武汉市2012-2019年输入性疟疾流行病学与临床特征分析  

Epidemiological and Clinical Characteristics of Imported Malaria in Wuhan,China,2012-2019

作　　者：余树坤 张首楠 张力 王雨欣[1] 谭雅心 魏晟[2] 石梓薇 吴凯 陶志阳[1] 无 YU Shu-kun;ZHANG Shou-nan;ZHANG Li;WANG Yu-xin;TAN Ya-xin;WEI Sheng;SHI Zi-wei;WU Kai;TAO Zhi-yang;无(Wuhan Dongxihu District Centers for Disease Control and Prevention,Wuhan 430040,China;Department of Epidemiology and Biostatistics,School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Yangjiachang Town Health Center,Gong’an County,Jingzhou 434303,China;Wuhan Centers for Disease Control and Prevention,Wuhan 430021,China)

机构地区：[1]武汉市东西湖区疾病预防控制中心,武汉430040 [2]华中科技大学同济医学院公共卫生学院流行病与卫生统计系,武汉430030 [3]湖北省公安县杨家厂镇卫生院,荆州434303 [4]武汉市疾病预防控制中心,武汉430021

出　　处：《中国人兽共患病学报》2024年第6期583-589,共7页Chinese Journal of Zoonoses

基　　金：湖北省卫生健康委2019年度第三批联合基金立项项目(No.WJ2019H406);武汉市医学科研项目(No.WG19Q09)联合资助。

摘　　要：目的武汉市自2013年以来已经消除了本地疟疾,但输入性疟疾作为本地疟疾传播的传染源仍然是一个潜在的威胁。了解输入性疟疾的流行病学和临床特征在已被消除本地疟疾的地区尤为重要。分析武汉市2012-2019年输入性疟疾的流行病学和临床特征,为进一步做好输入性疟疾防控工作提供依据。方法收集2012年1月1日至2019年12月31日在武汉诊断为输入性疟疾的患者信息,并对病例的流行病学和临床特征进行描述。采用病例对照研究,分析重症疟疾患者的特征;同时采用单因素和多因素Logistics回归来识别住院时间的影响因素。结果武汉市2012-2019年累计报告输入性疟疾病例229例。221例为男性(96.5%),男女性别比为28∶1,病例年龄段主要集中在18~50岁(89.1%)。82.1%的患者是境外务工人员,212例(92.6%)自非洲国家输入,主要来源国为尼日利亚36例(15.7%)、安哥拉27例(11.8%)、刚果金17例(7.4%)。病例以恶性疟为主(185例,80.8%),其次为间日疟24例(10.5%)和卵形疟16例(7.0%)。重症病例53例,重症率为23.1%。首次患疟疾(P=0.008)、感染恶性疟原虫(P=0.009),以及在最初诊断时被误诊(P<0.001)的患者发展为重症的比例要更高(均P<0.05)。患者的中位住院时间为6 d,病例类型(恶性疟)、抗疟药物(采用氯喹伯氨喹)、退热时间(超过3 d)和血涂片镜检转阴时间(超过3 d)都与较长的住院时间有关(均P<0.05)。结论本地疟疾已被消除多年,但输入性病例仍构成威胁。应加强对出境人员特别是前往非洲东南亚等疟疾流行地区的务工人员进行疟疾知识宣教。同时提高医疗机构的疟疾诊治能力,遵循规范化的治疗过程,减少患者的住院时间,降低疟疾给患者家庭和社会带来的负担。Although indigenous malaria has been eliminated in Wuhan since 2013,imported malaria remains a potential threat as an infectious source of local malaria transmission.The epidemiological and clinical characteristics of imported malaria are particularly important in areas where local malaria has been eliminated.This study was aimed at analyzing the epidemiological and clinical characteristics of imported malaria in Wuhan from 2012 to 2019,to provide a basis for further improving the prevention and control of imported malaria.Patients in Wuhan diagnosed with imported malaria from January 1,2012,to December 31,2019,were included in this study.A case-control study was conducted to analyze the features of patients with severe malaria.Univariate and multivariate logistic regression was used to identify risk factors for prolonged hospital length of stay(LOS).Among 229 imported malaria cases,212(92.6%)were in Chinese citizens,and most cases were in men(96.5%).The gender ratio is 28∶1,and the age of cases is mainly concertrated between 18 and 50 years old(89.1%).More than 80%of patients were migrant workers,and most cases were infections from African countries(92.6%).Plasmodium falciparum(80.8%)was the dominant species.Fifty-three severe malaria cases were identified during the study period.Compared with uncomplicated cases,severe cases tended to occur in patients with no history of malaria(P=0.008),patients infected with Plasmodium falciparum(P=0.009),and patients who were initially misdiagnosed(P<0.001).The median LOS was 6 days,and the species of infection(Plasmodium falciparum),the use of antimalarial drugs(group B),antipyretic time(longer than 3 days),and the turnaround time of blood smear microscopy(longer than 3 days)were significantly associated with longer LOS(all P<0.05).Although malaria has been eradicated in Wuhan for many years,imported cases continue to pose a threat.Efforts should be made to strengthen malaria knowledge education for outbound personnel.Additionally,medical institutions must enhance diagnos

关 键 词：输入性疟疾 恶性疟 重症疟疾 住院时间 影响因素 境外务工人员 

分 类 号：R383.3[医药卫生—医学寄生虫学]