2005-2008年中国报告恶性疟病例流行病学分析

Epidemiological analysis of falciparum malaria reported in China,2005-2008

目的明确中国2005-2008年报告恶性疟病例的流行病学特征,为当前恶性疟防控提供参考数据。方法本文所采用资料来源于中国疾病预防控制中心疾病监测信息报告管理系统,输入性病例仅指除云南和海南省外的其他地区报告的恶性疟病例,采用构成比等相对数描述中国恶性疟报告病例的三间分布和诊断情况,并采用χ2检验、秩和检验和Watson-Willian检验等方法对云南和海南省与其他地区的情况进行了分析比较。结果中国云南和海南省恶性疟报告发病率近年下降明显(P<0.001);而其他地区输入性恶性疟病例有上升迹象;云南和海南省的恶性疟发病高峰月份为4-6月,与其他地区的5-8月高峰不同(P<0.01);恶性疟发病以农民和民工为主,发病年龄主要集中在20～40岁年龄组;中国除云南、海南省外的其他地区恶性疟病死率(3.39%)、发病-诊断时间(中位数=5d)和病例订正报告比例(52.30%)均明显高于云南和海南省(分别为0.76%,3d和11.91%)(P<0.01),而实验室诊断比例(78.18%)低于云南和海南省(92.64%)(P<0.001)。结论近年来,中国恶性疟发病逐年下降,而云南、海南省以外的其他地区恶性疟报告病例上升,且诊断能力较低;建议在这些恶性疟非流行区,大力加强培训和宣传,提高医疗机构对恶性疟病例的诊断能力和诊断及时性,降低病死率。

Objective To identify the epidemiological characteristics of falciparum malaria reported from 2005 through 2008 in China.Methods Using data derived from the Disease Reporting Information System of China Center for Disease Control,where imported cases referred only to those of falciparum malaria reported outside Yunnan and Hainan provinces,the spatial-temporal distribution and diagnosed cases of the population suffering from falciparum malaria in China were described in terms of relative numbers such as constituent ratios,and the situation in Yunnan and Hainan was compared to the other regions using the chi-square test,Kruskal-Wallis test and Watson-Willian test.Results The incidence rate of falciparum malaria in Yunnan and Hainan provinces showed a remarkably declining trend in recent years,in contrast to the slightly increasing one of imported cases in other regions （P0.001）.The onset peak was present from April to June in Yunnan and Hainan rather than from May to August in other regions （P0.01）.Farmers and migrant workers were the group primarily affected by this disease,the age of onset ranging between 20 and 40 years.The fatality rate （3.39%）,mean onset-diagnosis interval （5 d） and proportion of revised report cards （52.30%） of falciparum malaria cases outside Yunnan and Hainan were significantly higher than those in the two provinces （0.76%,3 d and 11.91%,respectively;P0.01）.However,the proportion of laboratory confirmed cases （78.18%） of the former was lower than that of the latter （92.64%,P0.001）.Conclusion Despite its annually decreasing incidence in China in recent years,reported cases of falciparum malaria were accumulating outside Yunnan and Hainan in addition to low diagnostic capability.Therefore,health education and relevant training should be strengthened in non-prevalent areas to assist in early diagnosis and to improve the diagnostic capability in medical institutions,thereby reducing the fatality rate.