福建省消除疟疾不同时期输入性疟疾疫情分析

Epidemic status of imported malaria at different stages of malaria elimination in Fujian Province

目的分析比较福建省疟疾消除不同时期的输入性疟疾疫情,为消除后疟疾防治策略的制定与防治工作的开展提供科学依据。方法将福建省疟疾消除进程分成3个不同时期,消除前期(2005-2009年)、消除中期(2010-2015年)和消除后期(2016-2019年),收集不同时期疟疾个案和流行病学调查数据,采用SPSS 17.0软件对输入性疟疾疫情进行统计学分析。结果2005-2019年福建省共报告疟疾1105例,除2005年3例本地感染病例外,其余均为输入性病例。消除后期年平均报告输入性病例数为116.3例,高于消除中期的74.2例和消除前期的38.4例。其中恶性疟所占比例上升,消除前、中和后期分别为21.9%(42/192)、60.9%(271/445)和76.8%(357/465),差异有统计学意义(P<0.01)。感染来源,消除前、中期尚有境内输入,消除后期全部为境外输入,其中非洲输入的病例所占比例上升,消除前、中和后期分别为27.1%(52/192)、75.7%(337/445)和92.3%(429/465),差异有统计学意义(P<0.01)。医疗机构的报告病例比例上升,消除后期为95.1%(442/465),高于消除中期的65.6%(292/445)和消除前期的65.1%(125/192),差异有统计学意义(P<0.01)。病例报告季节分布,消除前期具有明显的季节分布,发病高峰在夏季;消除中期无明显季节性;消除后期在年初(1-2月)和年中(6-7月)有明显的报告高峰。报告地区分布,各时期均主要集中于福州地区,其所占比例上升,消除前、中和后期分别为36.0%(69/192)、72.8%(324/445)和78.1%(363/465),差异有统计学意义(P<0.01)。人群分布,均以青中年(20~59岁)男性为主,消除中期和消除后期所占比例分别为96.2%(428/445)和96.1%(447/465),均高于消除前期83.3%(160/192),差异有统计学意义(P<0.01)。结论福建省疟疾消除后,面临更加严峻的输入性疟疾,尤其是非洲输入的恶性疟的挑战,应加强重点人群的宣传教育和医疗机构的培训。

Objective To analyze the epidemic status of imported malaria at different stages of malaria elimination program in Fujian Province,in order to provide scientific basis for the formulation of malaria prevention and control strategy and implementation of control measures in later stage of elimination efforts.Methods The process of malaria elimination in Fujian Province was divided into three stages:the pre-elimination stage from 2005 to 2009,the elimination stage from 2010 to 2015,and the post-elimination stage from 2016 to 2019.Data of malaria cases and epidemiological investigations at different stages were collected to analyze the epidemic situation of imported malaria cases using SPSS 17.0 software.Results A total of 1105 malaria cases were reported in Fujian Province from 2005 to 2019,and all were imported cases except for 3 locally transmitted cases.The annual average number of imported cases reported in the post-elimination stage(116.3 cases per year)was higher than those in the elimination(74.2 cases)and the pre-elimination(38.4 cases)stages.The proportion of falciparum malaria cases increased with staging,from 21.9%(42/192)in the pre-elimination stage,to 60.9%(271/445)in the elimination stage,and to 76.8%(357/465)in the post-elimination stage(P<0.01).With regard to the infection source,there were cases with a source of local transmission in the pre-elimination and elimination stages,while in the post-elimination stage all cases were imported from abroad,among the imported,the case proportion from Africa increased from 27.1%(52/192)in the pre-elimination stage to 75.7%(337/445)in the elimination stage and to 92.3%(429/465)in the post-elimination stage(P<0.01).The proportion of cases reported from medical institutions increased,which was significantly higher in the post-elimination stage(95.1%,442/465)than in the elimination(65.6%,292/445)and pre-elimination stages(65.1%,125/192)(P<0.01).There was an obvious seasonal distribution of reported cases in the pre-elimination stage(peak occurred in summer),but not in the elimination stage,while in the post-elimination stage the reporting peak occurred in the beginning of the year(January-February)and the middle of the year(June-July).The regional distribution of reported cases in three stages found that the reporting was mainly concentrated in Fuzhou,but the proportion increased,showing the proportion in the pre-elimination,elimination and post-elimination stages was 35.9%(69/192),72.8%(324/445)and 78.1%(363/465)respectively,with statistically significant differences(P<0.01).The age distribution revealed that the cases were largely in young and middle-aged males(20-59 years old),accounting the proportions in the elimination and post-elimination stages were 96.2%(428/445)and 96.1%(447/465),both higher than 83.3%(160/192)in the pre-elimination stage(P<0.01).Conclusion During the malaria post-elimination stage,there is a more severe challenge of imported malaria in Fujian Province,especially falciparum malaria imported from Africa,thus public health education to key population and training for medical institutions should be strengthened.