摘要
目的掌握宁夏回族自治区(简称宁夏)职业人群布鲁氏菌病(简称布病)流行特征,为布病防控提供参考依据。方法2022年6-9月,以宁夏22个县(市、区)从事牛羊养殖、屠宰等高危职业人群作为调查对象,采集血样,采用虎红平板凝集试验(RBPT)进行初筛。对初筛阳性者或疑似病例进行试管凝集试验(SAT)检测,计算血清阳性率并估算宁夏职业人群感染布鲁氏菌人数,分析流行特征(地区、人群分布)及临床表现。另采用血培养方法对急性期布病患者进行病原学鉴定,分析暴发疫情处置情况。结果共检测163628人,RBPT初筛阳性6613人,SAT阳性6006人,血清阳性率为3.67%(6006/163628),95%置信区间为3.58%~3.76%,估算宁夏职业人群中有18391人感染布鲁氏菌。血清阳性率较高的5个地区分别为盐池县(7.35%,489/6649)、红寺堡区(6.72%,469/6978)、贺兰县(4.94%,166/3363)、利通区(4.77%,284/5953)和原州区(4.47%,490/10974)。男性血清阳性率(4.17%,3774/90406)高于女性(3.05%,2232/73222,χ^(2)=135.01,P<0.001)。随年龄增长,血清阳性率呈上升趋势(χ^(2)_(趋势)=462.93,P<0.001),其中60~<70岁年龄组血清阳性率最高(5.07%,1201/23679)。不同职业人群血清阳性率比较,差异有统计学意义(χ^(2)=158.88,P<0.001),其中农牧民血清阳性率最高(3.89%,5416/139347)。4892例确诊病例临床表现以发热(3751例,76.68%)、多汗(3306例,67.58%)、腰椎损伤(2651例,54.19%)多见。急性期布病患者共分离出布鲁氏菌231株,检出率为36.44%(231/634),其中羊种Ⅲ型占91.34%(211/231)。共发生5起人间布病暴发疫情,感染方式有养殖、屠宰和剥食死胎羊3种,疫情均得到有效处置。结论宁夏职业人群布鲁氏菌血清阳性率较高,具有明显的地区、人群流行特征,临床表现以发热、多汗、腰椎损伤多见,优势菌株为羊种Ⅲ型。提示今后应加强重点地区、重点人群的监测与行为干预,加强羊只检疫力度,同时积极开展患者治疗工作。
Objective To study the epidemiological characteristics of brucellosis in occupational populations in Ningxia Hui Autonomous Region(referred to as Ningxia),and to provide a reference basis for prevention and control of the disease.Methods From June to September 2022,blood samples were collected from high-risk occupational groups engaged in cattle and sheep breeding,and slaughtering,etc.,in 22 counties(cities and districts)of Ningxia.The Rose Bengal plate agglutination test(RBPT)was used for initial screening,and those who tested positive in the initial screening or suspected cases were further tested by the tube agglutination test(SAT).The serum positive rate was calculated and the number of people infected with Brucella in Ningxia occupational populations was estimated.The epidemic characteristics(regional and population distribution)and clinical manifestations were analyzed.In addition,blood culture method was used to conduct pathogen identification on patients with acute brucellosis and the handling of the outbreaks was analyzed.Results A total of 163628 individuals underwent blood test,with 6613 initially screened positive for RBPT and 6006 positive for SAT.The serum positive rate was 3.67%(6006/163628),95%CI was 3.58%-3.76%.It is estimated that there were 18391 individuals infected with Brucella in the occupational population of Ningxia.The five districts with high serum positive rates were Yanchi County(7.35%,489/6649),Hongsibao District(6.72%469/6978),Helan County(4.94%,166/3363),Litong District(4.77%,284/5953),and Yuanzhou District(4.47%,490/10974).The serum positive rate of male(4.17%,3774/90406)was higher than that of females(3.05%,2232/73222,χ^(2)=135.01,P<0.001).The serum positive rate increased with age(χ^(2)_(trend)=462.93,P<0.001),with the 60-<70 age group having the highest serum positive rate(5.07%,1201/23679).There was a statistically significant difference in serum positive rates among different occupational groups(χ^(2)=158.88,P<0.001),with the highest serum positive rate in farmers and herdsmen(3.89%,5416/139347).Among 4892 confirmed patients,fever(3751,76.68%),hyperhidrosis(3306,67.58%),and lumbar spine injury(2651,54.19%)were the most common symptoms.A total of 231 strains of Brucella were isolated,with a detection rate of 36.44%(231/634).Among them,Brucella melitensisⅢaccounted for 91.34%(211/231).There had been a total of 5 outbreaks of human brucellosis,with three modes of infection including breeding,slaughtering,and stripping of stillborn sheep,all of which had been effectively managed.Conclusions The serum positive rate of Brucella in the occupational population of Ningxia is relatively high,with obvious regional and population epidemic characteristics.Patients with clinical symptoms(fever,hyperhidrosis and lumbar spine injury)are more common,and the dominant strain is Brucella melitensisⅢ.It is suggested that in the future,monitoring and behavioral intervention should be strengthened in key areas and populations,with a focus on increasing immunization efforts for sheep,while actively carrying out patient treatment.
作者
吴向林
刘煊
段红菊
齐蓉婷
闫芳
马天波
Wu Xianglin;Liu Xuan;Duan Hongju;Qi Rongting;Yan Fang;Ma Tianbo(Department of Parasitic Diseases and Brucellosis Prevention and Control,Ningxia Center for Disease Prevention and Control,Yinchuan 750000,China)
出处
《中华地方病学杂志》
北大核心
2024年第12期980-985,共6页
Chinese Journal of Endemiology
基金
宁夏卫生健康委适宜技术推广项目(2022-NWSY-011)
关键词
布鲁氏菌病
流行特征
分析
Brucellosis
Epidemiological characteristics
Analysis
