武汉市消除疟疾阶段境外输入性疟疾疫情与病例处置机制

Characteristics and management mechanism of imported malaria from overseas during the malaria elimination phase in Wuhan City

目的分析武汉市境外输入性疟疾疫情特征,探讨现症病例的处置机制,为消除疟疾后大城市境外输入性疟疾处置积累经验。方法收集消除疟疾阶段(2010—2019年)武汉市境外输入性疟疾的流行病学资料,对病例性别、年龄、职业、重症相关因素等进行分析;根据疫情特征,结合防控现状,探讨“市-区联动24-7”病例现场处置机制的内容与经验。结果因武汉市医疗资源在中部地区最优,导致收治境外输入性疟疾病例数较多,2010—2019年共报告474例(占湖北省总病例数的40.79%),其中恶性疟359例,重症36例,死亡1例,病死率0.28%;病例以20~49岁中青年男性为主(占97.26%),外地转诊病例较多(占40.30%),报告无季节聚集性;恶性疟首诊未明确诊断比例为44.85%,且发病-诊断时间4d及以上病例占61.00%,重症发生与首诊未明确诊断(χ^(2)=35.46,P<0.001)及发病-诊断时间相关(Z=-6.49,P<0.001)。结论武汉市境外输入性疟疾发生频繁,以恶性疟为主,但“市-区联合24-7”病例现场处置机制有效遏制了重症死亡病例发生,为类似城市的境外输入性疟疾处置提供了宝贵经验。

Objective To analyze the characteristics of imported malaria epidemic from overseas in Wuhan,to explore the management mechanism of on-site cases,and to accumulate experience for the treatment of imported malaria in large cities after malaria elimination.Methods The epidemiological data on imported malaria from abroad during the period of malaria elimination(2010-2019)in Wuhan were collected.The gender,age and severe illness-related factors of the cases were analyzed.Based on the characteristics of the epidemic and the current situation of prevention and control,the content and experience of the"Municipal-District 24-7"case mechanism were discussed.Results The medical resources in Wuhan were the best in the central region,resulting in a large number of imported malaria cases,with a total of 474 cases reported from 2010 to 2019(40.79%of the total number of cases in Hubei Province),including 359 cases of falciparum malaria,36 severe cases and one death(the death rate was 0.28%).The patients were mainly young and middle-aged men aged 20 to 49 years old(97.26%).There were many referral cases(40.30%),and there was no seasonal clustering of cases reported.The undiagnosed proportion at the first visit was 44.85%,and the time of attack-diagnosis was 4 days or more in 61.00%of cases.The occurrence of severe cases was related to unconfirmed diagnosis at the first visit(χ^(2)=35.46,P<0.001)and attack-diagnosis time(Z=-6.49,P<0.001).Conclusion Imported malaria occurs frequently in Wuhan,mainly falciparum malaria.However,"Municipal-District 24-7"case mechanism has effectively curbed the occurrence of severe and death cases and provided valuable experience for case management in similar cities in China.