论文部分内容阅读
目的对2003-2013年杭州市境外输入性疟疾报告病例流行病学特征进行分析,为制定防治措施提供依据。方法根据《疟疾诊断标准》(WS259-2006),以血片镜检找到疟原虫为实验室确诊依据,收集确诊病例个案调查表,结合年报表和网络报告等资料,对病例的人群、地区、时间分布,感染来源及诊治情况进行描述性分析,并比较间日疟和恶性疟患者在人群、时间分布上的差异。结果杭州市2003-2013年共报告境外输入性疟疾病例147例,其中,恶性疟108例,占73.47%,间日疟39例,占26.53%;患者平均年龄为(37.6±11.5)岁,以20~49岁青壮年为主,占81.63%(120/147);发病人群主要为男性,占91.84%(135/147),且男性恶性疟的感染率(95.40%)显著高于间日疟(82.10%)(χ2=5.120,P=0.024);发病人群主要为劳务输出人员,占42.18%(62/147),恶性疟和间日疟在职业构成上差异有统计学意义(χ2=14.468,P=0.006);感染地为非洲的占76.87%(113/147),东南亚的占23.13%(34/147);全年各月均有病例发生,5月份和8~10月份出现2个发病高峰,占全年发病数的41.50%(61/147),恶性疟与间日疟患者在发病时间分布上差异无统计学意义(χ2=7.724,P=0.738);间日疟从发病到确诊的时间明显高于恶性疟(t=2.23,P=0.03),外地转入杭州诊治恶性疟的患者数明显高于间日疟(χ2=4.69,P=0.03);省级医疗单位的检出率为94.0%,县级及以下医疗单位的检出率仅为26.7%。结论杭州市境外输入疟疾病例以来自非洲的境外劳务输出人员为主,基层人员恶性疟镜检能力薄弱,因此应加强多部门合作,积极开展境外劳务输出人员的主动监测及健康教育,提高基层医疗单位人员疟疾诊治能力,这是实现杭州市消除疟疾目标的关键。
Objective To analyze the epidemiological characteristics of imported malaria cases outside of Hangzhou City from 2003 to 2013 and provide evidence for the development of prevention and treatment measures. Methods According to the Diagnostic Criteria of Malaria (WS259-2006), the malaria parasite was diagnosed by blood stained microscopy as the basis of laboratory diagnosis. The questionnaires were collected from case reports, combined with the annual reports and online reports, Time distribution, source of infection and diagnosis and treatment of patients with descriptive analysis, and comparison of vivax and falciparum malaria patients in the population, time distribution differences. Results A total of 147 imported cases of imported malaria were reported in Hangzhou from 2003 to 2013, of which 108 cases were falciparum malaria (73.47%), 39 cases were Plasmodium vivax (26.53%), and the mean age was (37.6 ± 11.5) years The prevalence was 81.63% (120/147) in adults aged 20-49 years old. The prevalence was mainly male, accounting for 91.84% (135/147). The prevalence of falciparum malaria in males (95.40%) was significantly higher than that of P. vivax (82.10%) (χ2 = 5.120, P = 0.024). The majority of the patients were labor exporters, accounting for 42.18% (62/147). There was significant difference in occupational composition between P. falciparum and P. vivax (χ2 = 14.468 , P = 0.006). Infected areas were 76.87% (113/147) in Africa and 23.13% (34/147) in Southeast Asia. Cases occurred in all months of the year and in May and August-October The peak incidence, accounting for 41.50% (61/147) of the annual incidence, there was no significant difference in the distribution of the incidence of falciparum malaria and vivax malaria (χ2 = 7.724, P = 0.738) The time of diagnosis was significantly higher than that of falciparum malaria (t = 2.23, P = 0.03). The number of cases of falciparum malaria transplanted outside Hangzhou to diagnose and treat falciparum malaria was significantly higher than that of P. vivax (χ2 = 4.69, P = 0.03) The rate of 94.0%, the county-level and below the detection rate of medical units only 26.7%. Conclusion The cases of malaria imported from outside of Hangzhou are mainly from overseas labor service exporters in Africa. The capability of grass-roots staff for microscopic examination of falciparum malaria is weak. Therefore, multisectoral cooperation should be strengthened to actively carry out active monitoring and health education of overseas labor exporters and improve primary care Malaria unit diagnosis and treatment capabilities, which is to achieve the goal of eliminating malaria in Hangzhou key.