Background The Hubei Province in China reported its last indigenous malaria case in September 2012, but imported malaria cases, particularly those related to Plasmodium vivax and Plasmodium falciparum , threaten Hubei’s malaria-free status. This study investigated the epidemiological changes in P. vivax and P. falciparum malaria in this province to provide scientific evidence for preventing malaria resurgence. Methods The prevalence, demographic characteristics, seasonal features, and geographical distribution of malaria were assessed using surveillance data and were compared across three stages: control stage (2005–2009) and elimination stages I (2010–2014) and II (2015–2019). Results In 2005–2019, 8483 malaria cases were reported, including 5599 indigenous P. vivax cases, 275 imported P. vivax cases, 866 imported P. falciparum cases, and 1743 other cases. Imported P. falciparum cases accounted for 0.07% of all cases reported in 2005, but increased to 78.81% in 2019. Most imported P. vivax and P. falciparum malaria occurred among males, aged 21–60 years, during elimination stages I and II. The number of regions affected by imported P. falciparum and P. vivax increased markedly in Hubei from the control stage to elimination stage II. Overall, 1125 imported P. vivax and P. falciparum cases were detected from 47 other nations. Eight imported cases were detected from other provinces in China. From the control stage to elimination stage II, the number of cases of malaria imported from African countries increased, and that of cases imported from Southeast Asian countries decreased. Conclusions Although Hubei has achieved malaria elimination, it faces challenges in maintaining this status. Hence, imported malaria surveillance need to be strengthened to reduce the risk of malaria re-introduction.

目的 对湖北省36个流行县在"十三五"全国血吸虫病防治规划期间达到血吸虫病消除标准进行评估.方法 按照《血吸虫病控制和消除(GB15796-2015)》和《血吸虫病防治地区达标考核评估方案》,制定《湖北省县级血吸虫病消除达标工作评估方案》,对达血吸虫病消除标准地区开展资料审核、人畜病情调查、螺情调查、监测能力等方面的评估.结果 自达到传播阻断标准以来,36个流行县原始资料保存完整,各种图、卡、册、原始数据、痕迹资料等编写规范、保存完整,在档案资料管理方面体现了"一有三专",并进行了计算机化管理.能准确反映出从传播阻断到消除阶段的人群病情、家畜病情、螺情逐年变化的情况.36个流行县,共计血清学检测99 570人,血检阳性率0.19％(0.00％～1.24％);粪检198人,受检率100％,未检测出阳性;家畜共检测牛1 806头、羊1 438只,未检测出粪检阳性家畜;现场钉螺调查177 485框,捕获钉螺15 680只,活螺14 458只,未发现感染性钉螺.抽取36个流行县的血防专业机构和医疗机构开展监测能力评估,其中393人进行血吸虫病防治知识测试,最高为(100.00±0.00)分、最低为(80.00±4.92)分;抽取血防专业机构人员开展检测能力和钉螺鉴别能力评估,其中钉螺鉴别最高为(10.00±0.00)分、最低为(6.00±0.67)分,检测能力最高为(10.00±0.00)分、最低为(5.50±0.97)分;各县监测能力评分在80.00～100.00分之间.36个评估县复核人群血检阳性样本、人群粪检阴性样本、家畜粪检阴性样本、阴性钉螺符合率均为100％,人群血检阴性符合率99.4％.结论 湖北省36个县在"十三五"防治规划期间达到血吸虫病消除标准,取得了巨大的成就,为全省早日实现"健康中国2030"规划纲要中消除血吸虫病危害的宏伟目标奠定了基础.

BACKGROUND:The Hubei province is one of the most schistosomiasis-epidemic-prone provinces in China. A series of strategies were adopted by the government to curb the rebound schistosomiasis endemic status that has prevailed since the early 2000s. This study aimed to elucidate the trends of schistosomiasis transmission and to appraise the effectiveness of the integrated control strategy in lake and marshland areas. METHODS:Surveillance data of schistosomiasis in the Hubei province between 2005 and 2018 were analyzed, including conventional health control measures, integrated strategies, and measures that focused on the infection source. According to the local annual plan for schistosomiasis control in endemic counties, previous measures were human and snail control and surveillance. Residents aged 6-65 years were screened by an immunological detection method called indirect hemagglutination assay (IHA) after the transmission season each year. All residents who tested positive were then asked to provide a fecal sample for examination by the miracidium hatching technique (MHT) to detect the presence of schistosomes. Moreover, systematic snail surveys were conducted as a part of the combined environmental sampling method. The latter included integrated strategies and measures that focused on the infection source. Bovine stool samples were also collected and concurrently assessed using the MHT by the agriculture department, river-hardening slope protection was constructed by the water conservancy department, and forestation promotion was conducted by the forest department. The effectiveness of the integrated control strategy was assessed using two indicators of resident and livestock infection rates and three indicators of snail epidemics across all endemic areas. RESULTS:From 2005 to 2018, a total of 28. 46 million and 2. 05 million residents were assessed by immunological (IHA) and etiological (MHT) detection techniques, respectively. Snail surveys and molluscicide application were performed in 2. 26 hectares and 0. 37 hectares, respectively. Moreover, 2. 60 million bovines were assessed by etiological detection techniques (MHT). The river-hardening slope protection project was implemented in 503 places, and 46 thousand hectares in endemic areas underwent environmental modification. Forestation was implemented at an area of 0. 15 million hectares. Between 2005 and 2018, the epidemic indicators, including resident and livestock infection rates and the infested areas and infection rate of snails, all presented downward trends. The resident infection rate decreased from 3. 78% in 2005 to 0% in 2016, which persisted through 2018. The livestock infection rate decreased from 5. 63% in 2005 to 0% in 2013, which also persisted through 2018. From 2005 to 2018, the snail-inhabited area was slightly reduced, but the area of infected snails decreased to 0 in 2012; this persisted through 2018. All counties met the goal for schistosomiasis infection control, transmission control, and disruption of schistosomiasis activity in 2008, 2013, and 2018 separately. That means the goal has been achieved in each stage. CONCLUSIONS:The decline of the schistosomiasis epidemic rate demonstrates that the Chinese government was successful in meeting its public health goal in Hubei province. In the next decade, precision interventions must be implemented in endemic counties with a relatively low epidemic status to achieve the goals of the Outline of the Healthy China 2030 Plan. A similar strategy can be applied in other countries to eliminate schistosomiasis globally.

目的 了解2020年洪涝灾害后湖北省钉螺扩散情况,为汛期控制钉螺扩散提供科学依据.方法 采用系统抽样结合环境抽查法,以县为单位、以水系为单元,在2020年汛后开展钉螺扩散范围和钉螺上爬附着物情况调查,并对捕获的钉螺进行实验室检测.结果 在湖北省63个血吸虫病流行县(市、区)及毗邻地区共调查933处环境,环境面积6965.77 hm2,涉及30余条水系,发现有20个流行县(市、区)有钉螺扩散,扩散总面积为4350.74 hm2,其中原有钉螺环境扩大面积为1360.39 hm2,复现钉螺环境面积1856.19 hm2,新发钉螺环境面积1134.16 hm2,捕获钉螺159997只,活螺149928只,未发现感染性钉螺.对出现钉螺扩散的20个流行县(市、区)开展钉螺上爬附着物情况调查,累计捡获钉螺85458只,在树木、墙面捡获钉螺较多,分别捡获33326只和35581只,未发现感染性钉螺.结论 2020年洪涝灾害后,湖北省部分血吸虫病流行区出现较大面积的钉螺扩散,需加强洪灾后的钉螺调查和监测,及时发现和处置钉螺扩散环境.

目的 对湖北省传疟媒介按蚊的种群分布、密度、季节消长及夜间活动规律等进行监测,为消除疟疾后阶段输入性疟疾防控策略的制定提供参考.方法 于2018-2020年每年7-9月在湖北省枣阳市的3个村(刘升镇刘湾村2组、琚湾镇琚庄村3组和七方镇文庄村1组)开展按蚊种群监测,于室内(人房或牲畜棚)、室外(靠近水稻田)各选取2个调查场所开展1次按蚊种群监测,采用灯诱法(19:00至次日7:00)捕蚊,连续监测3d.2018-2020年,另选择恩施市舞阳坝乡、丹江口市六里坪乡、枣阳市七方镇、武穴市石佛寺乡、江陵县白马寺镇和京山市孙桥镇等6个监测点,每年5-10月的上旬和下旬各开展1次按蚊密度监测,在监测点的居民区和蚊媒孳生地之间采用人诱法(19:00至次日7:00)捕蚊.捕获的所有按蚊冷冻处死后进行形态学鉴定.分析按蚊密度的季节消长趋势,夜间不同时间段按蚊密度的规律,以及人房、牲畜棚和室外等不同场所按蚊种群构成差异.按蚊密度的比较采用方差分析,按蚊种群构成的比较采用x2检验.结果 种群监测结果显示,2018-2020年灯诱法共捕获蚊虫4277只,其中中华按蚊819只(19.15％),淡色库蚊3440只(80.43％),骚扰阿蚊18只(0.42％).牲畜棚捕获蚊虫3502只,其中中华按蚊677只(19.33％),淡色库蚊2813只(80.33％),骚扰阿蚊12只(0.34％).室外捕获蚊虫总数503只,其中中华按蚊106只(21.07％),淡色库蚊393只(78.13％),骚扰阿蚊4只(0.80％).人房捕获蚊虫总数272只(2020年未进行人房按蚊监测),其中中华按蚊36只(13.24％),淡色库蚊234只(86.03％),骚扰阿蚊2只(0.74％).2018-2020年各年度人房、牲畜棚和室外等不同捕蚊场所按蚊种群构成差异均无统计学意义(x2=23.500、36.000、18.000,P＞ 0.05).按蚊密度监测结果显示,2018-2020年,湖北省6个监测点共捕获中华蚊虫8426只,未发现雷氏按蚊及其他按蚊.人诱法捕获中华按蚊数量最多的地区为江陵县,3年共捕获中华按蚊4671只;最少的为丹江口市,3年共捕获0只.2018-2020年,中华按蚊平均密度高峰分别出现在8月上旬(2018年)和7月下旬(2019、2020年),分别为15.91、13.93、6.91只/(人·h),三者差异无统计学意义(F=0.347,P＞ 0.05).6个监测点中,江陵县监测点的按蚊密度最高,其次为武穴市,按蚊密度分别为10.81和6.71只/(人·h).不同监测点按蚊密度差异有统计学意义(F=5.962,P＜0.05).湖北省中华按蚊夜间活动高峰出现在晚上19:00-21:00.结论 湖北省传疟媒介中华按蚊持续存在,仍有潜在的疟疾传播风险,应继续开展持续、规范的监测工作,进一步加强媒介控制工作.

OBJECTIVE To establish an indicator system for assessment of schistosomiasis transmission risk after transmission interruption in Hubei Province, so as to provide insights into the precise control of schistosomiasis. METHODS The indicator system was preliminarily established based on data collection, literature review, expert interviews. Two rounds of expert consultation were performed. The indicator system was screened based on the importance, operability, sensitivity and comprehensive score of the indicators, and the weights of each indicator were calculated. The credibility of the Delphi method was evaluated by calculating the active coefficient of the experts, degree of expert authority and coordination levels of experts' opinions. RESULTS An indicator system for assessment of schistosomiasis transmission risk was preliminarily established, including 3 primary indicators, 12 secondary indicators and 44 tertiary indicators. A Delphi consultation was performed among 17 experts participating in schistosomiasis control, management and research. Following two rounds of consultation, a risk assessment indicator system was finally constructed, including 3 primary indicators, 10 secondary indicators and 35 tertiary indicators. Among the primary indicators, the variable with the highest normalized weight was the current status of schistosomiasis (0.420 2), followed by social factors (0.397 3) and natural environments (0.182 5). Among the secondary indicators, those with high combined weights included risk monitoring (0.142 3), current snail status (0.140 1), and current prevalence of human and livestock infections (0.137 8). Among the tertiary indicators, those with high combined weights included the positive rate of wild feces (0.049 8), the prevalence of snail infections (0.047 4), and the area of snail habitats submerged by floods (0.046 8). During the two-round consultation, the active coefficients of the experts were 85.00% and 100.00%, the degree of expert authority was both 0.75 and greater, and the coordination levels of experts' opinions were 0.405 to 0.521 and 0.592 to 0.695 (all P values < 0.05). CONCLUSIONS An indicator system for assessment of schistosomiasis transmission risk is successfully established after transmission interruption in Hubei Province based on the Delphi method, which provides insights into the identification of the schistosomiasis transmission risk and the targets for schistosomiasis control in Hubei Province.

湖北省历史上流行的疟疾以间日疟为主,传疟媒介为中华按蚊和嗜人按蚊.曾先后于1954-1955年、1967-1973年出现过疟疾大流行,其中1970年发病率高达602.4/万.70年来,湖北省遵循"因地制宜、分类指导、突出重点"的原则,采取了不同的综合防治措施,到2010年全省疟疾发病率降至0.07/万.2010年湖北省启动了消除疟疾行动计划,2013年实现了无本地感染疟疾病例,2019年全省通过了消除疟疾考核,实现了消除疟疾目标.本文就湖北省疟疾流行概况、疟疾防治和消除历程、面临的挑战及展望等作一概述.

目的 了解当前湖北省人群血吸虫病抗体水平与变化趋势,评估人群血吸虫病传播风险.方法 于2016-2018年每年的9-12月,收集湖北省人群血吸虫病查病中血清抗体阳性者血清,采用间接血凝试验检测血清抗体滴度,记录抗体效价结果和阳性者基础信息;收集湖北省血吸虫病防治工作年报表中全省各疫区县(市、区)2016-2018年查病情况和达标进展资料,将血清抗体阳性报告数、血清抗体阳性率、阳性血清抗体效价构成比和流行区类型等4项指标设立为传播风险评估具体指标.以县为单位,评估各流行地区的人群病情传播风险等级,并用ArcGIS 10.5软件制作湖北省人群血吸虫病传播风险等级可视化地图.采用SPSS 26.0统计学软件分析2016-2018年血清抗体阳性者基础信息,评估重点防控人群分布特征.结果 2016-2018年湖北省血检人数分别为1728300、1531611、1498039人,血清抗体阳性数分别为41154、31532、22124例,血清抗体阳性率分别为2.38％、2.06％、1.48％,全省血清抗体阳性数呈逐年减少,血清抗体阳性率逐年下降(x2=3410.81,P＜ 0.01).2016、2017年以传播控制地区报告为主,分别占当年总血清抗体阳性数的95.47％ (39290/41154)、63.68％ (20081/31532) (x2=773.88,P＜0.01);2018年以传播阻断地区报告为主,占当年总血清抗体阳性数的99.84％ (22088/22124).其中2016-2018年血清抗体效价≥1:40者分别为4459例、4498例、2482例,占血清抗体阳性数的10.83％、14.26％、11.22％,3年间差异有统计学意义(x2=217.46,P＜0.01).人群血吸虫病传播风险等级分析结果显示,全省1级风险区5个,分别为公安县、沙市区、江陵县、松滋市和潜江市;2级风险区10个,分别为阳新县、洪湖市、嘉鱼县、荆州区、荆州开发区、汉南区、石首市、蔡甸区、汉川市和仙桃市;3级风险区10个;其余38个流行地区均为4级风险区.血吸虫病传播风险重点人群分析结果显示,2016-2018年血清抗体效价≥1:40人群中,均以男性和44～65岁年龄组人群为主,分别占血清抗体阳性数的62.43％ (7141/11439)和71.09％ (8132/11439).结论 2016-2018年湖北省人群血吸虫病血清抗体阳性数呈逐年减少,当前人群血吸虫病传播风险以4级风险区域为主,总体传播风险较低,1级风险、2级风险区域仍需加强防控,以男性和44～65岁年龄组人群为重点防控人群.

目的 了解在湖北省山丘型血吸虫病重点防控地区,人群病情小尺度空间聚集性探测的应用价值.方法 以松滋市2016—2018年血吸虫病血清学检测阳性抗体效价在1:80及以上(血阳高)病例、血吸虫病粪便检查阳性病例(粪阳)为研究对象.以该市村级小尺度为研究单元,采用Flexible不规则空间扫描统计量,分别设定参数K=2、K=6、K=10时,对人群病情进行空间聚集性探测分析.结果 松滋市2016—2018年未查出粪阳病例,血阳高病例分别为74人、206人、83人;2016—2018年血阳高病例均存在空间聚集性.Flexible不规则空间扫描统计分析探测到的聚集区域随着设定不同K值的变化而发生变化.不同参数下扫描探测结果显示松滋市血吸虫病人群病情聚集区域主要集中在老城镇、陈店镇、王家桥镇等最大似然聚集区的3个流行乡镇40个流行村.结论 Flexible不规则空间扫描统计量探测出湖北省山丘型血吸虫病流行区的人群病情在村级小尺度上存在空间聚集性,今后需继续保持与巩固血吸虫病监测、防控工作力度,早日实现全省血吸虫病消除目标.

目的 评估"十三五"期间湖北省27个达到血吸虫病传播阻断标准流行县(市、区)的防治效果.方法 按照《湖北省县级血吸虫病传播阻断达标工作评估方案》,对湖北省达血吸虫病传播阻断标准地区开展考核评估工作.结果 27个县(市、区)共计开展血清学检测88483人,血检阳性率1.88％(0～6.78％);粪检1665人,受检率100％,未检出阳性;检测家畜1289头(只),未检出阳性;现场钉螺调查162680框,捡获钉螺36382只,其中活螺25566只,经解剖未发现感染性钉螺.各县均建立了一套以行政村为单位的,较为完整的血防档案资料,能够反映从传播控制到传播阻断阶段人畜病情、螺情变化情况.同时,也建立健全了能适应当地疫情特点的敏感、有效的监测体系.结论 湖北省27个县(市、区)各项疫情指标已达到血吸虫病传播阻断标准,顺利完成了《"十三五"全国血吸虫病防治规划》既定目标要求.

Gamma-delta (γδ) T cells are the bridge between natural and adaptive immunity. In the present study, peripheral blood was collected from 13 patients with advanced schistosomiasis (schistosomiasis group) and 13 uninfected people (control group) to investigate the γδ T cells and their subtypes in human schistosomiasis. Compared with the control group, the proportion of Vδ1 cells and CD27+ Vδ1+ cells in the schistosomiasis group increased significantly, while CD27- cells and CD27- Vδ1- cells decreased. Only the level of IL-17A differed between the groups, being significantly decreased in the schistosomiasis group. In the schistosomiasis group, there were no correlations between the liver fibrosis and subsets of γδ T cells, or the level of cytokines. Additionally, the level of IL-17A correlated positively with the proportion of CD27- Vδ1- cells. Thus, there was a higher frequency of circulating Vδ1 γδT cells in patients with advanced schistosomiasis. The decreased IL-17A might be related to the reduction in CD27- Vδ1- cell.

回顾湖北省血吸虫病、疟疾、丝虫病、黑热病(内脏利什曼病)、土源性寄生虫病、食源性寄生虫病、棘球蚴病(包虫病)等七类重点人体寄生虫病的流行概况,掌握与分析其流行现状和态势.湖北省寄生虫病疫情已降至历史最低,但当前面临局部地区依然存在感染寄生虫的高风险因素;随着全球经济一体化程度的日益加深和"一带一路"战略的全面实施,与人类追求多元化的物资文化生活致饮食谱扩大等因素,面临罕见及多种寄生虫病输入带来的传播风险;当前监测力度随着工作保障程度的下降有所削弱,一旦疫情未得到及时有效控制,将存在局部暴发和流行等潜在风险.建议将继续保持政府领导下的多部门合作机制;进一步提升能力建设,确保一支精干、稳定的寄生虫病防控专业队伍;"十四·五"期间继续加大寄生虫病的监测工作力度,巩固全省寄生虫病防治成果,维护人民群众的身体健康.

目的 了解2015-2018年湖北省疟疾流行特征,为湖北省消除疟疾策略的调整提供依据. 方法 收集2015-2018年中国疾病预防控制中心传染病报告信息管理系统中网络报告的湖北省疟疾病例资料,采用描述流行病学方法,分析2015-2018湖北省网络报告疟疾的流行病学特征. 结果 2015-2018年湖北省累计报告疟疾病例494例,均为境外输入病例.2015-2018分别报告病例120、151、96和127例,均为实验室确诊病例.其中,恶性疟337例(68.2％)、间日疟65例(13.2％)、卵形疟75例(15.2％)、三日疟14例(2.8％)、混合感染3例(0.6％).病例主要分布在武汉(168例,34.0％)、宜昌(75例,15.2％)、黄冈(39例,7.9％)、黄石(35例,7.1％)、襄阳(31例,6.3％)和十堰(28例,5.7％)等6个市.疟疾病例报告高峰期为1-2月(129例,26.1％)和5-7月(137例,27.7％).以20～49岁年龄组居多,占85.2％ (421/494).男性473例,女性21例,男女性别比为22.5∶1.疟疾病例初诊单位主要集中在县级及以上医疗机构(324例,65.6％),345例(69.8％)病例首诊被诊断为疟疾.不同就诊单位初诊正确率差异有统计学意义(P＜0.05).病例就诊当天确诊者占44.3％(219/494),恶性疟、间日疟、卵型疟、三日疟和混合感染就诊当天确诊者分别占49.3％ (166/337)、41.5％ (27/65)、32.0％ (24/75)、1/14和1/3,不同疟疾类型从就诊到确诊时间间隔差异有统计学意义(P＜0.05).疟疾病例的确诊单位以县级以上医疗机构所占比较高,占57.7％ (285/494).94.1％ (465/494)的疟疾病例从非洲的30个国家输入,输入病例数居前的来源国家为刚果(金)(69例,14.0％)、尼日利亚(61例,12.3％). 结论 2015-2018年湖北省报告疟疾病例均为输入性病例,94.1％的疟疾病例为从非洲输入,44.3％病例在就诊当天确诊.

OBJECTIVES:Progress in national schistosomiasis control in China has successfully reduced disease transmission in many districts. However, a low transmission rate hinders conventional snail surveys in identifying areas at risk. In this study, Schistosoma japonicum-infected sentinel mice surveillance was conducted to identify high-risk areas of schistosomiasis transmission in Hubei province, China.METHODS:The risk of schistosomiasis transmission was assessed using sentinel mice monitoring in Hubei province from 2010 to 2018. Field detections were undertaken in June and September, and the sentinel mice were kept for approximately 35 days in a laboratory. They were then dissected to determine whether schistosome infection was present. Ripley's K-function and kernel density estimation were applied to analyze the spatial distribution and positive point pattern of schistosomiasis transmission.RESULTS:In total, 190 sentinel mice surveillance sites were selected to detect areas of schistosomiasis infection from 2010 to 2018, with 29 (15.26%) sites showing infected mice. Of 4723 dissected mice, 256 adult worms were detected in 112 infected mice. The infection rate was 2.37%, with an average of 2.28 worms detected per infected mouse. Significantly more infected mice were detected in the June samples than in the September samples (χ2=12.11, p<0.01). Ripley's L(d) index analysis showed that, when the distance was ≤34.52km, the sentinel mice infection pattern showed aggregation, with the strongest aggregation occurring at 7.86km. Three hotspots were detected using kernel density estimation: at the junction of Jingzhou District, Gong'an County, and Shashi District in Jingzhou City; in Wuhan City at the border of the Huangpi and Dongxihu Districts, and in the Hannan and Caidian Districts.CONCLUSION:The results showed that sentinel mice surveillance is useful in identifying high-risk areas, and could provide valuable information for schistosomiasis prevention and control, especially concerning areas along the Yangtze River, such as the Fu-Lun, Dongjing-Tongshun, and Juzhang River basins.

OBJECTIVE:To analyze the changing tendency in the endemic situation of schistosomiasis in the national surveillance sites of Hubei Province, so as to provide the scientific evidence for facilitating the progress towards the elimination of schistosomiasis in the province.METHODS:According to the National Schistosomiasis Surveillance Scheme (2014 version), a total of 65 national schistosomiasis surveillance sites were assigned in Hubei Province, and the Schistosoma japonicum infections in humans, domestic animals, snails and wild feces were monitored in these national surveillance sites from 2015 to 2019. All data pertaining to the surveillance results were descriptively analyzed.RESULTS:There were 151 159 person-time local residents and 70 928 person-time mobile populations screened for S. japonicum infections in the 65 national surveillance sites of Hubei Province from 2015 to 2019, and the seroprevalance of S. japonicum infections reduced from 3.45% (1 077/31 197) in 2015 to 1.57% (431/27 371) in 2019 among local residents and from 1.06% (98/9 249) in 2015 to 0.81% (116/14 318) in 2019 among mobile populations. During the period from 2015 through 2019, there were 22 egg-positive local residents and 2 egg-positive mobile populations identified in 2015, with 0.07% and 0.02% prevalence rates of S. japonicum infections, respectively. During the 5-year period, a total of 7 025 herd-time domestic animals examined for S. japonicum infections, with no infections detected, and a total of 2 035 wild feces were tested, with no egg-positives identified in the 65 national surveillance sites of Hubei Province. Snail survey was conducted covering 28 767.35 hm2 during the 5-year period, and the area of snail habitats ranged from 1 609.82 to 2 119.81 hm2. The mean density of living snails and occurrence of frames with snails reduced from 0.360 5 snails/0.1 m2 and 11.26% in 2015 to 0.175 9 snails/0.1 m2 and 8.43% in 2019, respectively, and no S. japonicum infection was found in snails during the 5-year period. In addition, no snails were found in the potential schistosomiasis transmission foci in the two national surveillance sites in the Three Gorges Dam.CONCLUSIONS:The overall endemic situation of schistosomiasis appears a tendency towards a decline in Hubei Province during the period from 2015 through 2019; however, the schistosomiasis transmission risk remains. Improving the surveillance system of schistosomiasis and increasing the sensitivity and performance of the surveillance system are required to provide insights into the implementation of precision control strategy and interventions in Hubei Province.

BACKGROUND:There have been an increasing number of imported cases of malaria in Hubei Province in recent years. In particular, the number of cases of Plasmodium ovale spp. and Plasmodium malariae significantly increased, which resulted in increased risks during the malaria elimination phase. The purpose of this study was to acquire a better understanding of the epidemiological characteristics of P. ovale spp. and P. malariae imported to Hubei Province, China, so as to improve case management.METHODS:Data on all malaria cases from January 2014 to December 2018 in Hubei Province were extracted from the China national diseases surveillance information system (CNDSIS). This descriptive study was conducted to analyse the prevalence trends, latency periods, interval from onset of illness to diagnosis, and misdiagnosis of cases of P. ovale spp. and P. malariae malaria.RESULTS:During this period, 634 imported malaria cases were reported, of which 87 P. ovale spp. (61 P. ovale curtisi and 26 P. ovale wallikeri) and 18 P. malariae cases were confirmed. The latency periods of P. ovale spp., P. malariae, Plasmodium vivax, and Plasmodium falciparum differed significantly, whereas those of P. ovale curtisi and P. ovale wallikeri were no significant difference. The proportion of correct diagnosis of P. ovale spp. and P. malariae malaria cases were 48.3% and 44.4%, respectively, in the hospital or lower-level Centers for Disease Control and Prevention (CDC). In the Provincial Reference Laboratory, the sensitivity of microscopy and rapid diagnostic tests was 94.3% and 70.1%, respectively, for detecting P. ovale spp., and 88.9% and 38.9%, respectively, for detecting P. malariae. Overall, 97.7% (85/87) of P. ovale spp. cases and 94.4% (17/18) of P. malariae cases originated from Africa.CONCLUSION:The increase in the number of imported P. ovale spp. and P. malariae cases, long latency periods, and misdiagnosis pose a challenge to this region. Therefore, more attention should be paid to surveillance of imported cases of P. ovale spp. and P. malariae infection to reduce the burden of public health and potential risk of malaria.

目的 分析2015-2019年湖北省血吸虫病监测点疫情资料,掌握全省血吸虫病流行态势,指导今后监测工作.方法 按《湖北省血吸虫病监测方案(2015年版)》要求,在全省13个地市设立207个血吸虫病监测点,开展常规监测、监测点监测和风险监测.监测内容包括本地居民及流动人群病情监测、家畜血吸虫感染监测以及螺情监测.对各年监测数据收集后进行统计分析.结果 监测结果显示,本地居民血吸虫病血检阳性率由2015年的2.75％(4 470/173 558)下降至2019年的2.09％(2 169/103 885),血吸虫感染率在2015年为0.07％(120/173 558),之后年份均为0,五年来均无急性血吸虫感染病例.流动人群血吸虫病血检阳性率由2015年的1.06％(98/9 249)下降到2019年的0.79％(100/12 602),血吸虫感染率在2015年为0.02％(2/9 249),之后年份均为0.五年间累计开展家畜查病7 880头,其中耕牛5 325头,未发现感染血吸虫.累计开展钉螺调查面积94 297.8 hm2,查出钉螺面积34 263.05 hm2,共捕获活螺876 392只,未发现感染性钉螺.活螺平均密度由2015年的0.291 5只/框下降至2019年的0.1241只/框,有螺框出现率由2015年的9.54％下降至2019年的6.19％.累计开展野粪监测2 035份,未发现阳性.累计在49处水域开展钉螺扩散监测,并打捞漂浮物6 942 kg,未发现漂浮物携带钉螺.对252处有螺环境开展风险监测,发现有阳性野粪的Ⅰ级风险处共12处.结论 2015-2019年湖北省血吸虫病疫情总体呈下降趋势,疫情已处于历史最低水平,但风险监测仍发现个别地区的血吸虫病传播风险不容忽视,需重点加大对现存耕牛的管控力度.

Schistosomiasis caused by Schistosoma japonicum is a public health concern in China, and Hubei is one of the most affected provinces. Although the routine surveillance since the mid 1950s has generated substantial data pertaining to the habitats of the intermediate snail host, Oncomelania hupensis, its spatiotemporal distribution is not known. A review of local chronicles on the annual records of schistosomiasis control program was conducted to retrospectively collect information about O. hupensis habitats. The habitats were mapped by a field survey in 2016. We categorized the habitats into five evolutionary types, namely, Type I, current habitat; Types II-IV, historical habitat; and Type V, suspected habitat according to habitat development. The shape of habitats was determined using geographical information systems. A visual database was established and managed on the ArcGIS platform. A total of 43 472 O. hupensis habitats, covering an area of approximately 430 000 hectares, were identified through the study. Over 60% of these habitats have been eliminated. The highest number of O. hupensis habitats was recorded in 1975; however, most of them were preserved until 1995. Our study, for the first time, sheds light on the spatiotemporal distribution of O. hupensis in the most affected province in China. The data will be valuable for policy making and for formulating strategies to eliminate schistosomiasis in Hubei Province.

目的 探索运用标记重捕技术计算野外钉螺种群数量的可行性.方法 通过对实验基地内沟渠中的钉螺进行标记和重捕,推算钉螺的种群数量,与传统查螺方法比较后,评价标记重捕技术应用于钉螺野外调查的可行性.结果 春季,按照标记重捕技术计算的六条沟渠内钉螺种群数量平均值分别为3833、3345、6951、4772、3329、4188只,按照传统查螺法推算的钉螺种群数量平均值分别为3765、3251、6994、4739、3304、4105只;秋季,按照标记重捕技术计算的钉螺种群数量平均值分别为4190、3486、7808、5344、3968、4772只,传统查螺法推算的钉螺种群数量平均值分别为4094、3471、7866、5304、3729、4696只,两种方法的一致性较好.结论 在一定的条件下,标记重捕技术可以用来推算钉螺种群数量.

This study aimed to describe the epidemiology of Plasmodium falciparum malaria and identify risk factors for severe disease in Hubei Province, China, using a case-based survey of retrospective data from 2013 to 2018. From 2013 to 2018, a total of 763 imported malaria cases were reported in Hubei Province; 69.2% (528/763) cases were caused by P. falciparum species. The proportion of malaria caused by P. falciparum increased from 66.7% in 2013 to 74.0% in 2018 (χ2 = 21.378, P < 0.05). Plasmodium falciparum malaria was reported in 77 counties of Hubei Province. The majority of imported P. falciparum cases originated from Africa (98.9%, 522/528); 9.7% (51/528) of patients infected with P. falciparum developed severe malaria. Three deaths (case fatality rate: 0.6%) were related to imported P. falciparum malaria. Risk factors for severe malaria were being female (odds ratio [OR] = 3.593, 95% CI: 1.003-12.874), age ≥ 50 years (OR = 2.674, 95% CI: 1.269-5.634), > 3 days between symptom onset and diagnosis (OR = 2.383, 95% CI: 1.210-4.693), and the first-visit medical institution at the township level or lower (OR = 2.568, 95% CI: 1.344-4.908). Malaria prevention should be undertaken among high-risk groups, infection with P. falciparum should be detected early to prevent severe disease and death, and healthcare providers in health facilities at the township level should be trained on early recognition of malaria.