2005-2021年中国流行性出血热的流行趋势分析

Analysis of the epidemic trend of epidemic hemorrhagic fever in China from 2005 to 2021

目的探讨2005-2021年中国流行性出血热(EHF)发病率的长期趋势,为完善EHF的防控措施提供参考依据.方法建立2005-2021年中国EHF发病率数据集.采用Joinpoint回归模型分析全国及各地区、各年龄段EHF发病率变化趋势.结果2005-2021年中国共报告EHF病例192066例,年均发病率为0.8345/10万;死亡1752例,年均死亡率为0.0076/10万,年均病死率为0.9122%.2005-2021年中国出血热发病率总体呈下降趋势,平均年度变化百分比(AAPC)为-5.56%(P=0.017),其中2008年和2012年为出血热发病率趋势变化转折点,2005-2008年间呈下降趋势,年度变化百分比(APC)为-26.92%(P=0.001);2008-2012年呈平稳趋势,APC为10.61%(P=0.224);2012-2021年呈下降趋势,APC为-4.11%(P=0.016).2005-2018年中国报告的出血热病例主要集中在东北部地区,病例数排名前5位(降序)的地区为黑龙江省、陕西省、山东省、辽宁省和吉林省.9个地区的出血热发病率呈下降趋势(均P<0.05),4个地区的出血热发病率呈上升趋势(均P<0.05),其余14个地区出血热发病率呈平稳趋势(均P>0.05);各年龄组均有病例发生,主要集中在25~64岁,占总发病数的79.86%;其中40~44岁年龄组比例最高,占12.75%.7个年龄组的出血热发病率均呈下降趋势(均P<0.05),1~岁组呈上升趋势(P<0.05),其余各年龄组处于平稳状态(均P>0.05).结论2005-2021年中国出血热发病率总体呈下降趋势,但黑龙江省、陕西省、山东省、辽宁省和吉林省等重点地区发病率仍在较高水平,下降幅度较小,流行风险仍存在.应针对重点地区与群体加强防治工作,持续开展病例与当地宿主动物监测;根据当地实际情况制定并落实精准综合防控措施,以降低出血热流行强度、发病率和死亡率.

Objective To investigate the long-term trend of the incidence of epidemic hemorrhagic fever(EHF)in China from 2005 to 2021,so as to provide a scientific reference basis for improving the preventive and control measures of hemorrhagic fever.Methods Establish a data set of the incidence of EHF in China from 2005 to 2021.A Joinpoint regression model was used to analyze the trend of EHF incidence in the whole country,regions and age groups.Results A total of 192066 cases of EHF were reported in China from 2005 to 2021,with an average annual incidence rate of 0.8345/100000;1752 cases died,with an average annual incidence rate of 0.0076/100000 and an average annual morbidity and mortality rate of 0.9122%.The incidence of EHF in China from 2005 to 2021 showed a decreasing trend with an average annual percentage change(AAPC)of-5.56%(P=0.017).Among them,the year 2008 and 2012 were the turning points of the trend of the incidence of EHF.With a decreasing trend between 2005 and 2008,withanannualpercentagechange(APC)of-26.92%(P=0.001);a stable trend between 2008 and 2012,with an APC of 10.61%(P=0.224);and a decreasing trend between 2012 and 2021,with an APC of-4.11%(P=0.016).From 2005 to 2018,reported cases of EHF in China were mainly concentrated in northeastern China,with the top five regions in terms of number of cases being Heilongjiang,Shaanxi,Shandong,Liaoning,and Jilin provinces.The incidence of EHF in 9 regions showed a decreasing trend(all P<0.05),that in 4 regions showed an increasing trend(all P<0.05),and that in the remaining 14 regions showed a stable trend(all P>0.05).Cases occurred in all age groups,mainly concentrated in 25-64 years old(accounting for 79.86%of all cases),and the age group of 40-44 years old with the highest proportion(accounting for 12.75%).The incidence of EHF in 7 age groups showed a decreasing trend(all P<0.05),the 1-year-old group showed an increasing trend(P<0.05),and the other age groups were stable(all P>0.05).Conclusion From 2005 to 2021,the incidence of EHF in China showed an overall decreasing trend,but the incidence in Heilongjiang,Shaanxi,Shandong,Liaoning,Jilin and other key regions is still at a high level,the decline rate is small,and the epidemic risk still exists.Prevention and control should be strengthened in key areas and groups,and surveillance of cases and local host animals should be carried out continuously.According to the actual local situation,precise and comprehensive prevention and control measures have been formulated and implemented to reduce the epidemic intensity,morbidity and mortality of EHF.