2014-2019年南京市猩红热流行特征和时空聚集性

马涛; 洪镭; 杜雪飞; 江根; 刘艳; 汪君君; 徐庆; 王恒学; 丁洁; 林丹; 张敏

doi:10.16462/j.cnki.zhjbkz.2021.03.018

2014-2019年南京市猩红热流行特征和时空聚集性

doi: 10.16462/j.cnki.zhjbkz.2021.03.018

马涛¹,
洪镭¹,
杜雪飞²,
江根³,
刘艳⁴,
汪君君¹,
徐庆¹,
王恒学¹,
丁洁¹,
林丹⁵,
张敏^1, ,

1.
210003 南京，南京市疾病预防控制中心急性传染病防制科
2.
210003 南京，南京市疾病预防控制中心微生物检验科
3.
210044 南京，南京市江北新区公共卫生服务中心疾控所
4.
211500 南京，南京市六合区疾病预防控制中心疾病控制科
5.
200023 上海，复旦大学公共卫生学院

基金项目:

南京市医学重点专科(传染病预防控制科) aaa

南京市卫生计生委“十三五”重大项目 ZDX16020

江苏省预防医学课题 Y2018077

详细信息

通讯作者:
张敏，E-mail: min_yezi@163.com

中图分类号: R181.3;R515.1
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- 被引次数: 0
出版历程
- 收稿日期: 2020-12-01
- 修回日期: 2021-01-05
- 刊出日期: 2021-03-10

Epidemiological characteristics and temporal-spatial clustering of scarlet fever in Nanjing from 2014 to 2019

1.
Department of Acute Infectious Disease Control and Prevention, Nanjing Center for Disease Control and Prevention, Nanjing 210003, China
2.
Department of Microbiological Laboratory, Nanjing Center for Disease Control and Prevention, Nanjing 210003, China
3.
Department of Disease Control and Prevention, Nanjing Jiangbei New Area Center for Public Health Service, Nanjing 210044, China
4.
Department of Disease Control and Prevention, Luhe District Center for Disease Control and Prevention, Nanjing 211500, China
5.
College of Public Health, Fudan University, Shanghai 200023, China

Funds:

Nanjing key medical specialty (Infectious disease prevention and control) aaa

Major project of the 13th Five-Year Plan of Nanjing health committee ZDX16020

Jiangsu Province preventive medicine program Y2018077

More Information

Corresponding author: ZHANG Min, E-mail: min_yezi@163.com

摘要

摘要: 目的了解南京市猩红热的流行特征，探寻防控重点地区，指导科学制定防控策略和措施。方法采用描述流行病学方法，分析2014-2019年南京市报告的猩红热病例流行病学特征，利用简单季节指数法、回顾性时空重排扫描，探索病例季节和时空分布特征。结果 2014-2019年南京市共报告猩红热病例1 578例，中位数为214例(120~596例)，报告发病率中位数为2.55 /10万(1.47/10万~7.06/10万)，2014年以来报告发病水平呈上升趋势。季节分布呈双峰特征，分别为11月至次年1月(季节指数为1.5、2.0、1.0)和4至6月(季节指数1.0、1.9、1.4)。病例年龄中位数为6岁(0~43岁)，6~10岁占61.4%，3~5岁占32.1%，0~2岁占4.0%；学生占51.2%，幼托儿童占39.9%，散居儿童占7.1%。江北新区和六合区报告发病水平远高于南京市其他地区，2019年报告发病率分别为37.78/10万(265例)和27.98/10万(212例)，江北新区江北人民医院和六合区中医院分别诊断报告了南京市58.8%和12.2%的病例。2014-2018年时空聚集地区为江北新区(RR=19.4, P < 0.001)，2019年时空聚集地区为江北新区、六合区和栖霞区(RR=9.5, P < 0.001)。结论建议加强对猩红热的防控，医疗机构开展猩红热诊治的培训并提高相应的实验室检测能力; 开展专题研究，调查医疗机构猩红热诊断质量。
- A群链球菌病 /
- 猩红热 /
- 流行特征 /
- 季节指数 /
- 时空聚集性
Abstract: Objective To analyze epidemiological characteristics of scarlet fever in Nanjing, and to explore key regions for prevention and control, in order to provide strategies and measures for control and prevention of scarlet fever. Methods Descriptive epidemiologic methods were used to analyze scarlet fever data in Nanjing from 2014 to 2019 from the Chinese Disease Surveillance Information Reporting System. Seasonal index method and time-space rescheduling scanning analysis were used to explore the seasonal distribution and spatio-temporal distribution characteristics. Results A total of 1 578 scarlet fever cases were reported in Nanjing from 2014 to 2019, the median cases was 214 (120 to 596). The median reported incidence was 2.55/100 000 (1.47/100 000 to 7.06/100 000) with increasing levels of reported incidence since 2014. The seasonal distribution showed a bimodal pattern with November to January of the following year (seasonal indexs were 1.5, 2.0 and 1.0) and April to June (seasonal indexs were 1.0, 1.9 and 1.4). The median age was 6 (0 to 43) years old. The proportion of cases aged 6 to 10 years old was 61.4%, aged 3 to 5 years old was 32.1%, and aged 0 to 2 years old was 4.0%. The proportion for students was 51.2%, for preschool children was 39.9% and for scattered children was 7.1%. The Jiangbei New Area and Luhe District had a much higher incidence level than the other districts of Nanjing. The reported incidences in 2019 of Jiangbei New Area and Luhe District were 37.78/100 000 (265 cases) and 27.98/100 000 (212 cases), respectively. Nanjing Jiangbei People's Hospital in Jiangbei New Area and Luhe Hospital of Chinese Medicine in Luhe District diagnosed 58.8% and 12.2% of the reported cases, respectively. The spatio-temporal clustering regions were Jiangbei New Area in 2014 to 2018 (RR=19.4, P < 0.001) and Jiangbei New Area, Liuhe District, and Qixia District in 2019 (RR=9.5, P < 0.001). Conclusions It's suggested to strengthen the importance and action for prevention and control of scarlet fever, and medical institutions develop training in scarlet fever diagnosis and improve development of appropriate laboratory test capacity. Special investigation should be conducted to investigate the diagnostic quality of scarlet fever in medical institutions.
- Group A streptococcus /
- Scarlet fever /
- Epidemiologic characteristics /
- Seasonal index /
- Temporal-spatial clustering analysis

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图 1 2014-2019年南京市猩红热报告病例数和发病率专题地图

Figure 1. Thematic map of scarlet fever cases and incidence in Nanjing from 2014 to 2019

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表 1 2014-2019年南京市报告猩红热病例月分布

Table 1. Monthly distribution of scarlet fever in Nanjing from 2014 to 2019

年份	1月	2月	3月	4月	5月	6月	7月	8月	9月	10月	11月	12月	合计	发病率(/10万)
2014	2	1	2	9	23	23	4	2	0	13	22	19	120	1.47
2015	58	14	15	18	31	23	18	3	8	9	14	31	242	2.97
2016	25	11	23	23	34	22	6	6	11	6	10	19	196	2.38
2017	8	10	29	25	40	28	9	7	4	4	8	20	192	2.32
2018	13	5	8	18	30	19	9	13	8	14	35	60	232	2.78
2019	29	15	36	44	97	69	25	15	14	38	106	108	596	7.06
合计	135	56	113	137	255	184	71	46	45	84	195	257	1 578	—
平均	22.5	9.3	18.8	22.8	42.5	30.7	11.8	7.7	7.5	14.0	32.5	42.8	21.9^a	3.16
注：^a为所有月份报告病例均值。

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表 2 2014-2019年南京市报告猩红热病例流行特征[n(%)]

Table 2. Epidemiological characteristics of scarlet fever in Nanjing from 2014 to 2019 [n(%)]

变量	2014年 (n=120)	2015年 (n=242)	2016年 (n=196)	2017年 (n=192)	2018年 (n=232)	2019年 (n=596)	合计 (n=1 578)
男	71(59.2)	148(61.2)	107(54.6)	127(66.1)	149(64.2)	366(61.4)	968(61.3)
年龄(岁)
0~	4(3.3)	8(3.3)	11(5.6)	5(2.6)	14(6.0)	22(3.7)	64(4.0)
3~	39(32.5)	66(27.3)	74(37.8)	64(33.4)	70(30.2)	193(32.4)	506(32.1)
6~	75(62.5)	157(64.9)	107(54.6)	121(63.0)	147(63.4)	362(60.7)	969(61.4)
11~43	2(1.7)	11(4.5)	4(2.0)	2(1.0)	1(0.4)	19(3.2)	39(2.5)
人群分类
学生	59(49.2)	138(57.0)	77(39.3)	92(47.9)	127(54.7)	315(52.9)	808(51.2)
幼托儿童	50(41.7)	79(32.6)	96(49.0)	89(46.4)	83(35.8)	232(38.9)	629(39.9)
散居儿童	10(8.3)	19(7.9)	19(9.7)	11(5.7)	21(9.1)	32(5.3)	112(7.1)
其他	1(0.8)	6(2.5)	4(2.0)	0(0.0)	1(0.4)	17(2.9)	29(1.8)
地区
江北新区	65(54.2)	116(47.9)	96(49.0)	135(70.3)	142(61.2)	265(44.5)	819(51.9)
六合区	6(5.0)	43(17.8)	35(17.8)	38(19.8)	26(11.2)	212(35.6)	360(22.8)
浦口区	20(16.7)	39(16.1)	27(13.8)	1(0.5)	9(3.9)	5(0.8)	101(6.4)
其他区	29(24.1)	44(18.2)	38(19.4)	18(9.4)	55(23.7)	114(19.1)	298(18.9)
报告单位
江北人民医院	72(60.0)	172(71.1)	137(69.9)	154(80.2)	136(58.6)	257(43.1)	928(58.8)
六合区中医院	0(0.0)	5(2.1)	6(3.1)	14(7.3)	11(4.8)	156(26.2)	192(12.2)
其他医疗机构	48(40.0)	65(26.8)	53(27.0)	24(12.5)	85(36.6)	183(30.7)	458(29.0)

下载: 导出CSV

表 3 2014-2019年南京市报告猩红热病例时空重排扫描结果

Table 3. Spatio-temporal scanning results of scarlet fever in Nanjing from 2014 to 2019

年份(年)	聚集地区	聚集时间	报告病例数	期望病例数	RR值	LLR值	P值
2014	江北新区	10月9日-12月31日	40	2	27.3	85.8	< 0.001
2015	江北新区	1月1日-7月2日	81	10	12.2	113.8	< 0.001
2016	江北新区	1月1日-7月2日	71	8	13.8	106.1	< 0.001
2017	江北新区	2月20日-8月20日	104	8	29.1	208.3	< 0.001
2018	江北新区	8月14日-12月31日	76	8	14.8	120.6	< 0.001
2019	江北新区、六合、栖霞	10月23日-12月31日	198	30	9.5	234.7	< 0.001

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