荆州市人畜同步化疗控制血吸虫病疫情12年纵向观察

Effect of Synchronous Chemotherapy for Residents and Livestock against Schistosomiasis Japonica for 12 Years in Jingzhou City

目的评价1992-2001年世界银行贷款中国血吸虫病控制项目期间,湖北省荆州市血吸虫病的防治效果,并观察该项目结束2年后疫情变化情况。方法采用回顾性纵向调查方法,收集整理1992-2003年荆州市8个县(市、区)人畜查病、治病、扩大化疗、查螺、灭螺和健康教育等年报资料,利用u检验进行疫情动态分析。结果2001年荆州市血吸虫病患者(77009例)比1992年(140438例)下降了45.2%,其中急性和晚期血吸虫病患者(63和1032例)分别比1992年(244和1841例)下降74.2%和43.9%;人群平均感染率由1992年的7.8%降至4.7%;防治前后人群平均感染率的差异有统计学意义(u=28.864,P<0.01)。2001年感染血吸虫的耕牛(3454头)比1992年(8035头)下降了57.0%,耕牛平均感染率亦由1992年的7.9%降至2001年的3.7%,防治前后耕牛平均感染率的差异有统计学意义(u=9.338,P<0.01)。2001年钉螺面积(19368hm2)比1992年(25395hm2)下降了23.7%。项目结束2年后,2003年急性血吸虫病例100例,比1992年下降了59.0%,但比2001年上升了58.7%。人群平均感染率上升至8.4%,比1992年和2001年分别上升了7.7%和78.7%(u=6.453、34.804,P<0.01)。耕牛平均感染率为6.5%,比1992年下降了17.7%,比2001年上升了75.6%(u=3.061、5.894,P<0.01)。钉螺面积上升至32853hm2,比1992年和2001年分别增加了29.3%和69.6%。结论人畜同步化疗可在短期内控制疫情和传播,项目结束后疫情发生反弹,甚至高于项目开始前的疫情水平。

Objective To evaluate the anti-schistosomiasis effect of World Bank loan for schistosomiasis control project 1992-2001 in Jingzhou City, Hubei Province, and observe the endemic situation after two years of the end of the project. Methods By a retrospective longitudinal survey,information from annual reports was collected, which included disease screening, treatment and extended chemotherapy for human population and livestock, the distribution of Oncomelania hupensis and health education information from eight counties in Jinzhou prefecture from 1992 to 2003. Statistical u test was used for phased retrospective dynamic analysis. Results In the year 2001, schistosomiasis patients（77 009 cases）were 45.2% less than that of 1992（140 438 cases）, The number of acute and advanced cases（63 and 1 032 cases, respectively）was 74.2% and 43.9% less than those of 1992（244 and 1 841 cases, respectively）. The average infection rate among residents was also reduced from 7.8% of 1992 to 4.7%（u=28.864, P〈0.01）. Number of infected cattle in 2001（3 454）was 57.0% less than that of 1992（8 035）, and the prevalence in cattle was reduced from 7.9% of 1992 to 3.7%,decreased by 53.2%（u=9.338, P〈0.01）. Snail-ridden area in 2001 was 19 368 hectares, 23.7% less than that of 1992（25 395 ha）. In 2003, two years after end of the project, number of acute schistosome infections was 100 cases, 59.0% less than that of 1992, but 58.7% more than that of 2001. The average infection rate in humans increased to 8.4% in 2003, 7.7% and 78.7% more than that of 1992 and 2001, respectively（u=6.453、34.804, P〈0.01）. The average infection rate in cattle increased to 6.5% in 2003, 17.7% less than that of 1992, but 75.6% more than that of 2001（u=3.061、5.894,P〈0.01）. Snail-ridden areas also increased in 2003 with 29.3% and 69.6% more than that of 1992 and 2001, respectively. Conclusion Synchronous chemotherapy for residents and livestock can reduce the prevalence of schistosomiasis and control its transmission effectively in several year period, but the disease may re-emerge after chemotherapy stopped.