1993～2002年广西伤寒、副伤寒流行特征及防治对策分析

Typhoid and paratyphoid fever epidemic in Guangxi, 1993-2002

目的 探讨广西伤寒、副伤寒流行特征 ,为制定有效的防治对策提供科学依据。方法 分析广西 1993～ 2 0 0 2年伤寒、副伤寒疫情报告资料及实验室检测资料。结果 1993～ 2 0 0 2年广西共报告伤寒、副伤寒病例 4 730 5例 ,年均发病率 10 2 7/ 10万 ,以 15～ 19岁最高 (14 5 0 / 10万 ) ,男性发病高于女性 ,年均病死率 0 10 % ;病例以农民为主 (占 4 1 0 9% ) ,主要分布在桂林市及所辖区 (占 5 1 99% ) ;发病高峰在 6～ 10月份 (占 6 1 5 6 % ) ;年均发病年龄以 10～ 4 4岁为主 (占 86 5 2 % )。 10年间共发生暴发疫情 2 2起 ,传播方式大多为水型 (占 77 2 7% ) ,多数发生在农村学校和城乡结合部的大中专院校 ,并有以桂林市及所辖区为重点向其他地区扩散的趋势 ;1994～ 1998年实验室分离的菌株 2 16株 ,均为伤寒沙门菌 ,自 1999年以后以甲型副伤寒为主 ,占 92 6 4 % (6 30 / 6 80 )。伤寒和甲型副伤寒沙门菌对氟哌酸、氯霉素等常用抗生素的敏感率均超过 90 % ,但对磺胺的敏感率较低 ,分别为 2 5 %和 77%。影响流行的因素主要有城镇和农村的供水和污水处理严重滞后、学校卫生安全存在薄弱的环节、迟报疫情和误诊、传染源的管理不善等。结论 近 10年广西伤寒、副伤寒维持较高的发病水平 ,优势菌型由?

Objective To understand the epidemic characteristics of typhoid and paratyphoid fever in Guangxi from 1993 to 2002 and develop preventive measures.Methods Data from regular case reporting system and laboratory records in this 10 years were analyzed.Results A total of 47 305 typhoid and paratyphoid fever cases were reported in Guangxi this 10 years. Average annual incidence was 10.27/100 000. The highest age specific incidence was in aged 15-19 (14 50/100 000). The incidence of male was higher than that of female. The average annual case fatality rate was 0.10%. Peasant cases accounted for 41.09% and majority cases (51 99%) were found in Guilin city. The peak of case onset was from June to October accounted for 61.56%. A total of 22 outbreaks were reported in this 10 years and most outbreaks occurred in rural middle schools and suburban colleges. The epidemic was spreading from Guilin city to other areas. 216 strains isolated from 1994 to 1998 were S. Typhi. Whereas 92.64% (630/680) isolates were S.Paratyphi A after 1999. The sensitivity rates of both S. typhi and paratyphi A to norfloxacin and chloramphenicol were over 90%, whilst 25% and 77% to sulfamethoxazole respectively. The major epidemic factors were poor water supply and non proper sewerage system in countryside, delayed case reporting, misdiagnosis, poor sanitation in campuses and insufficient case management. Conclusion In the past decade, incidence of typhoid and paratyphoid fever remained high in Guangxi. The predominance strains shifted from S.Typhi to S.Paratyphi.