2020年青海省棘球蚴病监测结果

doi:10.12140/j.issn.1000-7423.2023.03.009

摘要/Abstract

摘要：

目的了解青海省棘球蚴病的流行情况，为优化防控措施提供科学依据。方法 2020年在青海省39个棘球蚴病流行县（Ⅰ类32个、Ⅱ类7个）开展居民、小学生、中间宿主、终末宿主监测和小学生问卷调查。每个监测县随机抽取1个或相邻几个行政村（自然村）为监测点，监测点5年内不重复，每个监测点监测人数不少于1 000人。采用腹部超声检查居民棘球蚴病患病情况；每个监测县在监测点附近抽取1~5所小学，对1年级和6年级的所有学生进行腹部超声检查，人数不少于500人。在监测县集中屠宰场抽检本县饲养的牛或羊300~500头，肉眼观察或触摸肝、肺囊状物或硬结并进行剖检判定感染情况。多房棘球蚴病流行的监测县每个县选取10个有人群活动的区域捕捉小型啮齿类动物，每个区域不少于50只，剖检肝、肺判定多房棘球蚴感染情况。在监测县所有流行乡的每个行政村随机抽取10户养犬户，每户采集1份新鲜家犬粪样，Ⅰ类县增加无主犬、野外犬科动物粪样采集，用犬粪抗原试剂盒检测粪样棘球绦虫抗原。在开展监测的学校3~6年级抽取若干个班进行棘球蚴病防治知识和行为问卷调查，每个县不少于300人。结果 2020年，青海省共B超检查73 191人，检出棘球蚴病患者294例（含新发病例5例），总患病率为0.40%，居民和小学生的患病率分别为0.59%（276/46 922）和0.07%（18/26 269），其中Ⅰ类县居民和小学生的患病率分别为0.70%（276/39 364）和0.08%（18/22 646），Ⅱ类县居民和小学生均未检出棘球蚴病患者，Ⅰ类和Ⅱ类县居民棘球蚴病患病率差异有统计学意义（χ² = 53.32，P < 0.01）。共检查家畜11 626头，棘球蚴总感染率为0.55%（64/11 626）；其中羊的感染率为0.28%（18/6 491），牛的感染率为0.89%（46/5 135）。在多房棘球蚴病流行县共调查小型啮齿类动物7 121只，多房棘球蚴感染率为0.38%（27/7 121）。检测家犬粪样38 496份，棘球绦虫抗原阳性率为0.54%（208/38 496），其中Ⅰ类和Ⅱ类县家犬阳性率分别为0.63%（177/27 882）和0.29%（31/10 614）（χ² = 0.07，P > 0.05）；检测无主犬和野外犬科动物粪样7 253份，阳性率为0.65%（47/7 253），其中Ⅰ、Ⅱ类县的阳性率分别为0.63%（43/6 853）、1.00%（4/400）（χ² = 0.82，P > 0.05）。共12 216名小学生参加问卷调查，棘球蚴病防治知识知晓率为97.8%（11 944/12 216），优秀率为88.6%（10 827/12 216）。Ⅰ类和Ⅱ类县学生防治知识知晓率分别为97.7%（9 865/10 096）和98.1%（2 079/2 120）（χ² = 1.01，P > 0.05），优秀率分别为89.0%（8 986/10 096）和86.8%（1 841/2 120）（χ² = 8.16，P < 0.01）。青海省Ⅰ类流行县不同地形区棘球蚴病流行情况分析结果显示，青南地区、柴达木盆地、环湖地区和河湟谷地人群患病率分别为1.00%（261/25 980）、0.22%（21/9 354）、0.06%（10/17 200）和0.02%（2/9 446），4种地形区居民患病率差异有统计学意义（χ² = 271.31，P < 0.01）；青南地区、柴达木盆地、环湖地区和河湟谷地家犬粪棘球绦虫抗原阳性率分别为0.56%（34/6 043）、0.92%（21/2 283）、0.94%（62/6 613）和0.46（60/12 943），环湖地区与青南地区、河湟谷地，柴达木盆地与河湟谷地之间家犬粪抗原阳性率差异均有统计学意义（χ² = 5.90、15.86，7.64；P < 0.05或P < 0.01）；无主犬和野外犬科动物粪抗原阳性率分别为0.75%（24/3 190）、0.38%（3/800）、0.72%（13/1 812）和0（0/1 051），青南地区、环湖地区与河湟谷地之间无主犬和野外犬科动物粪抗原阳性率差异有统计学意义（χ² = 7.95、7.58，P < 0.01）。柴达木盆地牛的感染率最高，为1.71%（12/700），与青南地区（0.87%，20/2 307）、环湖地区（0.57%，7/1 228）之间差异有统计学意义（χ² = 4.22、6.58，P < 0.05）。多房棘球蚴病流行县主要分布在青南地区和环湖地区，其小型啮齿类动物棘球蚴感染率分别为0.39%（24/6 121）和0.60%（3/500）（χ² = 0.49，P > 0.05）。结论青海省棘球蚴病患者和新发病例均分布于青南地区的Ⅰ类流行县，传播循环尚未完全阻断，人群感染风险仍持续存在。

关键词: 棘球蚴病, 监测, 青海省

Abstract:

Objective To understand the epidemic situation of echinococcosis in Qinghai Province, to provide the scientific basis for optimization of prevention and control measures. Methods Echinococcosis surveillance was performed among residents, primary school students, intermediate hosts, definitive hosts, and questionnarire survey was conducted for primary school students in 39 echinococcosis endemic counties in Qinghai Province in 2020 (32 in typeⅠ and 7 in type Ⅱ). One or several nearby administrative villages (natural villages) were randomly sellected from each surveillance county as the surveiooance sites, each of which will not be repeated within 5 years. No less than 1 000 residents were surveyed at each surveillance, and examined using abdominal ultrasonography. From places near the surveillance site in the county, 1-5 primary schools were selected, in which all students in Grades 1 and 6 were examined by abdomen ultrasound scanning, with at least 500 students being examineds. A total of 300-500 cattle or sheep raised in the county were sampled from the surveillance county’s centralized slaughterhouse, and examined by inspection with naked eyes or palpation on the cystic matter or hard nodule of liver and the lung, with which autopsy was followed to determine Echinococcus infection. In each surveillance county with endemic alveolar echinococcosis, ten areas having people’s activity were selected to catch small rodents. From each selected area, no less than 50 animals were examined by dissection of livers and lungs to determine Echinococcus multilocularis infection. Ten dog owners were randomly selected from each administrative village in all epidemic townships in the surveiooance county to collect fresh domestic dog feces sample, one from each owner, while in type Ⅰ endemic county additional fecal samples of stray dogs and wild canines were collected. The Echinococcus antigen was detected using dog coproantigen detection kit. A questionnaire survey on echinococcosis prevention and control knowledge and behavior was undertaken in students of several classes selected from grade 3 to grade 6 in the schools under surveiooance scheme, with no fewer than 300 persons being surveyed in each county. Results In 2020, a total of 73 191 individuals in Qinghai Province were investigated by B-ultrasound, and 294 patients were with echinococcosis positive (including 5 new cases), with an overall prevalence of 0.40%. The prevalence in local residents and school children was 0.59% (276/46 922) and 0.07% (18/26 269), respectively. The residents and school children in type Ⅰ endemic counties had a prevalence rate of 0.70% (276/39 364) and 0.08% (18/22 646), respectively. There were no echinococcosis patients among type Ⅱ inhabitants or primary school students, showing a significant difference in the prevalence of echinococcosis between type Ⅰ and Ⅱ endemic counties (χ² = 53.32, P < 0.01). A total of 11 626 domestic animals were examined, and the total echinococcosis infection rate was 0.55% (64/11 626). The infection rate among sheep was 0.28% (18/6 491) and that among cattle was 0.89% (46/5 135). A total of 7 121 small rodents were investigated in the alveolar echinococcosis endemic county, and the infection rate of E. multilocularis was 0.38% (27/7 121). The positive rate of Echinococcus coproantigen was 0.54% (208/38 496) in 38 496 domestic dog feces samples. The positive rates of domestic dogs in type Ⅰ and Ⅱ endemic counties were 0.63% (177/27 882) and 0.29% (31/10 614), respectively, and the difference was not significant (χ² = 0.07, P > 0.05). A total of 7 253 fecal samples from stray dogs and wild canines were examined, and found coproantigen positive rate was 0.65% (47/7 253). Among them, the positive rates in type Ⅰ and Ⅱ endemic counties were 0.63% (43/6 853) and 1.00% (4/400) respectively, and the difference was not statistically significant (χ² = 0.82, P > 0.05). A total of 12 216 primary school students participated in the questionnaire survey. The awareness rate of knowledge on echinococcosis prevention was 97.8% (11 944/12 216), and the excellent rate was 88.6% (10 827/12 216). The awareness rates among students in type Ⅰ and Ⅱ endemic counties were 97.7% (9 865/10 096) and 98.1% (2 079/2 120) (χ² = 1.01, P > 0.05), and the excellent rates were 89.0% (8 986/10 096) and 86.8% (1 841/2 120) (χ² = 8.16, P < 0.01), respectively. The analysis of endemic situation of echinococcosis in different topographic areas of type Ⅰ endemic counties in Qinghai Province showed that the prevalence in people of Qingnan area, Qaidam Basin, arround the lake area and Hehuang Valley were 1.00% (261/25 980), 0.22% (21/9 354), 0.06% (10/17 200) and 0.02% (2/9 446). There was significant difference in the prevalence among residents in the four topographic areas (χ² = 271.31, P < 0.01). The positive rate of Echinococcus coproantigen from domestic dogs was 0.56% (34/6 043), 0.92% (21/2 283), 0.94% (62/6 613), and 0.46% (60/12 943) in the Qingnan area, Qaidam Basin, arround the lake area, and Hehuang Valley, respectively. The positive rate of coproantigen differed significantly between the area around the lake and Qingnan, Hehuang Valley, Qaidam Basin, and Hehuang Valley (χ² = 5.90, 15.86, 7.64; P < 0.05 or P < 0.01). The positive rates of coproantigen in stray dogs and wild canines were 0.75% (24/3 190), 0.38% (3/800), 0.72% (13/1 812) and 0 (0/1 051), respectively. There were significant differences in the positive rates of fecal antigen between street dogs and wild canines in Qingnan area, around the lake area and Hehuang Valley (χ² = 7.95, 7.58, P < 0.01). The infection rate of cattle in Qaidam Basin was the highest at 1.71% (12/700), which was significantly different from that in Qingnan area 0.87% (20/2 307) and around the lake area 0.57% (7/1 228) (χ² = 4.22, 6.58, P < 0.05). Alveolar echinococcosis endemic counties are mainly distributed in Qingnan area and around the lake area, where the infection rate of Echinococcus in small rodents was 0.39% (24/6 121) and 0.60% (3/500), respectively (χ² = 0.49, P > 0.05). Conclusion Both echinococcosis patients and new cases in Qinghai Province are distributed in typeⅠendemic counties in southern Qinghai Province, and the transmission cycle has not been entirely interrupted. The risk of infection in the population remains.

Key words: Echinococcosis, Surveillance, Qinghai Province

中图分类号:

R532.32

王威, 蔡辉霞. 2020年青海省棘球蚴病监测结果[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41(3): 319-324.

WANG Wei, CAI Huixia. Surveillance of echinococcosis in Qinghai Province in 2020[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2023, 41(3): 319-324.

图/表 1

表1

参考文献 15

[1]	Han XM, Zhang XY, Cai QG, et al. Epidemic status of alveolar echinococcosis in Tibetan children in South Qinghai Province[J]. Chin J Schisto Control, 2017, 29(1): 53-58. (in Chinese)
	(韩秀敏, 张学勇, 蔡其刚, 等. 青海省南部高原藏族儿童泡型包虫病流行现状分析[J]. 中国血吸虫病防治杂志, 2017, 29(1): 53-58.)
[2]	Wang TP. Parasiticzoonosis[M]. Beijing: People’s Medical Publishing House, 2009: 58-59. (in Chinese)
	(汪天平. 人兽共患寄生虫病[M]. 北京: 人民卫生出版社, 2009: 58-59.)
[3]	Li YL. Human Parasitology[M]. 7th ed. Beijing: People’s Medical Publishing House, 2010: 144-150. (in Chinese)
	(李雍龙. 人体寄生虫学[M]. 7版, 北京: 人民卫生出版社, 2010: 144-150.)
[4]	Liao S, Wang Q, Yang L, et al. Analysis of surveillance results of echinococcosis in Sichuan 2020[J]. J Prev Med Inf, 2021, 37(12): 1641-1647. (in Chinese)
	(廖沙, 王奇, 杨柳, 等. 2020年四川省包虫病监测结果分析[J]. 预防医学情报杂志, 2021, 37(12): 1641-1647.)
[5]	Liu P, Cai JS, Li JH, et al. Investigation on prevention and control of echinococcosis (hydatid disease) in Qinghai Province[J]. China Animal Health, 2017, 19(7): 66-68. (in Chinese)
	(刘平, 蔡金山, 李金花, 等. 青海省棘球蚴病(包虫病)防控工作调查[J]. 中国动物保健, 2017, 19(7): 66-68.)
[6]	Ministry of Health of the People’s Republic of China. Diagnostic criteria for echinococcosis: WS257—2006[S]. Beijing: People’s Medical Publishing House, 2006: 1-11. (in Chinese)
	(中华人民共和国卫生部. 包虫病诊断标准: WS257—2006[S]. 北京: 人民卫生出版社, 2006: 1-11.)
[7]	Zeng XM, Guan YY, Wu WP. Epidemiological distribution characteristics of echinococcosis[J]. Chin J Zoonoses, 2014, 30(4): 413-417. (in Chinese)
	(曾祥嫚, 官亚宜, 伍卫平. 棘球蚴病的流行病学分布特征[J]. 中国人兽共患病学报, 2014, 30(4): 413-417.)
[8]	Nakao M, McManus DP, Schantz PM, et al. A molecular phylogeny of the genus Echinococcus inferred from complete mitochondrial genomes[J]. Parasitology, 2007, 134(Pt 5): 713-722. doi: 10.1017/S0031182006001934 pmid: 17156584
[9]	He JG, Qiu JM, Liu FJ, et al. Epidemiological survey on hydatidosis in Tibitan region of western Sichuan Ⅱ. Infection situation among domestic and wild animals[J]. Chin J Zoonoses, 2000, 16(5): 62-65. (in Chinese)
	(何金戈, 邱加闽, 刘凤洁, 等. 四川西部藏区包虫病流行病学研究Ⅱ. 牲畜及野生动物两型包虫病感染状况调查[J]. 中国人兽共患病杂志, 2000, 16(5): 62-65.)
[10]	Qiu JM, Chen XW, Ren M, et al. Epidemiological study on alveolar hydatid disease in Qinghai-Xizang Plateau[J]. J PractParasit Dis, 1995(3): 106-109. (in Chinese)
	(邱加闽, 陈兴旺, 任敏, 等. 青藏高原泡球蚴病流行病学研究[J]. 实用寄生虫病杂志, 1995(3): 106-109.)
[11]	Zuo QQ, Zheng JX, Wang G, et al. The transimission ecology of the echinococcosis on the Tibetan Plateau[J]. Chin J Parasitol Parasit Dis, 2022, 40(4): 524-535. (in Chinese)
	(左清秋, 郑佳鑫, 王刚, 等. 青藏高原棘球蚴病的传播生态学[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(4): 524-535.)
[12]	Zhang JX, Ma X, Liu YF, et al. Endemic situation and distribution of echinococcosis in Qinghai Province in China[J]. Chin J Parasitol Parasit Dis, 2017, 35(5): 460-465. (in Chinese)
	(张静宵, 马霄, 刘玉芳, 等. 青海省棘球蚴病流行与分布情况调查[J]. 中国寄生虫学与寄生虫病杂志, 2017, 35(5): 460-465.)
[13]	Wei SH, Wu WP, Han S, et al. Analysis of the results of echinococcosis surveillance in China from 2016 to 2017[J]. J Pathog Biol, 2020, 15(8): 924-928. (in Chinese)
	(魏思慧, 伍卫平, 韩帅, 等. 2016—2017年全国棘球蚴病监测结果分析[J]. 中国病原生物学杂志, 2020, 15(8): 924-928.)
[14]	Kui Y, Wu WP, Han S, et al. Analysis of the results of echinococcosis surveillance in China from 2018 to 2019[J]. J Pathog Biol, 2020, 16(9): 1025-1029. (in Chinese)
	(蒉嫣, 伍卫平, 韩帅, 等. 2018—2019年全国棘球蚴病监测结果分析[J]. 中国病原生物学杂志, 2020, 16(9): 1025-1029.)
[15]	Liu YF, Wang W, Zhang XF, et al. Investigation on the prevalence of echinococcosis among primary school students in Gangcha County, Qinghai Province in 2020[J]. Qinghai Med J, 2022, 52(3): 54-56. (in Chinese)
	(刘玉芳, 王威, 张雪飞, 等. 2020年青海省刚察县小学生棘球蚴病流行情况调查[J]. 青海医药杂志, 2022, 52(3): 54-56.)

地形区 Region type		人群 Population						终末宿主 Final host
		调查人数 No. investigated		患病人数 No. patient		患病率/% Prevalence/%		家犬 Domestic dog						无主犬和野外犬科动物 Stray dog and wild canine animal
		调查人数 No. investigated		患病人数 No. patient		患病率/% Prevalence/%		粪样份数 No. detected		阳性份数 No. positive		阳性率/% Positive rate/%		粪样份数 No. detected		阳性份数 No. positive		阳性率/% Positive rate/%
青南地区 South area of Qinghai		25 980		261^a		1.00		6 043		34		0.56		3 190		24		0.75
环湖地区 District around Qinghai Lake		17 200		10		0.06		6 613		62		0.94		1 812		13		0.72
柴达木盆地 Qaidam Basin		9 354		21		0.22		2 283		21		0.92		800		3		0.38
河湟谷地 Hehuang Valley		9 446		2		0.02		12 943		60		0.46		1 051		0		0
合计 Total		61 980		294		0.47		27 882		177		0.63		6 853		40		0.58
地形区 Region type	中间宿主 Intermediate host
	家畜 Livestock												小型啮齿类动物 Small rodent
	羊 Goat						牛 Cattle						检查只数 No. detected		感染只数 No. positive		感染率/% Positive rate/%
	检查只数 No. detected		感染只数 No. positive		感染率/% Positive rate/%		检查头数 No. detected		感染头数 No. positive		感染率/% Positive rate/%		检查只数 No. detected		感染只数 No. positive		感染率/% Positive rate/%
青南地区 South area of Qinghai	200		0		0		2 307		20		0.87		6 121		24		0.39
环湖地区 District around Qinghai Lake	3 124		9		0.29		1 228		7		0.57		500		3		0.60
柴达木盆地 Qaidam Basin	1 306		5		0.38		700		12		1.71		-		-		-
河湟谷地 Hehuang Valley	650		4		0.62		950		7		0.73		-		-		-
合计 Total	5 280		18		0.34		5 185		46		0.89		6 621		27		0.41