2006至2015年南京市猩红热流行病学特征分析

Epidemiological characteristics of scarlet fever in Nanjing during 2006-2015

目的了解2006至2015年南京市猩红热流行病学特征，为进一步制定防控策略和措施提供依据。方法采用描述流行病学方法，分析2006至2015年南京市报告猩红热病例流行特征，主要分析猩红热病例在时间、地区和人群分布特征，报病医疗机构分布等信息，并重点比较了2015年与2006至2014年报告病例的流行病学特征。结果2006至2015年南京市共报告猩红热病例843例，年均发病率为1．15／10万；4～7月和11～2月为发病高峰，占总病例数的71．41％（602／843）；男性年均发病率（1．36／10万）高于女性（0．92／10万）；94．90％（800／843）的病例为15岁以下孩童，以学生[53．38％（450／843）]和幼托儿童[33．45％（282／843）]为主；年平均发病率前四位的地区为化学工业园区（15．78／10万）、浦口区（2．01／10万）、雨花台区（1．30／10万）、六合区（1．08／10万），江北3区（化学工业园区、浦口区和六合区）的病例数占全市总病例数的66．67％（562／843），化学工业园区病例数占比最高[42．59％（359／843）]；江北3区的病例主要来自相邻的4个街道，占江北3区病例总数的79．54％（447／562）。2015年报告发病率（2．97／10万）升高明显，季节、年龄和职业分布（χ2＝174．85，P ＞0．05）等特点与往年相似，但是江北3区尤其是化学工业园区的发病率（52．24／10万）升高最明显。时空分析也提示，化学工业园区于2014年4月6日至2015年12月31日（RR ＝49．42， LLR ＝506．72，P ＜0．01）期间存在聚集发病。51．13％（431／843）的病例由南京江北人民医院报告，且现住址均为江北3区，90．49％（390／431）为4个高发街道；2015年该院病例数占全市总病例数的71．07％（172／242），明显高于2006年至2014年的43．09％（259／601，χ2＝54．05，P ＜0．01）。结论南京市2015年猩红热发病率明显高于往年，疫情呈现上升趋势，江北3区（化学工业园区、浦口区和六合区）为高发地区，建议开展专题调查进一步明确高发原因。

Objective To investigate the epidemiological characteristics and trends of scarlet fever in Nanjing from 2006 to 201 5 for providing scientific evidence for making further strategy and measurements of prevention and control.Methods Descriptive epidemiological method was employed for epidemiological characteristics analysis of scarlet fever cases in Nanjing from 2006 to 201 5.SaTScan9.4.1 was used for retrospective spatial scanning,ArcGIS1 0.2 was for drawing area distribution toward case numbers and incidence,and EpiInfo7.0 was for statistical analyses.Results Total 843 scarlet fever cases were reported in Nanjing during the period of 2006 to 201 5.The average annual incidence was 1 .1 5 /1 00 000,and the&nbsp;reported incidence raised to 2.97 /1 00 000 in 201 5.The incidence peaked in April to July and November to February and accounted for 71 .41 % of the reported cases.The incidence of the disease in male was higher than that in female,and 94.90% of the cases were children under 1 5 years and the majorities were students and nursery children.The three districts in the north of the Yangtze River had higher reported incidence,in which the Chemical Industrial Park had an average annual incidence of 1 5.78 /1 00 000 and that for 201 5 was 52.24 /1 00 000,which was much higher than other districts.Clusters were also occurred in the Chemical Industrial Park and the period was April 6,201 4 to December 31 ,201 5.Four adjacent streets stretched across the three districts in the north of the Yangtze River reported 53.02% of the cases in Nanjing and 79. 54% of that in the three districts in the north of the Yangtze River.In the year of 201 5,the Jiangbei People’s Hospital in Nanjing reported 71 .07% cases in Nanjing,which increased significantly compared with 43.09% from 2006 to 201 4 (χ2 =54.05,P <0.001 ).Meanwhile,between 2006 and 201 5,the Jiangbei People’s Hospital reported 89.02% of cases in the 4 streets with high incidence and 32.08% of cases in other streets/counties in the three districts in the north of the Yangtze River,with statistically significant difference (χ2 =1 74.85,P <0.001 )and 99.78% of the patients reported by the Jiangbei People’s Hospital resided in the three districts in the north of the Yangtze River.Conclusion The incidence of scarlet fever in Nanjing shows a rising trend;the Chemical Industrial Park is an area of high incidence;the increase of reported cases from the Jiangbei People’s Hospital might cause the growth of the overall incidence in Nanjing.It is suggested that we should conduct special investigation on the cause of high incidence and further strengthen surveillance,prevention and control measure in schools and kindergartens at the same time.