四川省2015-2017年布鲁氏菌病新发县(区、市)病例调查研究

Investigation of human brucellosis cases in newly affected counties in Sichuan province, 2015-2017

目的:了解四川省2015-2017年布鲁氏菌病(布病)新发县(区、市)病例发现情况,为防控策略提供依据。方法:通过"中国疾病预防控制信息系统"收集布病发病及突发事件监测数据;以面对面访谈、在线调查等方式,收集病例流行病学特征、诊疗经历,以及医院、CDC布病实验室采样、诊断现状。结果:2013年以来四川省布病疫情上升明显,累计新发县(区、市)有103个。共调查23例新发县(区、市)病例,主要症状为发热,占91.30%(21/23);初诊医疗机构以县级及以下医院为主,占73.91%(17/23);初诊误诊率高达91.30%(21/23);发病到确诊的间隔中位数为52 d,最长142 d。病例布病知晓率为4.35%(1/23),与可疑牲畜接触中防护衣使用率为30.43%(7/23),手套使用率为8.70%(2/23),口罩使用率为4.35%(1/23),接触后使用消毒液洗手率为4.35%(1/23)。病例感染可疑牲畜均为羊,其中34.75%(8/23)为甘肃、青海等省份输入。调查临床医生295名,布病总知晓率为34.58%(102/295),相关知识培训率为58.31%(172/295)。调查33家医院,具备布病实验室诊断能力的仅占33.33%(11/33)。调查县级CDC 23家,具备布病实验室检测能力的占34.78%(8/23)。结论:四川省布病疫情防控形势较为严峻,新发县(区、市)病例初诊误诊率极高,诊断延迟明显,且布病知晓率低,自我防护意识差。临床医生布病知识知晓率低、培训不够;医院和基层疾病预防控制机构布病实验室诊断能力储备不足,为布病病例的早期发现、治疗及规范化管理等带来极大挑战。

Objective To understand the discovery of human brucellosis cases in new affected counties in Sichuan province,2015-2017,and provide evidences for prevention and control of human brucellosis.Methods The incidence data and outbreak data of human brucellosis in Sichuan were collected from Chinese Infectious Disease Surveillance Reporting System,and face to face interview,telephone interview and on-line survey were conducted to collect the case information,such as epidemiological characteristics,medical care seeking.Results The incidence of human brucellosis in Sichuan has increased obviously since 2013,and 103 counties reported human brucellosis cases for the first time.A total of 23 cases of human brucellosis were investigated,and the common symptoms of the cases was fever,accounting for 91.30%(21/23).The cases mainly sought medical care in hospitals under county-level for the first time,accounting for 73.91%(17/23),and the misdiagnosis rate was 91.30%at the first diagnosis(21/23).The median interval between onset and diagnosis was 52 days,and the longest one was 142 days.Only 4.35%(1/23)cases knew human brucellosis,and when they contacted with suspected livestock,the use rate of protective clothing was 30.43%(7/23),the use rate of gloves was 8.70%(2/23),the use rate of mask was 4.35%(1/23),and the rate of washing hands with disinfectant after contact with livestock was 4.35%(1/23).Goat was suspected to be the infection source of all the cases,and 34.75%(8/23)of the cases were from Gansu,Qinghai and other provinces.The overall awareness rate of human brucellosis in the doctors was 34.58%(102/295),and the training rate was 58.31%(172/295).Only 33.33%(11/33)of the hospitals could perform laboratory diagnosis of human brucellosis and 34.78%(8/23)of county CDCs could carry out laboratory test of human brucellosis.Conclusions The prevention and control of human brucellosis is facing challenge in Sichuan.The misdiagnosis rate was very high in newly affected counties,and the diagnosis were delayed obviously.The awareness of human brucellosis was low in the cases,and their awareness of self-protection was poor.The awareness rate about human brucellosis in doctors was low and they need more training;the capacity of brucellosis laboratory diagnosis in hospitals and CDCs at county-level should be improved.