2006-2010年传播阻断地区血吸虫病监测投入与效果评价

Evaluation on investment of schistosomiasis surveillance effectiveness in schistosomiasis transmissioninterrupted areas from 2006 to 2010

目的通过对血吸虫病传播阻断代表性地区2006--2010年血吸虫病监测工作投入与效果数据的收集和分析，探讨此类地区今后需加强的重点投入与防治措施，为监测巩固方案的修订提供参考。方法选择浙江省江山市、富阳市，广东省清新市、三水市，福建省福清市、龙海市等6个曾为流行区的市（县），采用回顾性调查、历史文献复习法和现场调查法收集与分析2006--2010年上述3省6市血吸虫病监测工作的经费投入与疫情监测效果。结果3省6市，2006--2010年，财政经费投入与支出总额排名：浙江省江山市最高（投入824．60万元、支出1047．48万元），广东省清新市最低（投入14．50万元、支出15．95万元）。投入一支出贴现分析显示6市中，广东2市低投入与低支出相对值较小，而与其他2省相比，无论投入与支出，绝对值相差较大。浙江2市，富阳市投入与支出平衡，江山市高投入与高支出并存，同时支出远大于投入。福建2市存在投入与支出前高后低现象且逐年减少。疫情监测结果显示，人群平均血检阳性率为0．67％，广东省三水市最高（1．46％），浙江省富阳市最低（0．03％）；血检阳性人群虫卵平均阳性率为1．04％（4／383）。查出4例确诊病例均为福建省福清市输入性病例，血检阳性人群虫卵阳性率为7．02％（4／57），其他各市未发现粪检阳性病例。家畜查病包括耕牛查病总数6811头，其他家畜（羊）180头，均未发现阳性。查螺总面积为4089．92hm2（1hm2=10000m。）其中福建省福清市、龙海市钉螺密度分别为0．0800只／0．1m2、0．0040只／0．1m2，浙江省江山市为0．0010只／0．1m2，其他3市未发现钉螺；6个调查市均未发现感染性钉螺。粪便管理方面，无害化厕所覆盖率以广东省三水市居首（98．73％），浙江省江山市居末（55．16％）。结论传播阻断区血吸虫病监测应采取外源性传染源监测为主，内源性传染源监测为辅的措施，同时，重点排查来自疫区的家畜，提高监测工作覆盖面。鉴于查灭螺工作投入与支出比重大，覆盖面广，应采取周期延长、环境轮换监测改进措施。部分阻断区无害化厕所覆盖率较低，存在发展为潜在传染源的可能性，需引起重视；部分地区投入较低影响监测效果有待改善。

Objective To study the focus of future investment measures to be strengthened for schistosomiasis control so as to provide a reference for the plan of schistosomiasis surveillance and consolidation amendment by collecting and analyzing the performance data of investment and effectiveness on schistosomiasis surveillance in the representative schistosomiasis transmission-interrupted areas from 2006 -2010. Methods The historical endemic areas of Jiangshan and Fuyang counties of Zhejian Province, Qingxin and Sanshui counties of Guangdong Province, Fuqing and Longhai counties of Fujian Province were selected. The retrospective investigation, history review of the literature and field survey were performed to collect and analyze the data for input and effectiveness of schistosomiasis surveillance in the above six counties of the three provinces from 2006 to 2010. Results From 2006 to 2010, in the six counties of the three provinces, the rank of total financial input of funds and expenditure were as following ： Jiangshan County, Zhejiang Province was the highest （824.60 ten thousand yuan investment, 1 047.48 ten thousand yuan expenditures）, Qingxing County, Guangdong Province was the minimum （14. 50 ten thousand yuan investment, 15.95 ten thousand yuan expenditures）. Investment expenditure discounted analysis showed that in the six counties, in Guangdong Province, investment expenditure of two counties was low and also the relative value was small, compared with the other two provinces, both investment and expenditure, the absolute value difference was relatively large. In Zhejiang Province, the input and expenditure were balance in Fuyang County while high input and high expenses existed in Jiangshan County with both than the input expenditure much higher. In two counties of Fujian Province, investment and expenditure were from high to low and decreasing year by year. The results of schistosomiasis surveillance showed that the average positive rate of blood examination in population was 0.67% in six counties of three provinces. Sanshui County of Guangdong Province was the highest （ 1.46% ）, whereas, Fuyang County of Zhejiang Province was the lowest （0.03%）. The average egg positive rate was 1.04% （4/383） among the positive population after blood examination. Four imported confirmed cases were reported in Fuqing County of Fujian Province, The average egg positive rate was 7.02% （4/57） among the positive population after blood examination. Moreover, the positive cases were not found by the method of stool examination in other counties. There were no positive cases upon examination of the total number of 6 811 bovines and 180 sheep in the above six counties. From 2006 to 2010, the total areas of snail investigation were 4 089.92 hm2 （ 1 hm2 = 10 000 m2 ） and no positive snails were found after snails investigation in the six counties of the three provinces. Density of Snails was O. 080 0 single/0, lm2 in Fuqing County, 0.004 0single/ 0. lm2 in Longhai county of Fujian Province, 0. 001 0single/0. lm2 in Jiangshan County of Zhejiang Province respectively. No snails were found in the other three counties. The cover age rate of non-hazardous sanitary latrine was topped to 98.73% in Sanshui County, Guangdong Province whereas 55.16% was the lowest in Jiangshan County, Zhejiang Province in respect of manure management. Conclusion The measures of mainly surveillance on external source of infection supplemented with internal source of infection monitoring should be adopted in schistosomiasis transmission-interrupted areas while focusing on livestock screening from the endemic areas to improve the monitoring coverage. In the view of a large proportion of the investment-expenditure for snails survey and the wide areas investigation coverage, means of extending the cycle investigation and environmental improvement for monitoring the rotation should be taken. Since the low coverage rate of non-hazardous sanitary latrine in the part of counties, it needs to pay attention to the possibilities of potential source of infection. The results of schistosomiasis surveillance should be improved for the impact of lower investment in parts of counties.