2010-2017年上海市疟疾报告病例的流行病学分析

doi:10.12140/j.issn.1000-7423.2019.01.010

摘要/Abstract

摘要：

目的了解上海市2010-2017年疟疾流行特征,为及时调整上海市消除疟疾进程中的策略和措施提供依据。方法收集中国疾病预防控制中心传染病报告信息管理系统中2010-2017年上海市疟疾病例的流行病学个案信息,采用Microsoft Excel 2010软件对疟疾病例的诊断分型、诊断时间、感染来源和流行特征等进行统计分析。结果 2010-2017年上海市共报告疟疾病例359例,死亡3例。报告病例中,临床诊断病例10例(2.8%),实验室确诊病例349例(97.2%),其中恶性疟241例（67.1%）、间日疟60例（16.7%）、卵形疟26例（7.2%）、三日疟13例（3.6%）,未分型9例（2.5%）。自2010年起,上海市无本地感染疟疾病例报告。病例诊断时间间隔的中位数为4.4 d,发病后3 d内确诊的病例占48.2% （173/359）。病例报告无明显季节分布。病例以男性中青年为主,包括在沪户籍105例（29.2%）,外省户籍207例（57.7%）,外籍47例（13.1%）。现居住地分布于全国19个省（市、区）的92个区（县）,其中上海市居住地病例占72.7%（261/359）,分布于全市16个区。报告病例中除1例输血感染的三日疟和1例感染地不明的三日疟外,其余均为输入性病例,其中境外输入病例占94.2%（338/359）,国内外省输入病例占5.3%（19/359）。自2012年起,上海市报告的输入性疟疾病例的感染来源地均为境外。结论上海市自2010年起无本地感染疟疾报告,仍有境外感染疟疾病例输入和死亡病例发生。

关键词: 疟疾, 流行病学, 输入性病例, 上海市

Abstract:

Objective To understand the epidemiological characteristics of malaria cases reported in Shanghai from 2010 to 2017, so as to provide evidence-based reference for adjusting strategies and measures in the process of malaria elimination in Shanghai. Methods The epidemiological data of malaria cases reported in Shanghai from 2010 to 2017 were collected. Classification, diagnosis time, infection source and epidemiological characteristics of the cases, were statistically analyzed by using Microsoft Excel 2010. Results A total of 359 malaria cases were reported in Shanghai from 2010 to 2017 with 3 deaths. Among them 10 patients were clinically diagnosed (2.8%, 10/359) and the rest were laboratory diagnosed (97.2%, 349/359). 241 were infected with P. falciparum (67.1%, 241/359), 60 with P. vivax (16.7%, 60/359), 26 with P. ovale (7.2%, 26/359), 13 with P. malariae (3.6%, 13/359) and 9 infected with unknown species (2.5%, 9/359). All cases were imported and there was no indigenous case reported in Shanghai since 2010. The median diagnosis time was 4.4 days after the clinical symptoms occurred, 47.8% (137/359) cases were diagnosed within 3 days. There was no significantly seasonal difference in the case report. Young and middle-aged men were preferably infected. The case distribution included 105 Shanghai native residents (29.2%, 105/359), 207 from other provinces (57.7%, 207/359) and 47 foreigners (13.1%, 47/359). The current living address of cases distributed in 92 counties in 19 provinces of China, and 261 cases (72.70%, 261/359) were Shanghai residents distributed in 16 districts of Shanghai. 338 cases (94.2%, 338/359) were imported from overseas, and 19 cases (5.3%, 19/359) were imported from other provinces of China. Since 2012 all reported cases were imported from overseas except for one case of P. malariae transmitted by blood transfusion and one case of P. malariae without definite source of infection. Conclusion No indigenous malaria case has been reported in Shanghai since 2010. However, there are still imported malaria cases mainly from overseas so that we need to pay attention to malaria surveillance in Shanghai.

Key words: Malaria, Epidemiology, Imported case, Shanghai

中图分类号:

R531.3

朱民, 蔡黎, 张宸罡, 张耀光, 王真瑜, 江莉, 马晓疆, 朱倩, 何艳燕. 2010-2017年上海市疟疾报告病例的流行病学分析[J]. 中国寄生虫学与寄生虫病杂志, 2019, 37(1): 55-60.

Min ZHU, Li CAI, Chen-gang ZHANG, Yao-guang ZHANG, Zhen-yu WANG, Li JIANG, Xiao-jiang MA, Qian ZHU, Yan-yan HE. Epidemiological analysis of malaria cases reported in Shanghai from 2010 to 2017[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2019, 37(1): 55-60.

图/表 6

表1

图1

表2

2010-2017年上海市疟疾报告病例的人群和地区分布情况

特征Feature	病例数 No. cases	占比/% Percentage/%	恶性疟 P. falciparum	间日疟 P. vivax	其他疟疾 Other species
性别Gender
男Male	320	89.1	219	48	53
女Female	39	10.9	22	12	5
年龄组/岁Age groups/Year
< 10	5	1.4	2	3	0
10~19	6	1.7	1	5	0
20~29	85	23.7	56	16	13
30~39	102	28.4	64	17	21
40~49	99	27.6	76	11	12
50~59	43	12.0	31	6	6
60~69	15	4.2	8	2	5
≥ 70	4	1.1	3		1
职业Occupation
务工人员Laborer	116	32.3	79	20	17
干部职员Office staff	42	11.7	34	2	6
商业服务Business services	59	16.4	47	7	5
家务待业、离退休和散居儿童Housework, retiree, scattered children	42	11.7	27	11	4
学生、教师和医务工作者 Student, teacher, medical staff	19	5.3	10	8	1
交通运输人员Transportation personnel	6	1.7	3	2	1
其他Others	75	20.9	41	10	24
户籍地Registered residence
上海市Shanghai	105	29.2	72	13	20
外省Other provinces	207	57.7	140	35	32
外籍Foreigner	47	13.1	29	12	6
居住地Present living address
上海市Shanghai
浦东新区Pudong	61	17.0	40	12	9
闵行区Minhang	32	8.9	20	8	4
宝山区Baoshan	30	8.4	22	5	3
松江区Songjiang	24	6.7	14	5	5
奉贤区Fengxian	19	5.3	9	3	7
长宁区Changning	18	5.0	15	1	2
普陀区Putuo	15	4.2	11	2	2
杨浦区Yangpu	10	2.8	6	2	2
嘉定区Jiading	8	2.2	5	2	1
黄浦区Huangpu	7	1.9	4	2	1
静安区Jing’an	7	1.9	7	0	0
金山区Jinshan	7	1.9	3	1	3
崇明区Chongming	7	1.9	4	2	1
徐汇区Xuhui	6	1.7	4	1	1
青浦区Qingpu	6	1.7	2	4	0
虹口区Hongkou	4	1.1	3	0	1
其他18省76县76 counties of 18 provinces
江苏省21县21 counties of Jiangsu	29	8.1	22	3	4
浙江省11县11 counties of Zhejiang	16	4.5	13		3
安徽省10县10 counties of Anhui	11	3.1	10	1	0
甘肃省2县2 counties of Gansu	8	2.2	1	4	3
江西省5县5 counties of Jiangxi	6	1.7	4		2
福建省4县4 counties of Fujian	5	1.4	3		2
河南省5县5 counties of Henan	5	1.4	4		1
其他11省18县11 counties of others	18	5.0	15	2	1

表2

图2

表3

表4

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感染来源Infection source	报告病例数 No. cases	实验室确诊病例Laboratory confirmed cases					临床诊断病例Clinical diagnosed case
感染来源Infection source	报告病例数 No. cases	恶性疟 P. falciparum	间日疟 P. vivax	卵形疟 P. ovala	三日疟 P. malariae	未分型Unclassified	临床诊断病例Clinical diagnosed case
境外Overseas	338	241	41	26	11	9	10
非洲地区Africa	291	232	11	24	8	7	9
尼日利亚Nigeria	59	51	1	3	1	3	0
安哥拉Angola	28	23	2	1	1	1	0
加纳Ghana	23	18	0	2	1	0	2
喀麦隆Cameroon	19	16	0	1	2	0	0
赤道几内亚Equatorial Guinea	18	14	1	2	0	1	0
刚果Congo	17	14	1	2	0	0	0
加蓬Gabon	16	12	0	3	1	0	0
几内亚Guinea	14	12	0	2	0	0	0
科特迪瓦Coted′Ivoire	9	7	0	0	0	1	1
埃塞俄比亚Ethiopia	7	1	5	0	0	0	1
坦桑尼亚Tanzania	7	6	0	0	1	0	0
乌干达Uganda	7	5	0	2	0	0	0
赞比亚Zambia	6	6	0	0	0	0	0
肯尼亚Kenya	5	5	0	0	0	0	0
莫桑比克Mozambique	5	4	0	0	1	0	0
非洲Africa	51	38	1	6	0	1	5
东南亚地区Southeast Asia	32	3	25	0	1	2	1
印度India	13	1	11	0	1	0	0
印尼Indonesia	11	2	9	0	0	0	0
缅甸Myanmar	6	0	4	0	0	2	0
巴基斯坦Pakistan	1	0	0	0	0	0	1
老挝Laos	1	0	1	0	0	0	0
其他地区Other areas	15	6	5	2	1	1	0
境内输入Domestically imported	19	0	19	0	0	0	0
安徽 Anhui	15	0	15	0	0	0	0
河南 Henan	2	0	2	0	0	0	0
江苏 Jiangsu	1	0	1	0	0	0	0
云南 Yunnan	1	0	1	0	0	0	0
合计Total	357	241	60	26	11	9	10

年份 Year	性别 Gender	年龄 Age	感染来源地 Infection source	感染疟原虫虫种 Plasmodium species	发病地点 Onset place	发病-确诊间隔/d Diagnosis interval/d	抗疟药物Antimalarial drugs	剂量 Dose	救治时间/h Treatment time/h
2011	女 Female	76	尼日利亚 Nigeria	恶性疟 P. falciparum	上海 Shanghai	3	蒿甲醚 Artemether	首剂肌注160 mg, 6 h后80 mg,次日80 mg The first dose 160 mg, im, 80 mg after 6 h, the next day 80 mg	41
2014	男 Male	47	刚果 Congo	恶性疟 P. falciparum	国外 Oversea	0	青蒿琥脂 Artesunate 蒿甲醚 Artemether	剂量不详,国外治疗6 d Unknown dose for 6 days	13
2015	男 Male	57	塞拉利昂 Sierra leone	恶性疟 P. falciparum	上海Shanghai	2	蒿甲醚 Artemether	首剂肌注160 mg The first dose 160 mg, im	14