收稿日期: 2023-06-27
修回日期: 2023-09-12
网络出版日期: 2023-12-27
Surveillance on soil-transmitted helminth infections in Yunnan Province from 2016 to 2022
Received date: 2023-06-27
Revised date: 2023-09-12
Online published: 2023-12-27
目的 了解云南省人群土源性线虫感染现状及流行趋势,为制定土源性线虫病防治策略和措施提供科学依据。方法 2016—2022年,按照《全国肝吸虫病和土源性线虫病监测方案(试行)》要求,在云南省各州(市)至少抽取1个县(市、区)设立土源性线虫病监测点,各监测点根据地理方位划分为5个片区(东、西、南、北、中),每个片区随机抽取1个乡(镇)的1个行政村开展监测,以3周岁及以上本地常住居民为监测对象,每个行政村整群抽取监测对象不少于200人,每个监测点监测人数不少于1 000人。采集监测对象的粪样(约30 g),采用改良加藤厚涂片法(Kato-Katz法,一粪两检)检测土源性线虫(钩虫、蛔虫、鞭虫和蛲虫)虫卵,计算感染率和感染度。钩虫卵阳性者粪便采用试管滤纸培养法鉴别钩虫虫种,3~9岁儿童加做透明胶纸肛拭法检测蛲虫感染情况。感染率的比较采用卡方检验。结果 2016—2022年在云南省共设立71个监测点,监测108 221人,检出土源性线虫感染7 475例,总感染率为6.91%(7 475/108 221),其中钩虫、蛔虫、鞭虫和蛲虫的感染率分别为3.75%(4 056/108 221)、1.68%(1 817/108 221)、2.23%(2 408/108 221)和0.11%(121/108 221)。试管滤纸培养法培养出钩蚴1 288份,其中美洲钩虫感染1 199份,十二指肠钩虫感染79份,两者混合感染10份。2016—2022年,云南省各年度人群土源性线虫感染率分别为12.03%(1 606/13 350)、8.67%(1 317/15 195)、7.10%(1 095/15 425)、5.37%(897/16 693)、5.83%(969/16 617)、5.77%(922/15 967)和4.47%(669/14 974),各年份间土源性线虫感染率差异有统计学意义(χ2 = 880.360,P < 0.01)。检测的16个州(市)中,土源性线虫感染率最高为西双版纳州(26.21%,1 312/5 006),最低为丽江市(0.15%,6/4 041),不同州(市)间土源性线虫感染率差异有统计学意义(χ2 = 8 081.151,P < 0.01)。女性和男性的土源性线虫感染率分别为7.40%(4 276/57 812)和6.35%(3 199/50 409)(χ2 = 46.198,P < 0.01)。不同人群的土源性线虫感染率中,年龄分布以10~19岁年龄组最高(8.56%,1 249/14 592),民族分布以布朗族最高(30.20%,778/2 576),职业分布以学生最高(7.96%,1 638/20 588),文化程度分布以文盲和半文盲人群最高(10.06%,1 078/10 719);不同年龄、民族、职业和文化程度间人群土源性线虫感染率差异均有统计学意义(χ2 = 139.432、8 546.389、324.218、833.291,均P < 0.01)。结论 2016—2022年云南省人群土源性线虫感染率呈下降趋势,但部分地区仍维持在较高水平,应继续加强对边境地区少数民族、农民、老年人等重点人群的土源性线虫病综合防治工作。
吴方伟 , 彭佳 , 字金荣 , 李奔福 , 严信留 , 蔡璇 , 王正青 , 徐倩 , 李建雄 , 杨亚明 . 2016—2022年云南省土源性线虫感染监测结果分析[J]. 中国寄生虫学与寄生虫病杂志, 2023 , 41(6) : 718 -724 . DOI: 10.12140/j.issn.1000-7423.2023.06.008
Objective To understand the prevalence and transmission of soil-transmitted helminth (STH) infection in Yunnan Province, providing scientific basis for formulating prevention and control strategies and measures. Methods The surveillance sites were selected in Yunnan Province according to the National Surveillance Program for Clonorchiasis and Soil-transmitted Nematodes (Pilot) from 2016 to 2022. From each district (city), at least one county (city, township) was selected as the surveillance site, which was further divided into 5 sectors (east, west, south, north and central) according to the geographic location. From each sector, one township (town) was selected randomly and an administrative village was selected from the township (town) to conduct the surveillance among permanent residents over 3 years old. No less than 200 residents were cluster sampled from each administrative village and no less than 1 000 residents from each surveillance site. Fecal samples (about 30 g) from the enrolled residents were collected and examined for STH eggs (hookworm, Ascaris lumbricoides, Truchuris trichiura and Enterobius vermicularis) by modified Kato-Katz thick smear method (two slide-reading for each sample). The infection rate and intensity of STH were calculated. The hookworm egg positive samples were further identified for species by tube-filter paper culture method. Children aged 3-9 were additionally examined for E. vermicularis eggs with transparent tape and anal swab method. Chi-square test was used to compare the infection rates. Results A total of 108 221 residents were enrolled in the surveillance from 71 surveillance sites in Yunnan Province and the total STH infection rate was 6.91% (7 475/108 221) from 2016 to 2022. The infection rates of hookworm, A. lumbricoides, T. trichiura and E. vermicularis were 3.75% (4 056/108 221), 1.68% (1 817/108 221), 2.23% (2 408/108 221) and 0.11% (121/108 221) respectively. A total of 1 288 cases of hookworm infection were identified by tube-filter paper culture method. 93.09% (1 199/1 288) of them were infected with Necator americanus, 6.13% (79/1 288) were infected with Ancylostoma duodenale and 0.78% (10/1 288) were co-infected. From 2016 to 2022, the annual infection rates of STH in Yunnan Province were 12.03% (1 606/13 350), 8.67% (1 317/15 195), 7.10% (1 095/15 425), 5.37% (897/16 693), 5.83% (969/16 617), 5.77% (922/15 967) and 4.47% (669/14 974) respectively. The differences between the infection rates among different years were statistically significant (χ2 = 880.360, P < 0.01). Among the 16 prefectures (cities) surveyed, the highest STH infection rate was found in Xishuangbanna (26.21%, 1 312/5 006) and the lowest was found in Lijiang City (0.15%, 6/4 041). The differences between the infection rates among different prefectures (cities) were statistically significant (χ2 = 8 081.151, P < 0.01). The STH infection rates in male and female were 6.35% (3 199/50 409) and 7.40% (4 276/57 812) respectively, with a significant difference (χ2 = 46.198, P < 0.01). Among the different age-groups, nationalities, occupations and educational levels, the highest infection rates were found in the group of 10 to 19 year-old (8.56%, 1 249/14 592), Bulang ethnic group (30.20%, 778/2 576), students (7.96%, 1 638/20 588) and illiteracy or semi-illiteracy group (10.06%, 1 078/10 719), with the significant differences (χ2 = 139.432, 8 546.389, 324.218, 833.291; all P < 0.01). Conclusion From 2016 to 2022, the STH infection rate in Yunnan Province showed a decreasing trend, but remained at a comparatively high level in some areas. It is imperative to continuously strengthen comprehensive control of STH for the key population including the ethnic groups near the border areas, farmers and the elderly.
Key words: Soil-transmitted helminth; Infection rate; Surveillance; Yunnan Province
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