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2012-2022年上海市公共卫生临床中心输入性疟疾病例流行病学分析

Epidemiological analysis of imported malaria in Shanghai Public Health Clinical Center from 2012 to 2022

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目的 分析上海市公共卫生临床中心输入性疟疾病例流行病学特征,为上海市疟疾消除后输入性疟疾的监测与防治提供科学依据.方法 收集上海市公共卫生临床中心信息管理系统中2012-2022年的疟疾报告病例资料,采用描述性流行病学方法对报告病例的感染虫种、感染来源、三间分布、就诊和确诊情况等进行分析.结果 2012-2022年上海市公共卫生临床中心共报告疟疾病例248例,均为境外输入病例.中国籍病例228例(占91.9%),外国籍病例20例(占8.1%).报告病例以恶性疟为主(83.9%,208/248),2017年报告病例数最多(16.5%,41/248).报告病例感染来源主要为非洲国家(229例,占92.3%),其余为亚洲国家(13例,占5.2%)、南美洲国家(1例,占0.4%)和未知地区(5例,占2.0%).各月均有病例报告,输入病例数量无季节性分布.报告病例现住址在外地的为126例,上海114例,未知地区8例,其中上海以浦东新区(24例)、闵行区(14例)和松江区(11例)的疟疾报告病例数居前3位.男性报告病例234例(占94.4%),女性报告病例14例(占5.6%),男女性别比为17:1;报告病例年龄主要集中在20~49岁,占81.9%(203/248);职业分布以外出务工人员为主,占75.4%(187/248).于非上海市医院和上海市医院就诊的病例总数分别为14、234例,其中上海市三甲医疗机构的疟疾诊出率为96.3%(154/160),上海市三甲以下医疗机构疟疾诊出率为81.1%(60/74).248例报告病例从发病到初诊的时间间隔均数为4.5 d,中位数为2(0,4)d,其中3d以内的189例(占76.2%),4~10 d的51例(占20.6%),10 d以上的8例(占3.2%),不同年份病例从发病至初诊中位时间差异有统计学意义(F=6.39,P<0.05).248例报告病例从初诊至确诊时间间隔均数为1.2 d,中位数为1(0,2)d,初诊当天确诊112例,3d内确诊共223例,超过3d确诊25例,不同年份病例从初诊至确诊中位时间差异无统计学意义(F=1.24,P>0.05).结论 2012-2022年上海市公共卫生临床中心报告的疟疾病例均为境外输入病例,以恶性疟为主,感染来源主要为非洲国家.上海市应持续加强输入性病例监测和处置,提升医疗机构诊治能力,加强出境人员健康教育,以巩固消除疟疾成果.
Objective To analyze the epidemiological characteristics of malaria cases reported in Shanghai Public Health Clinical Center to provide scientific basis for surveillance and prevention malaria of imported in the pos-elimination phase.Methods Data of the malaria cases from 2012 to 2022 were collected from the information man-agement system of Shanghai Public Health Clinical Center and analyzed using descriptive statistical method on the in-fected species,source of infection,triple distribution,and clinical visits and diagnosis.Results The results showed that a total of 248 malaria cases were reported in Shanghai Public Health Clinical Center during 2012-2022,and all cases were imported from overseas.There were 228 patients of Chinese nationality(91.9%)and 20 patients were foreign-ers(8.1%).The most cases were Plasmodium falciparum infection(208 cases,83.9%).The highest number of cases was seen in 2017.The infecting cases were mostly imported from African countries(229 cases,92.3%)and others were from Asian(13 cases,5.2%),South American countries(1 case,0.4%)and unkown area(5 cases,2.0%).There were cases reported in every month,and there was no seasonal pattern on the number of imported cases.The regional distri-bution of imported cases showed that 126 cases were located out of Shanghai,114 cases were in Shanghai.There were 8 cases unknown.Pudong New Area(24 cases,21.1%),Minhang District(14 cases,12.3%)and Songjiang District(11 cases,9.6%)had the highest number of cases in Shanghai.The reported malaria cases comprised 234 males(94.4%)and 14 females(5.6%),with a male-to-female ratio of 17:1.The age of the cases were mainly in the age groups of 20-49 years(203 cases,81.9%).The occupational background of the cases was dominated by migrant workers(187 cases,75.4%).The number of cases treated at non-Shanghai hospitals and Shanghai hospitals were 14 and 234 cases,respectively.The malaria successful diagnosis rate was 96.3%(154/160)in tertiary A-level hospital,and 81.1%(60/74)in lower medical institutions during 2012-2022 in Shanghai.According to the 248 malaria cases,the average time pe-riod from the onset of symptoms to initial examination was 4.5 days,with a median of 2(0,4)d.Of the Shanghai cases,189 cases(76.2%)had initial examination 3 days after the onset of symptoms,51 cases(20.6%)had that 4-10 days after the onset of symptoms,and 8 cases(3.2%)had that 10 days after the onset of symptoms.There was a sig-nificant difference between the median time from onset of symptoms to initial examination of malaria(F=6.393,P<0.05).The mean time intervals from initial examination to diagnosis was 1.2 d,and the median was 1(0,2)d.Of these cases,112 patients were diagnosed on the day of first examination;223 cases were diagnosed within 3 days after the initial exminatio and 25 were diagnosed more than 3 days after the initial examination.There was no significant differ-ence between the median time from first examination to diagnosis(F=1.24,P>0.05).Conclusion The malaria cases reported in Shanghai Public Health Clinical Center from 2012 to 2022 were all imported from abroad with the domi-nant species of P.falciparum.The infection source was mainly from African countries.It is urged that Shanghai should continuously strengthen the surveillance and management of imported malaria,enhance the capability of diagno-sis and clinical care in medical institutions,and strengthen health education for outbound personnel to consolidate the achievements of malaria elimination.

MalariaImported casesEpidemiological characteristicShanghai

文静、郭明权、张蓓、张腾飞、潘帅、孙丹凤、戚伟强

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上海市公共卫生临床中心检验医学科,上海 201508

疟疾 输入性病例 流行病学特征 上海

2024

中国寄生虫学与寄生虫病杂志
中华预防医学会,中国疾病预防控制中心寄生虫病预防控制所

中国寄生虫学与寄生虫病杂志

CSTPCD北大核心
影响因子:1.155
ISSN:1000-7423
年,卷(期):2024.42(2)