浙江省2012—2020年输入性疟疾重症病例流行特征分析

Epidemiological characteristics of imported severe malaria cases in Zhejiang Province from 2012—2020

目的了解浙江省2012—2020年输入性重症疟疾病例的流行特征和影响因素。方法收集2012—2020年浙江省报告的输入性重症疟疾病例资料,采用SPSS 20.0软件描述性分析重症疟疾种类、三间分布、感染地来源、诊断时间间隔,Logistic回归分析导致重症疟疾的影响因素。结果2012—2020年浙江省共报告输入性重症疟疾病例127例,占报告疟疾病例总数的7.96%(127/1596),全部为境外输入性病例,其中恶性疟107例(占84.25%)、间日疟11例(占8.66%)、卵形疟7例(占5.51%)、混合感染2例(占1.57%)。重症疟疾病例分布于浙江省11个地市,其中报告重症病例数前3位的地区为杭州(27例)、台州(24例)、温州(22例),重症病例数占报告病例总数前3位的地区为台州(17.65%,24/136)、宁波(13.45%,16/119)和温州(11.64%,22/189)。1月、10月及12月重症病例数占当月总报告病例数的比例均超过10%。重症疟疾病例中,男性116例,女性11例,男女性别比为10.55:1;30~59岁重症病例数最多,共98例(占77.17%);职业主要为务工和经商,共114例(占89.76%);外籍重症疟疾病例9例。死亡2例,2013、2016年各报告1例。93.70%(119例)重症疟疾病例来自非洲国家输入,重症疟疾病例数输入居前3位的国家为尼日利亚(35例,27.56%)、赤道几内亚(13例,10.24%)、刚果(金)(11例,8.66%)。发病到初诊间隔、初诊到确诊间隔中位数分别为1 d和1.5 d,重症病例初诊至确诊时间长于非重症病例(Z=-3.285,P<0.05)。Logistic回归分析结果显示,年龄(OR=1.022,95%CI:1.004~1.041)、初诊到确诊间隔时间(OR=1.046,95%CI:1.004~1.089)是导致重症疟疾的危险因素;外籍(OR=0.488,95%CI:0.241~0.990)、有疟疾病史(OR=0.598,95%CI:0.399~0.895)不易导致重症疟疾。结论浙江省输入性疟疾重症病例主要分布于杭州、台州、温州等地,人群分布以男性、30~59岁、务工和经商为主,主要来自非洲国家输入,年龄和初诊到确诊间隔时间是导致重症疟疾的危险因素。

Objective To understand the epidemiological characteristics and influencing factors of imported severe malaria cases in Zhejiang Province.Methods The epidemiological data of imported severe malaria cases in Zhejiang Province from 2012 to 2020 were collected.SPSS 20.0 software was used to analyze the species of Plasmodium,distribution of cases,countries source of infection,interval time from disease onset to diagnosis were analyzed.Multivariate logistic regression analysis was conducted to analyze factors affecting severe malaria.Results A total of 127 severe malaria cases were reported in Zhejiang Province from 2012 to 2020,all were imported from abroad.Of them,107 were infected with Plasmodium falciparum(84.25%),11 with P.vivax(8.66%),7 with P.ovale(5.51%),and 2 with mixed infection(1.57%).The severe malaria cases were distributed in 11 cities of Zhejiang Province,with the top 3 cities with the percentage to total reported cases being Taizhou(17.65%,24/136),Ningbo(13.45%,16/119)and Wenzhou(11.64%,22/189).The number of severe cases in January,October and December accounted for more than 10%of the total reported cases,respectively.Among the 127 cases,116 were males and 11 were females,and the mala/female ratio was 10.55:1,mainly occurred in the age of 30-59 years(98 cases,77.17%),and among workers and businessmen.There were 9 foreigner cases,and 2 deaths occurred in 2013 and 2016.The source place of infection showed that 93.70%of the severe cases were imported from African countries,with top countries of Nigeria(35,27.56%),Equatorial Guinea(13,10.24%)and Democratic Republic of Congo(11,8.66%).The time interval from initial diagnosis to diagnosis of severe malaria was longer than that of non-severe malaria cases(Z=-3.285,P<0.05).Age(OR=1.022,95%CI:1.004-1.041)and the time interval from initial diagnosis to diagnosis(OR=1.046,95%CI:1.004-1.089)were the risk factors for severe disease.Foreign nationality(OR=0.488,95%CI:0.241-0.990)and previous history of malaria(OR=0.598,95%CI:0.399-0.895)had less chance causing severe malaria.Conclusion Imported severe malaria cases in Zhejiang Province are distributed in Hangzhou,Taizhou,Wenzhou and other cities.Most of them are males,aged 30-59 years,among workers and businessmen.The severe cases were mainly imported from Africa.Age and the time interval between first diagnosis and diagnosis are risk factors leading to severe malaria.