2004-2019年湖南省血吸虫病综合防治效果

目的分析2004-2019年湖南省血吸虫病综合防治效果,为制定血吸虫病消除策略提供参考依据。方法回顾性收集2004-2019年湖南省卫生、农业、水利、林业和国土等部门血吸虫病综合防治措施实施情况,统计分析每年各项措施完成情况、防治费用以及人群、耕牛病情和螺情。采用Delphi法构建湖南省血吸虫病综合防治效果评价指标体系,计算血吸虫病综合防治效果指数;对人群及耕牛血吸虫感染率下降、垸内钉螺面积和感染螺面积压缩等方面进行费用-效果分析。结果 2004-2019年湖南省血吸虫病综合防治措施累计投入经费711 092.65万元;完成药物灭螺277 437.12hm^2,人群扩大化疗6 927 230人·次,牛扩大化疗2 116 247头·次,建造无害化厕所954 850座,圈养牛290 359头,淘汰牛136 666头,以机代牛141 905套,水改旱39 048.63 hm^2,灌区改造724.12 km,安全饮水覆盖人口399.43万人,种植抑螺防病林191 102.89 hm^2,土地平整38 535.27 hm^2。2004年,湖南省人群血吸虫感染率为4.29%,耕牛感染率为4.48%,垸内有螺面积2 449.37 hm^2,感染性钉螺面积3 423.74 hm^2;2019年,全省人群和耕牛血吸虫感染率均下降至0,垸内有螺面积较2004年下降了77.92%(540.92 hm^2),感染性钉螺面积下降至0。以2004年数据为基线,血吸虫病综合防治效果指数总体呈逐年增加趋势,2019年血吸虫病综合防治效果指数为97.35。每100人血吸虫感染率和每100头牛感染率下降1%的年平均费用分别为70.11元和4 204.78元,每1 hm^2垸内有螺面积和感染性钉螺面积压缩1%的年平均费用分别为2 010.20元和1 298.09元。结论湖南省以传染源控制为主的血吸虫病综合防治措施效果显著,人群和耕牛血吸虫感染率明显下降,垸内有螺面积和感染性钉螺面积大幅压缩。今后应继续保障资金投入,以进一步完善综合防治措施、巩固已取得的血吸虫病防治成果。

Effect of integrated schistosomiasis control measures in Hunan Province from 2004 to 2019

Objective To examine the effect of the integrated schistosomiasis control measures in Hunan Province from 2004 to 2019, so as to provide insights into the development of the schistosomiasis elimination strategy.Methods The integratedschistosomiasis control measures implemented by the health, agriculture, water resources, forestry, land and resources sectorswere retrospectively collected in Hunan Province from 2004 to 2019, and the completion of each measure, cost of control mea-sures, Schistosoma japonicum infections in humans and bovines, and snail status were analyzed each year. An index system for as-sessing the integrated schistosomiasis control effect was constructed using the Delphi method to calculate the integrated schisto-somiasis control effect index. In addition, a cost-effect analysis was performed in terms of the decline in the prevalence of S. ja-ponicum infections in humans and bovines, areas with snails in inner embankments, and areas with infected snails.Results Atotal of 7 110 926 500 Yuan were invested into the integrated schistosomiasis control program of Hunan Province from 2004 to2019. During the 16-year period, a total of 277 437.12 hm^2 snail habitats received molluscicidal treatments, 6 927 230 person-times given expanded chemotherapy, 2 116 247 bovine-times given expanded chemotherapy, 954 850 harmless toilets built,290 359 bovines fenced, 136 666 bovines eliminated, 141 905 machines used to replace bovines, 39 048.63 hm^2 water lands im-proved as dry lands, 724.12 km irrigation regions improved, 3 994 300 populations covered with safe water, 191 102.89 hm^2 for-ests planted and 38 535.27 hm^2 lands leveled. The prevalence of S. japonicum infections was 4.29% in humans and 4.48% in bo-vines in Hunan Province in 2004, with 2 449.37 hm^2 snail habitats in inner embankments and 3 423.74 hm^2 infected snail areas.In 2019, the prevalence of S. japonicum infections reduced to 0 in both humans and bovines, and areas of snail habitats reducedto 540.92 hm^2(77.92% reductions), while the areas with infected snails reduced to 0. The overall integrated schistosomiasis con-trol effect index appeared a tendency towards a rise over years since 2004, and the integrated schistosomiasis control effect indexwas 97.35 in 2019;the annual mean costs for a 1% reduction in the prevalence of S. japonicum infections in 100 populations and100 bovines were 70.11 Yuan and 4 204.78 Yuan, and the annual mean costs for a 1% reduction in the snail areas in inner em-bankments and infected snail areas were 2 010.20 Yuan and 1 298.09 Yuan, respectively.Conclusions The integrated controlmeasures achieve remarkable effectiveness for schistosomiasis control in Hunan Province, with a remarkable decline in the preva-lence of S. japonicum infections in humans and bovines and great shrinking of snail areas in inner embankments and infectedsnail areas. Adequate fund investment is required to improve the integrated schistosomiasis control measures and consolidate thecontrol achievements.