青岛市新型冠状病毒肺炎隔离点输入性疟疾病例的调查

doi:10.12140/j.issn.1000-7423.2022.02.021

摘要/Abstract

摘要：

收集2020年9月23日非洲几内亚包机回国人员在山东省青岛市新型冠状病毒肺炎隔离点隔离期间（9月23日—10月8日）发病的疟疾病例流行病学个案调查资料和同机回国人员流调信息,用描述法对疟疾病例流行病学特征、诊治情况和同行人员流调、快筛结果以及输入性疟疾疫情处置过程进行分析。结果显示,231名几内亚回国人员在隔离期间有4人陆续出现发冷、发热等疟疾症状,快速诊断检测（RDT）提示恶性疟原虫感染,结合患者的流行病学史、临床表现和实验室RDT检测结果,诊断为输入性恶性疟确诊病例。4例病例均为男性工人,年龄29~55岁,发病后转运至胶州市人民医院诊治。4例病例均于发病后自服蒿甲醚片,除病例1病情较重,给予静脉推注青蒿琥酯5 d共12支（60 mg/支）后,改服双氢青蒿素哌喹片1个疗程2 d共8片（每片含双氢青蒿素40 mg、磷酸哌喹320 mg）,其余3例均服用双氢青蒿素哌喹片1个疗程。231名回国人员中111人在境外曾患过疟疾,感染率为48.1%（111/231）。RDT检测共检出阳性23例,除4例病例外,19例阳性无症状,其中1人于3月后发病,被确诊为输入性三日疟。胶州市疾病预防控制中心和青岛市疾病预防控制中心实验室血片复核结果显示,4例病例和19例RDT阳性者镜检均为阴性;山东省寄生虫病防治研究所省级参比实验室复核4例疟疾病例结果显示,镜检均为阴性,疟原虫核酸检测结果均为恶性疟原虫阳性。提示新冠疫情常态化防控期间,对境外疟疾高流行区回国人员要建立新冠肺炎和疟疾同防意识,回国后集中隔离期间要进行疟疾筛查;要将健康教育“关口”前移,提高疟疾病例治疗依从性和主动性,减少因不规范治疗引起的再燃或复发。

关键词: 新型冠状病毒肺炎, 输入性疟疾, 几内亚, 青岛

Abstract:

The epidemiological data were collected from travellers who returned from Guinea on the 23rd of September, 2020 and were diagnosed with malaria at a COVID-19 quarantine site in Qingdao, Shandong Province. The epidemiological characteristics, diagnosis and treatment of the cases and the epidemiology investigation and the rapid test screening results for other travellers on from the same flight and the interventions in reaction to the imported malaria cases were analyzed. The results showed that 4 out of 231 Guinean returned travellers had developed malaria symptoms, including chills and fever, during the isolation period. Rapid diagnostic test (RDT) indicated Plasmodium falciparum infection. Considering the patients’ travel history, clinical manifestations, and laboratory RDT test results, a confirmed diagnosis of imported P. falciparum malaria was made. The four malaria cases, who are male workers aged 29 to 55, were transferred to Jiaozhou People’s Hospital for treatment. All four patients were administrated of artemether tablets upon diagnosis. One of the cases experienced severe malaria complications and were administrated with 12 doses (60 mg/dose) of artesunate intravenously for five days. The other three patients were treated with dihydroartemisinin and piperaquine phosphate tablets for one course of 8 tablets in 2 days (40 mg dihydroartemisinin and 320 mg piperaquine phosphate), respectively. Among the 231 returned travellers, 111(48.1%) had a history of malaria overseas. There were 23 positive cases detected by RDT, including the four symptomatic cases. The other 19 cases were asymptomatic. One of the asymptomatic cases became symptomatic three months later and was diagnosed as an imported P. malariae infection. Laboratory blood smear microscopic tests at the Jiaozhou City and Qingdao Municipal Center For Disease Control and Prevention showed negative results for the four malaria cases and the 19 RDT positive case. The samples from the four malaria cases were rechecked by the provincial reference laboratory of Shandong Institute of parasitic Disease. The results were negative for malaria infection by microscopic examination but positive for P. falciparum infection by nucleic acid test. It is suggested that during the routine control of COVID-19, the awareness of COVID-19 and malaria should be established among the returned travellers from high malaria-endemic areas. The health education “gate” should be moved forward to improve the treatment compliance for malaria cases and reduce the relapse or recrudescence caused by sub-optimal treatment.

Key words: COVID-19, Imported malaria, Guinea, Qingdao

中图分类号:

R531.3

柳素珍, 纪锋颖, 石李梅. 青岛市新型冠状病毒肺炎隔离点输入性疟疾病例的调查[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(2): 261-265.

LIU Su-zhen, JI Feng-ying, SHI Li-mei. Investigation of imported malaria cases at a COVID-19 isolation point in Qingdao[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2022, 40(2): 261-265.

图/表 1

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