全国人体重要寄生虫病现状调查报告

A National Survey on Current Status of the Important Parasitic Diseases in Human Population

目的为了解和分析我国人体重要寄生虫病的流行现状和态势,评估近十年来的防治效果,并为制定防治对策提供科学依据,卫生部于2001年6月2～004年底在全国(除台湾、香港、澳门外)进行了人体重要寄生虫病现状调查。方法按照对总体率进行估计的随机抽样样本量计算公式,确定全国调查的样本量及各省(区、市)调查的样本量,然后根据地理位置和经济条件这两个特征分层整群随机抽样的方法,分三步抽样,分别到县(市)、乡(镇)和点。在已知有华支睾吸虫流行的27省(区)同时另行抽样作“流行区调查”,样本量为217 829。土源性线虫、带绦虫和华支睾吸虫感染等采用病原学检查,棘球蚴病、囊尾蚴病(囊虫病)、并殖吸虫病、旋毛虫病和弓形虫病以血清学检查为主。结果以病原学检查方法在全国31个省(区、市)共检查356 629人,查出感染蠕虫26种,其中福建发现的东方次睾吸虫和埃及棘口吸虫为国内外人体感染首次报告,广西发现的扇棘单睾吸虫为国内人体感染首次报告。蠕虫总感染率为21.74%,其中土源性线虫感染率为19.56%(包括钩虫6.12%、蛔虫12.72%、鞭虫4.63%),推算全国感染土源性线虫人数约为1.29亿(钩虫、蛔虫、鞭虫感染人数分别约为3 930万、8 593万、2 909万);带绦虫感染率为0.28%,推算全国感染带绦虫人数约为55万;华支睾吸虫感染率为0.58%;流行区(27省、区、市)华支睾吸虫感染率为2.40%,推算感染华支睾吸虫人数约为1 249万。12岁以下儿童蛲虫感染率为10.28%。棘球蚴病、囊尾蚴病、并殖吸虫病、旋毛虫病和弓形虫病的血清阳性率分别为12.04%(4 796/39 826)、0.58%(553/96 008)、1.71%(1 163/68 209)、3.38%(3 149/93239)和7.88%(3 737/47 444)。结论本次调查结果与1990年全国性调查的相比,钩虫、蛔虫、鞭虫等土源性线虫感染率分别下降60.72%、71.29%和73.60%,感染人数显著减少。广东、广西、吉林等3省(区)的华支睾吸虫感染率明显上升,分别为182%、164%和630%。四川、西藏两省(区)的带绦虫感染率上升幅度最为明显,分别为98%和97%。棘球蚴病在西部地区流行仍较严重。许多寄生虫病仍在农村和牧区广为流行,农、牧民的寄生虫感染率、患病率较高,并导致一定的病死率,尤其对女性和儿童。

In order to understand the current status and trends of the important parasitic diseases in human population, to evaluate the effect of control activities in the past decade and provide scientific base for further developing control strategies, a national survey was carried out in the country （Taiwan, Hongkong and Macao not included） from June, 2001 to 2004 under the sponsorship of the Ministry of Health. The sample sizes of the nationwide survey and of the survey in each province （autonomous region and municipality, P/MM） were determined following a calculating formula based on an estimation of the sample size of random sampling to the rate of population. A procedure of stratified cluster random sampling was conducted in each province based on geographical location and economical condition with three strata： county/city, township/town, and spot, each spot covered a sample of 500 people. Parasitological examinations were conducted for the infections of soil-transmitted nematodes, Taenia spp, and Clonorchis sinensis, including Kato-Katz thick smear method, scotch cellulose adhesive tape technique and test tube-filter paper culture （for larvae）. At the same time, another sampled investigation for Clonorchis sinensis infection was carried out in the known endemic areas in 27 provinces. Serological tests combined with questionnairing and/or clinical diagnosis were applied for hydatid disease, cysticercosis, paragonimiasis, trichinosis, and toxoplasmosis. A total sampled population of 356 629 from the 31 P/A/M was examined by parasitological methods and 26 species of helminthes were recorded. Among these helminthes, human infections of Metorchis orientalis and Echinostoma aegypti were detected in Fujian Province which seemed to be the first report in the world, and Haplorchis taichui infection in Guangxi Region was the first human infection record in the country. The overall prevalence of helminth infections was 21.74%. The prevalence of soil-transmitted nematodes was 19.56% （including hookworm infection 6.12%, Ascaris infection 12.72% and Trichuris infection 4.63%）, and the estimated number of population infected with soil-transmitted nematodes was 129 million （with 39.3, 85.93 and 29.09 million for hookworm, Ascaris and Trichuris infections respectively）. The prevalence of Taenia infection was 0.28% with an infected population of 550 000. The prevalence of Clonorchis sinensis in the national survey was 0.58%. From the survey in the known Clonorchis endemic areas with a sample of 217 829, the prevalence was 2.40% hy which the number of infections was estimated to be 12.49 million. The prevalence of Enterobius vermicularis infection in children under 12 years old was 10.28%. The positive rate of serological tests for hydatid disease, cysticercosis, paragonimiasis, trichinosis, and toxoplasmosis was 12.04%（4 796/39 826）, 0.58%（553/96 008）, 1.71%（1 163/68 209）, 3.38%（3 149/93 239）and 7.88%（3 737/47 444） respectively. In comparison to the last national survey in 1990, the prevalence of hookworm, Ascaris lumbricoides and Trichuris trichiura infections has been reduced by 60.72%, 71.29% and 73.60% respectively, and the number of infected people by soil-transmitted nematodes has declined remarkably. However, the prevalence of Clonorchis infection significantly increased in the provinces of Guangdong, Guangxi and Jilin by 182%, 164% and 630% respectively. A remarkable increase of the prevalence of Taenia infection was found in Sichuan and Tibet, by 98% and 97% respectively. Echinococcosis is important in the Western part of China. Many parasitic diseases are still highly prevalent in the rural and pastoral areas with higher prevalence, morbidity and certain case fatality in farmers and herdsmen, especially in women and children.