2004—2018年湖北省人群血吸虫病流行趋势Joinpoint回归分析

目的　分析2004—2018年湖北省居民血吸虫病病情变化趋势，为制定消除血吸虫病策略提供参考依据。方法 　收集2004—2018年湖北省居民血吸虫病病情数据，应用Joinpoint 回归模型分析居民血检阳性率、粪检阳性率和血吸虫感染率变化趋势。结果　2004—2018年湖北省居民血吸虫病血检和粪检阳性人数均呈下降趋势，血吸虫感染率由6.85%降至0。Joinpoint 回归分析发现，2004—2018年湖北省居民血吸虫感染率总体呈下降趋势，平均年度变化百分比（AAPC）为 -24.1%（P < 0.01），其中2004—2006年和2006—2018年下降率均有统计学意义，年度变化百分比（APC）分别为-35.1%和-22.1%（P 均< 0.01）。2004—2018年，垸外洲滩、垸内和丘陵亚型流行区居民血吸虫感染率均呈下降趋势（AAPC = -25.1%、-26.4%和-32.5%，P均< 0.01）。在疫情控制（2004—2008年）、传播控制（2009—2013年）和传播阻断阶段（2014—2018年），湖北省居民血吸虫感染率均呈下降趋势（AAPC = -28.0%、-24.4%和-63.8%，P均< 0.01）。2004—2018年，湖北省居民血吸虫病血检阳性率总体呈下降趋势（AAPC = -14.5%，P < 0.01），其中2004—2012年和2012—2018年下降率均有统计学意义（APC = -8.4%和-22.1%，P均 < 0.01）。2004—2018年，湖北省居民血吸虫病粪检阳性率总体呈下降趋势（AAPC = -30.6%，P < 0.05），其中2007—2014年下降率有统计学意义（APC = -15.5%，P < 0.01）。结论　2004—2018年湖北省居民血吸虫病病情呈下降趋势，垸外洲滩和垸内亚型流行区是湖北省迈向消除阶段血吸虫病重点防控地区。

Epidemiological trends for human schistosomiasis prevalence in Hubei Province from 2004 to 2018 based on Joinpoint regression analysis

Objective　To analyze the trends of human schistosomiasis prevalence in Hubei Province from 2004 to 2018, so as to provide the evidence for formulating the schistosomiasis elimination strategy in the province. Methods　All data pertaining to human schistosomiasis prevalence in Hubei Province were collected from 2004 to 2018, and the trends for changes in seroprevalence, egg⁃positive rate and prevalence of human Schistosoma japonicum infection were analyzed using a Joinpoint regression model. Results 　Both of the numbers of residents seropositive and egg⁃positive for S. japonicum infections appeared a tendency towards a decline in Hubei Province from 2004 to 2018, and the prevalence of human S. japonicum infections reduced from 6.85% in 2004 to 0 in 2018. Joinpoint regression analysis showed that the prevalence of human S. japonicum infections appeared an overall tendency towards a reduction in Hubei Province from 2004 to 2018 [average annual percent change （AAPC） = -24.1%, P < 0.01], and the trends for the reduction were both significant during the period from 2004 to 2006 [annual percent change （APC） = -35.1%, P < 0.01] and from 2006 to 2018 （APC = -22.1%, P < 0.01）. The prevalence of human S. japonicum infections appeared a tendency towards a decline in islet （AAPC = -25.1%, P < 0.01）, inner embankment （AAPC = -26.4%, P < 0.01） and hilly subtypes of schistosomiasis⁃endemic areas （AAPC = -32.5%, P < 0.01） of Hubei Province from 2004 to 2018, and the prevalence all appeared a tendency towards a decline during the infection control stage （from 2004 to 2008）, the transmission control stage （from 2009 to 2013） and the transmission interruption stage （from 2014 to 2018） （AAPC = -28.0%, -24.4% and -63.8%, all P values < 0.01）. The seroprevalence of human S. japonicum infections appeared an overall tendency towards a decline in Hubei Province from 2004 to 2018 （AAPC = -14.5%, P < 0.01）, and the trends for the reduction were both significant during the period from 2004 to 2012 （APC = -8.4%, P < 0.01） and from 2012 to 2018 （APC = -22.1%, P < 0.01）. In addition, the egg⁃positive rate of human S. japonicum infections appeared an overall tendency towards a decline in Hubei Province from 2004 to 2018 （AAPC = -30.6%, P < 0.05）, and the trend for the reduction was significant during the period from 2007 to 2014 （APC = -15.5%, P < 0.01）. Conclusions　The prevalence of human schistosomiasis appeared a tendency towards a decline in Hubei Province from 2004 to 2018, and the islet and inner embankment subtypes of endemic areas are a high priority for schistosomiasis control during the stage moving towards elimination in Hubei Province.