2004-2015年青海省人间鼠疫疫情及控制分析

Epidemic situation of human plague in Qinghai Province from 2004 to 2015

目的了解青海省人间鼠疫疫情流行及控制现状，总结人间疫情防控经验，为“十三五”期间制定防控措施提供依据。方法收集2004—2015年青海省人间鼠疫疫情处置资料，采用回顾性分析方法，分析2004—2015年青海省人间鼠疫的类型，疫情的发现途径、时间分布、感染途径、实验室检测结果、疫情扩散情况以及患者的职业分布。结果2004—2015年青海省共发生人间鼠疫疫情10起，发病34例，死亡14例，病死率为41．18％。34例鼠疫患者中，原发性肺鼠疫21例：原发性肺鼠疫继发败血型鼠疫4例：腺鼠疫继发败血型鼠疫4例，原发性败血型鼠疫继发肺鼠疫1例，继发腺鼠疫2例；腺鼠疫并鼠疫蜂窝组织炎1例；腺鼠疫继发败血型鼠疫并肺鼠疫1例。10起疫情中，首发病例死亡后上报7起。疫情发生在6—11月，高峰在9、10月。感染途径以主动接触旱獭为主，占70％（7／10），染疫牧犬为人间肺鼠疫爆发流行的传染源。结论青海省人间鼠疫均有明显的动物间鼠疫前兆，应充分发挥村医在鼠疫控制中的前哨作用，加大对出外务工人员的鼠疫防治教育和管理，做好控制人间鼠疫疫情的各项应急准备。

Objective To understand the epidemic and control situation of human plague in Qinghai Province, to summarize experience and to provide a basis for formulating prevention and control measures for ＂the Thirteenth Five-Year Plan＂. Methods Disposal information on epidemic situation of human plague in Qinghai Province from 2004 to 2015 was collected; fatality rate and incidence trend of human plague were analyzed; way of infection, the laboratory test results, the spreading of epidemic situation and occupational distribution of the patients were analyzed retrospectively. Results There were 10 human plague epidemics and 34 cases in Qinghai Province from 2004 to 2015, and 14 eases died; the case fatality rate was 41.18%. Of the 34 cases of plague patients, 21 cases were primary pneumonic plague, 4 cases were primary pneumonic plague developed into septicemia and 4 cases were bubonic plague developed into septicemic plague, 1 case was primary septicemic plague developed into pneumonie plague, 2 cases was bubonic plague, 1 case was bubonic plague and plague cellulitis, 1 case was bubonic plague developed into septicemic plague and pneumonic plague. In the 10 outbreaks, seven initial cases were reported after death. The epidemic occurred from June to November, peaked in September and October. Active contact with the Marmot was still the main way of infection, accounted for 70% （7/10）. The infected shepherd became the source of human pneumonie plague outbreaks. Conclusions Human plague in Qinghai Province has an obvious animal plague precursor. Village doctors should play more important roles in control of the plague. Education and management of migrant workers should be strengthened. All kinds of emergency measures should be readily available.