甘肃省卓尼县棘球蚴病流行病学特征分析

Epidemiological characteristics of echinococcosis in Zhuoni County Gansu Province

目的了解卓尼县棘球蚴病（又称包虫病）流行趋势及其特点，为制定防控策略提供依据。方法2008-2016年，根据《甘肃省棘球蚴病防治项目监测方案》要求，采取整群抽样法，在卓尼县各乡镇，以行政村为单位，用B超检查人群棘球蚴病患病情况，依据《棘球蚴病诊断标准》（WS257-2006）、流行病学史及临床表现予以诊断，计算棘球蚴病检出率；每年在每个流行乡调查1所乡村小学全部12岁以下儿童，采集静脉血，分离血清，应用酶联免疫吸附试验（ELISA）检测棘球蚴IgG抗体。计算儿童棘球蚴IgG抗体阳性率；每年在每个流行乡抽取50。100户养犬户，每户采集1份犬粪样本，以双抗体夹心ELISA法检测犬棘球绦虫抗原，计算犬粪抗原阳性率；每年在卓尼县屠宰场随机剖解羊700只或牛300头，检查屠宰牛羊的肝、肺等脏器，触摸有无囊状物、包块或结节，计算当年家畜棘球蚴感染率。结果2008—2016年，卓尼县人群棘球蚴病检出率为0．18％（200／108522），均为囊型病例，女性检出率（0．23％，123／53556）高于男性（0．14％，77／54966），不同性别棘球蚴病检出率比较差异有统计学意义（x2=11．83，P〈0．05）；农民患者最多（58．00％，116／200），牧民次之（39．50％，79／200）；卓尼县96．94％（95／98）的行政村存在棘球蚴病流行，纯牧区的完冒乡患病最重（0．44％，15／3423），半农半牧区的纳浪乡次之（0．37％，29／7756），城镇的柳林镇最轻（0．06％，16／25923）。儿童棘球蚴IgG阳性率为2．13％（235／11048），犬棘球绦虫抗原阳性率为1．71％（183／10711），牲畜棘球蚴感染率为1-36％（100／7348）。人群棘球蚴病检出率由2009年的1．02％（106／10350）降至2016年的0．03％（3／11804），儿童棘球蚴IgG阳性率由2008年的7．50％（9／120）降至2016年的0．71％（9／1264），犬棘球绦虫感染率由2009年的3．13％（47／1500）降至2016年的0．30％（3／1000），牲畜棘球蚴感染率由2010年的4．21％（34／807）降至2016年的0．30％（3／1000）。结论卓尼县棘球蚴病流行广，危害重；经9年综合防治后，人群棘球蚴病检出率、儿童棘球蚴IgG阳性率、家犬棘球绦虫抗原阳性率、牲畜棘球蚴感染率均明显下降，表明综合防治策略成效显著。

Objective To understand the epidemic trend and characteristics of echinoeoccosis in Zhuoni County, and to provide evidence for formulating prevention and control strategies. Methods From 2008 to 2016, according to the ＂Monitoring Program for Prevention and Control of Echinocoecosis in Gansu＂, a cluster sampling method was adopted to examine the prevalence of echinococcosis in the villages and towns of Zhuoni County with the administrative village as a unit; B ultrasonic examination was used to study the prevalence of echinocoecosis in the population. According to ＂the Diagnostic Criteria of Echinococcosis＂ （WS 257-2006）, epidemiological history and clinical manifestations, the detection rate of echinococcosis was calculated; children under 12 years of age in one rural primary school were surveyed every year in each of the disease affected county; venous blood was collected, serum was separated, enzyme linked immunosorbent assay （ELISA） was used to detect the IgG antibody of echinococcosis, and the positive rate of IgG antibody of echinococcosis in children was calculated; 50 - 100 households were sellected every year in each of the disease affected village and town, one sample of canine feces was collected from each household, the fecal antigen of echinococcus canis was detected via the double antibody sandwich ELISA method, and the positive rate of dog fecal antigen was calculated; every year 700 sheep or 300cattle were randomly dissected at the slaughterhouse of Zhuoni County, and their organs such as liver and lungs of slaughtered cattle and sheep were examined, the infection rate of echinococcosis in the year was calculated. Results From 2008 to 2016, echinococcus detection rate in Zhuoni County was 0.18% （200/108 522）, and all of the cases were cystic; the detection rate of female （0.23%, 123/53 556） was higher than that of male （0.14%, 77/54 966）, and the difference was statistically significant （X2= 11.83, P 〈 0.05）; the number of farmer cases was the highest （58.00%, 116/ 200）, followed by herdsmen （39.50%, 79/200）; 96.94% （95/98） of the administrative villages in Zhuoni County had echinococcus; the disease was most severe in pure pastoral areas （0.44%, 15/3 423）, followed by semi pastoral areas （0.37%, 29/7 756）, and cities and towns the least （0.06%, 16/25 923）. The positive rate of IgG in children with echinococcus was 2.13% （235/11 048）, the infection rate ofechinococcus canis was 1.71% （183/10 711）, and the infection rate ofechinococcus in livestock was 1.36% （100/7 348）. The detection rate of echinococcus decreased from 1.02% （106/10 350） in 2009 to 0.03% （3/11 804） in 2016, the IgG positive rate of echinococcus in children dropped from 7.50% （9/120） in 2008 to 0.71% in 2016 （9/1 264）, the infection rate of echinococcus canis decreased from 3.13% （47/1 500） in 2009 to 0.30% （3/1 000） in 2016, and the rate of echinococcus in livestock infection decreased from 4.21% （34/807） in 2010 to 0.30% （3/1 000） in 2016. Conclusions County wide epidemic ofechinococcus is found in Zhuoni with serious damage; after 9 years of comprehensive prevention and control, the detection rate of echinococcosis, IgG positive rate of echinococcus in children, positive rate of echinococcus granulosus antigen in domestic dogs and infection rate of echinococcosis in livestock are all decreased significantly. It shows that comprehensive prevention and control strategy has achieved remarkable results.