Comprehensive measures succeeded in improving early detection of leprosy cases in post-elimination era: Experience from Shandong province, China
Comprehensive measures succeeded in improving early detection of leprosy cases in post-elimination era: Experience from Shandong province, China
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DOI：
10.1371/journal.pntd.0007891
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发表时间：
2020-02-01
影响因子：
3.8
通讯作者：
Zhang, Furen
中科院分区：
文献类型：
--
作者：
Chu, Tongsheng;Liu, Dianchang;Zhang, Furen
消灭麻风后，绝大多数麻风病例是被动发现的，晚期病例延迟较长时间和可见残疾是常见的。在过去的十年中，山东省在恢复政府承诺后，先后实施了包括健康促进、人员培训、奖励性症状监测和强大的转诊中心在内的综合病例发现措施。分析了2007-2017年期间检测到的231例病例，并探讨了与G2 D相关的因素。G2 D在新发病例中的年度比例呈下降趋势，从2008年的50%下降到2017年的23%。PB型、诊断延迟时间较长、由皮肤诊所以外的其他机构检出以及已知的感染源与G2 D相关。即使在麻风病控制的后期，某种形式的麻风病控制计划仍然是必要的。在政府承诺的基础上采取综合性的发现措施，将有利于提高麻风病的早期发现率。背景山东省在消灭麻风病后仍有少数新发麻风病例。在消灭后时期，政府承诺减少，积极的病例调查活动很少进行。大多数情况下，发现被动模式和先进的情况下，较长的延迟和可见的残疾是common.Materials和methodsComprehensive措施，包括健康促进，人员培训，奖励，症状监测和强大的转诊中心在过去的十年中实施。麻风病的诊断主要依据三大临床表现。采用WHO制定的两组分类系统，将病例分为多菌型（MB）和少菌型（PB）。方法对2007 - 2017年新发现的231例麻风病例进行回顾性分析，并探讨2级伤残（G2 D）的相关因素。诊断时的平均年龄为51.7 ± 16.0岁，男性、农民、文盲、MB病例、G2 D病例和移民的数量分别为130例（56.3%）、221例（95.7%）、73例（31.6%）、184例（79.7%）、92例（39.8%）和40例（17.3%）。181例（78.4%）来自皮肤科门诊，152例（65.8%）来自原高发县（区）。年度新增病例数呈下降趋势，从2008年的42例下降到2017年的13例。92例（39.8%）患者在诊断时表现为G2 D。G2 D新发病例的年度比例从2008年的50%下降到2017年的23%。PB型（OR = 2.76，95% CI，1.43-5.32），患者延迟>12个月（OR = 2.40，95% CI，1.38-4.19），总延迟时间>24个月（OR = 4.35，95%CI，2.33-8.11），由非皮肤诊所检测（OR = 3.21，95% CI，1.68-6.14），已知感染源（OR = 1.77，95%CI，1.01-3.12）与G2 D有关。结论麻风消灭后仍有零星病例存在，有必要采取相应的控制措施。政府的承诺，包括充分的财政保障和强有力的政策支持，至关重要。有必要采取全面的病例发现措施，包括健康宣传、人员培训、提供奖励，重点是以前的高度或中度流行地区，以改善疑似病例的早期报告，增加怀疑并鼓励所有相关医务人员的参与。基于强大的转移中心的症状监测可能在消除后时代早期发现新病例方面发挥重要作用。
Author summaryAfter elimination, most of the leprosy cases were detected passively and advanced cases with longer delay and visible disability were common. In the past decade, comprehensive case-finding measures including health promotion, personnel training, reward-offering symptom surveillance and a powerful referral center were implemented successively in Shandong province after the restoration of government commitments. 231 cases detected during 2007-2017 were analyzed and factors associated with G2D were explored. Annual proportion of G2D among new cases showed a declining trend, from 50% in 2008 to 23% in 2017. PB type, longer delay in diagnosis, detected by other than skin-clinics and known infectious sources were associated with G2D. Even in late phase of leprosy control, some kind of leprosy control program is still necessary. Comprehensive case-finding measures based on government commitments would be beneficial to improve early detection of leprosy cases.BackgroundA few new leprosy cases still can be seen in Shandong province after elimination. In post-elimination era, government commitments dwindled and active case-finding activities were seldom done. Most of the cases were detected by passive modes and advanced cases with longer delay and visible disability were common.Materials and methodsComprehensive measures including health promotion, personnel training, reward-offering, symptom surveillance and a powerful referral center were implemented in the past decade. The diagnosis of leprosy was mainly based on three cardinal clinical signs. Two-group classification system developed by the WHO was used and cases were classified into multibacillary (MB) type or paucibacillary (PB) type. Cases detected during period 2007-2017 were analyzed and associated factors of grade 2 disability (G2D) were explored.Results231 new leprosy cases detected during 2007-2017 were analyzed. The mean age at diagnosis is 51.7 +/- 16.0 years and the number of males, peasants, illiterates, MB cases, G2D cases and immigrants were 130(56.3%), 221(95.7%), 73(31.6%), 184(79.7%), 92(39.8%) and 40(17.3%) respectively. 181(78.4%) cases were reported by skin clinics and 152 (65.8%) cases came from formerly high endemic counties/districts. The annual number of new cases showed a decreasing trend, from 42 cases in 2008 to 13 cases in 2017. 92 (39.8%) cases presented with G2D at diagnosis. The annual proportion of new cases with G2D declined from 50% in 2008 to 23% in 2017. PB type (OR = 2.76, 95% CI, 1.43-5.32), >12 months of patient delay (OR = 2.40, 95% CI, 1.38-4.19), >24 months of total delay (OR = 4.35, 95% CI, 2.33-8.11), detected by non skin-clinic (OR = 3.21, 95% CI, 1.68-6.14), known infectious source (OR = 1.77, 95% CI, 1.01-3.12) were associated with G2D.ConclusionA few scattered cases still can be seen in post-elimination era and some kind of leprosy control program is still necessary. Government commitments including adequate financial security and strong policy support are vital. Comprehensive case-finding measures including health promotion, personnel training, reward-offering, with an emphasis on former high or middle endemic areas, are necessary to improve early presentation of suspected cases and to increase suspicion and encourage participation of all relevant medical staff. Symptom surveillance based on a powerful transfer center may play an important role in the early detection of new cases in post-elimination era.