2010—2020年常州市疟疾流行特征及病例诊断情况分析

目的 分析2010—2020年常州市疟疾流行特征，为制定和调整防控策略和措施提供依据。方法 通过中国疾病预防控制信息系统中的传染病监测系统和寄生虫病防治信息管理系统，收集2010—2020年常州市疟疾病例流行病学个案调查信息，运用SPSS 22.0软件对疟疾疫情和病例的三间分布、感染来源、发病及诊治情况等进行统计分析。结果 2010—2020年，常州市共报告疟疾病例233例，其中境外输入病例230例，本地感染病例2例，外省输入病例1例。境外输入病例主要来源于非洲（220例，95.65%）和东南亚（8例，3.48%）。除4例为临床诊断病例外，其余229例确诊病例中，恶性疟164例（71.62%），卵形疟42例（18.34%），间日疟16例（6.99%），三日疟7例（3.06%）。病例主要分布在金坛区（92例，39.48%）和溧阳市（85例，36.48%）；以男性为主（225例，96.57%），主要为22～59岁青壮年（230例，98.71%）；出境事由以务工为主（213例，92.61%）。境外输入病例入境到发病时间中位数为8 d，大部分病例（171例，77.03%）在入境14 d内发病。发病到确诊时间中位数为3 d，其中门诊治疗病例、一般住院治疗病例和危重症住院治疗病例发病到确诊时间中位数分别为2 d、3 d和6 d，差异有统计学意义（χ２=6.313，P=0.043）。初诊、确诊单位均以地市级及县级医疗机构为主。病例首诊确诊率为73.82%（172/233），其中地市级及县级疾控机构、地市级及县级医疗机构、乡镇卫生院及以下机构的首诊确诊率分别为100.00%（52/52）、79.07%（102/129）、34.62%（18/52），差异有统计学意义（χ２=61.636，P<0.001）。结论 境外输入性疟疾已成为常州市疟疾防控的主要任务，应加强赴非洲等疟疾流行区出境人员的疟疾防治知识宣传和教育，提高预防和及时就诊意识，并持续提升各级医疗卫生机构医务人员疟疾诊治能力，防止输入性病例再传播。

Analysis of malaria epidemic characteristics and case diagnosis in Changzhou City from 2010 to 2020

Objective To analyze the epidemiological characteristics of malaria in Changzhou City from 2010 to 2020, so as to provide evidence for formulating and adjusting the strategies and measures for prevention and control of malaria infection. Methods The epidemiological investigation information on the malaria cases in Changzhou City from 2010 to 2020 was collected through the sub-system of infectious disease monitoring and parasitic disease prevention and control information management under China Information System for Disease Prevention and Control. Software SPSS (version 22.0) was used to analyze malaria epidemic situation and the three-dimensional distribution, source of infection, time of onset, diagnosis and treatment. Results A total of 233 malaria cases were reported in Changzhou City from 2010 to 2020, including 230 cases imported from abroad, 2 cases of local infection and 1 case imported from another province. Imported cases were mainly from Africa (n=220, 95.65%) and Southeast Asia (n=28, 3.48%). Apart from 4 clinically diagnosed cases, 229 confirmed cases consisted of infection with Plasmodium falciparum(n=164, 71.62%), Plasmodium ovale(n=42, 18.34%), Plasmodium vivax(n=16, 6.99%) and Plasmodium malariae(n=7, 3.06%). The cases were mainly distributed in Jintan District (n=92, 39.48%) and Liyang City (n=85, 36.48%). The infection was most seen in males (n=225, 96.57%), and dominant in age ranging from 22 to 59 years old (n=230, 98.71%). The major reason for leaving the country was to work abroad (n=213, 92.61%). The median interval from entry to onset of malaria among imported cases was 8 days, and most cases (n=171, 77.03%) developed within 14 days after entry. The median interval from onset to diagnosis was 3 days, and 2, 3 and 6 days for patients confirmed on outpatient basis, inpatients and critical in patients, respectively. The difference was statistically significant (χ２=6.313, P=0.043). The primary and final diagnosis primarily occurred in medical institutions at city/county level. The overall proportion of malaria cases diagnosed at the initial visit was 73.82%(172/233), and 100.00%(52/52), 79.07%(102/129) and 34.62%(18/52) at city/county level CDCs, city/county level hospitals, township health centers or below, respectively. The difference was significant(χ２=61.636, P<0.001). Conclusion Imported malaria has become the main risk factor for the prevention and control of malaria in Changzhou City, which suggests that we should strengthen the publicity and education of malaria prevention and control knowledge for personnel leaving the country for working in malaria endemic areas such as Africa, so as to improve their awareness of malaria prevention and timely treatment. In addition, the capacity of malaria diagnosis and treatment of staff in medical and health institutions at all levels should be constantly improved to prevent the retransmission of imported cases.