2011-2020年南京市恙虫病流行特征与空间聚集性分析

Epidemiological characteristics and spatial clustering of scrub typhus in Nanjing from 2011 to 2020

目的了解南京市恙虫病报告发病水平和趋势变化、流行特征以及空间聚集性,探究防控关键季节、重点人群和区域,指导制定科学精准的防控策略和措施。方法在中国疾病预防控制中心"传染病监测系统"中,收集2011年1月1日至2020年12月31日南京市恙虫病报告数据,分析报告发病水平和趋势变化,描述季节、人群和空间分布特征,利用ArcGIS 10.3软件开展全局空间自相关分析,FleXScan 3.1.2软件开展空间扫描。结果2011-2020年,南京市共报告恙虫病病例192例,年报告发病率中位数为0.21/10万(范围为0.12/10万~0.49/10万)。10-11月报告病例占87.5%(168/192),高峰出现在11月(57.8%,111/192)。男性占64.1%(123/192);年龄中位数为59岁(范围为6~84岁),≥60岁和45~59岁组分别占47.9%(92/192)和31.2%(60/192),共占79.2%(152/192);农民占43.8%(84/192),家务及待业者占16.7%(32/192),离退人员占15.6%(30/192),工人占6.8%(13/192),共占82.8%(159/192)。报告病例总数前4位的地区分别为江宁区(23.4%,45/192),六合区(22.9%,44/192),鼓楼区(10.4%,20/192)和江北新区(8.9%,17/192),共占65.6%(126/192)。全局空间自相关分析Moran′s I=0.34(Z=5.90,P<0.001);FleXScan 3.1.2软件扫描探测到2个空间聚集区域,一级聚集区覆盖江宁区3个、雨花台区1个和浦口区2个街道[限制性对数似然比(RLLR)=26.91,P<0.001],二级聚集区覆盖六合区6个和江北新区4个乡镇/街道(RLLR=26.48,P<0.001),聚集区域均为涉农区。结论南京市恙虫病报告发病水平较低且平稳,属于典型的秋季型疫区,中老年人群和涉农区域分别为重点人群和重点区域。建议将恙虫病纳入法定或南京市重点传染病管理,开展恙虫病诊治技术和信息报告管理培训,在高发季节强化和落实健康宣教、个人防护、防鼠灭鼠、媒介控制等综合防控干预措施。

Objective To understand the reported incidence level,change of the trend,epidemic characteristics and spatial clustering of scrub typhus in Nanjing,to explore key seasons,populations and areas for prevention and control,and to guide formulation of scientific and precise prevention and control strategies and measures.Methods The reported data of scrub typhus in Nanjing from January 1,2011 to December 31,2020 were collected in the"Infectious Disease Surveillance System"from Chinese Center for Disease Control and Prevention.The reported incidence level and change of the trend were analyzed,and the seasonal,population and spatial distribution characteristics were described.Global spatial autocorrelation analysis was carried out by ArcGIS 10.3 software,and the spatial clustering scanning was carried out by using FleXScan 3.1.2 software.Results A total of 192 cases of scrub typhus were reported in Nanjing from 2011 to 2020.Median annual reported incidence was 0.21/100000(0.12/100000-0.49/100000).Totally 87.5%(168/192)of cases were reported from October to November,and the peak occurred in November(57.8%,111/192).Among these cases,males accounted for 64.1%(123/192);and the median age was 59 years old(6-84 years old).The groups≥60 years old and 45-59 years old accounted for 47.9%(92/192)and 31.2%(60/192),respectively,which accounted for 79.2%(152/192)in all groups.Farmers accounted for 43.8%(84/192),household chores and unemployed people accounted for 16.7%(32/192),retired persons accounted for 15.6%(30/192)and workers accounted for 6.8%(13/192),which accounted for 82.8%(159/192)in all occupations.The top four areas in the total number of reported cases were Jiangning District(23.4%,45/192),Luhe District(22.9%,44/192),Gulou District(10.4%,20/192)and Jiangbei New Area(8.9%,17/192),which accounted for 65.6%(126/192)in all districts.According to global spatial autocorrelation analysis,Moran's I=0.34(Z=5.90,P<0.001).FlexScan 3.1.2 software scanned and detected two spatial clusters areas,the first-class of cluster area covered three streets in Jiangning District,one street in Yuhuatai District and two streets in Pukou District[restricted log likelihood ratio(RLLR)=26.91,P<0.001].The second-class of cluster area included six townships/streets in Luhe District and four streets in Jiangbei New Area(RLLR=26.48,P<0.001).All the cluster areas were agriculture-related.Conclusions The reported incidence level of scrub typhus in Nanjing is low and stable which belongs to a typical autumn epidemic area.The middle-aged and elderly population is the key population and the agriculture-related area is key area.It is suggested that scrub typhus should be included in the management of statutory or regional key infectious diseases in Nanjing.Additionally,training on diagnosis and treatment technology and information report management of scrub typhus need to be carried out,and comprehensive prevention and control interventions such as health education,personal protection,rodent prevention and control and vector control should be strengthened and implemented in the high incidence season.