滨州市2003年肾综合征出血热流行特征分析

Investigation of hemorrhagic fever with renal syndrome in 2003 in Binzhou city

目的探讨滨州市肾综合征出血热(HFRS)的发病动态及分布特点。方法选择滨州市黄河北平原进行室内外鼠性监测,以常规夹夜法捕鼠,无菌剖取鼠肺,采用间接免疫荧光技术(I FAT)检测汉坦病毒(HV)抗原、抗体。患者血清来源于医院。HFRS依据临床表现,实验室检查及流行病学作为诊断标准。结果室内鼠密度4.9%,以褐家鼠为主,占63.1%,野外鼠密度4.6%,黑线姬鼠占58.6%。室内大小家鼠带毒率为0.6%。野鼠中黑线姬鼠、小家鼠带毒率为6.7%。HFRS发病315例分布全市7个县区、56个乡镇。邹平山区发病高达69.0/10万,个别乡镇达201.6/10万。多年无HFRS的黄河北平原的惠民县发病率亦达4.2/10万。3～4月份、10～11月份发病占88%。21～40岁为高发病年龄占73.3%,男女性别比为2.1∶1。农民占72.4%。病例以免疫荧光抗体检查HFRS确诊率为60.2%,临床诊断HFRS者再以抗体检查诊断符合率为72.2%。结论鼠带毒率与HFRS发病率有密切关系,可能是造成HFRS发病的直接原因。

Objective The present investigation was designed to understand the dynamics and distribution of hemorrhagic fever with renal syndrome(HFRS) in Binzhou city. Methods Indoor and outdoor surveillance of mice and rats was done in the plain of the north to the Yellow River in Binzhou city. Rats were captured by conventional night trapping method. And rat lungs were removed using aseptic technique. Hantavirus (HV) antigen and antibody were detected by indirect Immunofluorescence Assay technique. Sera were taken from hospital patients whose diagnosis of HFRS was made base on clinical manifestation, lab tests and epidemiological criterion. Results It was found that indoor rat density was 4.9%, with brown rats(Rattus norvegicus)predominant accounting for 63.1%. And filed rat density was 4.6% with Apodemus agrarius taking up 58.6%. The rate of virus-carriers in large and small house rats was 0.6%. Apodemus agrarius was the main species of field rats. The rate of virus-carriers in small house rats was 6.7%. Seven counties and districts and 56 rural and town administrative districts of the city were affected by HFRS with a total of 315 cases。The incidence of the epidemic in Zoupingshan area reached 69.0/100,000, with individual rural administrative district having a high incidence of 201.6/100,000. The incidence in the plain Huiming county to the north of the Yellow River, where HFRS had disappeared for many years, came to 4.2/100,000. The epidemic attacked mostly during March to April and October to November (88%). Individuals at 21 to 40 years of age were more often affected (73.3%) with the ratio of males to females being 2.1:1, and peasants accounting for majority of the cases (72.4%). 60.2% of HFSR cases were diagnostically confirmed by immunofluorescent antibody assay. The coincidence rate of clinical diagnosis and antibody detection of HFRS was 72.2%。Conclusion Virus-carrier rats are closely related to the occurrence of HFRS.