海口市2010-2020年输入性登革热病例发病至确诊间隔时间及影响因素分析

Analysis on the interval time between onset to diagnosis and influencing factors of imported dengue fever cases from 2010 to 2020 in Haikou City

目的了解海口市输入性登革热病例发病至确诊间隔时间的分布特征及其影响因素,为海口市输入性登革热的科学防控提供参考依据。方法采用描述性统计学方法对2010-2020年海口市输入性登革热病例发病至确诊间隔时间分布特征进行分析,采用Mann-Whitney U检验和Kruskal-Wallis H检验进行统计学差异分析,采用多因素Logistic回归分析其影响因素。结果2010-2020年海口市共报告输入性登革热病例72例,其中广东、云南和广西占国内输入病例的89.47%(17/19),东南亚国家占境外输入病例的94.34%(50/53)。所有病例的发病至确诊间隔时间的中位数为3.7 d,四分位数间距为2.9 d,70.83%的病例集中在2.0~5.0 d。单因素分析结果显示,发病地点、诊前自行服药、首诊使用登革病毒NS1抗原检测和首次就诊医疗机构等4个因素与发病至确诊间隔时间有关(P<0.05)。多因素Logistic回归分析结果显示,本市以外地区发病、诊前自行服药、首诊未使用NS1抗原筛查、首次就诊为国内其他地区医疗机构和首次就诊为境外医疗机构是输入性登革热病例晚发现的风险因素(P<0.05),其OR值(95%CI)分别为14.090(2.394~82.935)、25.011(1.667~375.273)、37.356(5.621~248.240)、10.556(1.070~104.114)和10.556(1.904~58.528)。结论加强广东、云南和广西等登革热高发省份来海口的病人以及东南亚等境外高发地区入境人员检验检疫和医学排查,提高群众防病就诊的意识;医疗机构早期使用NS1抗原筛查,可及时发现识别输入病例,降低输入或因输入导致本地登革热疫情发生的风险。

Objective To understand the distribution characteristics and influencing factors of the time interval between onset to diagnosis of imported dengue fever in Haikou city,and to provide reference basis for scientific preven-tion and control of imported dengue fever in Haikou city.Methods Descriptive statistical method was used to analyze the distribution characteristics of the time interval between onset and diagnosis of imported dengue fever cases in Haikou City from 2010 to 2020.Mann-Whitney U test and Kruskal-Wallis H test were used to analyze the statistical difference,and multivariate logistic regression was used to analyze the influencing factors.Results A total of 72 imported dengue fever cases were reported in Haikou City from 2010 to 2020.Among them,Guangdong,Yunnan and Guangxi accounted for 89.47%(17/19)of domestic imported cases,and Southeast Asian countries accounted for 94.34%(50/53)of overseas imported cases.The median of time interval between onset to diagnosis of all cases was 3.7 days,with the quartile interval for 2.9 days,and 70.83%of the cases concentrated in 2.0-5.0 days.The results of single-factor analysis showed that four factors,including the place of onset,pre-medication before treatment,the first use of dengue NS1 antigen testing and the first medical institution,were related to the interval between onset and diagnosis(P<0.05).Multivariate logistic regression analysis showed that the risk factors for late detection of imported dengue cases were onset outside Haikou City,taking medicine before diagnosis,not using NS1 antigen screening in the first visit,the first visit being in a medical institution in other regions of the country,and the first visit being in an overseas medical institution(P<0.05),and the OR values(95%CI)were 14.090(2.394-82.935),25.011(1.667-375.273),37.356(5.621-248.240),10.556(1.070-104.114)and 10.556(1.904-58.528),respectively.Conclusion Strengthening the inspection and quarantine and medical screening for the pa-tients in Guangdong,Yunnan and Guangxi provinces with high incidence of dengue fever,as well as the entry personnel in Southeast Asia and other high incidence areas,improving the awareness of disease prevention and treatment of the mass-es.Early use of NS1 antigen screening in medical institutions can timely detect and identify imported cases and reduce the risk of local dengue fever epidemic caused by imported or imported cases.