武汉 430079

收稿日期:2021-03-29 修回日期:2021-06-22 出版日期:2021-10-30 发布日期:2021-11-10
通讯作者: 朱红
作者简介:吴家利（1986-）,女,硕士,主管医师,从事寄生虫病控制研究。E-mail： wujiali86@126.com
基金资助:
湖北省科技计划项目(自然科学基金2018CFC896);国家自然科学基金青年科学基金(81803297);湖北省湖北省卫生与计划生育委员会科研项目(WJ2017X013)

Assessment of transmission risk of human schistosomiasis japonica based on human population antibody level in Hubei Province

WU Jia-li(), LI Bo, LIU Si, TU Zu-wu, TANG Li, TU Zhen, ZHOU Xiao-rong, SUN Ling-cong, XIAO Ying, ZHU Hong^*()

Hubei Provincial Center for Disease Control and Prevention,Wuhan 430079,China

Received:2021-03-29 Revised:2021-06-22 Online:2021-10-30 Published:2021-11-10
Contact: ZHU Hong
Supported by:
Hubei Provincial Science and Technology Planning Project(自然科学基金2018CFC896);National Natural Science Foundation of China Youth Science Fund Project(81803297);Hubei Provincial Health and Family Planning Commission Research Project(WJ2017X013)

摘要/Abstract

摘要：

目的了解当前湖北省人群血吸虫病抗体水平与变化趋势,评估人群血吸虫病传播风险。方法于2016—2018年每年的9—12月,收集湖北省人群血吸虫病查病中血清抗体阳性者血清,采用间接血凝试验检测血清抗体滴度,记录抗体效价结果和阳性者基础信息;收集湖北省血吸虫病防治工作年报表中全省各疫区县（市、区）2016—2018年查病情况和达标进展资料,将血清抗体阳性报告数、血清抗体阳性率、阳性血清抗体效价构成比和流行区类型等4项指标设立为传播风险评估具体指标。以县为单位,评估各流行地区的人群病情传播风险等级,并用ArcGIS 10.5软件制作湖北省人群血吸虫病传播风险等级可视化地图。采用SPSS 26.0统计学软件分析2016—2018年血清抗体阳性者基础信息,评估重点防控人群分布特征。结果 2016—2018年湖北省血检人数分别为1 728 300、1 531 611、1 498 039人,血清抗体阳性数分别为41 154、31 532、22 124例,血清抗体阳性率分别为2.38%、2.06%、1.48%,全省血清抗体阳性数呈逐年减少,血清抗体阳性率逐年下降（χ² = 3 410.81,P < 0.01）。2016、2017年以传播控制地区报告为主,分别占当年总血清抗体阳性数的95.47%（39 290/41 154）、63.68%（20 081/31 532）（χ² = 773.88,P < 0.01）;2018年以传播阻断地区报告为主,占当年总血清抗体阳性数的99.84%（22 088/22 124）。其中2016—2018年血清抗体效价≥ 1 ∶ 40者分别为4 459例、4 498例、2 482例,占血清抗体阳性数的10.83%、14.26%、11.22%,3年间差异有统计学意义（χ² = 217.46,P < 0.01）。人群血吸虫病传播风险等级分析结果显示,全省1级风险区5个,分别为公安县、沙市区、江陵县、松滋市和潜江市;2级风险区10个,分别为阳新县、洪湖市、嘉鱼县、荆州区、荆州开发区、汉南区、石首市、蔡甸区、汉川市和仙桃市;3级风险区10个;其余38个流行地区均为4级风险区。血吸虫病传播风险重点人群分析结果显示,2016—2018年血清抗体效价≥ 1 ∶ 40人群中,均以男性和44~65岁年龄组人群为主,分别占血清抗体阳性数的62.43%（7 141/11 439）和71.09%（8 132/11 439）。结论 2016—2018年湖北省人群血吸虫病血清抗体阳性数呈逐年减少,当前人群血吸虫病传播风险以4级风险区域为主,总体传播风险较低,1级风险、2级风险区域仍需加强防控,以男性和44~65岁年龄组人群为重点防控人群。

关键词: 血吸虫病, 人群病情, 传播风险, 分析评估, 湖北省

Abstract:

Objective To understand the current status of the antibody level and changing trend in human schistosomiasis japonica in Hubei Province, thereby to assess the transmission risk. Methods Serum samples were collected from the seropositives of Schistosoma infection during mass screening in September to December yearly of 2016—2018, and the serum antibody titer was determined by indirect hemagglutination test. The antibody titer and basic information of the examinees were recorded. The disease screening and control progress in endemic areas (cities, districts) of Hubei Province were collected from the annual report data in 2016—2018. Four indicators were defined for assessment of transmission risk: the number of serum antibody-positives, sero-positive rate, proportion of high antibody titers in sero-positives, and the type of endemic area. The transmission risk was evaluated by county, and visualized by constructing a risk grade map using ArcGIS 10.5 software. Basic information on the people with positive serum antibody was analyzed with SPSS 26.0 software, to assess the distribution characteristics of key population. Results From 2016 to 2018, the number of participants in schistosomiasis antibody testing was 1 728 300, 1 531 611 and 1 498 039, respectively. In the three years, the numbers of seropositives reports with positive serum antibody were 41 154, 31 532 and 22 124, and the sero-positive rates 2.38%, 2.06%, and 1.48%, respectively, showing a decrease in both number and rate each year (χ ² = 3410.81, P < 0.01). In 2016 and 2017, the sero-positives were mostly reported from the transmission-controlled areas, accounting for 95.47% (39 290/41 154) and 63.68% (20 081/31 532) of the total seropositives (χ ² = 773.88, P < 0.01), respectively, while in 2018, the seropositives were mainly reported from the transmission-interrupted areas, accounting for 99.84% (22 088/22 124) of the total. From 2016 to 2018, the numbers of seropositives with antibody titer ≥ 1 ∶ 40 were 4 459, 4 498 and 2 482, respectively, accounting for 10.83%, 14.26%, and 11.22% of the total sero-positives, with significant difference between years (χ ² = 217.46, P < 0.01). The assessment of transmission risk by grading found five risk grade 1 areas in the province: Gong’an County, Shashi District, Jiangling County, Songzi City, and Qianjiang City. Ten risk grade 2 areas were identified: Yangxin County, Honghu City, Jiayu County, Jingzhou District, the Jingzhou Development Zone, Hannan District, Shishou City, Caidian District, Hanchuan City and Xiantao City. In addition, ten risk grade 3 areas were found, and the remaining 38 endemic areas were all risk grade 4 areas. Analysis on key population at schistosomiasis transmission risk indicated that among the population with serum antibody titer ≥ 1 : 40, males (62.43%, 7 141/11 439) and people of 44-65 years-old (71.09%, 8 132/11 439) composed the majority. Conclusion During 2016—2018, the number of seropositive cases of schistosomiasis in Hubei Province declined year by year. Currently, the transmission risk of schistosomiasis japonica was assessed mainly as grade 4, indicative of overall low risk in the endemic areas. However, prevention and control in areas of risk grade 1 and 2 remain to be strengthened, targeting the key population of males and those at the age of 44-65 years old.

Key words: Schistosomiasis japonica, Human, Transmission risk, Analysis and evaluation, Hubei Province

中图分类号:

R532.21

吴家利, 李博, 刘斯, 涂祖武, 唐丽, 涂珍, 周晓蓉, 孙凌聪, 肖瑛, 朱红. 基于人群抗体水平的湖北省血吸虫病传播风险分析[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(5): 578-584.

WU Jia-li, LI Bo, LIU Si, TU Zu-wu, TANG Li, TU Zhen, ZHOU Xiao-rong, SUN Ling-cong, XIAO Ying, ZHU Hong. Assessment of transmission risk of human schistosomiasis japonica based on human population antibody level in Hubei Province[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2021, 39(5): 578-584.

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参考文献 18

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评分值 Score	血清抗体阳性数/例 No. of seropositive	血清抗体阳性率/% Seropositive rate/%	阳性血清抗体效价（≥ 1 ∶ 40）构成比/% Proportion of sero-positives with antibody titer ≥ 1 ∶ 40/%	流行区类型 Endemic area type
0	0	0	0
1	< 100	> 0~< 0.5%	> 0~< 5%	消除地区Eliminated areas
2	100~499	0.5%~< 1%	5%~< 10%	传播阻断地区Transmission interrupted areas
3	500~999	1%~< 2%	10%~< 20%	传播控制地区Transmission controlled areas
4	1 000~1 999	≥ 2%	≥ 20%
5	≥ 2 000

年份Year	< 100例 < 100 cases		100~499例 100-499 cases		500~999例 500-999 cases		1 000~1 999例 1 000-1 999 cases		≥ 2 000例 ≥ 2 000 cases		合计 Total
年份Year	报告县数No. county reported	报告例数No. case reported	报告县数No. county reported	报告例数No. case reported	报告县数No. count reported	报告例数No. case reported	报告县数No. county reported	报告例数No. case reported	报告县数No. county reported	报告例数No. case reported	报告县数No. county reported	报告例数No. case reported
2016	24	646	8	1 806	3	2 046	7	10 649	6	26 007	48	41 154
2017	22	618	9	1 696	4	3 036	7	9 850	4	16 332	46	31 532
2018	21	454	14	3 202	2	1 424	4	5 139	4	11 905	45	22 124

流行区类型Endemic area type	2016			2017			2018
	血清抗体阳性数No. seropositive case	血清抗体阳性率/%Seropositive rate/%		血清抗体阳性数No. seropositive case	血清抗体阳性率/%Seropositive rate/%		血清抗体阳性数No. seropositive case	血清抗体阳性率/%Seropositive rate/%
	血清抗体阳性数No. seropositive case	血清抗体阳性率/%Seropositive rate/%	消除 Eliminated areas	血清抗体阳性数No. seropositive case	血清抗体阳性率/%Seropositive rate/%	16	血清抗体阳性数No. seropositive case	血清抗体阳性率/%Seropositive rate/%	0.09	11	0.07	36	0.08
传播阻断Transmission interrupted areas	1 848	0.67	消除 Eliminated areas		11 440	1.95		22 088	1.52
传播阻断Transmission interrupted areas	传播控制Transmission control areas	39 290	2.74		20 081	2.16		-	-
合计Total	传播控制Transmission control areas	41 154	2.38		31 532	2.06		22 124	1.48

市 City	1级风险县（市、区） Risk grade 1 areas	2级风险县（市、区） Risk grade 2 areas	3级风险县（市、区） Risk grade 3 areas	4级风险县（市、区） Risk grade 4 areas
武汉Wuhan		汉南区、蔡甸区 Hannan District, Caidian District	东西湖区、黄陂区Dongxihu District, Huangpi District	省内其他流行区（38个） Other schistosomiasis endemic areas in Hubei Province (38)
黄石Huangshi		阳新县Yangxin County
宜昌Yichang			枝江市Zhijiang City
荆门Jingmen			京山县Jingshan County
孝感Xiaogan		汉川市Hanchuan City	云梦县Yunmeng County
荆州Jingzhou	沙市区、公安县、江陵县、松滋市Shashi District, Gongan County, Jiangling County, Songzi City	荆州区、荆州开发区、石首市、洪湖市Jingzhou District, Jingzhou Development Zone, Shishou City, Honghu City	监利县Jianli County
黄冈Huanggang			浠水县、武穴市 Xishui County, Wuxue City
咸宁Xianning		嘉鱼县Jiayu County	赤壁市Chibi City
仙桃Xiantao		仙桃市Xiantao City
潜江Qianjiang	潜江市Qianjiang City
天门Tianmen			天门市Tianmen City
襄阳Xiangyang
鄂州Ezhou

基于人群抗体水平的湖北省血吸虫病传播风险分析

Assessment of transmission risk of human schistosomiasis japonica based on human population antibody level in Hubei Province

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