2015-2019年河南省输入性疟疾病例诊断分析

目的　分析2015-2019年河南省输入性疟疾病例诊断情况，为开展消除疟疾后监测工作提供依据。方法　通过中国疾病预防控制中心传染病监测信息系统和寄生虫病防治信息管理系统，收集2015-2019年河南省疟疾病例信息，对其诊断方式、诊断机构、诊断时间进行统计分析。结果　2015-2019年河南省共报告输入性疟疾病例952例，所有病例均为实验室确诊病例。疟疾快速诊断试纸条（RDT）阳性检出率为98.61%（779/790），高于镜检检出率（94.22%，897/952），差异有统计学意义（[χ2] = 22.773，P＜0.05）。输入性疟疾病例在医疗机构诊断的比例由2015年的65.22%（120/184）升至2019年的81.50%（185/227）。238例在疾病预防控制（疾控）机构诊断的输入性疟疾病例中，71.01%（169/238）在县级疾控机构诊断；704例在医疗机构诊断的输入性疟疾病例中，仅8.38%（59/704）在县级医疗机构诊断。输入性疟疾病例从发病到确诊中位时间为3 d，其中从发病到初诊中位时间为1 d，各年从初诊到确诊时间差异有统计学意义（[χ2] = 24.956，P ＜ 0.05），其四分位数间距由2016年的4 d缩短为2019年的2 d。输入性重症恶性疟病例从初诊到确诊中位时间（2 d）长于非重症病例（1 d），差异有统计学意义（Z = 7.557，P ＜ 0.05）。结论　医疗机构在河南省输入性疟疾病例发现和监测中的作用越来越重要，但县级医疗机构诊断水平仍较低；应提高其诊断意识和能力，从而在消除疟疾后监测工作中发挥哨点医院作用。

Diagnosis of imported malaria cases in Henan Province from 2015 to 2019

Objective　To analyze the diagnosis of imported malaria cases in Henan Province from 2015 to 2019, so as to provide the evidence for malaria surveillance during the post?elimination stage. Methods　The data pertaining to malaria cases in Henan Province from 2015 to 2019 were extracted via the web?based Chinese Information System for Infectious Diseases Control and Prevention and the Parasitic Diseases Information Reporting Management System (PDIRMS) of Chinese Center for Disease Control and Prevention, and the diagnostic methods, diagnostic institutions and diagnostic time of imported malaria cases were analyzed. Results　A total of 952 imported malaria cases were reported in Henan Province during the period from 2015 through 2019, and all cases were laboratory?confirmed. The positive rate of malaria rapid diagnostic tests (RDTs) was 98.61% (779/790), which was significantly greater than that (94.22%, 897/952) of microscopic examinations ([χ2] = 22.773, P < 0.05). The proportion of imported malaria cases diagnosed in medical institutions increased from 65.22% (120/184) in 2015 to 81.50% (185/227) in 2019. Among the 238 imported malaria cases diagnosed in centers for disease control and prevention (CDC), 71.01% (169/238) were diagnosed in county?level CDC, and among the 704 cases diagnosed in medical institutions, only 8.38% (59/704) were diagnosed at county?level medical institutions. The median time from onset to definitive diagnosis of malaria was 3 days, and the median duration between onset and initial diagnosis of malaria was 1 day. The duration between initial diagnosis and definitive diagnosis of malaria varied significantly among years ([χ2] = 24.956, P < 0.05), and the interquartile range from initial diagnosis to definitive diagnosis reduced from 4 days in 2016 to 2 days in 2019. In addition, the median time from initial diagnosis to definitive diagnosis was significantly longer in severe falciparum malaria cases than in non?severe falciparum malaria cases (2 days vs. 1 day; Z = 7.557, P < 0.05). Conclusions　Medical institutions play a more and more important role in the identification and surveillance of malaria cases; however, the diagnostic capability of malaria remains low in county?level medical institutions. The diagnostic awareness and capability of county?level medical institutions requires to be improved, in order to play their roles as sentinel hospitals in the malaria surveillance during the post?elimination stage.