2021—2023年四川省棘球蚴病监测结果分析

doi:10.12140/j.issn.1000-7423.2025.01.003

摘要/Abstract

摘要：

目的了解2021—2023年四川省棘球蚴病疫情趋势变化，为后续防控措施制定提供参考。方法按照《全国包虫病监测方案（2020年版）》在四川省35个不同分类棘球蚴病流行县开展监测。Ⅰ、Ⅱ类县采用随机整群抽样选定区域作为监测点，完成不少于1 000人的超声筛查，监测点5年内不重复；Ⅲ类县在县级医院对就诊人群进行超声筛查；各县随机抽取1~5 所小学开展学生筛查（Ⅰ、Ⅱ类县500人，Ⅲ类县1 500人）。监测县的流行乡每个行政村随机采集家犬粪样10份，Ⅰ类县在定居点周边或乡村级公路两侧随机采集野外犬科动物粪样200份，采用免疫学方法检测犬粪棘球绦虫抗原。在监测县集中屠宰场或散宰点检查本地牛50~300头或羊100~500只，在混合流行县不同乡镇捕捉500只小型哺乳动物，采用触检法、剖检法了解宿主患病情况。在监测县采用问卷调查了解300名学生的棘球蚴病防治知识知晓及健康行为情况。各组率的比较采用卡方检验。结果 2021—2023年四川省监测点共筛查170 881人，总患病率为0.328%（561/170 881），其中2021—2023年患病率分别为0.334%（209/62 639）、0.458%（257/56 103）、0.182%（95/52 139），差异有统计学意义（χ² = 62.94，P < 0.01）。2021—2023年新患者检出率分别为3.19/10万、0、1.92/10万，差异无统计学意义（Fisher值 = 1.62，P > 0.05）。2021—2023年筛查小学生77 308人，未检出棘球蚴病新患者。2021—2023年，多房棘球蚴病患病率（0.181%，310/170 881）高于细粒棘球蚴病（0.132%，226/170 881）（χ² = 13.19，P < 0.01），女性患病率为（0.395%，360/91 102）高于男性（0.252%，210/79 779）（χ² = 22.66，P < 0.01），不同年龄段、不同地区患病率差异有统计学意义（χ² = 77.74、261.54，P < 0.01）。2021—2023年家犬粪棘球绦虫抗原阳性率分别为0.50%（133/26 450）、0.38%（108/28 264）、0.24%（72/29 847），呈现逐年降低的趋势（χ² = 26.19，P < 0.01）；野外犬科动物粪棘球绦虫抗原阳性率分别为1.60%（37/2 312）、0.40%（11/2 720）、0.35%（10/2 844），差异有统计学意义（χ² = 33.47，P < 0.01）。2021—2023年牲畜患病率分别为0.92%（82/8 898）、1.07%（78/7 312）、1.24%（92/7 416），差异无统计学意义（χ² = 3.90，P > 0.05）；小型哺乳动物患病率为3.48%（442/12 684）、2.58%（231/8 955）、1.39%（129/9 286），呈逐年降低（χ² = 93.20，P < 0.01）。2021—2023年监测县小学生棘球蚴病防治知识知晓率分别为92.62%（11 114/11 999）、92.17%（10 221/11 089）、93.32%（10 491/11 242），差异有统计学意义（χ² = 11.05，P < 0.05）。2021—2023年不接触犬的合格率为75.47%（9 056/11 999）、73.24%（8 122/11 089）、82.19%（9 240/11 242），饭前洗手的合格率为70.72%（8 486/11 999）、75.63%（8 387/11 089）、80.76%（9 079/11 242），不用生的家畜脏器喂犬的合格率为87.82%（10 537/11 999）、83.25%（9 232/11 089）、92.47%（10 395/11 242），不同年度间3种健康行为合格率的差异均有统计学意义（χ² = 274.81、316.96、444.35，P < 0.01）。结论 2021—2023年四川省棘球蚴人群新患者检出率、犬只粪抗原阳性率、中间宿主患病率稳步降低或保持较低水平，人群棘球蚴病防治知识知晓率和健康行为合格率稳步提高，但部分地区波动较大，需持续强化综合防控措施，防止疫情反弹。

关键词: 棘球蚴病, 监测, 四川省

Abstract:

Objective To identity the dynamic changes of echinococcosis in Sichuan Province, and to provide reference for further prevention and control. Methods According to the National Echinococcosis Disease Surveillance Plan (2020 Edition), surveillance work was conducted in 35 different classified echinococcosis-endemic counties in Sichuan Province. In counties of types Ⅰ and Ⅱ, random cluster sampling method was used to select surveillance villages. Ultrasonographic examination was carried out to screen no less than 1 000 people. In type Ⅲ counties, all outpatients of the ultrasound department in the county-level hospitals were included in the surveillance of echinococcosis. One to five primary schools were randomly selected in each county to conduct student ultrasonographic screening (500 students in counties of types Ⅰ and Ⅱ, 1 500 students in type Ⅲ counties). All fecal samples detected by immunological method, including 10 domestic dog feces of each village in endemic towns and 200 canine feces around settlements or on both sides of rural roads. Each county was required to monitor 50-300 yaks or 100-500 sheep in centralized or scattered slaughterhouses, while the counties endemic with alveolar echinococcosis were required to capture 500 small mammals in mixed endemic counties. And the echinococcosis infections in viscera of intermediate hosts were identified by touching detection or autopsy methods. Questionnaires were used to investigate 300 students’ knowledge and health behavior development regarding to echinococcosis control in each county. Chi-square test was used to compare the rates. Results From 2021 to 2023, a total of 170 881 people were screened in surveillance villages of Sichuan Province, with a total prevalence rate of 0.328% (561/170 881). The prevalence rates from 2021 to 2023 were 0.334% (209/62 639), 0.458% (257/56 103), and 0.182% (95/52 139), respectively, with statistically significant differences (χ² = 62.94, P < 0.01). The detection rates of new patients from 2021 to 2023 were 3.19/100 000, 0, and 1.92/100 000, respectively, with no statistically significant difference (Fisher value = 1.62, P > 0.05). 77 308 primary school students were screened from 2021 to 2023, and no new patients with echinococcosis were found. The prevalence rate of alveolar echinococcosis (0.181%, 310/170 881) was higher than that of cystic echinococcosis (0.132%, 226/170 881) (χ² = 13.19, P < 0.01), and the prevalence rate of female (0.395%, 360/91 102) was higher than that of male (0.252%, 210/79 779) (χ² = 22.66, P < 0.01). There were statistical differences in the prevalence among different age groups and regions (χ² = 77.74, 261.54, P < 0.01). The positive rates of Echinococcus spp. coproantigen in domestic dogs were 0.50% (133/26 450), 0.38% (108/28 264) and 0.24% (72/29 847) from 2021 to 2023, showing a decreasing trend by year (χ² = 26.19, P < 0.01). The positive rate of canine feces in the wild in 2021 (1.60%, 37/2 312) was significantly higher than it in 2022 (0.40%, 11/2 720) and 2023 (0.35%, 10/2 844) (χ² = 33.47, P < 0.01). During 2021 to 2023, the prevalence in livestock were 0.92% (82/8 898), 1.07% (78/7 312) and 1.24% (92/7 416), respectively, with no statistical difference between years (χ² = 3.90, P > 0.05), and the prevalence in small mammals were 3.48% (442/12 684), 2.58% (231/8 955) and 1.39% (129/9 286), with a decreasing trend by year (χ² = 93.20, P < 0.01). The awareness rates of knowledge on echinococcosis prevention among primary school students from 2021 to 2023 were 92.62% (11 114/11 999), 92.17% (10 221/11 089) and 93.32% (10 491/11 242), respectively, with statistical significance (χ² = 11.05, P < 0.05). From 2021 to 2023, the qualified rates of no touching the dog was 75.47% (9 056/11 999), 73.24% (8 122/11 089) and 82.19% (9 240/11 242), respectively, and that of washing hands before meals were 70.72% (8 486/11 999), 75.63% (8 387/11 089) and 80.76% (9 079/11 242), respectively, and that of no feeding dogs with raw livestock viscus were 87.82% (10 537/11 999), 83.25% (9 232/11 089) and 92.47% (10 395/11 242). The difference in health behavior qualification rates of students between different years was statistically significant (χ² = 274.81, 316.96, 444.35; all P < 0.01). Conclusion The detection rate of new echinococcosis patients and the positive rate of animal hosts in Sichuan have decreased steadily or maintained a low level, and the rate of health awareness and behavior among the population is gradually increasing. However, some regions have significant fluctuations, and it is necessary to continuously strengthen comprehensive prevention and control measures to prevent the resurgence of the endemic.

Key words: Echinococcosis, Surveillance, Sichuan Province

中图分类号:

R532.32

廖沙, 张仲双, 杨柳, 喻文杰, 何伟, 张光葭, 姚人新, 李汭芮, 黄燕, 王谦. 2021—2023年四川省棘球蚴病监测结果分析[J]. 中国寄生虫学与寄生虫病杂志, 2025, 43(1): 14-19.

LIAO Sha, ZHANG Zhongshuang, YANG Liu, YU Wenjie, HE Wei, ZHANG Guangjia, YAO Renxin, LI Ruirui, HUANG Yan, WANG Qian. Surveillance of echinococcosis in Sichuan Province from 2021 to 2023[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2025, 43(1): 14-19.

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监测人群 Monitoring population	年份 Year	常住人口数 No. resident	调查人数 No. surveyed	患者数 No. patient	新检出患者数 No. newly diagnosed patient	患病率/% Prevalence/%	新患者检出率/（10万）^-1 Newly diagnosed rate /100 000^-1
常驻居民 Resident	2021	67 875	62 639	209	2	0.334	3.19
常驻居民 Resident	2022	62 149	56 103	257	0	0.458	0
	2023	58 579	52 139	95	1	0.182	1.92
小学生 Primary school students	2021	-	27 221	2	0	0.007	0
	2022	-	25 135	1	0	0.004	0
	2023	-	24 952	7	0	0.028	0

特征 Characteristics	检查人数 No. exam’d	细粒棘球蚴病 Cystic echinococcosis		多房棘球蚴病 Alveolar echinococcosis		混合感染 Mix infection		未分型 Pending		合计 Total
特征 Characteristics	检查人数 No. exam’d	患者数 No. patient	患病率/% Prevalence/%	患者数 No. patient	患病率/% Prevalence/%	患者数 No. patient	患病率/% Prevalence/%	患者数 No. patient	患病率/% Prevalence/%	患者数 No. patient	患病率/% Prevalence/%
性别 Sex
男 Male	79 779	88	0.110	107	0.134	0	0	6	0.008	201	0.252
女 Female	91 102	138	0.151	203	0.223	2	0.002	17	0.019	360	0.395
年龄组/岁 Age group/Year
0~9	8 258	1	0.012	2	0.024	0	0	0	0	3	0.036
10~19	17 521	22	0.126	10	0.057	0	0	1	0.006	33	0.188
20~29	28 121	24	0.085	29	0.103	0	0	1	0.004	54	0.192
30~39	24 752	33	0.133	56	0.226	0	0	4	0.016	93	0.376
40~49	29 632	49	0.165	86	0.290	0	0	8	0.027	143	0.483
50~59	24 108	35	0.145	61	0.253	0	0	5	0.021	101	0.419
≥ 60	38 489	62	0.161	66	0.171	2	0.005	4	0.010	134	0.348
地区 Region
甘孜州 Ganzi Prefecture	88 868	182	0.205	271	0.305	2	0.002	19	0.021	474	0.533
阿坝州 Aba Prefecture	43 680	43	0.098	39	0.089	0	0	4	0.009	86	0.197
雅安市 Ya’an City	16 876	0	0	0	0	0	0	0	0	0	0
凉山州 Liangshan Prefecture	21 457	1	0.005	0	0	0	0	0	0	1	0.005
合计 Total	170 881	226	0.132	310	0.181	2	0.001	23	0.013	561	0.328