中国倡导的“丝绸之路经济带”沿线五个国家病毒性传染病流行概况分析

Analysis of Epidemiological Situation of Viral Infectious Diseases in Five Countries along the Silk Road Economic Belt Advocated by China

随着"丝绸之路经济带"倡议的提出和设施联通、贸易畅通、资金融通、民心相通的不断推进,我国面临传染病输入风险增加的可能。分析"丝绸之路经济带"沿线部分国家病毒性传染病疫情,为防止传染病跨境传播提供科学依据。通过不同途径获取病毒性传染病文献,两人同时阅读、提取相关信息并进行分析或比较。选择俄罗斯、哈萨克斯坦、沙特阿拉伯、伊朗、阿富汗5个国家,共获得有效文献231篇,确定13种分析病种。各国获取的文献数量、文献内容、疾病流行特点不尽相同,例如,俄罗斯流感文献提供了较完整的监测数据,除2009年全球A(H1N1)pdm大流行外,各年以H3N2或B型流感为主。5个国家中,A(H1N1)pdm检出率俄罗斯高达79.00%、阿富汗最低为2.32%。阿富汗2006年前未建立流感监测系统,2011年后该系统受到削弱。伊朗针对克里米亚-刚果出血热(Crimean-Congo hemorrhagic fever,CCHF)开展了许多研究,该国CCHF在1999~2011年间的病死率为14.50%,高危人群、牲畜感染率分别是14.80%~16.49%、3.7%~66.95%,蜱虫带毒率11.30%~70.00%,高危职业、蜱虫叮咬史是感染CCHF的危险因素,所分离病毒与欧洲世系土耳其人源病毒II组密切相关。其余各国均有病例报道,多呈散发状态。沙特阿拉伯提供了迄今为止大部分揭示中东呼吸综合征(Middle East respiratory syndrome,MERS)流行规律的数据,该国一般人群感染率为0.15%,疑似病例和密切接触者感染率为0.70%、高危人群感染率为2.30%~3.60%。糖尿病、心脏病、吸烟是感染中东呼吸综合征病毒(Middle East respiratory syndrome coronavirus,MERS-CoV)的独立危险因素。全基因组序列和蝙蝠病毒核苷酸分析提示,骆驼是重要但并非唯一的储存宿主。除伊朗外,其它3国尚无输入性MERS病例报道。本研究提示,为促进我国倡导的"丝绸之路经济带"建设,首先需要了解各国传染病流行状况,并充分发挥口岸传染病监测和出入境检验检疫工作的前哨作用。

With the proposal of "Silk Road Economic Belt" and the continuous advancement of facilities,trade,capital and people’s common aspiration,the risk of importing infectious diseases in China is increasing.The aim of this study is to analyze the epidemic situation of viral infectious diseases in 5 countries along the Silk Road Economic Belt and provide a scientific basis for preventing the cross-border transmission of these diseases.Literatures on viral infectious diseases were obtained through different methods. Two people read and extracted relevant information at the same time and finally made analysis or comparisons. Five countries,including Russia,Kazakhstan,Saudi Arabia,Iran and Afghanistan,were selected. A total of 231 useful literature articles were obtained and 13 types of diseases were identified. For example,influenza literature from Russian can provide more complete monitoring data. Except the global A(H1N1)pdm pandemic in 2009,influenza H3N2 or B was the main influenza virus each year in Russian. Among the five countries,the detection rate of A(H1N1)pdm was 79.00% in Russia and 2.32% in Afghanistan.The Afghan influenza surveillance system was not established until 2006 and weakened after 2011. Many studies were carried out in Iran on Crimean-Congo hemorrhagic fever(CCHF). The case fatality rate of CCHF in the country was 14.50% between 1999 and2011. The infection rates in high-risk populations and livestock were 14.80%~16.49%,3.70%~66.95%,respectively. The infection rate of ticks was 11.30%~70.00%. A high-risk occupation and the history of tick bites were the risk factors for CCHF infection. The virus isolated from Iran was closely related to the European Turkish human-borne virus group II. Other countries also reported some cases,mostly sporadic. Saudi Arabia has provided the most complete data so far revealing the epidemic pattern of Middle East respiratory syndrome(MERS). The prevalence of MERS was 0.15% in the general population,0.70% in suspected cases and close contacts,and 2.30%~3.60% in high-risk populations. Diabetes mellitus,heart disease and smoking were independent risk factors for infection with Middle East respiratory syndrome virus. The camel genome sequence and bat virus nucleotide analysis suggested that camel was an important but not the only reservoir host. No MERS imported cases have been reported in countries other than Iran. In conclusion, to promote the construction of the Silk Road Economic Belt advocated by China,it is essential to first understand the epidemic situation of infectious diseases in various countries,and to play the substantial outpost role of infectious disease port surveillance and entry-exit inspection and quarantine.