2011-2020年山东省麻风病例早期发现综合措施效果评价

目的:通过比较历年新发麻风病例2级畸残比,评价我省综合防治措施在麻风病例早期发现中的作用。方法:近10年来,我省相继开展了麻风可疑者筛查、密切接触者检查、大众宣传、人员培训、疑似病例转诊、省级诊断确认、报病奖励、强化转诊中心、麻风症状监测等病例发现措施。结果:我省2011-2020年共发现113例新发病例,其中男71例,女42例,平均年龄52.2岁,2例儿童病例。输入病例31例,主要来自云、贵、川等高发省份,以外来媳妇和务工人员为主。本土病例主要来自原高、中流行市县,以农民(工)为主。2011-2015年平均就诊延迟期为31.7个月,2016-2020年为13.0个月,差异有统计学意义(t=2.101,P=0.04)。2011年新发病例中G2D占比40%,2020年下降至20%。多因素分析发现,诊断延迟期超过24个月与2级畸残的发生相关。结论:我省采取的麻风病例综合早期发现措施有效降低了新发患者G2D占比。     

麻风病基本消灭阶段的流行病学特征

目的：分析麻风病基本消灭阶段流行病学特征,以指导麻风防治工作。方法：根据山东省历年的麻风病人登记表,分析比较麻风基本消灭阶段与防治初期的流行学特征。结果：麻风基本消灭阶段的流行病学特征与防治初期比较有显著变化;新病例呈散在分布;发病年龄显著升高;少年儿童发病显著减少;多菌型病例所占比升高。复发病例在新发病例中占比升高。结论：麻风病中、高流行区达到基本消灭麻风病后,应根据其流行病学特征采取相应防治对     

麻风低流行状态是否仍需要接触者检查?

目的：分析麻风低流行状况下，接触者检查对发现新发病人的效果。方法：对山东省近11年来新发麻风病人的发病潜伏期和相关资料进行回顾性分析。结果：1991-2001年诊断的547例麻风病人中有252例有麻风接触史，平均潜伏期为23年，90例家庭内接触者中仅有12例(13．3％)和10例(11．1％)可在5-10年内被发现，占总新发现病人的2％。结论：在山东麻风低流行状态下，现行政策的接触者检查的效果较低，为了尽早发现新的麻风病人，需寻求其他方法，如对医务人员加强有关麻风早期诊断知识的培训。     

开展消除麻风运动后对当地新发现病人状况的影响

目的：分析开展消除麻风运动后对当地新发现麻风病人状况的影响。方法：通过比较麻风高流行县（市）开展消除麻风运动前、中和后一年的麻风新发现病人资料，分析新发现麻风病人各个方面情况。结果：发现所有8个县（市）在开展消除麻风运动当年发现病人数均为最高。在开展消除麻风运动后一年，防治力量强的县（市）发现病人数维持在开展消除麻风运动前一年的水平，防治力量弱的县（市）发现病人数则比开展运动前一年有减少。在开展消除运动期间发现的病人居住地离县麻风专业机构的距离最远，平均为62．8公里／人。开展消除运动期间疾病延迟期为最长，平均为42．9月，消除运动后一年发现的病人疾病平均延迟期缩短至26．5月。结论：开展消除麻风运动后在短期内不会对当地的新发现病人数产生很大的影响，但其促进了部分麻风流行病学指标好转，从而促进了当地麻风防治。     

A survey on knowledge and skills in the early diagnosis of leprosy in general health services at different levels in Shandong Province, The People's Republic of China

In the late phase of a leprosy control programme, problems arise with regard to the early detection and treatment of a small number of new incident cases. We describe a study in the province of Shandong, People's Republic of China, on the knowledge and skills regarding leprosy of general health service staff, including rural doctors, paramedical doctors at township level, doctors from county general and provincial hospitals and dermatologists. The results showed that there is a continuing need for suitable training programmes for medical staff in the general health services. Most dermatologists had good levels of knowledge and skills and more than 80% of new cases have been diagnosed in skin clinics in this province since 1990. Their participation in early diagnosis and training of staff should be strengthened.     

Analysis on the detection of new leprosy cases before, during and after the year of leprosy elimination campaigns

To analyse the impact on of case finding of leprosy elimination campaigns (LECs), data on newly detected leprosy cases in a leprosy endemic area were collected before, during and after the year of LEC. The number of new leprosy cases detected during the year of LEC was significantly higher than previously. The number of newly detected cases after the year of LEC was similar to that of detected before the year of LEC in counties with persisting case finding activities. However, the number of newly detected cases after the year of LEC significantly decreased in counties without active case finding activities. The average distance from the homes of leprosy cases detected during LEC to the leprosy control unit at the count town was 62.8 km, which is farther than that of other leprosy cases detected before and after the year of LEC. The average time from disease onset to diagnosis of leprosy cases detected after the year of LEC shortened. The results also showed that carrying out LECs is unlikely to have a significant impact on the trend of case finding within a short time in local areas, but it may improve some indicators of leprosy patients and so promote leprosy control in local areas.     

Role of leprosy villages and leprosaria in Shandong Province, People's Republic of China: past, present and future

In the late phase of the leprosy control programme in Shandong Province, People's Republic of China, there are a few old and disabled ex-patients living in 54 leprosy villages/leprosaria. The small, and declining number of patients makes the running of these leprosy villages/leprosaria uneconomic. In this paper, we review the history and the role of leprosy villages/leprosaria in the care of leprosy patients and the control programme in Shandong province. We then analyse the present situation of the 643 people still living in these leprosy villages/leprosaria, using information collected from a questionnaire-based survey. Finally, we offer some suggestions and recommendations for policy makers and leprosy control managers, in order to improve the present situation and make better use of existing resources.     

Incidence of leprosy in school-children and their family members in Berhampur

A school survey, followed by a contact survey, was carried out in Berhampur, a city in southern Orissa. In a study of 8,870 school-children, leprosy was detected in 15, giving a prevalence rate of 16.91 per 10,000 with a male:female ratio of 8:7. Of these, 14 (93.99%) had paucibacillary leprosy. More cases [11 (73.33%)] were seen in the age-group of 10-15 years. Exposed parts, such as lower limbs, upper limbs and head and neck in that order, were the sites of predilection, accounting for 85.71% of total lesions. Nerve involvement was found in 2 (13.33%) girls with deformity (ulnar claw) in one of them (6.66%). BCG scar was present in 11 (73.33%) cases. Among the vaccinated cases, tuberculoid type was the most common, followed by indeterminate, pure neuritic and borderline, in that order. A contact survey detected 2 multibacillary cases in two families (13.33%). In each case, the father was the index source. The study revealed that a maximum number of students, 8 (53.3%), belonged to the middle socioeconomic class. Of the 15 affected, 60% were undernourished and the rest well nourished. No other systemic disease was found clinically associated with leprosy.     

Assessment of knowledge and skills in early diagnosis of leprosy and attitudes towards leprosy amongst doctors working in dermatological services, Shandong Province, People's Republic of China

After the leprosy control programme in Shandong Province, China, had declared elimination in 1994, it was no longer cost effective to rely on rapid surveys, population surveys and contact tracing for case detection, and since then most new cases have been diagnosed by the dermatological services. The dermatological services will continue to play an important role in diagnosis of the few incident leprosy cases scattered in wide geographic areas and in a population of 90 million. In order to better understand the knowledge and skills in early diagnosis of leprosy among doctors working in dermatological services around the province, doctors attending the dermatological annual meeting and a dermatological training workshop were assessed on their knowledge and skills in early diagnosis of leprosy and their attitude towards leprosy with a semi-structured questionnaire. The results showed that continuous training was needed for dermatologists from both general hospitals and the leprosy control programme. In particular, the training methods for the skills in nerve examination including palpation of peripheral nerves and nerve function assessment should be improved.     

重复开展消除麻风运动对当地新发现病人情况的影响

目的:观察贵州省兴义市重复开展消除麻风运动对当地新发现麻风病人的影响.方法:收集1996～2004年新发现麻风病人的有关资料进行比较分析.结果:9年共发现麻风病人166例,平均每年发现18.4例,年均发现率为2.65/10万.1999年首次开展消除麻风运动后3年,新病人中的2级畸残率和延迟期呈明显下降趋势,低于开展前3年的水平.两次开展消除麻风运动时的畸残率和平均延迟期均达较高水平,提示该地区虽两次开展消除麻风运动但麻风流行程度仍处于较高水平.结论:重复实施消除麻风运动可促进某些流行病学指标的好转,应反复多次开展.     

重复开展消除麻风运动地区的病例发现和患者临床情况分析

目的：观察湖南省西部2个麻风高流行县重复开展消除麻风运动对当地麻风患者发现及临床指标的影响。方法：收集自1997—2002年麻风新发病例，其中包括开展消除麻风运动年份的病例资料，对各年发现病人数，平均确诊年龄，畸残率，延迟期等进行比较分析。结果：从1997年至2002年共发现133例患者。平均每年发现22．2例，年发现率2．4/10万。1998年开展LEC时发现的新病人数是接近开展IEC前一年的2倍，以后新发现病人数减少到一个稳定的低水平，在2002年重复开展LEC时，发现数又是接近前一年的2倍。但与1998年首次开展LEC时发现数相比，减少了50％。新发病人的疾病延迟期平均为34．8月，疾病延迟期在开展LEC前后未显示有缩短或延长的趋势。133例患者中，35例有可见畸残(26．3％)。但新发现病人中2级畸残率从1998年的32．0％下降到2002年重复实施LEC时的12％。结论：作者认为重复实施消除麻风运动促进了当地某些流行病学指标的好转。     

Experiences from a collaborative project on the prevention of disability in leprosy patients in Shandong Province, the People's Republic of China.

Shandong Province (present population 89 million) in the People's Republic of China established a leprosy control programme in 1955. Between that year and the end of 1999, allowing for death and migration, the cumulative number of cases registered was 53,618, including 120 cases on multiple drug therapy (MDT) and 18,248 who had completed satisfactory courses of dapsone monotherapy and/or MDT. Of this latter group, 9500 cases (52%) suffered from visible disabilities (grade 2 of the WHO classification). Prevalence and incidence rates of leprosy have decreased dramatically since 1955 and, on average, only 50-70 new cases are now being detected annually in the entire province. Leprosy is thus no longer a public health problem, but the existence of such a large number of patients with grade 2 disabilities is clearly a matter of serious concern. This paper describes a pilot project to investigate the potential of health personnel in the leprosy programme and the dermatology and sexually transmitted diseases services to (a) prevent deterioration of existing disabilities in ex-patients through self-care and (b) prevent new neuritis in patients on MDT through early detection and the use of steroids.     

贵州省新发麻风病患者特征分析

目的了解贵州省低流行状态下新发麻风患者特征,为今后发现更多早期麻风患者,有效降低2级残疾比提供科学的依据。方法采用统一问卷进行现场一对一的调查,并将患者调查问卷和病案信息录入EXCEL表格建立数据库,用SPSS18.0软件进行分析。结果贵州省2012-2018新发的387例麻风患者中,男281例,女106例,男∶女=2.65∶1,14岁及以下患者占4.13%,平均延迟期为43.80个月。周围神经受损主要有尺神经311例(80.36%)、腓总神经176例(45.48%)、耳大神经125例(32.30%),皮损主要有麻木98例(25.32%)、红斑95例(24.55%)、脱眉85例(21.96%)。MB型占75.50%,MB∶PB=3.07∶1,通过比较,麻风的不同型别在性别、年龄和延迟期之间无差异,但少数民族患者的MB型显著性高于汉族(P<0.05),有明确传染源的MB型患者高于不明传染源的(P<0.05),差异均有统计学意义。病期在2年内且无疾残的早期患者为220例(56.85%),以文化程度较高(初中以上)的早期患者为主(70.59%)。不明传染源的患者2级残疾比明显高于有明确传染源的患者,差异有统计学意义(P<0.001),延迟期越长,残疾情况越严重。94.44%的14岁及以下患者均有明确的传染源接触史。结论近年来贵州省新发麻风以多菌型为主,且每年都有儿童患者被发现,仍有局部流行风险,患者延迟诊断情况较严重,急待提升医务人员识别早期麻风能力和患者接触检查质量,实现麻风患者的早期发现。     

Report of the national leprosy elimination campaign (NLEC) of Bangladesh, 1999

A national leprosy elimination campaign (NLEC) was implemented country-wide in all the 64 districts of Bangladesh for 6 days from 7 to 12 February 1999. The campaign was jointly funded by the Government of Bangladesh (GOB)/World Bank (US$250,000) and the remaining US$381,000 was provided by other international non-governmental organizations (NGOs). A total of 44,400 health workers and community volunteers were directly involved in the campaign. In all, 60,878 suspected leprosy cases were identified during the campaign, of whom 31,433 were examined and 2435 were confirmed as leprosy cases. The remaining suspects are expected to be examined within the next 2 months. Details of the new cases detected are given in Table 8. The impact of NLEC has been significant, the number of cases detected during NLEC being 20% of the annual case detection in 1998. About 52% of the total population were directly contacted through a rapid house-to-house survey and over 90% of the population was targeted through extensive use of electronic/print media and various information, education and communication (IEC) activities.     

Qualitative assessment of social, economic and medical needs for ex-leprosy patients living in leprosy villages in Shandong Province, The People's Republic of China

After successful control of the endemic of leprosy in Shandong Province, China, how to deal with ex-leprosy patients living in the leprosy villages/leprosaria has become a hot topic among programme managers, medical staff and governmental officials at different levels. One of the possible solutions in dealing with the problem was proposed to combine small leprosy villages into a few larger, already existing, leprosaria/leprosy villages with better facilities, in order to provide better care for ex-leprosy patients and make better use of existing resources. With this assumption, social, economic and medical needs felt by ex-leprosy patients in three leprosy villages of Shandong province were assessed qualitatively, and the possibilities and obstacles regarding combination were explored. The results showed that the basic needs for living, such as food and clothes, were provided by state governments, although living standards remained at a low level. Medical care was not satisfactory, as many health problems related and unrelated to leprosy were increasing, and self-care needed to be addressed, as the dependents grew older and the disability status became worse. Although the majority of ex-leprosy patients, medical staff and government officials interviewed agreed with the idea of the adjustment of leprosy villages/leprosaria, some obstacles, including stigma, existed. Government commitment, ideally at top level, was needed in order to facilitate the process of combination.     

2011-2020年山东省麻风现症病例管理方式改革效果评价

目的:以麻风反应、神经炎、药物不良反应的发现率和救治率,以及现症病例新畸残发生率为评价指标,评价我省现症病例管理措施的成效。方法:近十年来,我省采取常规麻风现症病例管理措施有人员培训、耐药监测、病例管理信息化、工作督导和技术指导等,我省的特色管理措施包括氨苯砜(DDS)超敏综合征(DHS)精准预防、病例省级管理、麻风反应神经炎和药物不良反应的省级确认与救治。结果:2011-2020年期间,我省共有麻风现症病例328例,失访20例,死亡26例,外迁2例,判愈224例,截止到2020年底,尚有现症患者56例。全省共救治麻风反应312人次,神经炎106人次,药物不良反应8例,救治率均达到100%。规划期间,共有新发及重症麻风现症患者41例接受了住院治疗,救治神经炎34人次,麻风反应41人次。通过实施现症病例管理措施,我省麻风现症病例的麻风反应、神经炎和药物不良反应早期发现和及时救治率达到100%。联合化疗期间新畸残发生率为1.3%,明显低于国家规划不超过10%的控制目标。山东省皮防所首先成功定位了DHS的风险位点,为2015年以来全国21省份的3197例新发麻风病例进行疗前监测,阳性者避免服...     

The factors influencing the operational efficiency of leprosy case detection programme.

Under our National Leprosy Eradication Programme, Leprosy cases are being detected by para-medical workers by conducting population surveys. In order to detect the leprosy cases early, for their timely anti-leprosy treatment, it is necessary that the leprosy surveys are implemented and supervised efficiently. However, present experience indicates that the existing survey efficiency needs to be improved, for which it is necessary to analyse the factors which may interfere with the optimal survey efficiency of para-medical workers. An attempt has been made through present piece of work to identify such factors in relation to (i) the para-medical workers and survey facilities, (ii) the implementation and supervision of leprosy survey and (iii) the community involved in survey. These factors are discussed in detail to assist the NLEP Administrators in devising a suitable action plan to improve leprosy case detection efficiency.     

贵阳市2005-2009年麻风新发现病例分析

目的分析贵阳市2005-2009年麻风新发病例特征,为制定麻风防控策略提供依据。方法收集贵阳市2005-2009年报告的新发现麻风病例资料,采用Excel软件进行统计分析。结果共收集新发麻风病例63例,平均发现率为0.34/10万;发病年龄以40～60岁为主,占38.10%,儿童发病4.76%,农民占82.54%。新发病例疾病诊断延误期平均为3.7年,畸残率为58.73%。结论早期发现和神经功能监测仍是麻风病防控工作的重点。此外,除继续加大麻风防治知识宣传力度外,还应重视对县、乡两级医院门诊医生的专业培训。     

Leprosy survey in night high schools in greater Bombay

A survey of 6096 students attending night high schools in Bombay, gave the prevalence rate of leprosy 9.3 per 1000 in this group. 10.5% of the cases identified were having more serious forms of leprosy characterised by nerve involvement or skin smear positivity. Night school screening has limited value as it can only be conducted in big industrial cities and such surveys cover only a very small proportion of the population. However, in view of the current tendency of population shift from rural to urban areas and since such survey can identify a number of established cases it can be included among the other routine leprosy case detection activities in big cities, where night schools exist.