2016年我国疟疾死亡病例分析

The analysis of deaths due to malaria in China, 2016

目的探究2016年我国15例疟疾死亡病例的原因,为减少疟疾病例死亡提供借鉴和依据。方法收集2016年1月—12月我国疟疾专报系统中报告的15例疟疾死亡病例数据和医疗机构病案资料,通过临床医疗和疾病控制专家会商,分析病例死亡的可能原因。结果 15例死亡病例中,男性14例、女性1例,以出国务工的青壮年为主,均为恶性疟感染,输入来源地均为撒哈拉以南的非洲国家。死亡病例回国至出现发热症状的平均时间差为5.27 d(中位数4 d),初次发热至初次就诊平均时间差为3.07 d(中位数1 d),初次就诊至确诊的平均时间差为5.40 d(中位数3 d),确诊到死亡的平均时间差为2.00 d(中位数1 d),回国至死亡的平均时间差为15.73 d(中位数13 d)。结论医疗机构诊治能力不足导致的确诊不及时和病例防疟意识较低导致的就医延迟可能是死亡病例发生的主要原因,需提高医疗机构的疟疾诊治能力和加强出国人员疟疾防治相关的健康教育。

Objective To analyze possible causes of 15 deaths due to malaria in 2016 for providing evidence-based reference to reduce deaths from malaria. Methods Information about medical records from hospitals and case reports from the National Information System for malaria from Jan. to Dec. 2016, were collected and analyzed through consultancy workshops participated by experts from both hospitals and CDCs. Results Among 15 deaths 14 were male and 1 case was female, all of which were young adults with recent history of traveling to sub-Saharan African countries and infected with Plasmodium falcipurum malaria outsides of China. The average time interval returning home to death was 15.73 d （median, 13 d） with the decomposition of 5.27 d （median, 4 d） from returning home to onset of fever; 3.07 d （median,1 d） from onset of fever to healthcare seeking; 5.40 d （median, 3 d） from healthcare seeking to diagnosis of malaria, 2.00 d （median, 1 d） from diagnosis of malaria to death. Conclusion There are delays and the lack of awareness to prevent malaria existed in each step from onset of fever to death which imply that health educations should be provided to workers going to endemic countries and trainings about malaria diagnosis and treatment are necessary to hospital doctors.