河北省2011-2012年地方性斑疹伤寒监测结果与分析

Endemic typhus surveillance results analysis during in Hebei province 2011-2012

目的了解河北省地方性斑疹伤寒的流行状况,开展病例实验室诊断,为制定防治措施提供依据。方法采用微量间接免疫荧光抗体检测方法对病例标本进行莫氏立克次体血清Ig G、Ig M抗体检测,应用复合式巢氏PCR方法对病例急性期血液进行DNA检测分析,应用描述性流行病学方法对病例特征进行分析。结果辛集市、定州市和迁安市3个监测点共报告病例111例,血清学阳性者78例,阳性率为70.27%,3个市的血清学阳性率分别为76.56%（49/64）、57.89%（11/19）、64.29%（18/28）,三者之间差异无统计学意义（χ2=3.09,P〉0.05）。111份血DNA样本中检测出12份阳性标本,阳性率为10.81%,其中辛集市为15.62%（10/64）、定州市为10.53%（2/19）、迁安市为0.00%（0/28）,三者之间差异无统计学意义（χ2=4.93,P〉0.05）。报告病例中女性多于男性,2~3月病例最多,小年龄组病例较多,职业以农民和学生为主。结论河北省地方性斑疹伤寒以散发为主,实验室诊断能力较低,今后应提高该省地方性斑疹伤寒的实验室诊断能力并加强监测。

Objective To analyze the epidemiological status of endemic typhus in Hebei province from 2011 to2012,develop laboratory diagnosis,and provide evidence for developing typhus prevention and control strategies. Methods The micro-indirect immunofluoresce assay was used for determination of Rickettsia mooseri Ig G and Ig M antibody. DNA was extracted from the blood samples of the acute patients and tested by duplex and nested PCR methods. Descriptive epidemiological method was used to analyze characteristics of Endemic typhus case. Results There were a total of 111 reported cases in Xinji,Dingzhou,and Qianan 3 survey sites reported,serological positive cases was 78,the total positive rate was 70. 27%,the serological positive rates in the 3 cities were 76. 56%（ 49 /64）,57. 89%（ 11 /19）,and 64. 29%（ 18 /28） respectively. By analysis,there was no statistical difference among the 3 cities（ χ2= 3. 09,P〉0. 05）. Of 111 samples,12 samples were positive for TGR and the positive rate was 10. 81%,among which was 15. 62%（ 10 /64） in Xinji city,10. 53%（ 2 /19） in Dingzhou city,and 0. 00%（ 0 /28） in Qianan city respectively,there was no difference between the 3 cities（ χ2= 4. 93,P〉0. 05）. In reported cases,the incidence of females was higher than that of males,the peak epidemic period was from February to March,most cases were in low age group,vocational high risk population were farmers and students. Conclusions The cases of Endemic typhus in Hebei province were mainly sporadic,the diagnostic rate of laboratory is low,it is necessary to improve laboratory diagnosis and strengthen monitoring.