广东省2015-2021年肾综合征出血热流行特征及其与气象因素的关系研究

Epidemiological Characteristics of Hemorrhagic Fever with Renal Syndrome and Its Relationship with Meteorological Factors in Guangdong from 2015 to 2021

背景肾综合征出血热(HFRS)是一种严重的急性传染病;根据疫情报告,尚存在某些防治缺陷。目的分析广东省2015—2021年HFRS流行特征,探索气象因素对HFRS流行特征的影响。方法分别从中国疾病预防控制信息系统和国家气象科学数据中心收集2015—2021年广东省HFRS资料、人口信息和气象资料。HFRS资料包括病例报告地、病例现居住地、发病时间、死亡时间、年龄、性别和职业等,人口信息包括常住人口及性别比例,气象资料包括平均气压(AP)、平均相对湿度(ARH)、平均气温(AT)、最高气温(MaT)、最小相对湿度(MRH)、最低气温(MiT)、20时至后1 d 20时降水量(PR)和日照时数(SD);采用自回归滑动平均模型(ARIMA)分析HFRS流行特征及其与气象因素的相关性。结果广东省2015—2020年HFRS年均发病率为0.23/10万,呈波动下降趋势;户籍为广东省确诊病例数为1627例,病死率为0.18%;临床诊断病例与确诊病例的比例为1∶2.36(690/1627)。广州、东莞和深圳病例数共占63.24%(1029/1627);病例时间-空间聚集性特征表现为广州聚集(38.3%,其中广州占75.6%)和东莞聚集(61.7%,其中东莞占27.8%)。发病高峰在1月和3~5月;确诊病例男/女比例为3.11∶1,确诊病例变异系数(CV)男、女不同,为30%vs 41%。HFRS确诊病例发病年龄主要为25~50岁(62.75%);不同年份HFRS确诊病例年龄比较,差异有统计学意义(P=0.031)。HFRS确诊病例职业主要集中于待业、商业服务、工人和农民(70.68%);不同年份HFRS确诊病例职业分布比较,差异有统计学意义(P=0.035)。偏相关分析发现,HFRS月发病数与空气湿度(ARH、MRH;Lag4M)、日照时数和降水量(SD、PR;Lag2M)具有相关性(P<0.05);采用ARIMA(1,1,0)(R^(2)_(平稳)=0.710)对2021年上半年HFRS发病情况进行预测分析,拟合值与实测值的相符率为(61±18)%。结论广东省2015—2021年HFRS年均发病率呈波动下降趋势;湿度高和降水多可能升高下季度HFRS流行水平。针对广州和东莞聚集性HFRS流行地区,当前面临的HFRS防控工作是加强野外防护和提高临床诊断病例实验室诊断率。

Background Hemorrhagic fever with renal syndrome(HFRS)is a severe acute infectious disease and there are still some control deficiencies according to the epidemic report.Objective To analyze the epidemiological characteristics of HFRS in Guangdong from 2015 to 2021,and explore its impacts by meteorological factors.Methods The HFRS and meteorological data in Guangdong from 2015 to 2021 were collected from the China Disease Prevention and Control Information System and the National Meteorological Science Data Center,respectively.HFRS case information includes the region reported,current address,date of onset,date of death,age,sex and occupation.The population information includes the resident population and sex ratio.Meteorological data includes AP,ARH,AT,MaT,MRH,MiT,PR and SD.SPSS 23.0 was used for descriptive statistical analysis and tested to learn the correlation between HFRS cases and meteorological factors with ARIMA.Results The average annual incidence of HFRS in Guangdong from 2015 to 2020 was 0.23/100,000,showing a fluctuating downward trend.The confirmed cases of HFRS in Guangdong totalled 1627 as its fatality rate was 0.18%.The ratio of clinical cases vs confirmed cases was 1∶2.36(690/1627),as the number of cases in Guangzhou,Dongguan and Shenzhen accounted for 63.24%(1029/1627).The temporal-spatial clusterings featured in Guangzhou clustering(38.3%,of which Guangzhou accounted for 75.6%)and Dongguan clustering(61.7%,of which Dongguan accounted for 27.8%).The incidence peaks were in January and March to May.The sex ratio(male/female)was 3.11∶1 and these coefficient of variations(CV)were 30%and 41%,respectively,the later suggested a greater chance of susceptibility in females.The 25-50 year-old group accounted for 62.75%,where the statistical differences existed among the yearly age-groups(P=0.031).The occupations included mainly housework and unemployed,business service,labor and farmer,occupied 70.68%.The results included that HFRS cases were significantly correlated with relative humidity(ARH,MRH;Lag4M),sunshine duration and precipitation(SD,PR;Lag2M)(P<0.05).The ARIMA(1,1,0)(R^(2)_(stationary)=0.710)predicted the HFRS cases in the first half of 2021,with(61±18)%of the agreement rate between the fitted value and the measured value.Conclusion The HFRS epidemic in Guangdong from 2015 to 2021 showed a fluctuating downward trend;high humidity and precipitation might increase the level of HFRS epidemic in the next seasonal quarter.For the clustered HFRS epidemic areas in both Guangzhou and Dongguan,the current HFRS prevention and control mission is to strengthen field protection to HFRS and improve the laboratory diagnosis rate of clinical HFRS cases.