1996-2017年浙江省输入性血吸虫病病例的流行病学调查分析

摘要/Abstract

摘要：

目的分析浙江省1995年达到血吸虫病传播阻断标准后输入性疫情动态变化及其影响因素。方法采用回顾性调查法收集1996-2017年浙江省输入性血吸虫病疫情、本地螺情等资料,建立数据库,对病例三间分布、感染状况、诊疗情况和螺情风险因素进行分析。结果 1996-2017年浙江省30个县（市、区）共报告输入性血吸虫病病例245例,包括急性病例41例。其中241例为国内其他省份输入,主要来自毗邻的江西省和安徽省,分别占37.3%（390/241）和29.9%（72/241）;境外输入埃及血吸虫病病例3例和曼氏血吸虫病病例1例,均来自非洲的尼日利亚。输入性病例数在2005年之前呈上升趋势,之后呈下降趋势。每年下半年报告的输入性病例数较多,合计占总报告输入性病例数的80.8%（198/245）。全省共30个县（市、区）有输入性血吸虫病病例报告,其中杭州、宁波、嘉兴、湖州、绍兴、金华、衢州和台州8个历史流行市25个流行县累计报告输入性病例230例,5个非流行县报告输入性病例15例。输入性血吸虫病病例报告最多的为宁波市,占55.9%（137/245）,杭州市和衢州市次之,分别占18.4%（45/245）和6.9%（17/245）。245例病例中,男性180例,女性65例;学历以初中和小学为主,分别占49.4%（121/245）和29.8%（73/245）;职业以农民、工人和学生为主,分别为42.0%（103/245）、23.3%（54/245）和14.7%（36/245）。国内其他省份输入的241例病例中,85.1%（205/241）的病例感染地为当年的血吸虫病未控制地区或疫情回升地区,12.4%（30/241）的病例感染地为当年的血吸虫病传播控制地区。感染方式以游泳戏水和农业生产用水接触为主,分别占37.1%（91/245）和36.3%（89/245）。疾病预防控制机构主动监测查病报告病例占51.4%（126/245）,医院被动报病报告病例占48.6%（119/245）。病例首诊医疗机构以县级最多,为59.6%（146/245）,被动报病中有49.6%（59/119）存在首诊误诊情况。全省除宁波、丽水市外,累计有7个市30个流行县发现有钉螺孳生,累计查到有螺面积1 739.0 hm²。结论 1996-2017年浙江省通过主动监测和被动报病共发现输入性血吸虫病病例245例,年病例数自2005后逐年下降,主要感染地为国内当年的血吸虫病未控制地区或疫情回升地区。

关键词: 血吸虫病, 输入性, 疫情, 流行病学, 浙江省

Abstract:

Objective To analyze the dynamic change and the factors that effect on the imported schistosomiasis case since the disease transmission blocking criteria have been met in Zhejiang Province in 1995. Methods Data for the imported case of schistosomiasis and snail investigation in Zhejiang Province from 1996 to 2017 were collected and analyzed retrospectively for the case distribution, diagnosis, treatment and for snail ridden area. Results Totally 245 cases of imported schistosomiasis were reported in 30 counties in Zhejiang Province from 1996-2017, including 41 cases of acute Schistosoma japonicum infection. Among them, 241 cases were imported from other provinces in China, mainly from neighboring Jiangxi (37.3%, 90/241） and Anhui (29.9%, 72/241). Four of them were imported from Nigeria in Africa including 3 cases of S. haematobium and 1 case of S. mansoni infections. The number of imported cases was increased in the years before 2005 with up to 40 cases in 2005, and then gardually to decreased. More cases were reported in the second half of each year (80.8%, 198/245). The imported cases were reported in total 30 counties (cities, district) in the province, most of them (230) were reported in 25 counties in the 8 historially endemic cities, and Ningbo had the largest number of imported cases (55.9%, 137/245) followed by Hangzhou (18.4%, 45/245) and Quzhou (6.9%, 17/245). Among the total 245 cases, 180 were males and 65 females. More cases were found in those with low education (29.8% with primary school and 49.4% with junior high school) and with blue collar occupations (farmers 42.0%, workers 23.3%) and in students (14.7%). Of the 241 cases imported from other provinces, 85.1% (205/241) cases were infected from uncontrolled or re-emerging endemic areas. Most cases were infected by the contact with contaminated water during swimming (37.1%) or agricultural practices (36.3%). More cases were identified by active monitor of local disease control authorities (51.4%, 126/245) than in clinics (48.6%, 119/245). 59.6% of the cases seeked for medication at the first time at the local county hospitals and 49.6% of them（59/119）was misdiagnosed. Snail was found in 30 formally endemic counties with a total area of 1 739.0 hm². Conclusion The total 245 cases of imported schistosomiasis have been reported in Zhejiang Province through active monitoring and passive reporting system from 1996 to 2017. The number of cases has decreased since 2005. The main sources of the imported cases are from the uncontrolled or re-emerging areas of schistosomiasis in the country.

Key words: Schistosomiasis, Imported case, Endemic, Epidemiology, Zhejiang Province

中图分类号:

R532.21

张剑锋, 严晓岚, 闻礼永, 张晓, 俞丽玲, 杜海娟, 杨明瑾. 1996-2017年浙江省输入性血吸虫病病例的流行病学调查分析[J]. 中国寄生虫学与寄生虫病杂志, 2018, 36(6): 586-592.

Jian-feng ZHANG, Xiao-lan YAN, Li-yong WEN, Xiao ZHANG, Li-ling YU, Hai-juan DU, Ming-jin YANG. Epidemiological analysis on the imported cases of schistosomiasis in Zhejiang Province during 1996-2017[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2018, 36(6): 586-592.

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参考文献 21

[1]	张利娟, 徐志敏, 钱颖骏, 等. 2016年全国血吸虫病疫情通报[J]. 中国血吸虫病防治杂志, 2017, 29(6): 669-677.
[2]	国家技术监督局, 中华人民共和国卫生部. GB 15977-1995 血吸虫病诊断标准及处理原则[S]. 北京: 中国标准出版社, 1996.
[3]	中华人民共和国卫生部. WS 261-2006血吸虫病诊断标准[S]. 北京: 人民卫生出版社, 2006.
[4]	任光辉, 梁幼生. 非洲血吸虫病学[M]. 北京: 人民卫生出版社, 2016: 170-218.
[5]	闻礼永, 朱明东, 严晓岚, 等. 1996-2005年浙江省血吸虫病巩固监测报告[J]. 中国人兽共患病学报, 2007, 23(6): 605-607.
[6]	俞丽玲, 朱明东, 林丽君, 等. 浙江省达标后首例病原学阳性历史慢性血吸虫病[J]. 中国血吸虫病防治杂志, 2008, 20(6): 464.
[7]	闻礼永, 郑伟, 严晓岚, 等. 浙江省血吸虫病疫情纵向监测及防治策略探讨[J]. 寄生虫与医学昆虫学报, 2010, 17(3): 135-139.
[8]	闻礼永, 严晓岚, 张剑锋, 等. 当前我国传播阻断省份血吸虫病监测情况和巩固策略[J]. 中国血吸虫病防治杂志, 2011, 23(1): 18-21.
[9]	金嘉宁, 党辉, 张利娟, 等. 2016年全国血吸虫病监测点疫情分析[J]. 中国寄生虫学与寄生虫病杂志, 2017, 35(6): 542-548.
[10]	陈文, 朱明东, 严晓岚, 等. 浙江省血吸虫病粪检实验室质控测试分析[J]. 中国血吸虫病防治杂志, 2011, 23(3): 318-320.
[11]	林丽君, 严晓岚, 朱明东, 等. 浙江省血吸虫病粪检实验室质量控制考核结果分析[J]. 国际流行病学传染病学杂志, 2014, 41(3): 215-216.
[12]	张剑锋, 闻礼永, 朱明东, 等. 输入性血吸虫病病情监测及成本效果分析[J]. 国际流行病学传染病学杂志, 2007, 34(3): 163-165.
[13]	林丽君, 闻礼永, 朱明东, 等. 浙江省流动人口血吸虫感染情况抽样调查及分析[J]. 中华临床感染病杂志, 2010, 3(6): 340-342.
[14]	张丽, 李石柱, 王强, 等. 2011年全国寄生虫病防治技术竞赛成绩分析报告:蠕虫检测能力分析[J]. 中国寄生虫学与寄生虫病杂志, 2012, 30(4): 305-308.
[15]	朱瑞, 刘小波. 浙江省流动人口的空间自相关分析[J]. 城市地理, 2017, 5: 252-253.
[16]	叶丽萍, 许国章, 张吉楠, 等. 宁波市血吸虫病防治历程和展望 [J]. 中国热带医学, 2008, 8(9):1600, 1617.
[17]	高奕, 夏时畅, 胡伟, 等. 浙江省“中央农村改厕项目”无害化处理效果分析[J]. 中国农村卫生事业管理, 2013, 33(1): 35-37.
[18]	关周, 吕山, 李石柱, 等. 我国流动人口血吸虫病流行现状及防控挑战[J]. 中国寄生虫学与寄生虫病杂志, 2017, 35(6): 598-603.
[19]	张剑锋, 闻礼永, 朱蓉, 等. 浙江省首例输入性曼氏血吸虫病[J]. 中国寄生虫学与寄生虫病杂志, 2014, 32(3): 封二.
[20]	朱素娟, 王衡, 徐卫民, 等. 浙江省首例境外输入性埃及血吸虫病病例报告[J]. 预防医学, 2016, 28(10): 1021-1022.
[21]	郑巧飞, 褚邦勇, 陈玉宇, 等. 浙江省台州市首例输入性埃及血吸虫病病例报道[J]. 中国寄生虫学与寄生虫病杂志, 2017, 35(1): 17-18.

年份Year	浙江省输入性病例数No. of imported cases in Zhejiang Province					全国血吸虫病病例数/万 No. of cases with schistosomiasis in China/10 thousand
年份Year	慢性日本血吸虫病病例数 No. of cases with chronic schistosomiasis japonica	急性日本血吸虫病病例数 No. of cases with acute schistosomiasis japonica	曼氏血吸虫病病例数 No. of cases with schistosomiasis mansoni	埃及血吸虫病病例数 No. of cases with schistosomiasis haematobia	合计 Total
1996	0	0	0	0	0	81.0
1997	0	1	0	0	1	79.1
1998	1	1	0	0	2	76.2
1999	0	3	0	0	3	75.7
2000	0	4	0	0	4	69.5
2001	2	1	0	0	3	82.1
2002	1	8	0	0	9	81.0
2003	3	3	0	0	6	84.3
2004	9	8	0	0	17	84.3
2005	37	3	0	0	40	79.9
2006	31	1	0	0	32	67.1
2007	23	1	0	0	24	51.6
2008	11	2	0	0	13	41.3
2009	19	1	0	0	20	36.6
2010	9	0	0	0	9	32.6
2011	7	2	0	0	9	28.7
2012	6	1	0	0	7	24.1
2013	13	0	1	0	14	18.5
2014	9	0	0	0	9	11.6
2015	7	0	0	1	8	7.7
2016	7	0	0	2	9	5.4
2017	5	1	0	0	6	3.8
合计Total	200	41	1	3	245	1 121.9

特征Feature	急性日本血吸虫病病例 No. of cases with acute schistosomiasis japonica	慢性日本血吸虫病病例 No. of cases with chronic schistosomiasis japonica	曼氏血吸虫病病例 No. of cases with schistosomiasis mansoni	埃及血吸虫病病例 No. of cases with schistosomiasis haematobia	构成比/% Proportion/%
文化程度Education
文盲llliteracy	4	6	0	0	4.1
小学Primary school	20	53	0	0	29.8
初中Junior high school	17	100	1	3	49.4
高中Senior high school	0	27	0	0	11.0
大专及以上College and above	0	14	0	0	5.7
职业Occupation
农民Farmer	11	92	0	0	42.0
工人Worker	2	52	0	3	23.3
学生Student	23	13	0	0	14.7
商业服务者Business Services	0	21	1	0	9.0
渔船民Fisherman and boatman	5	15	0	0	8.2
教师及干部 Teacher or government employee	0	7	0	0	2.8
感染方式Way of infection
游泳戏水 Swimming and water-playing	23	65	0	3	37.1
农业生产Agricultural production	11	77	1	0	36.3
渔业生产Fishery production	6	26	0	0	13.1
生活用水Daily life activity	0	30	0	0	12.2
未知Unknown	1	2	0	0	1.3
既往史Previous history
无治疗史Without treatment history	37	131	1	3	70.2
有治疗史Treatment history	4	69	0	0	29.8

初诊单位 First visited medical units	病例数 No. of cases	构成比/% Proportion/%	其中被动报病数 No. of cases of passive surveillance	误诊人数 No. of cases of misdiagnosis	误诊率/% Misdiagnosis rate/%
省级Provincial-level	10	4.1	10	4	40.0
市级Prefecture-level	34	13.9	28	12	42.9
县级County-level	146	59.6	44	16	36.4
乡（镇）级Township	55	22.4	37	27	73.0
合计Total	245	100	119	59	49.6