2015-2018年我国内脏利什曼病疫情分析

doi:10.12140/j.issn.1000-7423.2020.03.013

摘要/Abstract

摘要：

目的了解 2015-2018年我国内脏利什曼病疫情状况,为制定防治策略和措施提供科学依据。方法收集 2015-2018年中国疾病预防控制中心传染病报告信息管理系统中内脏利什曼病报告病例信息,剔除疑似病例、重复病例以及皮肤利什曼病病例,建立数据库,采用Microsoft Excel 2016软件对内脏利什曼病报告病例的三间分布进行描述性流行病学分析。结果 2015-2018年全国16个省份的177个县共报告内脏利什曼病1 194例,病例主要分布于新疆（669例）、甘肃（271例）和四川（79例）等3个省。其中73个县属于流行区,共报告本地感染病例1 064例,其余104个县属于非流行区,共报告输入性病例130例。新疆伽师县（497例）和甘肃省舟曲县（94例）、宕昌县（49例）和武都区（71例）为主要流行县,报告病例数占全国总病例数的59.5%（711/1 194）。2015-2018年,甘肃、山西、陕西和河南等4省共有9个县出现内脏利什曼病复燃,报告本地感染病例25例。内脏利什曼病患者发病高峰为10-11月,男女患者比为1 : 0.7。婴幼儿和农民是我国内脏利什曼病高风险人群,分别占全部病例数的67.3%（803/1 194）和18.8%（224/1 194)。内脏利什曼病病例主要分布于0~2岁年龄组（727例）,不同流行类型病例年龄分布明显不同,野生动物源型和人源型内脏利什曼病病例主要分布于0~2岁年龄组（557、30例）,犬源型内脏利什曼病病例主要分布于≥ 15岁年龄组（198例）。结论我国内脏利什曼病呈低度流行态势,但流行范围逐渐扩大。

关键词: 内脏利什曼病, 中国, 疫情, 分布

Abstract:

Objective To understand the prevalence of visceral leishmaniasis (VL) in China during 2015-2018, providing scientific basis for formulating strategies and measures for prevention and control. Methods Information of VL cases reported during 2015-2018 from the web-based National Diseases Reporting Information System (NDRIS) operated by the Chinese Center for Disease Control and Prevention was collected. A database was established after excluding suspected cases, duplicate cases and cutaneous leishmaniasis cases. The three-compartment distribution of VL cases was analyzed with descriptive statistics using Microsoft Excel 2016. Results During 2015-2018, a total of 1 194 VL cases were reported in 177 counties (cities) of 16 provinces (autonomous regions and municipalities). They were mainly distributed in Xinjiang (669 cases), Gansu (271 cases) and Sichuan Province (79 cases). Of the 177 counties (cities), 73 were endemic areas, reporting 1 064 indigenous cases, while the other 104 counties (cities) were non-endemic areas, reporting 130 imported VL cases. In particular, Jiashi County (497 cases), Zhouqu county (94 cases), Dangchang county (49 cases) and Wudu district (71 cases) were major endemic regions; the number of cases reported in the 4 areas accounted for 59.5% (711/1 194) of the grand total reported. During 2015-2018, VL recurrence occurred in 9 counties of 4 provinces including Gansu, Shanxi, Shaanxi and Henan Provinces, where 25 indigenous cases were reported. The onset of VL peaked during October-November, with a male/female ratio of 1: 0.7. Infants and farmers were high-risk populations of VL, accounting for 67.3% (803/1 194) and 18.8% (224/1 194) of total cases, respectively. The VL cases were mainly distributed within ages of 0-2 years (727 cases). The age distribution of different epidemiological types of VL obviously varied. The desert-type zoonotic and anthroponotic types of VL were mainly distributed within ages of 0-2 years (557 cases and 30 cases), while the mountain-type zoonotic VL was mainly distributed at ages ≥15 years (198 cases). Conclusion Visceral leishmaniasis endemic in China displays a status of low prevalence, but the endemic area shows a trend of expansion.

Key words: Visceral leishmaniasis, China, Prevalence, Distribution

中图分类号:

R531.6

周正斌, 李元元, 张仪, 李石柱. 2015-2018年我国内脏利什曼病疫情分析[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38(3): 339-345.

ZHOU Zheng-bin, LI Yuan-yuan, ZHANG Yi, LI Shi-zhu. Prevalence of visceral leishmaniasis in China during 2015-2018[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2020, 38(3): 339-345.

图/表 5

表1

表2

2015-2018年我国流行区内脏利什曼病病例的地区分布

流行区类型 Types of endemic area	省（自治区） Province (autonomous region)	流行县（区、县级市）及病例数 Endemic counties (districts, cities) and No. of cases
人源型AVL	新疆 Xinjiang	阿克苏市Aksu City（1）、阿克陶县Akto County（3）、阿图什市Atush City（5）、喀什市Kashgar City（17）、库车县Kuqa County（9）、沙雅县Shaya County（2）、莎车县Shache County（17）、疏附县Shufu County（3）、疏勒县Shule County（5）、乌什县Wushi County（1）、英吉沙县Yingjisha County（7）
野生动物源型 DT-ZVL	新疆 Xinjiang	阿瓦提县Awati County（1）、巴楚县Bachu County（39）、策勒县Celle County（1）、伽师县Jiashi County（497）、高昌区Gaochang District （1）、库尔勒市Korla City（3）、轮台县Luntai County（1）、民丰县Minfeng County（8）、且末县Qiemo County（3）、图木舒克市Tumshuk City（3）、托克逊县Toksun County（1）、尉犁县Yuli County（3）、岳普湖县Yuepuhu County（11）、泽普县Zepu County（6）、44团场44th regiment farm（1）、46团场46th regiment farm（1）、50团场50th regiment farm（1）、53团场53rd regiment farm（1）、伽师总场Jiashi regiment farm （4）
犬源型 MT-ZVL	甘肃 Gansu	宕昌县Dangchang County（49）、迭部县 Diebu County（10）、甘谷县Gangu County（1）、环县Huanxian County（3）、礼县Lixian County（1）、麦积区Maiji District（1）、秦州区Qinzhou District（1）、清水县Qingshui County（2）、庆城县Qingcheng County（1）、文县Wenxian County（13）、武都区Wudu District（71）、武山县Wushan County（1）v西和县Xihe County（3）、舟曲县Zhouqu County（94）
	山西 Shanxi	大宁县Daning County（2）、潞州区Luzhou District（3）、平定县Pingding County（11）、曲沃县Quwo County（4）、武乡县Wuxiang County（8）、乡宁县Xiangning County（2）、襄汾县Xiangfen County（1）、襄垣县Xiangyuan County（2）、阳泉市城区Urban District of Yangquan（9）、阳泉市郊区Suburb District of Yangquan（18）、阳泉市矿区Mining District of Yangquan（3）、盂县 Yuxian County（1）、尧都区 Yaodu District （1）
	陕西 Shaanxi	宝塔区Baota District（4）、韩城市Hancheng City（19）、华州区Huazhou District（2）、临渭区Linwei District（3）、宁强县Ningqiang County（1）、清涧县Qingjian County（4）、绥德县Suide County（2）、延长县Yanchang County（2）、宜川县 Yichuan County（4）
	四川 Sichuan	黑水县Heishui County（13）、九寨沟县Jiuzhaigou County（18）、理县Lixian County（5）、茂县Maoxian County（4）、汶川县Wenchuan County（4）、平武县Pingwu County（1）
	河南Henan	林州市Linzhou City（6）

表2

表3

表4

图1

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年份Year	流行区Endemic areas			非流行区 Non-endemic areas	合计Total	构成比/% Composition rate/%
年份Year	人源型AVL	野生动物源型DT-ZVL	犬源型MT-ZVL	非流行区 Non-endemic areas	合计Total	构成比/% Composition rate/%
2015	13	385	82	18	498	41.7
2016	22	178	95	27	322	27.0
2017	24	17	114	39	194	16.2
2018	11	6	117	46	180	15.1
合计Total	70	586	408	130	1 194	100

主要流行县（区）Major endemic County (District)	流行类型Endemic type	年均病例数Average annual No. of cases	2017年地区人口数Population size in 2017	发病率/10 000^-1 Incidence/ 10 000^-1
新疆伽师县Jiashi County,Xinjiang	DT-ZVL	124	414 400	3.0
甘肃舟曲县Zhouqu County,Gansu	MT-ZVL	24	137 400	1.7
甘肃宕昌县Dangchang County, Gansu	MT-ZVL	12	278 300	0.4
甘肃武都区Wudu District, Gansu	MT-ZVL	18	559 200	0.3

特征 Characters	流行区Endemic area								非流行区 Non-endemic area		合计 Total
	人源型AVL		野生动物源型 DT-ZVL		犬源型 MT-ZVL		小计Subtotal		非流行区 Non-endemic area		合计 Total
	病例数No. of cases	构成比/%Composition rate/%	病例数No. of cases	构成比/%Composition rate/%	病例数No. of cases	构成比/%Composition rate/%	病例数No. of cases	构成比/%Composition rate/%	病例数No. of cases	构成比/%Composition rate/%	病例数No. of cases	构成比/%Composition rate/%
年龄组/岁 Age group/years
0~2	30	42.9	557	95.1	131	32.1	718	67.5	9	6.9	727	60.9
3~6	10	14.3	14	2.4	42	10.3	66	6.2	4	3.1	70	5.9
7~14	9	12.9	3	0.5	37	9.1	49	4.6	5	3.8	54	4.5
≥15	21	30.0	12	2.0	198	48.5	231	21.7	112	86.2	343	28.7
职业Occupation
婴幼儿 Infants and young children	42	60.0	571	97.4	177	43.4	790	74.2	13	10.0	803	67.3
学生Students	7	10.0	3	0.5	43	10.5	53	5.0	5	3.8	58	4.9
农民Farmers	11	15.7	9	1.5	132	32.4	152	14.3	72	55.4	224	18.8
工人Workers	1	1.4	0	0	6	1.5	7	0.7	11	8.5	18	1.5
干部职员 Officials	1	1.4	0	0	11	2.7	12	1.1	3	2.3	15	1.3
家务及待业 Housewives and unemployed	7	10.0	1	0.2	20	4.9	28	2.6	10	7.7	38	3.2
其他Others	1	1.4	2	0.3	19	4.7	22	2.1	16	12.3	38	3.2
性别Gender
男Male	38	54.3	335	57.2	244	59.8	617	58.0	91	70.0	708	59.3
女Female	32	45.7	251	42.8	164	40.2	447	42.0	39	30.0	486	40.7
合计Total	70	100	586	100	408	100	1 064	100	130	100	1 194	100