2016—2021年我国儿童蛲虫感染率meta分析

Prevalence of Enterobius vermicularis infections among children in China from 2016 to 2021:a meta-analysis

目的 分析2016—2021年我国儿童蛲虫感染率,为儿童蛲虫病防控及防治策略制定提供科学依据。方法 在万方数据库、中国期刊全文数据库、维普网、PubMed数据库中,检索2016年1月至2023年6月公开发表的关于我国儿童蛲虫感染率的文献。根据纳入排除标准筛选文献,采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心患病率研究评价工具进行文献偏倚风险评价。提取纳入文献中的调查时间、调查范围、研究对象、样本量和感染例数等数据,采用meta分析进行合并分析。以感染率为自变量,样本量、样本来源、调查范围、调查方式、地理区域、省份作为因变量进行meta回归分析,探讨研究异质性来源。结果 共纳入66篇文献进行分析,研究范围覆盖我国23个省(直辖市、自治区),调查时间为2016—2021年。Meta分析结果显示,2016—2021年我国儿童蛲虫合并感染率为4.5%[95%可信区间(confidence interval,CI):(3.1%,6.0%)],各年感染率分别为4.1%[95%CI:(2.2%,6.5%)]、4.2%[95%CI:(2.4%,6.6%)]、4.2%[95%CI:(2.2%,6.8%)]、3.2%[95%CI:(1.5%,5.4%)]、2.3%[95%CI:(0.9%,4.3%)]、1.1%[95%CI:(0.4%,2.1%)]。样本量<5000例的研究儿童蛲虫合并感染率为4.9%[95%CI:(3.4%,6.8%)],高于样本量≥5 000例的研究[2.1%,95%CI:(0.2%,3.6%)];调查对象来源于学校的研究合并感染率为5.2%[95%CI:(2.9%,8.2%)],高于来源于社区的研究[4.2%,95%CI:(2.7%,6.0%)];监测类型为综合监测的研究合并感染率为4.4%[95%CI:(2.8%,6.2%)],低于专项监测研究[4.8%,95%CI:(2.6%,7.7%)];调查范围为县(区)级的研究合并感染率为5.7%[95%CI:(3.8%,7.8%)],高于调查范围为地市级[4.8%,95%CI:(2.3%,8.0%)]和省级的研究[1.8%,95%CI:(0.3%,4.7%)]。华南地区儿童蛲虫感染率[11.3%,95%CI:(7.5%,15.7%)]高于华中[5.2%,95%CI:(2.8%,8.2%)]、华东[5.2%,95%CI:(2.8%,8.2%)]与西南地区[2.6%,95%CI:(1.4%,4.1%)]。Meta回归分析结果显示,地理区域和调查省份为研究异质性的影响因素。结论目前我国儿童蛲虫感染总体处于中度流行水平,不同地区感染率差异较大,华南地区感染率较高,且感染存在小范围聚集现象。各地应因地制宜开展监测和健康教育等工作,以进一步降低儿童蛲虫感染率。

Objective To investigate the prevalence of Enterobius vermicularis infections among children in China from 2016 to 2021,so as to provide insights into enterobiasis control and formulation of the enterobiasis control strategy among children.Methods Publications pertaining to the prevalence of E.vermicularis infections among children were retrieved from Wanfang Data,CNKI,VIP and PubMed databases published from January 2016 to June 2023.Eligible publications were screened according to inclusion and exclusion criteria,and the publication bias was evaluated using the assessment tool for prevalence studies proposed by the Joanna Briggs Institute Evidence-Based Practice Resources in Australia.The study period,study areas,study subjects,sample size and number of infections were extracted from publications,and a pooled analysis was performed using a meta-analysis.A meta-regression analysis was performed with the prevalence of E.vermicularis infections as an independent variable,and sample size,source of samples,study area,study method,geographical area and province as dependent variables to identify the source of the study heterogeneity.Results A total of 66 studies were included,covering 23 provinces(municipalities,autonomous regions)in China,and with the investigations conducted between 2016 and 2021.Meta-analysis showed that the pooled prevalence of E.vermicularis infections was 4.5%[95%confidence interval(CI):(3.1%,6.0%)]among children in China from 2016 to 2021,and the annual prevalence was 4.1%[95%CI:(2.2%,6.5%)],4.2%[95%CI:(2.4%,6.6%)],4.2%[95%CI:(2.2%,6.8%)],3.2%[95%CI:(1.5%,5.4%)],2.3%[95%CI:(0.9%,4.3%)]and 1.1%[95%CI:(0.4%,2.1%)]from 2016 to 2021.The pooled prevalence of E.vermicularis infections was 4.9%[95%CI:(3.4%,6.8%)]in studies with a sample size of<5000 cases,which was higher than that in studies with a sample size of 5000 cases and higher[2.1%,95%CI:(0.2%,3.6%)],and the pooled prevalence of E.vermicularis infections was 5.2%[95%CI:(2.9%,8.2%)]among subjects from schools,which was higher than that among subjects from communities[4.2%,95%CI:(2.7%,6.0%)].The pooled prevalence of E.vermicularis infections was 4.4%[95%CI:(2.8%,6.2%)]among children included in comprehensive surveillance,which was higher than that among children included in specific surveillance[4.8%,95%CI:(2.6%,7.7%)],and the pooled prevalence of E.vermicularis infections was 5.7%[95%CI:(3.8%,7.8%)]among children included in county-level surveys,which was higher than that among children included in city-[4.8%,95%CI:(2.3%,8.0%)]and province-level surveys[1.8%,95%CI:(0.3%,4.7%)].In addition,the pooled prevalence of E.vermicularis infections was higher among children in southern China[11.3%,95%CI:(7.5%,15.7%)]than that in central China[5.2%,95%CI:(2.8%,8.2%)],eastern China[5.2%,95%CI:(2.8%,8.2%)]and southwestern China[2.6%,95%CI:(1.4%,4.1%)].Meta-regression analysis identified geographical area and survey province as factors affecting the study heterogeneity.Conclusions Currently,the overall prevalence of E.vermicularis infections is moderate among children in China,and the prevalence varies greatly in regions,with a high prevalence rate in southern China and presence of small-scale clusters.Enterobiasis surveillance and health education pertaining to enterobiasis control are required with adaptations to local circumstance to reduce the prevalence of E.vermicularis infections among children.