低流行状态下麻风防治策略研究——基于山东省皮肤病专科联盟成员单位的麻风症状监测

Study on leprosy prevention and control strategies in low epidemic state—based on leprosy symptom monitoring by member units of Shandong dermatology departments alliance

目的:麻风是重要的公共卫生问题,诊断延迟会增加疾病传播的风险,同时也会引起残疾、毁容等不可逆转的危害,早发现、早诊断、早治疗是阻断传播、消除危害的主要措施。进入新世纪特别是近十年来,我国麻风进入低流行状态,传统的主动发现麻风患者的方式—人群普查、密切接触者筛查和依靠各级专病防治机构—省市县(区)皮肤病防治所的垂直管理体系因成本效益比差而不再适应新时代麻风防治的需求,亟需探讨新的防治策略。方法:探讨以综合医院皮肤科和专病防治机构为单位组成的水平和垂直系统相结合的疑难皮肤病转诊系统—全省皮肤病专科联盟为依托的麻风早发现策略,把麻风症状监测工作由过去的专病防治机构承担转变为综合医院皮肤科与专病防治机构共同承担,所有疑似病例均由省皮肤病性病防治研究所作出最终诊断。结果:项目实施4年来,共接受转诊病例3043例,其中确诊麻风39例,诊断延迟期和二级畸残比分别下降66.23个月和38.08%,且二级畸残比较项目实施前下降25.61%。结论:基于综合医院皮肤科和专病防治机构相结合的症状监测方案的实施是新时代早发现麻风患者的有效策略。

Objective:Leprosy is an important public health issue worldwide.Delay in diagnosis augments the transmission of infection and may also cause irreversible harm such as disability and disfigurement.Early detection,early diagnosis,and early treatment are the main measures to eliminate the hazards of leprosy.In the 21st century,especially in the past ten years,leprosy has turned into a low endemic infectious disease in China.Due to the low cost-benefit ratio,the traditional methods of active detection of leprosy patients,population survey,close contact screening based on the provincial,municipal,and prefectural leprosy control and prevention institutions,are no longer suitable for the needs of leprosy control.Thus,it is urgent to explore new control strategies.Methods:This study introduced the early detection strategy of leprosy based on the provincial alliance of dermatology departments,which is a horizontal and vertical referral system composed of dermatology department of general hospital and leprosy prevention and control institutions.The dermatology departments of general hospitals were included into the leprosy symptom monitoring system,which made up the shortcomings of the traditional leprosy control and prevention institutions.All the suspected cases were finally diagnosed by the Provincial Institute of Dermatology and Venereology.Results:In the past four years,3043 suspects were transferred to the Provincial Institute of Dermatology and Venereology through the leprosy symptom monitoring system,39 cases of leprosy were diagnosed.The delay period of diagnosis and the proportion of grade 2 disability(G2D)decreased by 66.23 months and 38.08%,respectively,and the proportion of G2D decreased by 25.61%compared with that before the implementation of the project.Conclusion:The implementation of the symptom monitoring scheme based on the combination of dermatology department of general hospital and specialized disease prevention and control institutions is an effective strategy for early detection of leprosy patients in the new era.