云南省孟连县疟疾漏报程度分析

目的了解云南省孟连县疟疾发病实情和漏报程度。方法采用回顾性调查方法,统计2002年疟疾报告疫情、血检情况、疟疾治疗及村民疟史等。以捕获-再捕获方法估计疟疾实际发病和漏报率。结果孟连县疟疾发病率为21.5/万。7个乡均有病例分布,被调查3个乡的疟疾发病率分别为47/万、15/万和5/万。所调查的25个自然村在2002年共报告5例疟疾,采用发热病人血检、查阅医生疟疾治疗处方、调查疟史3种再捕获方法核实疫情,估算得孟连县3种疟疾疫情漏报率分别为0、70.59%和97.80%。结论孟连县疟疾漏报现象比较普遍。     

Patterns of attendance in methadone maintenance treatment program in Yunnan Province,China

Objective: To describe the patterns of patients' attendance over the first three quarters of a year under methadone maintenance treatment (MMT) clinics in Yunnan Province, China. Methods: Data were obtained from drug abuse treatment databases from five MMT clinics in Yunnan Province. Patients registered between April 2007 and December 2007 were included in the analysis. The study period was divided into three phases consisting of 3 months each. Logistic regression was used to predict factors determining whether the patients attended the clinic on each day with repetition of the patients taken into account. Results: The median number of days attending the clinics was 61 in the total treatment period, and the likelihood of a patient attending the clinic in the second and third phases was significantly less [odds ratio (OR) = .44 and .30, 95% confidence interval (CI) = .40–.49 and .26–.34] compared with the first phase. The predictors for attendance at clinic were being unmarried (OR = .63, 95% CI = .49–.82), self-employed (OR = .18, 95% CI = .11–.28), having a history of syringe sharing (OR = .67, 95% CI = .48–.92), and having been in a detoxification program (OR = 1.59, 95% CI = 1.09–2.33). Conclusion: Heroin users attended MMT programs irregularly and their periods of attendance significantly declined by duration of the time they stayed in the treatment program. Additional interventions should be employed to help patients adhere to this long-term treatment program.     

云南省疟疾流行情况及药物治疗、抗药性研究现状

本文综述了近10年来云南省疟疾流行情况,介绍了疟疾的药物治疗及抗药性的研究进展。     

云南省孟连县疟疾流行及防治现状调查

目的 了解孟连县疟疾流行现状及其控制能力。方法 采用横断面回顾性调查方法，统计2002年疟疾报告疫情、血检能力等，对人群疟疾常识知晓、村民疟史、蚊帐使用情况进行问卷调查。结果 2000～2002年孟连县疟疾发病率为21．5／万，61．33％为当地感染病例，恶性疟占28．53％，7个乡均有病例分布，各乡的发病率在5／万～55．6／万之间，被调查3个乡的疟疾发病率分别为47／万、15／万、和5／万。调查25个自然村在2002年共报告5例疟疾，其中恶性疟3例，对发热患者血检、医生疟疾治疗处方、疟史调查核实，估算孟连县的血检、处方、走访漏报率分别为0．00％、70．59％和98．45％。3173名学生和村民的疟疾常识知晓程度不高，村民的经验积累型疟防知识的知晓与中、小学生相当，但间接传授型疟防知识弱于中、小学生。结论 孟连县应在采取综合治理疟疾的前提下，加强对流动人员疟疾监测和防治，尽力落实媒介控制措施。在进一步规范疟疾治疗处方管理的基础上，用处方漏报率估算当地疟疾发病比较合理。     

云南省2001-2005年疟疾疫情分析

目的 分析2001-2005年云南省疟疾流行态势, 为制定和实施“十一五”抗疟规划提供参考依据。方法 用Microsoft office excel 2003 及ArcView GIS 3.3等软件, 对2001-2005年疟疾疫情数据进行统计分析。 结果 2001-2005年云南省16州(市)129县(市)各县各月均有疟疾病例报告, 计63 562例, 发病高峰在5～8月和10～11月。5年平均发病率为3.049/万, 比前5年上升4.67％, 差异具有统计学意义( χ2＝63.15, P＜0.05), 各年发病率呈上升趋势。发病数和发病率处于前5位州(市)和排名前10位的县(市)除梁河县(二线边境县)外均为边境州(市)和一线边境县(市)。发病率为5/万以上的23县人口仅占全省总人口的12.74%, 发病占全省的80.31%。45岁以下年龄组发病占87.30％, 死亡占79.36％; 发病数和死亡数男女之比分别为3.44 ∶ 1和6 ∶ 1; 农民、 民工和学生的发病率在各职业中居前3位; 流动人口发病和死亡数分别占全省发病和死亡数的17.06％和23.42％,是感染疟疾的高风险人群。 结论 云南省疟疾流行态势依然严峻。“十一五”期间, 应全面抓好疟疾的病例管理、 态势监测并及时开展各种防控工作。     

2013年云南省腾冲县疟疾监测结果分析

目的 目的 分析腾冲县2013年疟疾监测结果, 为开展疟疾消除工作提供依据。 方法 方法 收集2013年腾冲县疟疾疫 情数据和监测资料, 分析该县疟疾流行情况及不明原因发热病人血检、 主动病例侦查、 漏报调查、 哨点监测以及传疟蚊媒 的种群和密度等监测指标。 结果 结果 2013年腾冲县共报告疟疾病例138例,其中间日疟118例、 恶性疟20例, 均为输入性 病例, 无本地感染病例。该县不明原因发热病人血检和病例报告及个案调查完成率均达到100%, 开展主动侦查57次, 未发现阳性病例; 开展2次漏报调查, 发现1例漏报病例; 在境内和境外同时开展哨点监测, 检测疟疾疑似病例172例, 共 检出阳性15例; 共筛查归国人员528人, 均为阴性。媒介构成以中华按蚊和凉山按蚊为主, 其次是微小按蚊、 多斑按蚊 等。结论 结论 2013年腾冲县疟疾疫情基本稳定, 各项监测工作顺利完成, 但在疟疾防治及实现疟疾消除过程中仍面临一 些困难, 今后应加强输入性病例监测和流动人口管理, 以及疟疾防治队伍能力建设。     

云南省孟连县溪络渡电站移民疟疾流行情况调查

目的 了解移民和移民区的疟疾流行情况，为防治提供依据。方法 调查移民和当地居民的疟疾发病情况、居住房屋及防蚊情况、小学生和当地居民疟疾带虫情况，收集全县疟疾疫情和移民点周围发热患者血检资料，媒介情况和防治措施。结果 近6年全县的疟疾发病率波动在15．25／万～31．19／万之间，2002～2003年42．48％的疟疾病例为境外感染，2004年勐马地区恶性疟占17．39％，小学生和当地村民的带虫率为O；移民的住房和防蚊条件好于村民，移民疟史率为0，当地居民为21．28％；查获微小按蚊等9种按蚊，微小按蚊占总数的3．350／0。结论 移民具有良好的居住及生活环境，免受疟疾感染。鉴于当地是疟疾高发区，又受境外疟疾高度流行的影响，要继续做好移民的疟疾防范工作。     

云南省2003年疟疾流行态势及暴发情况分析

目的积累流行病学资料，为制定疟疾防治措施提供依据。方法根据云南省疟疾疫情统计，疟防工作年报表，镇康、沧源、耿马、盈江、盐津疟疾暴发情况报告等资料进行分析和描述。结果云南省2003年疟疾发病数比2002年同期上升了26．30％，恶性疟比例占总发病数的23．28％；边境地区发病数占全省发病数的67．07％。盐津县豆沙镇石门村9～10月发生间日疟点状暴发。受缅甸边境2003年疟疾严重流行的影响，我国境内镇康、沧源、耿马11月疟疾发病数分别比2002年同期上升536．67％、156．67％和38．89％，并在11月内连续出现12个点状暴发村；盈江县苏典乡鲁苗村11月发生的疟疾暴发以恶性疟为主。结论云南疟疾流行态势依然严峻。     

Malaria control in Henan Province, People's Republic of China

We analyzed malaria prevalence and evaluated the effect of malaria control measures in Henan Province, People's Republic of China between 1993 and 2004. Data relating to malaria epidemics, malaria control measures and their effects, and vector surveillance between 1993 and 2004 were collected and analyzed. Mean malaria incidence during this period was 2.96/100,000. After integrated vector control measures and appropriate treatment of malaria cases were carried out, the number of malaria cases in Henan Province decreased from 4,815 in 2000 to 2,112 in 2004. The parasite-positive rate and the density of Anopheles anthropophagus were also reduced. Malaria control measures were effective and malaria incidence decreased in Henan. However, there are still more cases in this province than in 1992. Local malaria outbreaks and epidemics have occurred in areas where Anopheles anthropophagus and An. sinensis are present. Thus, malaria control measures should be strengthened.     

云南不明原因心源性猝死心肌酶学研究

目的 探索发病村村民与周围自然村村民的心肌酶在本病流行期和非流行期是否存在差异,为深入开展具有针对性的病因研究提供线索.方法 选取发病村村民24人和3个对照村每村30人作为研究对象,在流行期和非流行期分别采集研究人群的血清作心肌酶、肝、肾功等检测. 结果 发病村和对照村人群的4个心肌酶指标在各次检测中异常率均较高,依次是CK-MB、CK、HBDH 、LDH.发病村异常率高于对照村;CK-MB/CK均大于5%;CK-MB最高值为上限值5倍,CK为4倍,HBDH为2.36倍,LDH为1.5倍;发病村人群非流行期LDH,HBDH较流行期明显下降. 结论 发病村村民和同在一山系的对照村村民的4种心肌酶指标异常率在流行期和非流行期均较高,提示该地区(山系)自然环境中可能存在某些致心肌酶增高的危险因素.     

Malaria in Zhejiang Province,China, from 2005 to 2014

To summarize the changing epidemiological characteristics of malaria in Zhejiang Province, China, we collected data on malaria from the Chinese Notifiable Disease Reporting System (NDRS) and analyzed them. A total of 2,738 malaria cases were identified in Zhejiang Province from 2005 to 2014, of which 2,018 were male and 720 were female. Notably, only 7% of malaria cases were indigenous and the other cases were all imported. The number of malaria cases increased from 2005 to 2007, peaked in 2007, and then decreased from 2007 to 2011. There were no indigenous cases from 2012 to 2014. Of all cases, 68% of cases contracted Plasmodium vivax, 27% of cases contracted P. falciparum, and two cases contracted P. malariae. About 88% of malaria cases during 2005–2011 occurred yearly between May and October, but the number of malaria cases in different months during 2012–2014 was similar. The median age was 33 years, and 1,892 cases occurred in persons aged 20–50 years. The proportion of businessmen increased and the proportion of migrant laborers decreased in recent years. The median time from illness onset to confirmation of malaria cases was 5 days and it decreased from 2005 to 2014. Some epidemiological characteristics of malaria have changed, and businessmen are the emphases to surveillance in every month.     

云南省嗜人按蚊分布区疟疾血清流行病学监测

目的了解云南省1998-2001年嗜人按蚊分布区疟疾流行情况。方法采用间接免疫荧光检测(IFA)血清学监测和发热患者监测方法在2个县开展学龄儿童血清学纵向监测和居民发热血检监测。结果通过疟疾感染概率估算,水富县楼坝镇的疟疾感染概率在0~0·14%之间,年带虫发病率在0~0·44/万之间;绥江县的年疟疾感染概率在0~2·70%之间,带虫发病率为0~0·87/万之间,血清学监测估算的疟疾发病比血片镜检确诊的疟疾高。结论提示疟疾年带虫发病率不能发现全部疟疾患者,为了使疟疾疫情逐步接近真实情况,疫情报告除上报试验室确诊病例外,还应上报临床症状诊断及抗疟药试治诊断病例。     

Malaria control and fever management in Henan Province, China, 1992

Henan Province, which once had the highest malaria prevalence in China, had only 318 reported cases in 1992. Our purpose was to investigate this late 'consolidation phase' of malaria control in Henan with reference to malaria surveillance. We conducted a questionnaire survey of village doctors in Shang Shi Qiao Township during the transmission period of 1992. Of the 732 recorded fever cases, 16 were probable malaria cases by clinical and treatment response criteria, but only one received a full course of antimalarials. Of the 732 patients, 61% had fever every day, 37% went for treatment the first day, 52% waited 2–3 days and 10% waited longer. One hundred and twenty‐eight patients took self‐medication before seeing the doctor. Blood examination was carried out in 526 (71%) fever cases but only four were positive, all for Plasmodium vivax . Our findings highlight problems relating to patient behaviour and motivation of village doctors, malaria treatment, surveillance and microscopy, rural migration, economic development and malaria transmission. All need to be considered for reforming the malaria control strategy in Henan Province.     

Risk Factors for Border Malaria in a Malaria Elimination Setting: A Retrospective Case-Control Study in Yunnan,China

A retrospective case-control study was conducted to identify risk factors for border malaria in a malaria elimination setting of Yunnan Province, China. The study comprised 214 cases and 428 controls. The controls were individually matched to the cases on the basis of residence, age, and gender. In addition, statistical associations are based on matched analyses. The frequencies of imported, male, adult, and vivax malaria cases were respectively 201 (93.9%), 194 (90.7%), 210 (98.1%), and 176 (82.2%). Overnight stay in Myanmar within the prior month was independently associated with malaria infection (odds ratio [OR] 159.5, 95% confidence interval [CI] 75.1–338.9). In particular, stays in lowland and foothill (OR 5.5, 95% CI 2.5–11.8) or mid-hill (OR 42.8, 95% CI 5.1–319.8) areas, or near streamlets (OR 15.3, 95% CI 4.3–55.2) or paddy field or pools (OR10.1, 95% CI 4.4–55.8) were found to be independently associated with malaria. Neither forest exposure nor use of vector control measures was associated with malaria. In conclusion, travel to lowland and foothill or mid-hill hyperendemic areas, especially along the waterside in Myanmar, was found to be the highest risk factor for malaria. In considering the limitations of the study, further investigations are needed to identify the major determinants of malaria risk and develop new strategies for malaria elimination on China-Myanmar border.     

云南省元江流域现行疟疾预防措施的成本效果分析

目的　评价现行疟疾预防措施在元江流域的成本效果。　方法　通过 3个现场干预试验和经济学分析 ,评价预防服药、单一 DDT滞留喷洒和两者综合使用的防疟作用和成本效果。　结果　 1对筑路民工每月 1次的哌喹 /磺胺多辛预防服药 ,相对发病率指数为 0 .35 (95 % CI:0 .2 0～ 0 .5 9) ,7～ 11月保护 1人的费用为 6 .6 9元 ,减少 1例疟疾患者的费用为 4 5 9元。 2在河谷高疟村寨 ,10 d1次的氯喹加伯氨喹预防服药 ,相对发病率指数为 0 .2 8(95 % CI:0 .0 8～ 0 .99) ,5个月保护 1人的费用为 5 .30元 ,减少 1例疟疾患者的费用为 30 0元。 3在 5～ 9月 ,1月 1次的乙胺嘧啶/磺胺多辛预防服药组、 4月份 1次的 DDT滞留喷洒组、以及综合使用组的标准发病指数 (SMR)分别为 10 0 %、98%和5 0 % ;保护 1人的费用分别为 1.4 9、2 .4 8和 3.97元 ;单一预防服药组疟疾病例数 ,未能在上一年基础上继续减少 ,DDT滞留喷洒组和综合措施组减少 1例疟疾患者的费用分别为 14 5 35元和 90 8元。　结论　每月 1次的哌喹 /磺胺多辛和 10 d 1次的氯喹加伯氨喹预防服药成本差异不大。每月 1次的哌喹 /磺胺多辛在该地区的效果得到进一步证实。与单一措施相比较 ,综合性措施成本效果最佳 ,但费用昂贵。     

云南省疟疾不同流行区血清学监测

目的了解间接荧光抗体试验 ( IFAT)对云南省疟疾不同流行区监测结果。方法 1 999年对 7个地 (州 ) 2 8个县 (市 ) 1 5 374人作了 IFAT监测。结果显示我省中缅边境地区疟疾流行相对较高 ,元江流域次之 ,中越边境相对较低 ,基本消灭疟疾地区存在点状流行。它们的 IFAT阳性率、居民原虫率、年带虫发病率分别为中缅边境3.4 4%、4 .0 9%、1 .96‰。元江流域 1 .2 8%、0 .6 2 %、0 .5 4‰ ;中越边境 1 .2 6 %、0 .1 5 %、0 .36‰ ;基本消灭疟疾地区 1 .6 1 %、0 .35 %、0 .1 1‰。在不同年龄组及不同疟疾流行区 IFAT检测结果差异具有显著性。结论 IFAT在灭疟后期管理与监测中有一定意义 ,同时对试验中存在的问题作分析探讨。     

云南省西双版纳州鼠型斑疹伤寒暴发的调查(英文)

目的 阐明云南省西双版纳州鼠型斑疹伤寒的流行状况。方法 收集云南省鼠型斑疹伤寒病例资料。于2011年6-9月在西双版纳地区采集鼠型斑疹伤寒临床诊断病例的急性期和恢复期血清,并在发病地区的居民区捕鼠,采集鼠血液和脾脏标本。用间接免疫荧光试验检测患者和鼠血清中的鼠型斑疹伤寒立克次体的IgM和IgG抗体,用实时荧光PCR试验检测急性期病人血块和鼠脾脏中的鼠型斑疹伤寒立克次体热休克蛋白基因(groEL gene)。结果 2004-2011年,云南省共报告鼠型斑疹伤寒病例8 361例,所有州(市)均有病例报告,其中西双版纳州发病数和发病率最高(86.6/10万),占全省总病例数的73.1%(6 111/8 361)。发病数具有逐年上升之势,全年均有病例发生,6-10月为主要流行期。2011年云南省共报告鼠型斑疹伤寒1 369例,其中西双版纳州报告病例1 157例,发病率为102.10/10万,病例数占云南省病例数的84.51%。勐海县、勐腊县和景洪市分别占全州病例数的79.95%(n=925, 278.74/10万)、18.06%(n=209,74.10/10万)和1.99%(n=23,4.42/10万),勐海县发病率显著高于勐腊县(χ²=346.3, P<0.001)和景洪市(χ²=1369, P<0.001)。对2011年的80例病人进行了实验室检测,在80例急性期病人血清标本中有 63例为IgM抗体阳性;75例病人双份血清标本中有61例的恢复期血清滴度高于急性期4倍及以上;80例患者急性期血块中有8例为PCR阳性。依据实验室诊断标准,74例被确诊为鼠型斑疹伤寒,其中血清学诊断73例(包含7例同时为分子诊断),分子诊断1例,临床诊断和实验室检测符合率为92.50%(74/80)。黄胸鼠血清鼠型斑疹伤寒立克次体IgG抗体阳性率为14.0% (14/100),脾脏的PCR阳性率为9.0% (9/100)。结论 西双版纳州存在较为严重的鼠型斑疹伤寒流行,其中勐海县流行最为严重。