2010―2022年广东省肾综合征出血热流行特征及时空聚集性分析

Epidemic characteristics and spatiotemporal clustering of hemorrhagic fever with renal syndrome in Guangdong Province,2010-2022

目的回顾性分析2010—2022年广东省肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)流行特征和时空聚集性,为探索HFRS高危地区和制定防控措施提供参考。方法HFRS数据来源于中国疾病预防控制信息系统,运用Joinpoint 4.6.0.0软件对HFRS报告病例数据进行趋势分析,运用GeoDa 1.16软件开展全局和局部空间自相关分析,使用SaTScan 10.1软件进行时空扫描,通过计算对数似然比(log-likelihood ratio,LLR)分析HFRS时空聚集性。结果2010—2022年广东省累计报告HFRS病例4322例,年均发病率为0.31/10万,利用平均年度变化百分比(average annual percent change,AAPC)来评价整体趋势性变化,发病率整体呈下降趋势(AAPC=-8.4%,95%CI:-12.6%~-3.9%)。3—4月为HFRS高发月份(RR=1.61,LLR=82.78,P=0.001)。珠三角地区、男性、30~69岁人群发病率最高。职业以家务及待业(973例,占22.51%)、商业服务(726例,占16.80%)、工人(645例,占14.92%)和农民(638例,占14.76%)居多。HFRS发病存在空间聚集性,“高-高”聚集区主要分布在珠三角地区的广州市和佛山市。时空扫描分析结果显示,1个一类聚集区位于广州市、佛山市的9个县(区),发生在2013年2—3月;2个二类聚集区主要涉及珠三角地区的7个地级市和粤西地区的阳江市的25个县(区),发生在2015年1—2月和2017年5—6月。每年的聚集区均出现在珠三角地区,不同年份涉及的地级市和县(区)有所不同,主要集中在广州市、佛山市,主要发生在冬春季,少数年份在夏季初。结论2010—2022年广东省HFRS发病率呈下降趋势,发病存在季节性和空间聚集性,冬春季为高发季节,珠三角地区为高发区域,中老年为主要高发人群。

Objective To conduct a retrospective analysis of the monitoring data on hemorrhagic fever with renal syndrome(HFRS)in Guangdong Province from 2010 to 2022,and explore characteristics and spatiotemporal clustering of HFRS data,so as to identify high-risk areas for HFRS and provide references for the development of targeted prevention and control measures.Methods The data on HFRS were obtained from the Chinese National Disease Reporting Information System.We conducted a trend analysis of HFRS case data using Joinpoint 4.6.0.0 and assessed spatial autocorrelation with GeoDa 1.16.Spatio-temporal clusters were identified using SaTScan 10.1,where the log-likelihood ratio(LLR)indicated the strength of clusters.Results From 2010 to 2022,Guangdong reported 4322 HFRS cases,with an average annual incidence rate of 0.31 per 100000.The incidence rate exhibited a decreasing trend(AAPC=-8.4%,95%CI:-12.6%--3.9%).Peak cases occurred in March and April(RR=1.61,LLR=82.78,P=0.001).Males and those aged 30-69 were disproportionately affected.The Pearl River Delta,especially Guangzhou and Foshan,reported the highest incidence.Occupationally,those engaged in household chores and unemployed individuals(n=973,22.51%),commercial service personnel(n=726,16.80%),workers(n=645,14.92%),and farmers(n=638,14.76%)were relatively numerous.Spatial clustering was evident,with clusters centered in the Pearl River Delta.Spatio-temporal analysis identified clusters in Guangzhou,Foshan,and other regions of Guangdong.HFRS occurred primarily in winter and spring,with occasional summer outbreaks,consistently affecting the Pearl River Delta,particularly Guangzhou and Foshan.The spatial clustering of HFRS cases is prominent,with"high-high"clusters concentrated in Guangzhou and Foshan within the Pearl River Delta.Through spatiotemporal scanning analysis,we identified one typeⅠcluster encompassing nine counties in Guangzhou and Foshan from February to March 2013.Additionally,two typeⅡclusters were detected,occurring in January to February 2015 and May to June 2017,respectively.One affected seven cities in the Pearl River Delta,while the other encompassed 25 counties in Yangjiang City in West Guangdong.Annual scans showed that while HFRS primarily occurs in winter and spring,there are occasional early summer outbreaks.The affected cities and counties vary annually,but the Pearl River Delta,especially Guangzhou and Foshan,remains a consistent focal point.Conclusions The incidence of HFRS in Guangdong shows a downward trend.HFRS occurs frequently in winter and spring.The middle-aged and the elderly are the main groups with high incidence.The disease exhibits seasonal and spatial clustering characteristics,with the Pearl River Delta region being the high-incidence area.