论文部分内容阅读
目的分析2013年石家庄市流行性乙型脑炎(简称乙脑)暴发疫情患者的流行病学和临床特征,为乙脑疫情的早期预警提供依据。方法收集本次乙脑暴发疫情患者临床资料和随访资料。于本次疫情暴发期间(2013年10月中旬)选择藁城市、无极县、平山县和井陉县有乙脑病例发生的村进行健康人群血清乙脑抗体检测。收集2003年石家庄市乙脑抗体检测资料作为历史对照。在疫情发生县采用诱蚊灯法进行蚊种监测,收集成蚊进行计数和分类鉴定。结果 2013-08-26至11-05,石家庄市医疗机构共报告乙脑患者121例,其中农村101例(83.5%),市区20例(16.5%);男女性别比为0.92∶1;20岁及以上患者占全部患者的79.3%(96/121);职业以农民为主,共73例(60.3%)。患者发病后中位就诊时间为2 d,发病后中位诊断时间为17 d。94例采集血清进行乙脑病毒Ig M抗体检测,其中阳性79例,阳性率为84.0%。50.0%及以上的患者表现有急性起病、发热、精神萎靡、意识障碍。随访到的105例患者有后遗症35例(33.3%),死亡11例,病死率为10.5%。6例(5.0%)有乙脑疫苗接种史。2013年石家庄市健康人群乙脑抗体阳性率为13.4%(114/850),低于2003年的30.9%(122/395)(P<0.05);其中2013年10岁~及20岁~健康人群乙脑抗体阳性率低于2003年(P<0.05)。2013年监测到的641只蚊中,淡色库蚊600只(93.6%),骚扰阿蚊25只(3.9%),帕氏按蚊16只(2.5%)。结论 2013年石家庄市乙脑暴发疫情呈现成年人患者增多的特点,后遗症和死亡风险较高,健康人群乙脑抗体阳性率较低。需密切关注人群抗体水平、蚊媒密度变化,加强乙脑疫情监测,及早发现流行态势以有效控制疫情。
Objective To analyze the epidemiological and clinical characteristics of patients with outbreak of Japanese encephalitis (JE) in Shijiazhuang in 2013, and provide the basis for early warning of JE epidemic. Methods The clinical data and follow-up data of the outbreaks of JE were collected. In the outbreak of the outbreak (mid-October 2013), we selected villages with JE cases in Gaocheng City, Wuji County, Pingshan County and Jingtai County to conduct serological detection of JE antibodies. Shijiazhuang City, collected in 2003 JE antibody test data as a historical control. Mosquitoes were monitored by mosquito lamp in the county where the epidemic occurred, and the mosquitoes were collected for counting and classification. Results From 2013-08-26 to 11-05, 121 cases of JE were reported from medical institutions in Shijiazhuang, including 101 cases in rural areas (83.5%) and 20 cases in urban areas (16.5%). The sex ratio was 0.92:1. 79.3% (96/121) of the total patients were aged or older. Of the total, 73 were farmers (60.3%). The median time to treatment was 2 days after onset and the median time to diagnosis was 17 days. 94 cases of serum collected for detection of IgM antibodies to JE virus, of which 79 were positive, the positive rate was 84.0%. 50.0% and above patients with acute onset, fever, apathetic, disturbance of consciousness. Of the 105 patients who were followed up, 35 (33.3%) had sequelae and 11 died, with a mortality rate of 10.5%. 6 cases (5.0%) had a history of Japanese encephalitis vaccination. In 2013, the positive rate of Japanese encephalitis antibody in healthy population was 13.4% (114/850) in Shijiazhuang, down from 30.9% (122/395) in 2003 (P <0.05) The positive rate of JE antibody was lower than that of 2003 (P <0.05). Of the 641 mosquito species detected in 2013, 600 (93.6%) were Culex pipiens pallens, 25 (3.9%) were Alzheimer’s mosquito and 16 (2.5%) were Anopheles parasite. Conclusion In 2013, the epidemic situation of Japanese encephalitis in Shijiazhuang was characterized by an increase of adult patients, with a high risk of sequelae and death. The positive rate of Japanese encephalitis B was lower in healthy people. Close attention should be paid to the level of antibody in the population, changes in the density of mosquito vectors, monitoring of the epidemic of JE, and early detection of epidemics to effectively control the epidemic.