山西省2015—2019年输入性疟疾病例诊断情况分析

目的 分析山西省2015—2019年输入性疟疾病例诊断情况,为消除疟疾后防止输入再传播的监测工作提供依据。方法 通过传染病报告信息管理系统和寄生虫病防治信息管理系统,收集整理2015—2019年山西省疟疾病例信息,对其诊断机构、诊断及时性等情况采用χ²检验、秩和检验进行统计分析。结果 2015—2019年全省共报告疟疾病例72例,均为境外输入性病例,其中恶性疟占68.1%（49/72）,间日疟占18.1%（13/72）,卵形疟占8.3%（6/72),三日疟占2.8%（2/72）,混合感染2.8%（2/72）。所有病例均为实验室确诊病例,镜检检测率均为100.0%。95.8%（69/72）的病例在医疗机构诊断,而69例在医疗机构诊断的病例中,73.9%（51/69）在省级医疗机构诊断,21.7%（15/69）在市级医疗机构诊断,仅4.3%（3/69）在县级医疗机构诊断。疟疾病例从发病-确诊时间中位数为5 d,其中发病-初诊时间中位数为3 d,发病-初诊和初诊-确诊时间各年份差异均有统计学意义,四分位数间距由2017年最长的10 d缩短为2019年最短的 0 d。结论 山西省医疗机构在疟疾病例发现和监测中具有重要作用。疟疾病例诊断以省级医疗机构为主,提示市、县级医疗机构的诊断水平较低。今后要加强市县级医疗机构的培训以提高其疟疾诊断意识和诊断能力。

Analysis on the diagnosis of imported malaria cases in Shanxi, 2015-2019

Objective To provide the basis for the surveillance to prevent re-transmission after malaria elimination by analyzing the diagnosis imported malaria cases in Shanxi Province during 2015-2019. Methods Data on imported malaria cases in Shanxi Province from 2015 to 2019 were collected and sorted through the National Infectious Diseases Information Reporting Management System (IDIRMS) and the Parasitic Diseases Information Reporting Management System (PDIRMS). Diagnostic institutions and diagnostic timeliness of imported malaria cases were described and analyzed by chi-square test and rank-sum test. Results A total of 72 imported malaria cases were reported in Shanxi during 2015-2019, all cases were imported from abroad, among which falciparum malaria accounted for 68.1% (49/72), vivax malaria 18.1% (13/72), ovale malaria 8.3% (6/72), malariae malaria 2.8% (2/72), and mixed infection 2.8%（2/72). And all of which were diagnosed with laboratory tests (100.0%). The rate of diagnosis in medical institutions was 95.8% (69/72), while 73.9% (51/69) were diagnosed in provincial medical institutions, 21.7% (15/69) were diagnosed in municipal medical institutions, 4.3% (3/69) of 69 cases diagnosed in medical institutions were diagnosed in county-level medical institutions. The median time from onset to diagnosis of malaria cases was 5 days, in which the median time from onset to first visit was 3 day. There were significant difference in the time both from onset to first visit and first visit to diagnosis (P<0.05), the interquartile interval of malaria cases was shortened from the longest 10 days in 2017 to the shortest zero days in 2019. Conclusion Medical institutions in Shanxi Province play an important role in malaria case detection and monitoring. We should improve the diagnostic awareness and capabilities of county-level medical institutions, and to play the role of sentinel hospitals in the surveillance of preventing re-transmission after malaria elimination.