Epidemiological characteristics of scarlet fever cases in Yangpu district, Shanghai, 2015−2020
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摘要:
目的 了解上海市杨浦区猩红热病例的三间分布、临床症状与体征等流行病学特征,为今后该地区的疫情防控提供理论依据。 方法 运用描述性流行病学方法对2015—2020年上海市杨浦区猩红热的三间分布特征进行描述及分析,运用系统聚类中Ward聚类分析法对猩红热的临床症状与体征进行分析。 结果 所有病例中男性多于女性;年龄主要为 5~7 岁,以6岁组占比最高(31.60%);中心街道的发病水平高于周边街道;2015—2020年发病率先上升后下降,且在每年的 5—6 月及 11 月至次年 1 月呈现2个发病高峰。 病例的临床症状与体征可分为较常出现组、较少出现组及未出现组3类,以全身症状及口咽部症状最多见。 结论 2015—2020年上海市杨浦区猩红热整体发病水平先上升后下降,在日常诊疗及防控工作中应重点关注春末夏初及秋末冬初时期的学龄期男性儿童,应加强对猩红热常见症状体征的鉴别诊断。 Abstract:Objective To understand the epidemiological characteristics of scarlet fever in Yangpu district, Shanghai, from 2015 to 2020, and provide theoretical basis for the prevention and control of scarlet fever. Methods Descriptive epidemiological method was used to describe and analyze the distributions of scarlet fever in Yangpu, and Ward cluster method was used to analyze the clinical symptoms and signs of scarlet fever. Results More scarlet fever cases occurred in boys than in girls. The age of the cases was 5−7 years and the cases aged 6 years had highest proportion (31.60%). The incidence level in central streets was higher than that in surrounding streets. The incidence level during 2015−2020 showed an upward trend followed by a downward trend, while the annual incidence had two peaks during May−June and during November−January. The cases could be divided into 3 groups according to the clinical symptoms and signs: more symptom group, less symptom group and non-symptom group, while the most common symptoms were systemic and oropharyngeal symptoms. Conclusion In recent years, the overall incidence level of scarlet fever in Yangpu showed an upward trend and then a downward trend. In the diagnosis, treatment and prevention and control of scarlet fever, special attention should be paid to school aged boys in late spring and early summer and in late autumn and early winter, while the differential diagnosis should be strengthened. -
表 1 2015-2020年上海市杨浦区猩红热时间序列季节因子分析
Table 1. Time series seasonal factor analysis on scarlet fever in Yangpu district, Shanghai, 2015−2020
月份 季节因子 月份 季节因子 1 5.731 7 −6.060 2 −4.269 8 −4.952 3 −3.277 9 −5.944 4 −1.477 10 −4.335 5 3.915 11 4.473 6 0.498 12 15.698 表 2 2015-2020年上海市杨浦区猩红热病例性别分布
Table 2. Sex Distribution of scarlet fever cases in Yangpu district, Shanghai, 2015−2020
性别 病例数 2015年
(n=18)2016年
(n=22)2017年
(n=40)2018年
(n=202)2019年
(n=125)2020年
(n=27)χ2值 P值 男性 261(60.14) 16(88.89) 9(40.91) 26(65.00) 116(57.43) 79(63.20) 15(55.56) 11.340 0.045 女性 173(39.86) 2(11.11) 13(59.09) 14(35.00) 86(42.57) 46(36.80) 12(44.44) 注:括号外数据为病例数,括号内数据为构成比(%) 表 3 2015-2020年上海市杨浦区猩红热病例年龄分布
Table 3. Age distribution of scarlet fever cases in Yangpu district, Shanghai, 2015−2020
年龄(岁) 病例数(例) 构成比(%) 累积百分比(%) 1 1 0.23 0.23 2 2 0.46 0.69 3 17 3.92 4.61 4 44 10.14 14.75 5 85 19.59 34.34 6 137 31.57 65.91 7 80 18.43 84.34 8 36 8.29 92.63 9 16 3.69 96.32 10 8 1.84 98.16 11 5 1.15 99.31 12 1 0.23 99.54 22 1 0.23 99.77 24 1 0.23 100.00 合计 434 100.00 − 注:−. 无数据 表 4 2015-2020年上海市杨浦区各街道猩红热发病数及发病率
Table 4. Cases and incidence rate of scarlet fever in streets of Yangpu district, Shanghai, 2015−2002
街道 2015年 2016年 2017年 2018年 2019年 2020年 总计 定海路 1(0.89) 1(0.90) 1(0.90) 8(7.09) 6(5.54) 3(2.77) 20(3.01) 平凉路 0(0.00) 1(0.87) 1(0.91) 6(5.81) 4(4.28) 0(0.00) 12(1.98) 江浦路 1(1.05) 0(0.00) 4(4.28) 21(22.45) 11(12.48) 2(2.27) 39(7.09) 四平路 2(1.81) 1(0.92) 3(2.78) 33(30.20) 11(10.04) 4(3.65) 54(8.23) 控江路 1(1.02) 3(3.03) 5(5.00) 39(38.81) 30(29.40) 1(0.98) 79(13.20) 长白新村 0(0.00) 2(2.75) 1(1.41) 11(15.50) 6(8.37) 2(2.79) 22(5.14) 延吉新村 1(1.15) 3(3.48) 5(5.87) 18(21.13) 14(16.40) 3(3.51) 44(8.59) 殷行 2(1.17) 3(1.77) 4(2.37) 14(8.26) 7(4.10) 1(0.59) 31(3.04) 大桥 2(1.35) 1(0.68) 5(3.39) 20(13.57) 11(8.23) 2(1.50) 41(4.79) 五角场 6(4.05) 3(2.00) 3(2.01) 12(7.69) 7(4.33) 5(3.09) 36(3.86) 新江湾城a 0(0.00) 0(0.00) 2(4.79) 8(17.47) 6(12.13) 0(0.00) 16(5.73) 长海路 2(1.32) 4(2.62) 6(3.97) 12(7.97) 12(7.69) 4(2.56) 40(4.36) 合计 18(1.37) 22(1.68) 40(3.05) 202(15.39) 125(9.58) 27(2.07) 434(5.52) 注:a. 新江湾城2017年起报告病例,2017年之前数字统一计算在殷行街道;括号外数据为病例数(例),括号内数据为发病率(/10万) 表 5 病例临床症状与体征
Table 5. Clinical symptoms and signs of the cases
组别 病例数(例) 临床症状(例) 体征(例) 发热a 咽痛b 扁桃体红肿 呕吐 腹泻 关节痛 口周皮肤苍白圈 草莓舌ac 全身弥漫性鲜红色皮疹a 脱屑 发病年份 2015 9 9 9 7 0 0 0 0 3 5 1 2016 21 19 18 12 2 0 1 5 13 6 0 2017 38 31 23 21 2 0 0 7 24 24 4 2018 117 98 84 56 7 2 1 12 53 90 7 2019 93 69 64 48 2 0 0 13 28 61 4 2020 28 13 16 11 1 0 1 3 8 24 5 性别 男性 190 146 133 97 6 1 2 27 70 132 16 女性 116 93 81 58 8 1 1 13 59 78 5 年龄(岁) <7 190 148 133 93 9 1 2 26 85 128 16 ≥7 116 91 81 62 5 1 1 14 44 82 5 职业 散居儿童 7 6 1 2 0 0 0 3 4 4 2 幼托儿童 46 121 111 78 8 1 2 19 68 96 10 学生 152 111 101 74 6 1 1 18 57 110 9 教师 1 1 1 1 0 0 0 0 0 0 0 合计 306 239 214 155 14 2 3 40 129 210 21 注:a. 各年份间差异,发热P=0.01,草莓舌P=0.02;b. 各职业间差异P=0.02;c. 性别间差异(χ2=5.314,P=0.024) -
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