目的 观察2016-2018年江西省信丰县华支睾吸虫病综合防治示范区防治效果,探讨“以健康教育为先导,以传染源控制为主”的综合防治策略在华支睾吸虫病防治工作中的作用。方法 将信丰县有食“鱼生”习惯的26个行政村全部列入示范区范围,分别于2016年和2018年的10-11月,在示范区开展干预前的基线调查和干预后的防治效果调查。每村整群抽取150名3岁以上居民作为调查对象,采集粪样,采用改良加藤厚涂片法（一粪二检）检测居民华支睾吸虫感染情况,同步对其进行华支睾吸虫病防治知识、行为与态度、药物驱虫等问卷调查。在鱼塘和小溪等自然水体采集淡水螺和淡水鱼（每村不少于100尾）,采用压碎镜检法检测中间宿主华支睾吸虫囊蚴的感染情况。每村采集5份猫、犬或猪粪便,采用水洗沉淀集卵法检查保虫宿主粪便中的虫卵。结果 信丰县示范区覆盖5个乡（镇）26个村,共79 764人。居民感染率由2016年的21.56%（878/4 072）下降至2018年的8.85%（365/4 125）,降幅为58.95%。2016年,示范区男性和女性华支睾吸虫感染率分别为29.53%（577/1 954）和14.21%（301/2 118）,差异有统计学意义（P < 0.05）;2018年,男性和女性感染率分别降至13.09%（266/2 032）和4.73%（99/2 093）,差异有统计学意义（P < 0.05）。两次调查均显示,华支睾吸虫感染率随年龄增大而上升,以20岁以上成年人为主要感染人群。与2016年相比,2018年各年龄组感染率均明显下降,差异有统计学意义（均P < 0.01）。3~19岁和20~39岁人群感染率下降分别达72.99%和74.85%。与2016相比,除商人和公职人员的感染率差异无统计学意义外（均P > 0.05）,其他各职业人群感染率均有所下降。示范区感染人群驱虫覆盖率由2016年54.21%（476/878）提高至2018年的84.01%（310/369）,差异有统计学意义（P < 0.05）。2016年和2018年分别检获纹沼螺400只和1 000只,均未检出华支睾吸虫雷蚴和尾蚴。淡水鱼平均感染率由2016年的8.24%（144/1 747）下降至2018年0.80%（1/125）,降幅为90.29%。2016年保虫宿主平均感染率为2.27%（8/353）,2018年降为0。居民华支睾吸虫病防治知识知晓率和不食“鱼生”行为合格率分别由2016年的13.02%（525/4 033）和80.49%（3246/4 033）分别提高至2018年的20.80%（850/4 087）和83.41%（3 409/4 087）,差异有统计学意义（均P < 0.05）。3年来,累计驱虫890人,平均服药覆盖率为65.78%;新增无害化厕所3 465座,无害化厕所平均覆盖率由2016年的93.48%（16 326/17 464）增加至2018年的97.21%（1 9791/20 360）,增长了3.99%。结论 信丰县通过3年综合防治,“以健康教育为先导,以传染源控制为主”的综合防治策略在华支睾吸虫病防治工作中发挥了积极作用,示范区防治效果显著,达到了预期目标。

Objective To evaluate the effect of comprehensive control of clonorchiasis in the demonstration area in Xinfeng County of Jiangxi Province during 2016-2018, and discuss the role of the integrated control strategy “led by health education and prioritizing infection source control” in clonorchiasis control. Methods All 26 administrative villages in Xinfeng County with the habit of eating raw fish were included in this study. Investigations on the baseline information before intervention and the intervention effect after intervention were carried out in the demonstration area in October-November of 2016 and 2018, respectively. From each village, 150 residents at the age over 3 years were cluster sampled for examination by modified Kato-Katz thick smear method (two slide reading/one sample) to detect Clonorchis sinensis infection. Meanwhile, questionnaire surveys to the residents was conducted to investigate the knowledge awareness, behavior and attitude on clonorchiasis as well as administration history of anthelmintics. Freshwater snails and fish (no less than 100 in each village) were collected from natural water bodies such as fish ponds and streams, and C. sinensis metacercaria infection in intermediate hosts was detected by crushing microscopy. Five fecal samples from cats, dogs or pigs were collected from each village, and C. sinensis eggs in the feces of reservoir hosts were examined by the method of washing sedimentation for egg concentration. Results The demonstration area in Xinfeng County covered 26 villages in 5 towns, with a total population of 79 764. The infection rate dropped from 21.56% (878/4 072) in 2016 to 8.85% (365/4 125) in 2018, a decrease of 58.95%. In 2016, the infection rates of C. sinensis in males and females in the demonstration area were 29.53% (577/1 954) and 14.21% (301/2 118), respectively, with statistically significant differences (P < 0.05). In 2018, the infection rates in males and females decreased to 13.09% (266/2 032) and 4.73% (99/2 093), respectively, showing statistically significant differences (P < 0.05). Both surveys showed that the infection rate of C. sinensis increased with age, with adults over 20 years old being the main population infected. Compared with 2016, the infection rates in all age groups decreased significantly in 2018 (P < 0.01). The decrease rates in the populations at age of 3-19 years and 20-39 years reached 72.99% and 74.85%, respectively. Compared with 2016, the infection rate decreased significantly in all occupation groups except in businessmen and public officials. The deworming coverage among the infected residents in the demonstration area increased from 54.21% (476/878) in 2016 to 84.01% (310/369) in 2018, with statistically significant difference (P < 0.05). In 2016 and 2018, 400 and 1 000 snails were collected for examining C. sinensis infection, respectively, but neither redia nor cercaria were found. The average infection rate in freshwater fish dropped from 8.24% (144/1 747) in 2016 to 0.80% (1/125) in 2018, decreased by 90.29%. The average infection rate in reservoir host was 2.27% (8/353) in 2016, and declined to 0 in 2018. The awareness rate of prevention and control and the rate of correct behavior of not eating raw fish increased from 13.02% (525/4 033) and 80.49% (3 246/4 033) in 2016 to 20.80% (850/4 087) and 83.41% (3 409/4 087) in 2018, respectively, with statistically significant differences (P < 0.05). Over the 3 years, 890 people were treated with anthelmintic, with an average coverage rate of 65.78%, and 3 465 new non-hazardous toilets were built, with the average coverage of non-hazardous toilets increasing from 93.48% (16 326/17 464) in 2016 to 97.21% (1 9791/20 360) in 2018, increased by 3.99%. Conclusion The 3-year control efforts in Xinfeng County suggest that the integrated control strategy “led by health education and prioritizing infection source control” plays a positive role in clonorchiasis control in the demonstration area, indicative of significant achievement in clonorchiasis control in the area gained as expected.