青岛市肾综合征出血热流行趋势与疫区演变

Epidemic trend and focus change of hemorrhagic fever with renal syndrome in Qingdao

目的掌握青岛市肾综合征出血热（HFRS）的流行趋势与疫区演变，指导防治工作。方法对历年监测资料进行分析。结果青岛市1977—2006年HFRS发病率波动在0～33．34／10万之间，年平均为7．07／10万；病死率在0-27．27％之间，年平均为5．06％。流行过程分为早期、第1次高峰期、平稳期、第2次高峰期和缓慢下降期5个阶段。每期发病均有明显的秋冬季高峰，从平稳期开始出现了春夏季增高。秋冬季发病与夏秋季之比为2．26：1，前者病死率较高。发病年龄为0-85岁，20-59岁年龄组占80．93％，男女之比为2．37：1，农民占83．83％。主要发病地区为郊区5个市和黄岛区。发病率远郊高于近郊，近郊高于城区。宿主动物密度为1．56％，阳性率为2．45％。野外和居民区小兽带病毒率分别为2．42％和2．46％。黑线姬鼠、褐家鼠分别是野外和居民区的优势种。荧光抗体法检测发现黑线姬鼠、褐家鼠、小家鼠、大仓鼠、黑线仓鼠和臭鼠句鼯带病毒抗原。结论青岛市HFRS疫区由姬鼠型疫区演变为以姬鼠型为主的混合型疫区。近年来，虽然发病率较低，但宿主动物带病毒率增高，应采取措施加强防治。

Objective To roaster the epidemic trend and focus change of hemorrhagic fever with renal syndrome（HFRS） and guide its prevention and control in Qingdao. Methods Surveillance data was analyzed. Results From 1977 to 2006, the morbidity rate of HFRS fluctuated between 0 and 33.34/100 000, and the annual average was 7.07/100 000. Fatality rate ranged from 0 and 27.27%, and the average was 5.06%. The whole period was divided into five phases： the early phase, the first high peak, the stationary phase, the second high-peak and the slow decline phase. There was a case peak in autumn and winter in each phase, but the cases began to increase in the spring and summer since the stationary phase. The ratio of cases in autumn-winter to that in spring-summer was 2.26 ： 1, and the case fatality rate of former was higher than the latter. The patient＇ s ages ranged from 0 to 85 years old, and the group from 20 to 59 years old accounted for 80.93 %. The ratio of male to female was 2.37：1. Peasants accounted for 83.83 %. The main epidemic areas were five suburban counties and Huangdao district. Morbidity rate in rural areas was significantly higher than that in suburbs, and that in suburbs was higher than that in urban. The host density was 1.56% and its positive rate was 2.45%. The positive rate was 2.42% and 2.46% in the field and the residential area, respectively. Apodemus agrarius and Rattus norvegicus were the dominant species in the field and the residential area, respectively. Using fluorescent antibody test method the Hantavirus antigen was found in A. agrarius, R. norvegicus, Mus musculus, Tscherskia triton, Cricetulus barabensis and Suncus murinus. Conclusion The HFRS focus changed from the Apodemus-type at the early phase to the mixed ones in which the Apodemus-type was dominant. In resent years the morbidity rate decreased, but the positive rate of reservoir bests increased significantly. Preventive measures should be strengthened.