目的 了解和分析全国人体重点寄生虫病的流行现状和态势,为制定防治规划提供科学依据。 方法 2014-2016年在全国31个省（直辖市、自治区,未包括港澳台地区）的农村地区根据全国生态功能区划分和各县农民年人均纯收入划分（高、中、低）,采用分层整群随机抽样的方法,在每省抽取4~36个县,每县抽取2~4个自然村,共1 890个调查点,每个调查点抽样调查常住居民250人,采集粪便,应用改良加藤厚涂片法（Kato-Katz法,一粪二检）检测蠕虫感染情况,生理盐水涂片法和碘液涂片法检测原虫感染情况,对3~6岁儿童采用透明胶纸肛拭法检测蛲虫感染情况。同时,在城镇地区调查人群华支睾吸虫感染情况,按感染水平将全国划分为5类华支睾吸虫流行区（Ⅰ~Ⅴ）,不同流行区类型的各省抽取2~37个县,在城镇地区以居委会为调查点,共抽样517个调查点, 每个调查点调查常驻居民250人,仅调查华支睾吸虫感染情况。 结果 全国31个省（直辖市、自治区）共调查617 441人,其中农村484 210人,城镇133 231人,检出重点寄生虫感染者20 351例,检出率为3.30%;查出虫种34种,其中蠕虫23种,原虫11种。重点寄生虫加权感染率为5.96%,推算感染人数约为3 859万。其中蠕虫加权感染率为5.10%,肠道原虫加权感染率为0.99%,推算感染人数约为642万;土源性线虫加权感染率为4.49%,推算感染人数约为2 912万;3~6岁儿童蛲虫感染率为3.43%,推算感染人数约为155万;带绦虫加权感染率为0.06%,推算感染人数约为37万。全国华支睾吸虫加权感染率为0.47%,推算感染人数约为598万;农村华支睾吸虫加权感染率为0.23%,推算感染人数约为152万;城镇华支睾吸虫加权感染率为0.71%,推算感染人数约为446万。重点寄生虫感染流行呈明显区域性分布,土源性线虫中、高度流行区主要分布在四川、海南、贵州、云南、重庆、广西、广东和江西等省（直辖市、自治区）。华支睾吸虫流行区主要集中在广东、广西、黑龙江和吉林等省（自治区）;带绦虫感染仍然主要分布在西藏;3~6岁儿童蛲虫高感染地区主要集中在海南、江西、广东、广西、贵州和重庆等省（直辖市、自治区）。50%以上的肠道原虫感染者集中分布在西藏、贵州和广西等西部省（自治区）。 结论 全国重点寄生虫感染率大幅降低,尤其是土源性线虫病下降最明显,绝大部地区处于低度流行或散发状态,且流行区域也明显缩小,但仍有一些省或局部地区感染较严重。重点寄生虫感染流行呈明显区域性分布,土源性线虫中、高度流行区主要分布在西南和南部两大片区,华支睾吸虫流行区主要分布在华南和东北两大片区,带绦虫仍然主要分布在西藏,3~6岁儿童蛲虫高感染地区主要集中在华南和西南地区,肠道原虫呈现出局部地区感染率较高的特点,主要分布在西部省份。我国农村地区重点寄生虫感染人数仍然较多,防控任务仍然艰巨。
陈颖丹
,
周长海
,
朱慧慧
,
黄继磊
,
段磊
,
诸廷俊
,
钱门宝
,
李石柱
,
陈红根
,
蔡黎
,
胡桃
,
雷正龙
,
李华忠
,
李中杰
,
汪天平
,
孙军玲
,
许汴利
,
严俊
,
杨益超
,
曾小军
,
王国飞
,
臧炜
,
王聚君
,
周晓农
. 2015年全国人体重点寄生虫病现状调查分析[J]. 中国寄生虫学与寄生虫病杂志, 2020
, 38(1)
: 5
-12
.
DOI: 10.12140/j.issn.1000-7423.2020.01.002
Objective To understand and analyze the current status and endemic trends of important human parasitic diseases, and provide scientific basis for the formulation of control programs in China. Methods The survey was carried out in 31 provinces (autonomous regions/municipalities) (hereinafter referred to as "P/A/Ms", excluding Hong Kong, Macao and Taiwan regions) of China from 2014 to 2016, using stratified cluster random sampling method. In rural areas, survey sites were selected based on the strata of ecological function in the nationwide eco-mapping and farmer’s income level (high, moderate and low annual net income per capita) in the county, by sampling 4-36 counties per province and 2-4 natural villages each sampled county. Totally, 1 890 survey sites were sampled, from each of them 250 permanent residents were surveyed by fecal examination for helminthes infection using modified Kato-Katz thick smear method (one sample, two slide-readings), applying saline smear and iodine solution smear method for protozoa infection, and by anal transparent tape test to examine Enterobius vermicularis infection for the children aged 3-6 years. In urban areas, however, only human Clonorchis sinensis infection was surveyed by fecal examination. For this purpose, the country was categorized into five endemic regions (I-V) based on the C. sinensis infection prevalence by region. A total of 517 survey sites were sampled, by selecting 2-37 counties from each province of all endemic regions, and taking urban resident community as the survey site. From each site, 250 permanent residents were surveyed for C. sinensis infection. Results A total of 617 441 people were surveyed in 31 P/A/Ms, comprising 484 210 from rural areas and 133 231 from urban areas, among them, 20 351 were found infected with important parasites (detection rate, 3.30%). A total of 34 species of parasites were found, including 23 helminth species and 11 protozoan species. The weighted infection rate of important parasites was 5.96%, accordingly, having estimated 38.59 million infected people. More specifically, the weighted infection rate of helminths was 5.10%, and that of intestinal protozoa was 0.99%, estimating 6.42 million people being infected. The weighted infection rate of soil-transmitted helminthes (STHs) was 4.49%, estimating 29.12 million people infected. The infection rate of Enterobius vermicularis was 3.43% in children aged 3-6 years, estimating 1.55 million infected children. The weighted infection rate of Taenia spp. was 0.06%, estimating 0.37 million infected. The weighted infection rate of C. sinensis in the country was 0.47%, estimating 5.98 million infected people. The weighted infection rate of C. sinensis in rural areas and urban areas was 0.23% and 0.71%, respectively, estimating 1.52 million and 4.46 million people infected. The important parasite infection displays an obvious regional distribution. The highly endemic areas of STHs infection were mainly distributed in Sichuan, Hainan, Guizhou, Yunnan, Chongqing, Guangxi, Guangdong and Jiangxi; the endemic areas of C. sinensis were restrictedly distributed in Guangdong, Guangxi, Heilongjiang and Jilin; the Taenia infection was mainly distributed in Tibet; and the highly endemic areas of E. vermicularis infection in children aged 3-6 years were mainly located in Hainan, Jiangxi, Guangdong, Guangxi, Guizhou and Chongqing. Over 50% of intestinal protozoa-infected people were distributed concentratedly in west China including Tibet, Guizhou and Guangxi. Conclusion The infection rate of important parasites, especially STHs, has been reduced significantly in China, showing a low level of prevalence or sporadically distributed in most of areas, and the scope of endemic regions has been markedly reduced as well. However, severe infection still exists in some provinces or local areas. The important parasite infection displays evident regional distribution pattern. Medium- and high-prevalence areas of STHs are mainly distributed in two broad regions in south and southwest China. The endemic areas of C. sinensis infection are mainly distributed in another two broad regions in southern and northeastern part of China. Taenia infection remains distributed in Tibet. The highly endemic areas of E. vermicularis infection in children aged 3-6 years are concentrated located in the southern and southwestern China. The intestinal protozoa infection is characterized with higher infection occurred in some limited areas, mainly distributed in western provinces. The number of people infected with important parasites in rural areas remains high, thus, prevention and control in this regard is still an arduous task.
[1] Xu LQ, Yu SH, Xu SH.Distribution and pathogenic impact of human parasites in China[M], Beijing: People’s Medical Publishing House, 1999: 1-664. (in Chinese)
(许隆祺, 余森海, 徐淑惠. 中国人体寄生虫病分布调查[M]. 北京: 人民卫生出版社, 1999: 1-664.)
[2] Xu LQ, Jiang ZX, Yu SH, et al. Nationwide survey of the distribution of human parasites in china-infection with parasite species in human population[J]. Chin J Parasitol Parasit Dis, 1995, 13(1): 3-9. (in Chinese)
(许隆祺, 蒋则孝, 余森海,等. 全国人体寄生虫分布调查——虫种的人群感染[J]. 中国寄生虫学与寄生虫病杂志, 1995, 13(1): 3-9.)
[3] Wang LD.Report on the national survey of current status of major human parasitic diseases in China[M]. Beijing: People’s Medical Publishing House 2007: 1-27. (in Chinese)
(王陇德. 全国人体重要寄生虫病现状调查[M]. 北京: 人民卫生出版社, 2007: 1-27.)
[4] Coording Office of the National Survey on the Important Human Parasitic diseases. A national survey on current status of the important parasitic diseases in human population[J]. Chin J Parasitol Parasit Dis, 2005. 23(5 Suppl): 332-340. (in Chinese)
(全国人体重要寄生虫病现状调查办公室. 全国人体重要寄生虫病现状调查报告[J]. 中国寄生虫学与寄生虫病杂志, 2005, 23(5增刊): 332-340.)
[5] Yan J, Hu T, Lei ZL.The endemic situation and challenges of major parasitic diseases in China[J]. Chin J Parasitol Parasit Dis, 2015, 33(6): 412-417. (in Chinese)
(严俊, 胡桃, 雷正龙. 全国重点寄生虫病的防控形势与挑战[J]. 中国寄生虫学与寄生虫病杂志, 2015, 33(6): 412-417.
[6] General Office of the National Health and Family Planning Commission. Notice of the general office of the national health and family planning commission on the investigation plan on the status of key human parasitic diseases (General office of the national health and family planning commission letter [2014] no. 898) [Z]. 2014. (in Chinese)
(国家卫生计生委办公厅. 国家卫生计生委办公厅关于印发全国人体重点寄生虫病现状调查方案的通知(国卫办疾控函〔2014〕898号)[Z]. 2014.)
[7] China ecosystem assessment and ecological security database (China’s ecological function zoning plan)[Z]. (2014-06-06). http://www.ecosystem.csdb.cn/ecoass/ecoplanning.jsp. (in Chinese)
(中国生态系统评估与生态安全数据库(中国生态功能区划方案)[Z]. (2014-06-06). http://www.ecosystem.csdb.cn/ecoass/ecoplanning.jsp.)
[8] Ministry of Environmental Protection, Chinese Academy of Sciences. Chinese Academy of Sciences. Chinese Academy of Sciences. National ecological function zoning[Z]. 2008. (in Chinese)
(中华人民共和国环境保护部: 中国科学院. 全国生态功能区划[Z]. 2008.)
[9] China CDC.Annual report on surveillance of selected infectious diseases and vectors, China, 2012[R]. Beijing: China CDC, 2013. (in Chinese)
中国疾病预防控制中心. 中国重点传染病和病媒生物监测报告2012[R]. 北京: 中国疾病预防控制中心, 2013.
[10] Chen YD, Huang JL, Zhu HH, et al. China’s control process of soil-transmitted helminth infections from pandemic to low-endemic levels[J]. Chin J Parasitol Parasit Dis, 2019, 37(4): 395-398. (in Chinese)
(陈颖丹, 黄继磊, 朱慧慧, 等. 我国土源性线虫从高感染到低感染水平的防治历程[J]. 中国寄生虫学与寄生虫病杂志, 2019, 37(4): 395-398.)
[11] Chen YD, Zhu HH, Huang JL, et al. Status and working principals of soil-transmitted nematodiasis during new period in China[J]. Chin J Schisto Control, 2019, 31(1): 23-25. (in Chinese)
(陈颖丹, 朱慧慧, 黄继磊, 等. 我国土源性线虫病流行现状及新时期防控原则[J]. 中国血吸虫病防治杂志, 2019, 31(1): 23-25.)
[12] Zhu TJ, Zhou CH, Wang JJ, et al. Evaluation of soil-transmitted helminth control after cessation of intervention measures in eight demonstration plots[J]. Chin J Parasitol Parasit Dis, 2017, 35(5): 439-444. (in Chinese)
(诸廷俊, 周长海, 王聚君, 等. 8个干预示范区停止干预措施后土源性线虫病的控制现状评价[J]. 中国寄生虫学与寄生虫病杂志, 2017, 35(5): 439-444.)
[13] Zhu TJ, Chen YD, Xu LQ. Prevention and treatment of ascariasis in demonstration plots of integrated control from 2006 to 2009[J]. Chin J Schisto Control, 2011, 23(5): 490-494. (in Chinese)
(诸廷俊, 陈颖丹, 许隆祺. 我国寄生虫病综合防治示范区蛔虫病3年防治效果[J]. 中国血吸虫病防治杂志, 2011, 23(5): 490-494.)
[14] Zheng CJ, Wang RR, Chen YD, et al. Organization and management in demonstration plots carrying out integrated control measures for parasitic diseases[J]. Chin J Schisto Control, 2011, 23(5): 561-562. (in Chinese)
(郑灿军, 王蓉蓉, 陈颖丹, 等. 寄生虫病综合防治示范区工作的组织管理[J]. 中国血吸虫病防治杂志, 2011, 23(5): 561-562.)
[15] Chen YD, Wang JJ, Zang W, et al. Cost-effectiveness analysis of integrated control strategy of parasitic diseases in demonstration plots[J]. Chin J Schisto Control, 2011, 23(5): 501-505. (in Chinese)
(陈颖丹, 王聚君, 臧炜, 等. 寄生虫病综合防治示范区不同驱虫方案的防治成本效果分析[J]. 中国血吸虫病防治杂志, 2011, 23(5): 501-505.)
[16] Wu WP, Wang H, Wang Q, et al. A nationwide sampling survey on echinococcosis in China during 2012-2016[J]. Chin J Parasitol Parasit Dis, 2018, 36(1): 1-14. (in Chinese)
(伍卫平, 王虎, 王谦, 等. 2012-2016年中国棘球蚴病抽样调查分析[J]. 中国寄生虫学与寄生虫病杂志, 2018, 36(1): 1-14.)
[17] Wang GQ. Survey on the prevalence of echinococcosis in China[M]. Shanghai: Shanghahi science and technology publishing house, 2016: 22-23. (in Chinese)
(王国强. 全国包虫病流行情况调查[M]. 上海: 上海科学技术出版社, 2016: 22-23.)
