Epidemiological characteristics and spatiotemporal distribution of hemorrhagic fever with renal syndrome in Ningbo, Zhejiang, 2005−2021
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摘要:
目的 探讨2005—2021年浙江省宁波市肾综合征出血热（HFRS）的流行特征和时空分布特征，为制定HFRS精准防控措施提供依据。 方法 在中国疾病预防控制信息系统的传染病监测系统收集2005—2021年宁波市HFRS病例资料并对资料进行描述性分析；使用Geoda 1.2.0软件对HFRS发病率进行空间自相关分析；通过SaTScan 10.0软件探测病例的时空聚集性并用Arcgis 10.8软件对病例时空分布进行可视化呈现。 结果 2005—2021年宁波市共报告1 903例HFRS病例，年均报告发病率为1.50/10万；病例分布呈现明显的季节性，4—6月和11月至次年1月为发病高峰。 病例主要集中在30～60岁人群（66.00%），以农民为主（53.91%），男女性别比为3.04∶1。 鄞州区、象山县、奉化区和宁海县是宁波市HFRS主要的高发地区，占所有病例的74.25%（1 413/1 903）。 全局空间自相关分析结果显示，2015—2018年宁波市各乡镇（街道）HFRS发病率有空间聚集性（均P <0.05）。 局部空间自相关分析显示，2015—2019年HFRS发病率每年均有热点区域（高–高）出现，但热点区域范围每年呈现动态变化。 时空扫描分析共探测到2个聚集区，一类聚集区的时间为2017年6月1日至2019年6月30日，以象山县墙头镇为中心，覆盖宁波市东南部的41个乡镇（街道）。 二类聚集区的时间为2015年6月1日至2017年6月30日，以鄞江镇为中心，覆盖3个乡镇（街道）。 结论 宁波市HFRS疫情存在时空聚集性特征，有由东南部向西部移动的趋势，建议对重点地区和人群开展针对性防控措施，以实现HFRS的精准防控。 Abstract:Objective To investigate the epidemiological characteristics and spatiotemporal distribution of hemorrhagic fever with renal syndrome (HFRS) in Ningbo, Zhejiang province, from 2005 to 2021, and provide evidence for the formulation of precise prevention and control measures for HFRS. Methods The incidence data of HFRS in Ningbo during 2005−2021 were collected from China National Notifiable Infectious Disease Reporting Information System (NNDS) for a descriptive analysis. Software ArcGIS 10.8 was used for spatial autocorrelation analysis and visual presentation. Results A total of 1903 cases of HFRS were reported in Ningbo from 2005 to 2021, with an average annual incidence rate of 1.50/100 000. The distribution of cases showed a clear seasonal pattern, with peaks from April to June and from November to January. The cases were mainly people aged 30–60 (66.00%), and the cases were mainly farmers (53.91%), the male to female ratio of the cases was 3.04∶1. Yinzhou, Xiangshan, Fenghua and Ninghai were the areas with high incidence of HFRS in Ningbo, with reported cases accounting for 74.25% (1413/1903) of the total. The result of the global spatial autocorrelation analysis showed that the incidence of HFRS in all towns/streets in Ningbo had spatial clustering from 2015 to 2018 (all P<0.05). Local spatial autocorrelation analysis showed that the incidence of HFRS during 2015–2019 had hot spots (H-H), and the range of hot spots showed dynamic changes. Two clustering areas were detected by spatial-temporal clustering analysis. The class Ⅰ clustering area was in Qiangtou of Xiangshan, involving 41 sub-districts in southeast Ningbo, during June 1, 2017 - June 30, 2019. The class Ⅱ cluster area was in Yinjiang of Haishu, involving 3 sub-districts in the urban area, during June 1, 2015 - June 30, 2017. Conclusion Obvious spatiotemporal clustering of HFRS cases was found in Ningbo from 2015 to 2019 and clustering areas changed dynamically from the south central part to the west in Ningbo. It is necessary to strengthen the prevention and control programs of HFRS in these areas. -
图 1 2005－2021年宁波市肾综合征出血热发病数和发病率
Figure 1. Cases and incidence of hemorrhagic fever with renal syndrome in Ningbo, 2005−2021
图 2 2005－2021年宁波市各县（市、区）肾综合征出血热的发病率
注：2016年原江东区管辖的行政区域划归宁波市鄞州区管辖，故2016年之后的数据缺如
Figure 2. Incidence of hemorrhagic fever with renal syndrome in counties/districts of Ningbo, 2005−2021
图 3 2005－2021年宁波市各县（市、区）肾综合征出血热病例数的月分布
Figure 3. Monthly distribution of hemorrhagic fever with renal syndrome cases in counties/districts of Ningbo, 2005−2021
图 4 2015－2021年宁波市各乡镇（街道）肾综合征出血热发病率分布及局部空间自相关分布
Figure 4. Local spatial autocorrelation distribution of hemorrhagic fever with renal syndrome incidence in Ningbo, 2015−2021
图 5 2015－2021年宁波市肾综合征出血热病例时空聚集性区分布
Figure 5. Distribution of spatiotemporal clustering areas of hemorrhagic fever with renal syndrome cases in Ningbo, 2015−2021
表 1 2005－2021年宁波市肾综合征出血热病例的人群分布特征
Table 1. Population distribution of hemorrhagic fever with renal syndrome cases in Ningbo, 2005−2021
人口学特征 病例数（例） 构成比（%） 性别 男性 1 433 75.30 女性 470 24.70 年龄组（岁） <30 297 15.60 30～ 1 254 65.90 ≥60 352 18.50 职业 农民 1 026 53.91 民工 186 9.78 工人 173 9.09 家务及待业 165 8.67 其他 353 18.55 
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表 2 2015－2021年宁波市肾综合征出血热发病率全局空间自相关分析
Table 2. Global spatial autocorrelation analysis on hemorrhagic fever with renal syndrome incidence in Ningbo, 2015−2021
年份 Moran's I系数 Z值 P值 2015 0.243 5.11 <0.01 2016 0.075 1.800 0.05 2017 0.077 1.774 0.05 2018 0.116 2.926 0.01 2019 0.050 1.180 0.13 2020 0.039 1.055 0.56 2021 −0.049 −0.929 0.17
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