中国恙虫病流行及临床研究进展(2010-2020)

A review of the epidemic and clinical study on scrub typhus in China(2010⁃2020)

恙虫病是由恙虫病东方体(Orientia tsutsugamushi,Ot)感染引起的急性发热性疾病。主要通过恙螨幼虫叮咬传播,啮齿类动物在恙虫病传播过程中发挥重要作用。随着气候变化和人类活动范围的扩大等原因,我国恙虫病感染病例数和流行区域呈明显增加和北扩趋势。本文基于文献总结分析了2010~2020年我国各地区恙虫病发病情况、流行病学特征、临床研究等进展。结果表明Kato、Karp、Gilliam型为我国恙虫病东方体主要流行基因型;恙虫病在我国各地区均有分布,其中云南、广州、福建等地是高发区;传播媒介种类呈明显地理差异;本病发病高峰期与季节温度、人群年龄、职业等相关。对我国恙虫病流行趋势变化、人群感染风险、环境影响等因素的研究,将为优化媒介防控措施、完善临床诊治方案、提高突发疫情的应急处置能力及精准防控策略的制定提供科学的指导。

Scrub typhus is an acute febrile vector-borne zoonotic disease caused by the obligate intracellular growth bacteri-um Orientia tsutsugamushi(Ot).Mites are the primary vectors and rodents play a pivotal role in the transmission of scrub typhus.Due to the climate warming,increased human activity and other factors,cases of scrub typhus have been increased sharply during the past decade in China,especially in the northern China.To understand the incidence trend,epidemic pattern,clinical sign,diag-nosis and therapy of this diseases as well as genotype evolution of Orientia tsutsugamushi,we summarized and analyzed the current knowledge of scrub typhus in China from 2010 to 2020.The data indicated that the dominate genotypes of scrub typhus in China were Karp,Kato and Gilliam.Although the disease was distributed national wide,Yunnan,Guangzhou and Fujian showed the highest incidence rate.The main vector of scrub typhus in southwest,middle east and southeast of China appeared a geographic preference respectively.Seasonal timing,age and occupation were the key factors that relate to the peak incidence of scrub typhus.Notably,farmer was the occupation with the highest risk of Ot infection.Further study on the epidemic characteristics,risk fac-tors,diagnosis and treatments of scrub typhus will be of benefit to a comprehensive guideline for prevention and control of this an-cient disease.