江苏省无锡市1989—2018年麻风流行特征分析

Analysis of leprosy epidemic characteristics in Wuxi, Jiangsu, 1989-2018

目的通过分析无锡市近30年来麻风流行特征,探讨目前麻风防治工作存在的挑战,以及在低流行状态下如何有针对性地开展好麻风病防治管理工作。方法对无锡市1989—2018年麻风病例资料进行流行病学分析。结果1989—2018年无锡市报告麻风病病例63例,其中新发病例48例,复发15例。30年来麻风发现率和患病率均呈下降趋势,患者确诊时平均年龄(43.81±14.52)岁。80.95%的患者职业为农民,近年来发病人群以外地来锡务工人员为主,其中来自高流行省份的病例占71.43%。患者延迟期中位数为8个月,新、复发病人诊断延迟期中位数为13个月和2个月,差异有统计学意义(P<0.05),MB型别比(多菌型∶少菌型)为5.3∶1。新发病例Ⅱ级畸残率25%,22.92%新发患者为家庭内传播。73.02%的患者由皮肤科就诊发现。结论根据无锡市近30年来的麻风流行病学特征,以及发现率、MB型比、Ⅱ级畸残率等主要指标的分析结果,无锡市仍处于麻风病低流行状态,但仍面临人口流动造成的输入性病例、因病例少造成防治意识松懈等问题带来的挑战。必须保持麻风病防治体系的健全和防治工作的持续性。加强技术培训,加大宣传力度,以麻风病症状监测为主要手段,从而尽早发现病人、治疗病人。早发现、早治疗是减少麻风病人因神经损害或畸残造成的疾病负担的重要手段。

Objective This paper has analyzed the epidemic characteristics of leprosy in the last three decades in Wuxi city and discussed the challenges,and we also discussed how to carry out prevention and control of leprosy under low epidemic situation.Methods Epidemiology of leprosy cases reported were analyzed in Wuxi from 1989 to 2018.Results Totally 63 leprosy cases reported in Wuxi City from 1989 to 2018,including 48 new cases and 15 relapses.The detection rate and prevalence rate of leprosy showed a downward trend in the past 30 years.The average detection age was(43.81±14.52)years old.And 80.95%of the patients were farmers.In recent years,the majority of the infected people were migrant workers in Wuxi,71.43%of them were from high-prevalence provinces.The median delayed period of the patients was 8 months.The median time of delayed period was 13 months among the new cases and 2 months among the relapsed,with a significant difference(P<0.05).The ratio of multibacillary type to paucibacillary type was 5.3∶1.And 25%of new cases with grade 2 disabilities,and 22.92%of them were get infected by family members;73.02%of the cases were reported by dermatological clinic.Conclusion We can be sure that Wuxi is still in a state of low leprosy prevalence according to the results of epidemiological characteristics,prevalence rates,the ratio of multibacillary type to paucibacillary type,and grade 2 disabilities ratio of leprosy in the past 30 years.However,we still face challenges from imported cases caused by population movement and lax prevention and control awareness caused by fewer cases.The integrity and the continuity of leprosy prevention and control system must be maintained.We need to strengthen technical training and public health promotion and use the symptom monitoring as the main method in order to detect and treat patients as early as possible.Early case detection,regular and complete treatment,and early detection of impairment and disability have played a pivotal role in reducing the disease and disability burden in the community.