1起恙虫病暴发疫情的流行病学调查及病例经济负担分析

Investigation of a scrub typhus outbreak in Jingjiang and analysis of patients' economic burden

目的 分析2013年靖江市1起恙虫病暴发疫情的流行病学特征,评估经济损失。方法 在流行季节开展应急监测和主动搜索以发现病例;病例诊断采用RT-PCR法检测恙虫病东方体特异核酸或酶联免疫法（ELISA）检测恙虫病IgM和IgG抗体。采用自行设计的问卷对确诊病例进行调查,内容包括基本情况、诊治过程、诊疗费用及相关经济损失,计算患病后直接、间接、无形经济损失和总经济损失。结果 这起恙虫病疫情累计报告确诊病例271例,无死亡病例,发病率39.6/10万。发病时间为10月18日-12月11日,流行高峰期为11月上旬（占48.3%）;14个乡镇有病例报告,发病率为4.1/10万~220.5/10万。男女发病率比为1∶1.63,差异有统计学意义（P〈0.01）。病例多为50~69岁（占58.6%）,职业以农民为主（占86.9%）。评估这起恙虫病暴发总经济负担为1 958 885元,人均7 228元,其中直接经济负担998 093元,人均3 683元;间接经济负担331 530万元,人均1 542元;无形经济负担629 262元,人均2 322元。结论 靖江市恙虫病暴发属于南方模式,与秋天水稻收割有关;发病后首诊未能及时确诊和治疗是经济负担增加的重要原因,以较高的直接经济负担为主。

Objective To analyze epidemiologieal characteristics of a scrub typhus outbreak in Jingjiang in 2013; to evaluate economic burden of patients. Methods Patients were identified by emergent surveillance and active search in epidemic seasons. Patients were diagnosed by RT-PCR to detect specific nucleic acid or ELISA to detect IgM/igG of scrub typhus orientia tsut- sugamushior. Patients were surveyed by self designed questionnaires for basic information, process and fees of diagnosis and treatment and other cost. Direct, indirect, intangible loss together with total loss was calculated based on survey results. Re- sults A total of 271 confirmed patients were reported during the outbreak, resulting incidence of 39. 6/10^5 , no death cases were reported. The epidemic duration was from Oct 18th to Dec 11th , while the first half of Nov was epidemic peak （accounted for 48.3%of all patients）. Patients were reported in 14 counties, with incidence of 4.1/10^5--220.5/10^5. Ratio of male inci dence to that of female was 1：1.63, with statistical difference（P〈0.01）. Majority of patients were 50--69 years old （accoun- ted for 58.6 % of all patients）, farmers were main occupation （accounted for 86.9 % of all patients）. The estimated economic loss of the outbreak was 1 958 885 RMB in total and 7 228 RMB per patient; in which direct loss was 998 093 RMB in total and 3 683 RMB per patient, indirect loss was 331 530 RMB in total and 1 542 RMB per patient, intangible loss was 629 262 RMB in total and 2 322 RMB per patient. Conclusion The scrub typhus outbreak in Jingjiang was southern mode, which was related to rice harvesting. Failure of initial diagnosis and treatment was important reason for increasing economic loss of patients, es- pecially direct economic loss.