2016—2023年浙江省嵊州市发热伴血小板减少综合征的流行特征及蜱、动物感染监测

doi:10.11853/j.issn.1003.8280.2024.06.012

摘要/Abstract

摘要： 目的分析浙江省嵊州市发热伴血小板减少综合征（SFTS）流行特征,调查其宿主动物、媒介生物和人群本底感染状况,为防控策略制定提供科学依据。方法通过中国疾病预防控制信息系统中2016－2023年的SFTS病例信息及流行病学个案调查资料,采用描述流行病学方法分析SFTS病例的人群、时间和空间分布、流行病学史、临床特征及就诊情况。χ²检验和Mann-Whitney U检验用于分析组间差异。采集健康人群及宿主动物血清样本进行大别班达病毒（DBV）抗体检测。采用体表检蜱法和人工布旗法开展寄生蜱和游离蜱监测。采用实时荧光定量PCR法对宿主动物及蜱进行DBV检测。结果 2016－2023年报告SFTS病例27例,其中2023年报告17例；年平均发病率为0.56/10万,病死率为22.22%；男性10例（37.04%）,女性17例（62.96%）；23例（85.19%）为本地采茶、种田的农民；发病年龄51～94岁,中位数68岁；发病具有明显的季节性,主要集中在4－8月,圆形分布法表明发病高峰位于5月11日－8月29日；在15个乡镇（街道）中,有9个乡镇（街道）报告了本土病例。所有病例在发病2周前有野外活动史；临床表现主要为发热（96.30%）、乏力（81.48%）、食欲不振（59.26%）、白细胞减少（96.30%）、血小板减少（88.89%）；2023年报告的病例从发病到就诊的中位数为3.0 d,从就诊到确诊的中位数为2.0 d；其中1例经过4次就医行为被确诊,58.82%（10例）经过1次就医行为被确诊。健康人群的血清抗体阳性率为2.50%。2016－2023年嵊州市共捕获游离蜱35只,平均游离蜱密度为0.23只/（布旗·100 m）,寄生蜱417只,平均寄生蜱指数为4.53。经检测宿主动物羊、牛、犬的血清均有抗体阳性,阳性率分别为27.69%、11.11%、6.67%。蜱及宿主动物的DBV核酸均为阴性。结论 2023年嵊州市SFTS的发病率呈快速升高趋势,可能存在SFTS自然疫源地,疫情具有明显的季节性,高龄的农民发病风险较高,需要重点加强SFTS的宣传教育,落实环境整治和媒介生物控制工作,提高基层医疗机构的诊疗水平。

关键词: 发热伴血小板减少综合征, 流行特征, 宿主动物, 媒介生物

Abstract: Objective To analyze the epidemic characteristics of severe fever with thrombocytopenia syndrome (SFTS) and monitor the infection of host animal, vectors, and human populations in Shengzhou, Zhejiang Province, China, 2016-2023, so as to provide a scientific basis for the development of prevention and control strategies. Methods The population, temporal, and spatial distributions, epidemiological history, clinical characteristics, and hospital visit of SFTS cases were analyzed using the descriptive epidemiological method. Chi-square test and Mann-Whitney U test were used to analyze differences between groups. SFTS cases from 2016 to 2023 were obtained from the China Disease Prevention and Control Information System and epidemiological investigations of the cases. Serum samples of healthy people and host animals were collected for detection of Dabie bandavirus antibody. On-host and free-living ticks were monitored using animal body surface examination and the drag/flag sampling method. Dabie bandavirus in host animals and ticks was detected by real-time fluorescence quantitative PCR. Results From 2016 to 2023, 27 cases of SFTS were reported, of which 17 cases in 2023, including 10 (37.04%) males and 17 (62.96%) females, with an average annual incidence of 0.56/100 000 and a fatality rate of 22.22%. Moreover, 23 (85.19%) cases were local farmers engaged in tea picking and agriculture. The age of onset ranged from 51 to 94 years, with a median of 68 years. The incidence showed significant seasonality, mainly from April to August. Circular distribution analysis showed that the peak of the disease occurred between May 11 and August 29. Locally transmitted cases were reported in 9 out of 15 townships (streets). All cases had a history of field activities 2 weeks before onset. The main clinical manifestations were fever (96.30%), fatigue (81.48%), loss of appetite (59.26%), leukopenia (96.30%), and thrombocytopenia (88.89%). In 2023, the median time from onset of symptoms to hospital visit was 3.0 days, and the median time from visit to diagnosis was 2.0 days. One case was diagnosed after 4 visits, and 10 (58.82%) cases were diagnosed after 1 visit. The positive rate of Dabie bandavirus antibody in the serum of healthy population was 2.50%. A total of 35 free-living ticks were captured in Shengzhou from 2016 to 2023, with a mean density of 0.23 ticks/(flag·100 m). Additionally, 417 parasitic ticks were captured, with a mean on-host tick index of 4.53. Of host animals, sheep, cattle, and dogs were positive for Dabie bandavirus antibody in serum, and the positive rates were 27.69%, 11.11%, and 6.67%, respectively. Ticks and host animals were negative for Dabie bandavirus nucleic acids. Conclusions The incidence of SFTS in Shengzhou increased rapidly in 2023. There may be a natural epidemic focus of SFTS in Shengzhou. The epidemic showed significant seasonality, and elderly farmers were at high risk. It is necessary to strengthen the publicity and education regarding SFTS, implement environmental remediation and vectors control, and improve the diagnosis and treatment levels of primary medical institutions.

Key words: Severe fever with thrombocytopenia syndrome (SFTS), Epidemic characteristics, Host animal, Vector

中图分类号:

R183.5

钱佳文, 沈钰钢, 王宏伟, 欧晓阳, 张灵, 李严, 任力波, 竹璐彬, 肖招英. 2016—2023年浙江省嵊州市发热伴血小板减少综合征的流行特征及蜱、动物感染监测[J]. 中国媒介生物学及控制杂志, 2024, 35(6): 692-698.

QIAN Jia-wen, SHEN Yu-gang, WANG Hong-wei, OU Xiao-yang, ZHANG Ling, LI Yan, REN Li-bo, ZHU Lu-bin, XIAO Zhao-ying. Epidemic characteristics of severe fever with thrombocytopenia syndrome and surveillance of infection in ticks and animals in Shengzhou, Zhejiang Province, China, 2016-2023[J]. Chinese Journal of Vector Biology and Control, 2024, 35(6): 692-698.

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