云南省2013-2022年恙虫病的流行病学特征分析

Epidemiological characteristics of scrub typhus in Yunnan Province,China,2013-2022

目的分析云南省2013-2022年恙虫病的三间分布特征,为制定恙虫病的防治策略提供科学依据。方法收集云南省2013-2022年的恙虫病疫情资料,采用描述流行病学方法和ArcGIS 10.3软件的可视化技术等,系统研究云南省恙虫病流行及时空分布特征,确定高风险地区。结果10年间云南省累计报告恙虫病病例69246例,死亡19例,年均发病率为14.58/10万,年发病率由2013年的5.95/10万上升至2022年的25.53/10万,呈线性递增趋势(χ_(趋势)^(2)=30.573,P<0.001),病死率为0.036%;发病县(区)从2013年的70个扩增至2022年的97个,发病率排前3位的为德宏傣族景颇族自治州(10906例,85.14/10万)、临沧市(13677例,55.67/10万)和保山市(13406例,52.44/10万),年均增长率为17.82%,年均增长率最快的3个州(市)为怒江傈僳族自治州(84.15%)、曲靖市(48.91%)和文山壮族苗族自治州(45.12%);2013年发病率较高的地区主要集中在云南省西、中部,自2019年开始,高发病率地区由西、中部地区逐渐向东南扩散。总体来说,男性发病率高于女性(χ^(2)=332.635,P<0.001);0~<5和50~<55岁组人群发病数较多,分别占11.05%和11.19%;职业以农民居多,流行季节仍以夏、秋季为主。报告病例以县(区)级医院报告为主(56.44%),从发病至确诊的时间中位数为4 d,医院等级越高发病到确诊的时间越短(H=15.924,P<0.001)。病例以临床诊断病例为主,占96.07%。结论云南省恙虫病发病呈逐年上升趋势,病例由滇西、中部向东南扩散,5、6月病例快速上升,中老年女性农民高发,近几年乡镇卫生院报告病例数明显增多,应加强基层医生的培训及居民和旅游者的健康教育工作。

Objective To analyze the disease distribution characteristics of scrub typhus in Yunnan Province,China from 2013 to 2022,so as to provide scientific evidence for formulating prevention and control strategies for scrub typhus.Methods By using descriptive epidemiological methods and visual analysis in ArcGIS 10.3 software,the data about scrub typhus in Yunnan Province from 2013 to 2022 were systematically analyzed to determine the epidemiological characteristics,spatiotemporal distribution,and high-risk areas of scrub typhus in Yunnan Province.Results A total of 69246 cases of scrub typhus were reported in Yunnan Province from 2013 to 2022,including 19 deaths.The average annual incidence rate was 14.58/100000.The annual incidence rate showed a rapid increase over the years,from 5.95/100000 in 2013 to 25.53/100000 in 2022(χ_(trend)^(2)=30.573,P<0.001).The fatality rate was 0.036%.The number of affected counties or districts increased from 70 in 2013 to 97 in 2022.The top three regions by incidence rate were the Dehong Dai and Jingpo Autonomous Prefecture(10906,85.14/100000),Lincang(13677,55.67/100000),and Baoshan(13406,52.44/100000).The average annual growth rate of new cases was 17.82%.The top three regions by average annual growth rate were the Nujiang Lisu Autonomous Prefecture(84.15%),Qujing City(48.91%),and the Wenshan Zhuang and Miao Autonomous Prefecture(45.12%).In 2013,the areas with high incidence were mainly concentrated in the western and central part of Yunnan Province,but since 2019,the hotspots gradually spread to the southeastern part.In general,the incidence of scrub typhus was higher in males(χ^(2)=332.635,P<0.001).The cases were more in the age group of 0-<5 and 50-<55 years accounting for 11.05% and 11.19%,respectively,more among farmers,and more in summer and autumn.The cases were mainly reported by county/district-level hospitals(56.44%).The median time from disease onset to diagnosis was 4 days.Hospitals at higher levels were associated with a shorter time from onset to diagnosis(H=15.924,P<0.001).Clinically diagnosed cases accounted for 96.06%of the total number.Conclusions The incidence of scrub typhus has shown an increasing trend in Yunnan Province,and tended to spread from western and central regions to southeastern regions.Scrub typhus occurs frequently in May and June,and is more prevalent in middle-aged and elderly female farmers.In recent years,the number of cases reported by township-level hospitals has increased remarkably.It is necessary to strengthen training of primary care doctors and health education for residents and tourists.