Dynamics of spatiotemporal distribution of schistosomiasis in Hubei Province, China
Dynamics of spatiotemporal distribution of schistosomiasis in Hubei Province, China
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DOI：
10.1016/j.actatropica.2018.01.004
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发表时间：
2018-04-01
期刊：
影响因子：
2.7
通讯作者：
Huang, Xi-Bao
中科院分区：
文献类型：
--
作者：
Chen, Yan-Yan;Liu, Jian-Bing;Huang, Xi-Bao
血吸虫病是由血吸虫的寄生扁虫引起的，在中国仍然是一个主要的公共卫生问题。过去几十年来，中国在血吸虫病控制方面取得了重大进展，使日本血吸虫的流行率和感染强度显著降低到极低的水平。因此，消灭血吸虫病一直受到中国国家政府的推动。湖北省是主要的病区，即沿长江中下游的华南湖沼地区。消除湖北省血吸虫病的传播具有挑战性。当前的问题是确定血吸虫病传播的分布和聚集性。本研究对湖北省2011 - 2015年血吸虫病的空间分布和县域风险进行了评价，旨在为湖北省湖泊和沼泽地区消除血吸虫病传播提供指导。根据研究区2011 - 2015年血吸虫病年度监测数据，建立研究区县域人血吸虫感染空间数据库。采用Moran’s I全球空间自相关统计量来描述人类血吸虫感染的空间自相关。此外，采用纯空间扫描统计与时空扫描统计相结合的方法确定疫情聚集。2011 - 2015年，湖北省各流行县日本血吸虫感染率呈下降趋势。全球自相关分析显示，研究期间人类日本血吸虫感染率有统计学意义（Moran’s I > 0, P < 0.01）。结果表明，5年来日本血吸虫感染分布具有空间聚集性。2011 - 2015年日本血吸虫感染的纯空间分析结果显示，日本血吸虫感染的最可能聚集性和次要聚集性分别为4个县和1个县。时空聚类分析确定2011-2012年各有1个最可能聚类和1个次可能聚类，分别出现在4个县和5个县。然而，随着时间的推移，聚类焦点的数量逐渐减少，2013年后没有检测到聚类。聚类焦点均位于长江中游及其连接支流汉北河的江汉平原。湖北省县域人感染日本血吸虫的空间分布无时间变化。2011 - 2015年时空聚类呈下降趋势。但应持续实施有效的控制策略和综合防治，特别是在长江和汉北流域的江汉平原地区。通过多变量统计分析来调查漏检、漏治和未标准化治疗事件的风险。结果表明，年龄、文化程度和卫生厕所是漏检的危险因素（b < 0, OR < 1），既往治疗次数和村组饲养牛是漏检的保护因素（b < 0, OR < 1）。我们还发现，年龄和教育水平是漏治的危险因素（b > 0, OR > 1）。对不规范治疗风险的研究显示，职业是危险因素（b < 0, OR < 1），教育程度是保护因素（b < 0, OR < 1）。因此，精准防控应主要针对这些特殊人群。
Schistosomiasis caused by parasitic flatworms of blood flukes, remains a major public health concern in China. The significant progress in controlling schistosomiasis in China over the past decades has resulted in the remarkable reduction in the prevalence and intensity of Schistosoma japonicum infection to an extremely low level. Therefore, the elimination of schistosomiasis has been promoted by the Chinese national government. Hubei Province is the major endemic area, that is, along the middle and low reaches of the Yangtze River in the lake and marshland regions of southern China. Eliminating the transmission of schistosomiasis in Hubei Province is challenging. The current issue is to determine the distributions and clusters of schistosomiasis transmission. In this study, we assessed the spatial distribution of schistosomiasis and the risk at the county level in Hubei Province from 2011 to 2015 to provide guidance on the elimination of schistosomiasis transmission in lake and marshland regions. Spatial database of human S japonicum infection from 2011 to 2015 at the county level in the study area was built based on the annual schistosomias is surveillance data. Moran's I, the global spatial autocorrelation statistics, was utilized to describe the spatial autocorrelation of human S. japonicum infection. In addition, purely spatial scan statistics combined with space-time scan statistics were used to determine the epidemic clusters. Infection rates of S. japonicum decreased in each endemic county in Hubei from 2011 to 2015. Human S. japonicum infection rate showed statistical significance by global autocorrelation analysis during the study period (Moran's I > 0, P < 0.01). This result suggested that there were spatial clusters present in the distribution of S. japonicum infection for the five years. Purely spatial analysis of human S. japonicurn infection showed one most likely cluster and one secondary cluster from 2011 to 2015, which covered four and one counties, respectively. Spatiotemporal clustering analysis determined one most likely cluster and one secondary cluster both in 2011-2012, which appeared in 4 and 5 counties, respectively. However, the number of clustering foci decreased with time, and no cluster was detected after 2013.The clustering foci were both located at the Jianghan Plain, along the middle reaches of the Yangtze River and its connecting branch Hanbei River. Spatial distribution of human S. japonicum infections did not change temporally at the county level in Hubei Province. A declining trend in spatiotemporal clustering was observed between 2011 and 2015. However, effective control strategies and integrated prevention should be continuously performed, especially at the Jianghan Plain area along the Yangtze and Hanbei River Basin. Multivariate statistical analysis was carried out to investigate the risk of missing examinations, missing treatment, and unstandardized treatment events. The results showed that age, education level and Sanitary latrines are risk factors for missing examinations (b > 0, OR > 1), and treatment times in past and feeding cattle in village group are protective factors (b < 0, OR < 1). We also found that age and education level are risk factors for missing treatment (b > 0, OR > 1). Study of the risk for un-standardized treatment revealed that occupation is risk factors (b > 0, OR > 1), though, education level is protective factors (b < 0, OR < 1). Therefore, precise prevention and control should be mainly targeted at these special populations.