2014-2019年南京市猩红热流行特征和时空聚集性

Epidemiological characteristics and temporal-spatial clustering of scarlet fever in Nanjing from 2014 to 2019

目的了解南京市猩红热的流行特征,探寻防控重点地区,指导科学制定防控策略和措施。方法采用描述流行病学方法,分析2014―2019年南京市报告的猩红热病例流行病学特征,利用简单季节指数法、回顾性时空重排扫描,探索病例季节和时空分布特征。结果2014―2019年南京市共报告猩红热病例1578例,中位数为214例(120~596例),报告发病率中位数为2.55/10万(1.47/10万~7.06/10万),2014年以来报告发病水平呈上升趋势。季节分布呈双峰特征,分别为11月至次年1月(季节指数为1.5、2.0、1.0)和4至6月(季节指数1.0、1.9、1.4)。病例年龄中位数为6岁(0~43岁),6~10岁占61.4%,3~5岁占32.1%,0~2岁占4.0%;学生占51.2%,幼托儿童占39.9%,散居儿童占7.1%。江北新区和六合区报告发病水平远高于南京市其他地区,2019年报告发病率分别为37.78/10万(265例)和27.98/10万(212例),江北新区江北人民医院和六合区中医院分别诊断报告了南京市58.8%和12.2%的病例。2014―2018年时空聚集地区为江北新区(RR=19.4,P<0.001),2019年时空聚集地区为江北新区、六合区和栖霞区(RR=9.5,P<0.001)。结论建议加强对猩红热的防控,医疗机构开展猩红热诊治的培训并提高相应的实验室检测能力;开展专题研究,调查医疗机构猩红热诊断质量。

Objective To analyze epidemiological characteristics of scarlet fever in Nanjing,and to explore key regions for prevention and control,in order to provide strategies and measures for control and prevention of scarlet fever.Methods Descriptive epidemiologic methods were used to analyze scarlet fever data in Nanjing from 2014 to 2019 from the Chinese Disease Surveillance Information Reporting System.Seasonal index method and time-space rescheduling scanning analysis were used to explore the seasonal distribution and spatio-temporal distribution characteristics.Results A total of 1578 scarlet fever cases were reported in Nanjing from 2014 to 2019,the median cases was 214(120 to 596).The median reported incidence was 2.55/100000(1.47/100000 to 7.06/100000)with increasing levels of reported incidence since 2014.The seasonal distribution showed a bimodal pattern with November to January of the following year(seasonal indexs were 1.5,2.0 and 1.0)and April to June(seasonal indexs were 1.0,1.9 and 1.4).The median age was 6(0 to 43)years old.The proportion of cases aged 6 to 10 years old was 61.4%,aged 3 to 5 years old was 32.1%,and aged 0 to 2 years old was 4.0%.The proportion for students was 51.2%,for preschool children was 39.9%and for scattered children was 7.1%.The Jiangbei New Area and Luhe District had a much higher incidence level than the other districts of Nanjing.The reported incidences in 2019 of Jiangbei New Area and Luhe District were 37.78/100000(265 cases)and 27.98/100000(212 cases),respectively.Nanjing Jiangbei People’s Hospital in Jiangbei New Area and Luhe Hospital of Chinese Medicine in Luhe District diagnosed 58.8%and 12.2%of the reported cases,respectively.The spatio-temporal clustering regions were Jiangbei New Area in 2014 to 2018(RR=19.4,P<0.001)and Jiangbei New Area,Liuhe District,and Qixia District in 2019(RR=9.5,P<0.001).Conclusions It’s suggested to strengthen the importance and action for prevention and control of scarlet fever,and medical institutions develop training in scarlet fever diagnosis and improve development of appropriate laboratory test capacity.Special investigation should be conducted to investigate the diagnostic quality of scarlet fever in medical institutions.