Analysis on spatial epidemiological characteristics of human infection with avian influenza A(H7N9) virus in Fujian Province
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摘要:
目的 分析福建省人感染H7N9禽流感疫情和时空特征,为制定和调整防控策略提供依据。 方法 采用SAS 9.2、ArcGIS 10.3、SaTScan 9.4等软件对福建省2013-2017年人感染H7N9禽流感病例进行空间流行病学分析。 结果 截止到2017年12月31日,福建省共报告108例人感染H7N9禽流感确诊病例,死亡28人,病死率25.93%。疫情以散发为主,占96.30%,冬春季病例多,农村病例占比多于城市。县级层面病例主要聚集在沿海,全局自相关(Z=3.74,P < 0.001)和高/低聚类分析(Z=5.26,P < 0.001)结果提示存在空间聚集性。长乐区、福清市、晋江市和思明区是高-高聚集区和局部热点。2014年12月-2015年3月,存在2个时空聚集区域,最大可能集聚区是以漳浦县为圆心,63.04 km为半径(RR=4.72,LLR=11.41,P < 0.001)的区域;二级可能聚集区是以福清市为圆心,81.98 km为半径(RR=4.07,LLR=7.96,P=0.037)的区域。 结论 福建省人感染H7N9禽流感疫情存在时间和空间聚集性,防控措施应向高发季节、重点区域倾斜,并加强病原学监测。 -
关键词:
- 人感染H7N9禽流感 /
- 时空聚集性 /
- 时空扫描
Abstract:Objective The aim is to analyze the spatial epidemiological characteristics for human infection with avian influenza H7N9 in Fujian Province, so as to provide scientific evidence for developing and adjusting related control strategies. Methods The epidemiological data of human infection with H7N9 avian influenza in Fujian Province, from 2013 to 2017 was analyzed by SAS 9.2, ArcGIS 10.3 and SaTScan 9.4 software. Results There were a total of 108 cases and 28 deaths reported in Fujian Province, up to December 31, 2017. The case fatality rate was 25.93%.96.30% of cases were sporadic. There were more incidences in winters and springs, more incidences in rural areas. The global spatial autocorrelation and high/low clustering analysis indicated that clusters at the county level were in the shore areas (Z=3.74, P < 0.001; Z=5.26, P < 0.001). The cities of Changle, Fuqing, Jinjiang and Siming were the high-high clustered areas and local hot-points. There were two clusters, from December 2014 to March 2015, the most likely cluster regions was centered around Zhangpu County with a radius of 63.04 km (RR=4.72, LLR=11.41, P < 0.001). The secondary cluster regions was centered around Fuqing City with a radius of 81.98 km (RR=4.07, LLR=7.96, P=0.037). Conclusions Human infection with avian influenza H7N9 in Fujian Province is spatially and temporally clustered. The measures of prevention and control should be focused on high incidence seasons and key regions, and the surveillance of etiology should be strengthened. -
表 1 福建省人感染H7N9禽流感累计病例时空扫描结果
Table 1. Space-time clustering analysis of avian influenza(H7N9) in Fujian Province
聚集分级 聚集时间(年/月) 区/县数(个) 聚集圆心 半径(km) 实际病例 期望病例 RR值 LLR值 P值 最大可能 2014.12-2015.3 10 漳浦县 63.04 16 3.84 4.72 11.41 <0.001 二级可能 2014.12-2015.3 20 福清市 81.98 13 3.52 4.07 7.96 0.037 -
[1] Gao R, Cao B, Hu Y, et al. Human infection with a novel avian-origin influenza A(H7N9) virus[J]. N Engl J Med, 2013, 368(20): 1888-1897. DOI: 10.1056/NEJMoa1304459. [2] Pawar SD, Tandale BV, Gurav YK, et al. Immunity status against influenza A subtype H7N9 and other avian influenza viruses in a high-risk group and the general population in India[J]. J Infect Dis, 2014, 210(1): 160-161. DOI: 10.1093/infdis/jiu033. [3] Cowling BJ, Freeman G, Wong JY, et al. Preliminary inferences on the age-specific seriousness of human disease caused by avian influenza A(H7N9) infections in China, March to April 2013[J]. Euro Surveill, 2013, 18(19): 20475. http://www.bmj.com/lookup/external-ref?access_num=23725807&link_type=MED&atom=%2Fbmj%2F346%2Fbmj.f3693.atom [4] Chen Y, Liang W, Yang S, et al. Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome[J]. Lancet, 2013, 381(9881): 1916-1925. DOI: 10.1016/S0140-6736(13)60903-4. [5] World Health Organization. Influenza at the human-animal interface: summary and assessment, 30 October to 7 December 2017[EB/OL]. (2017-12-31)[2018-4-28]. http://www.who.int/influenza/human_animal_interface/Influenza_Summary_IRA_HA_interface_12_07_2017.pdf?ua=1. [6] 祝寒松, 王灵岚, 林代华, 等. 福建省2011-2016年人间布鲁氏菌病流行病学分析和时空聚集探测[J]. 中华流行病学杂志, 2017, 38(9): 1212-1217. DOI: 10.3760/cma.j.issn.0254-6450.2017.09.014.Zhu HS, Wang LL, Lin DH, et al. Analysis on epidemiology and spatial-temporal clustering of human brucellosis in Fujian Province, 2011-2016[J]. Chin J Epidemiol, 2017, 38(9): 1212-1217. DOI: 10.3760/cma.j.issn.0254-6450.2017.09.014. [7] Xie J, Weng Y, Ou J, et al. Epidemiological, clinical, and virologic features of two family clusters of avian influenza A (H7N9) virus infections in southeast China[J]. Sci Rep, 2017, 7(1): 1512. DOI: 10.1038/s41598-017-01761-w. [8] Virlogeux V, Feng L, Tsang TK, et al. Evaluation of animal-to-human and human-to-human transmission of influenza A (H7N9) virus in China, 2013-2015[J]. Sci Rep, 2018, 8(1): 552. DOI: 10.1038/s41598-017-17335-9. [9] 阮菁如, 黄佳峰, 钟春燕, 等. 思明区人感染H7N9禽流感流行特征及防控[J]. 海峡预防医学杂志, 2017, 23(1): 25-27. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYF201701010.htmRuan JR, Huang JF, Zhong CY, et al. Epidemic characteristics and prevention and control of human infection with H7N9 avian influenza in Siming District[J]. Strait J Prev Med, 2017, 23(1): 25-27. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYF201701010.htm [10] 许可, 霍翔, 黄昊頔, 等. 2013-2016年江苏省人感染H7N9禽流感流行特征及影响因素分析[J]. 江苏预防医学, 2017, 28(3): 241-244. DOI: 10.13668/j.issn.1006-9070.2017.03.01.Xu K, Huo X, Huang HD, et al. Analysis of epidemiological characteristics and risk factors for human infection with avian influenza A(H7N9) virus in Jiangsu Province from 2013 to 2016[J]. Jiangsu J Prev Med, 2017, 28(3): 241-244. DOI: 10.13668/j.issn.1006-9070.2017.03.01. [11] 任瑞琦. 人感染H7N9禽流感流行病学特征及发病危险因素研究[D]. 北京: 中国疾病预防控制中心, 2015.Ren RQ. Epidemiological characteristics and risk factors of human infection with avian influenza A (H7N9) virus in mainland China[D]. Beijing: Chinese Center for Disease Control and Prevention, 2015. [12] 福建省畜牧兽医学会. 福建省家禽学学科发展研究报告[C]. 福州: 福建省畜牧兽医学会, 2017: 4-18.Fujian Provincial Animal Husbandry and Veterinary Association. A research report on the development of poultry science in Fujian Province[C]. Fuzhou: Fujian Provincial Animal Husbandry and Veterinary Association, 2017: 4-18. [13] Xu M, Cao C, Li Q, et al. Ecological niche modeling of risk factors for H7N9 human infection in China[J]. Int J Environ Res Public Health, 2016, 13(6)E600. DOI: 10.3390/ijerph13060600. [14] Teng Y, Bi D, Guo X, et al. Contact reductions from live poultry market closures limit the epidemic of human infections with H7N9 influenza[J]. J Infect, 2018, 76(3): 295-304. DOI: 10.1016/j.jinf.2017.12.015. [15] Li J, Chen J, Yang G, et al. Case-control study of risk factors for human infection with avian influenza A(H7N9) virus in Shanghai, China, 2013[J]. Epidemiol Infect, 2015, 143(9): 1826-1832. DOI: 10.1017/S0950268814003264. [16] 董雯, 杨昆, 许泉立. 2013-2014年中国地区人感染H7N9禽流感疫情空间分布格局及时空聚集模式研究[J]. 中华疾病控制杂志, 2017, 21(7): 650-654. DOI: 10.16462/j.cnki.zhjbkz.2017.07.002.Dong W, Yang K, Xu QL. A research on the spatial distribution structure and spatiotemporal clustering of A(H7N9)human infections in China during 2013 and 2014[J]. Chin J Dis Control Prev, 2017, 21(7): 650-654. DOI: 10.16462/j.cnki.zhjbkz.2017.07.002. [17] Ai J, Huang Y, Xu K, et al. Case-control study of risk factors for human infection with influenza A(H7N9) virus in Jiangsu Province, China, 2013[J]. Euro Surveill, 2013, 18(26): 205-210. DOI: 10.1017/S0950268814003264. [18] Deng Y, Li C, Han J, et al. Phylogenetic and genetic characterization of a 2017 clinical isolate of H7N9 virus in Guangzhou, China during the fifth epidemic wave[J]. Sci China Life Sci, 2017, 60(12): 1331-1339. DOI: 10.1007/s11427-017-9152-1. [19] Artois J, Jiang H, Wang X, et al. Changing geographic patterns and risk factors for avian influenza A(H7N9) infections in humans, China[J]. Emerg Infect Dis, 2018, 24(1): 87-94. DOI: 10.3201/eid2401.171393. [20] Yang L, Zhu W, Li X, et al. Genesis and spread of newly emerged highly pathogenic H7N9 avian viruses in mainland China[J]. J Virol, 2017, 91(23): e01277-e01317. DOI: 10.1128/jvi.01277-17. [21] 董泽丰, 夏瑜, 王笛, 等. 2013-2017年苏州市H7N9禽流感病毒流行特征及耐药突变监测分析[J]. 中华疾病控制杂志, 2018, 22(11): 1185-1188. DOI: 10.16462/j.cnki.zhjbkz.2018.11.022.Dong ZF, Xia Y, Wang D, et al. Drug-resistance and epidemiological characteristics of avian influenza A(H7N9) virus infections in Suzhou City from 2013 to 2017[J]. Chin J Dis Control Prev, 2018, 22(11): 1185-1188. DOI: 10.16462/j.cnki.zhjbkz.2018.11.022. [22] 洪志恒, 李超, 杨静, 等. 2018年11月中国大陆需关注的突发公共卫生事件风险评估[J]. 疾病监测, 2018, 33(11): 887-890. DOI: 10.3784/j.issn.1003-9961.2018.11.003.Hong ZH, Li C, Yang J, et al. Risk assessment of public health emergencies concerned in the mainland of China, November 2018[J]. Disease Surveillance, 2018, 33(11): 887-890. DOI: 10.3784/j.issn.1003-9961.2018.11.003.