上海市1984～2000年肾综合征出血热监测研究

[目的 ]　掌握本市肾综合征出血热流行规律、特征和流行因素 ,制订防治对策。　 [方法 ]　采用现场调查、实验室病原学、血清学和分子生物学检测方法 ,开展人间疫情和宿主动物监测研究。　 [结果 ]　我市上个世纪 90年代以来发病率有所下降 ,无明显周期性。每年有冬夏两季流行高峰 ,80年代以冬季高峰为主 ,近 10年夏季峰值明显增加 ,冬季峰相应减弱。发病以青壮年、农民为主。临床病人检测血清符合率为 96.70 % ,出血热病人抗体持续时间长达 2 0年之久。疫区健康人群隐性感染率为 1.65 %～ 3 .79%。宿主动物监测黑线姬鼠和褐家鼠携带HV高于其他动物 ,分别为 4.3 0 %和2 .60 %。分子生物学分型黑线姬鼠等自然携带Ⅰ型 (HTN )病毒 ,褐家鼠主要携带Ⅱ型 (SEO)病毒 ,也带有Ⅰ型病毒。出血热病人血清分型Ⅰ型占 60 % ,Ⅱ型占 2 3 %。在重点发病地区开展灭鼠等措施 ,能降低鼠密度 ,控制出血热发病。　 [结论 ]　本市属姬鼠型为主的混合型疫区 ,近年来流行特征出现变化 ,黑线姬鼠、褐家鼠是主要传染源 ,人群免疫水平低下 ,应加强重点地区夏季流行灭鼠为主综合防治

Surveillance study of renal syndrome hemorrhagic fever in Shanghai (1984-2000)

To know the rule, characteristics and influencing factors of epidemic of renal syndrome hemorrhagic fever (HFRS) and to establish the countermeasures for its prevention and cure. Field study, laboratory detection of pathogen, serological and molecular biological methods were used for the surveillance study of epidemics in people and host animals. The incidence of HFRS had declined since the 1990's in Shanghai and showed no apparent periodicity. The prevalence showed two peaks every year, one in winter and another in summer. In 1980's, the winter peak was predominant. The summer peak value apparently increased in the recent 10 years, while the winter peak value reduced. The patients were mainly young and middle aged farmers. The rate of coincidence in clinical patient with serum detection was 96.7%. The antibody in HFRS patients can maintain for 20 years. The subclinical rate of incidence of healthy people in the epidemic area was 1.65 %～3.79%. Inspection in host animals showed that the HV in A. agrarius and R. norvegicus were higher than that in any other animal, the rate of incidence was 4.30% and 2.60%. The type based on molecular biology showed that A. agrarius naturally carried type Ⅰ virus, while R.norvegicus naturally carried type Ⅱ (Seoul virus) and it might also carry type Ⅰ virus (HTN virus). The sero classification of HFRS patients showed 60% belonged to type Ⅰ and 23% type Ⅱ. Elimination of rat in focal places could reduce the density of rat and control the incidence of HFRS. [Conclusion] Shanghai belongs to the mixed type (including apodemus type) epidemic region. The characteristics of epidemic has changed in recent years. A. agrarius and R. norvegicus are the main sources of infection. The immunity level of people is very low. Comprehensive prevention and cure especially elimination of rat in summer in focal regions must be strengthened.