青海省人间鼠疫流行特征及控制措施的研究(摘要)(英文)

A Study on the Epidemic Patterns and Control Measures of Human Plague in Qinghai Province

本文研究了1958～1992年青海省166起391例人间鼠疫的流行特征。其主要传染源为喜马拉雅旱獭,占73.50％;非啮齿动物宿主为15.66％,并可引起原发性肺、肠、眼型鼠疫。传播途径以剥食染疫的旱獭或野生动物为主(占病例数的47.67％),引起腺鼠疫或败血症,并易继发为肺鼠疫;通过呼吸道感染造成人与人之间的肺鼠疫流行,占病例数的47.05％,该途径在青海省占有重要位置;而以鼠-蚤-人的途径仅占2.31％。人间鼠疫病例的性别、年龄、职业及民族等特点,均与接触疫源动物多寡和在疫源地内活动时间呈正相关。其流行季节自4月～12月均可见到病例,流行高峰在8月,由于一些非啮齿动物宿主参与流行并成为人间鼠疫的传染源,构成了流行季节推迟的特殊现象。青海省每年都有病例发生反映了人间鼠疫的连续性,但从具体发病地区看,呈散在发生,有些地区间隔20～30年又突然发生,反映了人间鼠疫的间断性和突发性。其临床型以肺型多见,占57.37％,单纯腺型23.77％,败血型16.31％,但以每次流行的首发病例统计,仍以腺型为最多,占87.95％,其中73例继发其他型鼠疫。腺肿部位以上肢为多见(58.60％)。其病死率,肺鼠疫为53.79％,腺鼠疫为28.57％,而败血型则高达100％。若经有效治疗,治愈率可达被治疗病例的95.31％。 基于研究与掌握了这些流行特?

Patterns of 166 human plague epidemics occured between 1958 and 1992 in Qinghai were analysed. Among the natural animal reservoirs, Marmota himalayana acted as major infectious reservoir for-up to 73.5% of the epidemics, non-rodent animals that could transmit primary pneumonic, enteric and ophthalmic plague in human comprised 15.66%. Of the 391 human cases, bubonic and septicaemic plague were caused predominantly through skinning and mealing of infected marmota or wild animals and liable to change to secondary pneumonia, which covered 47.67% of the total. Pneumonic epidemics spread directly from person to person via respiratory tracts occupied 47.05%, while the infection through rodents to fleas and to person accounted only for 2.31%. Distributions of sex, age, profession and race were all correspondent to the intimacy with infected animals and the time of stay in endemics. Seasonal pattern analyses revealed that the epidemic could occur through April to December, with a peak around August. The delayed seasonal pattern was due to involvements of non-rodents which played a part in the transmision of human plague. The human cases happening yearly in Qinghai has reflected a sort of succession of plague, on the other hand, the epidemics were characterized by their discontinuity and suddenness in terms of the particular endemic where the plague was sporadic and some areas could have been in stationary stages for 20 to 30 years, while the other regions could be active again after 10 to 20 years. Clinical patterns consisted of mainly pneumonic (57.37%), simple bubonic (23.77%), and septicaemic cases (16.31%). On the basis of the first seen cases in every epidemics, the incidence of bubonic plague was as high as 87.95%, in which 73 of the cases worsened to turn to the secondary infections. Buboes were seen mostly on the upper arms (58.60%). Fatality rates were 53.79% in pneumonic cases, 28.57% in bubonic ones and even 100% in septicaemic ones, respectively. The curative rate was up to 95.31% on condition that effective treatments had been adopted. Based on well known of the human plague epidemic patterns, approparate steps have been taken in Qinghai, which have declined the incidence rate apprently since 1984. So it suggested a possibility that human plague could be prevented so long as a long term systemitical control measure remained relatively constant.