2015—2020年南通市疟疾疫情及病例诊断分析

Epidemiological features and diagnosis of malaria cases in Nantong City from 2015 to 2020

目的分析2015—2020年南通市疟疾疫情流行特征及诊断情况,为防止疟疾输入再传播、巩固消除疟疾成果提供参考依据。方法从国家传染病报告信息管理系统和寄生虫病防治信息管理系统中提取2015—2020年南通市疟疾疫情数据,同时收集疟疾病例个案流行病学调查报告。对疟原虫虫种分类、感染来源、疟疾病例三间分布及诊断情况进行统计分析。结果2015—2020年南通市累计报告241例疟疾病例,均为境外输入性病例,其中恶性疟191例(占79.25%)、间日疟8例(占3.32%)、卵形疟33例(占13.69%)、三日疟9例(占3.73%)。输入性疟疾病例感染地分布于亚洲、非洲、南美洲的34个国家,以非洲为主(97.93%);报告病例数主要集中在崇川区、海安市和海门区,占病例总数的90.04%(217/241);疟疾病例年龄20~68岁,中位年龄45(13)岁;以男性为主(97.10%)。241例输入性疟疾病例中,从回国至发病中位时间为7(9)d,从发病至初诊中位时间为2(2)d,从初诊至确诊中位时间为2(2)d,初诊确诊率为69.29%;疟疾病例主要由地市级医疗机构(53.53%,129/241)和县级医疗机构(41.49%,100/241)诊断,其中地市级医疗机构报告的疟疾病例数占比由2015年的39.62%上升至2020年的81.25%(χ^(2)=6.94,P<0.01)。结论南通市疟疾初诊确诊率还有待进一步提高。相关部门应对赴境外务工人员有针对性地开展疟疾防治知识宣传,提高就诊及时性;对医疗机构医务人员应加大培训,提高输入性疟疾诊断能力和危重恶性疟病例救治能力。

Objective To investigate the epidemiological characteristics and diagnosis of malaria cases in Nantong City from2015 to 2020,so as to provide insights into the prevention of re-establishment of imported malaria and consolidation of malaria elimination achievements in the city.Methods The epidemic data of malaria in Nantong City from 2015 to 2020 were captured from the National Notifiable Disease Report System,the Information Management System for Parasitic Disease Control and individual epidemiological survey reports of malaria cases.The malaria parasite species,source of infections,population distribution,temporal distribution,spatial distribution and diagnosis of imported malaria cases were descriptively and statistically analyzed.Results A total of 241 malaria cases were reported in Nantong City from 2015 to 2020,and all were overseas imported cases,including 191 cases with Plasmodium falciparum malaria(79.25%),8 cases with P.vivax malaria(3.32%),33 cases with P.ovale malaria(13.69%)and 9 cases with P.malaria malaria(3.73%).Overseas imported malaria cases acquired infections from 34 countries in Asia,Africa and Latin America,and 97.93%of the cases were infected in Africa,and 90.04%(217/241)were reported in Chongchuan District,Hai’an City and Haimen District.Imported malaria cases were aged from 20 to 68 years,and a median age of 45(13)years,and 97.10%were male.The median duration between returning to China and malaria onset was 7(9)days among all imported malaria cases,and the median duration from initial diagnosis to definitive diagnosis was 2(2)days.There were 167 cases that were initially diagnosed as malaria,with a correct rate of 69.29%,and 53.53(129/241)of malaria cases were diagnosed at city-level medical institutions and 41.49%(100/241)at county-level medical institutions.In addition,the proportion of malaria cases reported by city-level medical institutions increased from 39.62% in 2015 to 81.25% in 2020(χ^(2)=6.94,P<0.01).Conclusions The accuracy of initial malaria diagnosis requires to be improved in Nantong City.Malaria control knowledge should be specially given to migrant workers to shorten the duration of seeking medical care,and malaria training requires to be intensified among healthcare professionals to improve the diagnostic capability of imported malaria cases and the cure of severe P.falciparum malaria cases.