【作者】 李建华；

【导师】 薛付忠； 王志强；

【作者基本信息】 山东大学 ， 流行病与卫生统计学， 2008， 硕士

【摘要】 肾综合征出血热(Hemorrhagic Fever with Renal Syndrome,HFRS)是一种自然疫源性疾病,该病以亚洲、欧洲大陆多发。其中流行性出血热(EHF,HFRS的一种)主要流行于亚洲地区,而发病最多的是中国。HFRS是由汉滩病毒引起的,经研究证实分为9个血清型,我国主要是汉坦型和汉城型流行。目前该病在我国流行仍十分严重,并且出现了新的流行特征:①发病例数上升明显;②现有疫区范围不断扩大,新疫区时有出现;③大中城市流行强度上升,疫情向大中城市蔓延;④流行的季节性发生变化,除冬季外,其它季节的月发病差异不明显。研究目的:莒南县以低海拔的平原、丘陵为主,境内河流密布;平邑县是典型的山区地形,海拔较高,河流较少。两县相距100余公里,但地理生态环境相差大,且两县HFRS发病率都较高,都是我国HFRS监测点。本研究利用两县历年HFRS发病资料、宿主动物监测资料等,应用描述流行病学研究方法,探讨具有不同地理特征与生态环境HFRS疫源地的异质性及其影响因素,以便为在不同地理特征与生态环境的疫区进行HFRS的预防和控制提供科学的理论依据。本研究结果表明:1.莒南县1975年9月1日～2005年12月1日共发生HFRS病例16118例,平均发病率58.61/10万,累计病死203例,平均病死率1.26%。其中男性占67.24%,15～64岁占总发病数88.05%,农民占总病例的88.92%;平邑县1980年12月～2005年12月,累计发生HFRS病例9384例,平均发病率29.48/10万,死亡265例,平均病死率2.82%。男性占64.96%,35～45岁人群发病所占比例最高(33.23%);农民占88.99%。2、两县HFRS的年发病水平呈周期性变化,平邑县流行周期约3～5年,莒南县约5～7年;两县均经历了秋冬季的单峰型→以秋冬峰为主的双峰型→以春峰为主的双峰型的季节性波动;总体上,两县HFRS秋冬季病死率大于春季,病死率总的趋势随时间在下降。3、两县疫源地先后经历了由姬鼠型散发阶段→姬鼠型暴发流行阶段→家鼠、姬鼠混合型散发流行阶段→家鼠型为主的混合型暴发→家鼠型为主的混合型散发阶段的变化过程,到2005年12月两县仍处在家鼠型为主的混合型散发阶段。鼠密度高峰在第三季度,鼠带毒率第4季度最高。4、HFRS病例的分布在两县乡镇有明显的聚集性。高发区多位于地势低洼,易受内涝及河水流过的平原地带;中发病区,主要分布在干旱丘陵地区和低山林区;低发病区域多分布在较高海拔的干旱山区,两县HFRS的发病也有一定的家庭聚集现象。结论:(1)平邑县和莒南县HFRS的流行都经历了以下5个过程:散发→局部流行→暴发→广泛流行→散发阶段,但莒南县有一个HFRS的持续高发流行阶段(1990～1994年)。两县疫源地都经历了由HTN型→HTN型为主的混合型→SEO型为主的混合型的疫源地演变过程;两县病死率总的趋势在下降,秋冬季病死率明显高于春季病死率。(2)两县的年发病率、病死率、流行周期存在差异。莒南县的年发病率明显高于平邑县的年发病率,平邑县病死率则高于莒南县病死率。平邑县流行周期约为3～5年,莒南县HFRS流行周期约为5～7年,(3)HFRS发病率随地形地貌、生态景观等空间环境的改变而发生变化。HFRS疫区有从莒南县所在的东南平原河网地区向西北部山区丘陵地带迁移的趋势。更多还原

【Abstract】 Hemorrhagc Fever with Renal Syndrime(HFRS)is a natural focus disease,and it prevails in Asia and Europe,Epidemic hemorrhagic fever(EHF,one kind of HFRS) often occurs in some areas of the Asia,mostly in China.HFRS is causes by the Hantan virus,researchs confirmed the virus was divides into 9 typies,At present,Hantan and Seoul.type are popular in China,and HFRS epidemics still serious in our country, and it also appeares new epidemic characteristics:①The number of HFRS patients is rising obviously;②Old epidemic areas’ scope expanded,the new epedemic areas appeared continually.③The big and media-sized cities’ epidemic intensity rising,the disease is spreading to the big and media-sized cities.④The epidemic seasonal characteristics changed obviously,besides the winter,HFRS occurs has no difference in other seasons.Objective:The Junan county is a plain low elevation area,and full of rivers;Pingyi County is a typical mountain area with only a few rivers,the elevation is higher.The distance of two counties is about 100 kilometers,but ecological environments are very different.Their epidemic of HFRS are all serious,and they are all our countrys’ HFRS monitoring points.This research plans to use the two counties’ HFRS mornitoring materials to unifies geographical environment,ecology characteristic,and so on,with epidemiology research technique,to analyze the difference of spatial structure and propose theories to HFRS in same areas in order to prevent and control the disease. Results from this study showed that:1.In Junan county 16118 HFRS patients occured from 1975～2005 altogether,the average incidence rate 58.61/100,000,203 people died of the illness,average mortality rate 1.26%.Man account for 67.24%,88.05%patients’ age from 15 to 64, farmers account for 88.92%,is the highest proportion among the case;In Pingyi County 9384 patients of HFRS occurred from 1980.11 to 2005.11,the average disease incidence rate 29.48/100,000,265 were died of the illness,average fatality rate 2.82%.The male accounts for 64.96%,patients among 35～45 years old account for the highest proportion(33.23%);farmers accounts for 88.99%.2.The epidemic characters of HFRS in the two counties varied periodictly, Pingyi County epidemic cycle approximately 3～5 years,the Junan county approximately 5～7 years.Morbidity seasonal characer,the two counties each experienced a single peak of fall and winter type~→double peaks of fall and winter type~→double peaks of spring type.As a whole,the two county HFRS fatality rate in autumn and winter season is bigger than spring,the tendency of case fatality rate dropped by time.3.Epidemic areas in the two counties have followed four stages:meadow mouse caused highly sporadic stage~→meadow mouse caused mixed type outbreak stage~→house and meadow mouse mixed type highly sporadic stage~→house mouse primarily mixed type outbreak stage~→house mouse primarily caused mixed type highly sporadic stage.Till December,2005,the two counties’ HFRS still in the mixed type stage primary caused by house mouse.Fieldmouse peak occurs in September to February of the next year,house mouse peak occurs in March to May.The mouse density peak occurs in the third quarter,the mouse’ poison rate in 4th quarter is the highest.4.The case of HFRS has the obvious accumulation distribution between towns of the two counties.The high incidence areas are often located in low plains which full of rivers;The medium incidence areas mainly locate in the dry and low wooded mountain areas;The low incidence areas distribute in the high elevation mountain areas.At the same time,incident in the two counties also has family accumulation phenomenon.Conclusion:1.The two counties epidemic areas experienced:HTN type~→fixed HTN type~→fixed SEO type,and the two counties all have five followed epidemic stages:highly sporad→local epidemic→outbreak→extensive epidemic→highly sporadic.The two counties’ fatality rate droped continuously with time,fatality rates in autumn and winter season is higer than spring times.2.There is difference between annual incidence rate and fatality rates.The Junan county’s annual incidence rate is higher than Pingyi County,but fatality rate is lower; The HFRS epidemic characters of HFRS in the two counties varied periodictly,and the period in Pingyi County occurs approximately 3～5 years,but in Junan County,it occurs approximately 5～7 years.3.Incidence rate of HFRS in the two counties varied from geography and ecological. In the Linyi municipal,the epidemic areas of HFRS migrated from southeast plain areas which full of rivers to the northwest mountainous areas.更多还原