ACTIVE SURVEILLANCE AND RISK-FACTORS FOR LEPTOSPIROSIS IN HAWAII
ACTIVE SURVEILLANCE AND RISK-FACTORS FOR LEPTOSPIROSIS IN HAWAII
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DOI：
10.4269/ajtmh.1993.48.35
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发表时间：
1993-01-01
影响因子：
3.3
通讯作者：
MIDDLETON, CR
中科院分区：
文献类型：
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作者：
SASAKI, DM;PANG, L;MIDDLETON, CR
一个诊所，医院为基础的钩端螺旋体病监测计划进行，以确定在非流行性设置的发病率和危险因素的研究进行了两个岛屿，考艾岛和夏威夷（大岛），在夏威夷州的一年，在1988年和1989年。在大岛上使用了一个积极的、更全面的病例检测系统，使我们能够确定临床疾病的发病率。来自两个岛屿的受试者用于进行风险因素的病例对照研究。来自大岛的172名受试者（出现以下症状中的任何两种：发热、头痛、肌痛或恶心/呕吐）入组研究。20例病例在尸检时通过培养、血清学或荧光抗体组织染色诊断。6例需要住院治疗，2例死于致命感染。我们估计，这些病例在我们的目标人群中的年发病率为128/100，000人年。对于33例病例，77名对照在岛屿、年龄、性别和发病时间方面相匹配。以双盲方式对病例和对照组进行回顾性访谈，并评估了约30个风险因素。与钩端螺旋体病发展最密切相关的因素是家庭使用雨水集水系统（P = 0.003）、潜伏期内存在皮肤割伤（P = 0.008）、接触牛或牛尿（分别为P = 0.05和P = 0.03）和处理动物组织（P = 0.005）。未显示与疾病相关的疑似风险因素包括接触泥浆或淡水、在淡水中游泳、处理垃圾和饲养宠物。我们的研究表明，钩端螺旋体病是一种令人惊讶的常见疾病，在流感样疾病中占很高比例。此外，病例对照研究相对简单，可用于确定每个人群和环境的特定风险因素。
A clinic-hospital-based leptospirosis surveillance program was conducted to determine the morbidity and risk factors in nonepidemic settings The study was conducted on two islands, Kauai and Hawaii (Big Island), in the state of Hawaii for one year during 1988 and 1989. An active, more comprehensive case detection system was used on the Big Island that enabled us to determine the incidence of clinical disease. Subjects from both islands were used to conduct a case-control study for risk factors One hundred seventy-two subjects from the Big Island (who presented with any two of the following symptoms: fever, headache, myalgia, or nausea/vomiting) were enrolled in the study. Twenty cases were diagnosed by culture, serology, or fluorescent antibody tissue staining at autopsy. Six cases required hospitalization and two succumbed to fatal infections. We estimated that these cases represented an annual incidence rate of 128 per 100,000 person-years in our target population. For 33 cases, 77 controls were matched for island, age, sex, and time of onset of illness. Interviews were conducted retrospectively in a double-blinded fashion with cases and controls and evaluated approximately 30 risk factors. Factors that were associated most strongly with development of leptospirosis were household use of rainwater catchment systems (P = 0.003), presence of skin cuts during the incubation period (P = 0.008), contact with cattle or the urine of cattle (P = 0.05 and P = 0.03, respectively), and handling of animal tissues (P = 0.005). Suspected risk factors that did not show an association with the disease were contact with mud or freshwater, swimming in freshwater, handling of garbage, and keeping of pets. Our study showed that leptospirosis is a surprisingly common disease, accounting for a high proportion of flu-like illness. Furthermore, a case-control study is relatively simple to conduct and useful for identifying risk factors specific to each population and setting.