摘要目的 分析我国秋冬型恙虫病主要疫源地山东、江苏、安徽省近年来恙虫病流行病学特征及流行相关因素.方法 收集三省2006-2013年(安徽省为2008-2013年)恙虫病报告疫情资料,分析其“三间分布”特征,并应用地理信息技术(GIS)在县区尺度上使用面板负二项回归模型分析其流行相关因素.结果 山东、江苏、安徽省监测期间分别报告恙虫病病例2 968、2 331和3 447例,年均发病率分别为0.39/10万、0.38/10万和0.94/10万,除安徽省2012-2013年发病率略有回落外,另两省年发病率均呈显著上升趋势.研究期间,三省恙虫病疫源地范围不断扩大,报告发病乡镇分别增至38.0％、48.2％和46.5％.疫情高峰均为10、11月.三省主要发病人群均为女性、老年人和农民,且农民的构成比在3个省均呈现上升趋势,而山东省家政家务人员、安徽省散居及幼托儿童也出现一定的上升趋势.面板负二项回归模型显示3个省恙虫病的流行风险随着月均温度升高出现先升后降的趋势,而月降雨量的增加可降低恙虫病的流行风险;山东和安徽省恙虫病的流行风险还随着月相对湿度的增加而上升;山东和江苏省恙虫病的流行风险随日照时数的增加出现先升后降的特点;此外,山东省林区呈现较高的流行风险.结论 应加强3个省温暖湿润地区以及山东省森林茂密区域恙虫病的监测,尤其是针对老年人及农民等高发人群,以及山东省家政家务人员和安徽省的散居及幼托儿童等人群.

abstractsObjective To investigate the spatiotemporal expansion and risk factors of scrub typhus (ST) in Shandong,Jiangsu and Anhui provinces.Methods Based on the reported cases in Shandong and Jiangsu from 2006 to 2013,and Anhui from 2008 to 2013 epidemiological characteristics of ST and associated environmental factors were analyzed,using the panel negative binomial regression model.Results A total of 2 968,2 331 and 3 447 ST cases were respectively reported in Shandong,Jiangsu and Anhui during 2006-2013,with the average annual incidence rates as 0.39,0.38 and 0.94 per 100 000 population.Uptrend in Shandong and Jiangsu,but a slight rollback seen in Anhui were observed.Expansion of natural foci was found in the 3 provinces,with affected counties accounted for 38.0％,48.2％ and 46.5％ in Shandong,Jiangsu and Anhui,respectively in 2013.Cases were clustered in autumn but with a peak of single epidemic appeared in October or November,in all the 3 provinces.More female and elderly patients were seen,than in the other age groups,in all the 3 provinces.Majority of the cases were farmers,with an increasing trend in incidence,in all these provinces,followed by housekeepers in Shandong and preschool children in Anhui.The risk factors of transmission in all the 3 provinces were negatively associated with the monthly precipitation,and showing an "inverted-U" pattern in association with monthly temperature.A positive relationship between the risk of transmission and monthly relative humidity was found in Shandong and Jiangsu provinces.However,an "inverted-U" pattern between the risk of transmission and the monthly sunshine hour,appeared in Shandong and Anhui provinces.The incidence of Scrub typhus in Shandong was also positively related to the coverage of forest.Conclusion Surveillance programs and health education measures should focus on the warm and moist areas in all the 3 provinces,and also on forestry areas in Shandong.Health education and prevention on mite-bite should be targeted,especially on high-risk populations as the elderly and farmers,in the 3 provinces.Housekeepers in Shandong and children in Anhui should also be under special concern.