Epidemiological characteristics and spatiotemporal clustering of hepatitis A in Yuxi, Yunnan, 2005−2020
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摘要:
目的 分析2005—2020年云南省玉溪市甲型病毒性肝炎（甲肝）流行特征与时空聚集性，为甲肝防控提供理论依据。 方法 从国家传染病报告信息管理系统下载2005年1月1日至2020年12月31日的相关资料。 描述甲肝病例的三间分布特征，季节性分析采用改良的集中度M值分析法，不同年龄亚组的甲肝报告发病率比较采用Poisson回归分析。 根据甲肝疫苗纳入免疫规划时间，划分为2005—2008年和2009—2020年两个时期，应用GeoDa 1.14软件完成全局及局部空间自相关分析，SaTScan 9.7软件进行时空扫描分析。 结果 2005—2020年玉溪市累计报告甲肝病例1451例，年均报告发病率为3.92/10万，由2005年的8.36/10万下降至2020年的1.60/10万（趋势χ2=456.272，P<0.001）。 除2005年和2012年甲肝发病有一定季节性外，其余年份无明显季节性。 报告病例年龄中位数呈上升趋势（P=0.004），0～9岁、10～19岁和20～59岁亚组报告发病率均呈下降趋势（均趋势性P<0.001）；2011—2020年≥20岁组发病风险均高于0～9岁组（均RR>1，P<0.05）。 年均报告发病率的趋势由西向东逐渐升高，由北向南逐渐升高再缓慢下降。 局部空间自相关分析显示：2005—2008年，通海县九龙街道、四街镇和高大乡为高-高聚集区域；2009—2020年，通海县四街镇为高–高聚集区域。时空扫描分析发现：2007年、2010年存在时空聚集区，其中2007年的Ⅱ类聚集区转变为2010年的I类聚集区。 结论 2005—2020年玉溪市甲肝发病呈下降趋势，发病年龄高峰后移，时空聚集区主要集中在玉溪市中部和东南，需重点关注并制定区域化的精准防控策略，有效遏制甲肝疫情。 Abstract:Objective To analyze the epidemiological characteristics and spatiotemporal clustering of hepatitis A in Yuxi prefecture, Yunnan province, during 2005−2020, and suggest countermeasures for hepatitis A prevention and control. Methods The incidence data of hepatitis A in Yuxi from January 1, 2005 to December 31, 2020 were downloaded from National Notifiable Disease Report System. The population, time and space distributions of hepatitis A cases was described, the seasonality of hepatitis A incidence was analyzed using improved muster method, and the Poisson regression models was used to compare the reported incidence of hepatitis A in different age groups. The data during 2005−2008 (before the inclusion of hepatitis A vaccine into immunization program) and during 2009−2020 (after the inclusion of hepatitis A vaccine into immunization program) were used in the analysis. Software GeoDa 1.14 was used in global and local spatial autocorrelation analyses, and software SaTScan 9.7 was used in spatiotemporal scanning analysis. Results A total of 1451 hepatitis A cases were reported in Yuxi during this period, the average annual incidence rate was 3.92/100 000, the incidence rate decreased from 8.36/100 000 in 2005 to 1.60/100 000 in 2020 (trend χ2=456.272, P<0.001), no obvious seasonality of the incidence of hepatitis A was observed except 2005 and 2012. The median of age of the cases showed an increasing trend (P=0.004), and the incidences showed decreasing trends in age group 0–9, 10–19 and 20−59 years (all of the P<0.001). From 2011 to 2020, the incidence risk was higher in age group ≥20 years than in age group 0−9 years (all RR>1, P<0.05). The average incidence increased gradually from the west to the east, but increased then decreased gradually from the north to the south in Yuxi. The local spatial autocorrelation analysis showed that the high-high clustering areas at tow level were Jiulong, Sijie and Gaoda in Tonghai county from 2005 to 2008 and Sijie in Tonghai county from 2009 to 2020. The spatiotemporal scanning analysis revealed that there were spatiotemporal clustering areas in 2007 and 2010, and the spatiotemporal clustering areas changed from type Ⅱ in 2007 to type I in 2010. Conclusion The incidence of hepatitis A decreased in Yuxi from 2005 to 2020 and the incidence peaked gradually in older age group. The spatiotemporal clustering areas were observed in the central and southeast areas of Yuxi, specific prevention and control strategy is needed to reduce the incidence of hepatitis A. -
图 2 2005－2020年玉溪市甲型病毒性肝炎年均报告发病率三维趋势图
Figure 2. The three-dimensional trend of annual reported incidence of hepatitis A in Yuxi prefecture, 2005−2020
图 3 2005－2020年玉溪市各乡镇甲型病毒性肝炎年均报告发病率空间分布
Figure 3. The spatial distribution of annual reported incidence of hepatitis A among town level in Yuxi prefecture, 2005−2020
图 4 2005－2020年玉溪市甲型病毒性肝炎年均报告发病率的局部空间自相关分析
Figure 4. The local spatial autocorrelation analysis of annual reported incidence of hepatitis A in Yuxi prefecture, 2005−2020
图 5 2005－2020年玉溪市甲型病毒性肝炎发病时空扫描分析
Figure 5. The spatio-temporal scanning analysis of the incidence of hepatitis A in Yuxi prefecture, 2005−2020
表 1 2005－2020年玉溪市不同年龄亚组甲型病毒性肝炎报告发病率
Table 1. The reported incidence of hepatitis A of different age subgroups in Yuxi prefecture, 2005−2020
年份 0～9岁 10～19岁 20～59岁 ≥60岁 发病率
（/10万， 95%CI）RR值 发病率
（/10万， 95%CI）RR值（95%CI） 发病率
（/10万， 95%CI）RR值 （95%CI） 发病率
（/10万， 95%CI）RR值（95%CI） 2005—2006 25.45
（21.04～29.86）1.000 11.40
（8.87～13.92）0.490
（0.372～0.646）5.97
（5.05～6.90）0.234
（0.186～0.296）3.98
（2.31～5.64）0.159
（0.102～0.249）2007—2008 23.42
（19.25～27.60）1.000 12.45
（9.78～15.14）0.488
（0.367～0.648）3.89
（3.15～4.62）0.166
（0.128～0.215）2.64
（1.17～3.75）0.108
（0.063～0.187）2009—2010 6.67
（4.46～8.89）1.000 5.47
（3.73～7.21）0.818
（0.519～1.291）4.26
（3.49～5.02）0.632
（0.434～0.919）3.12
（1.68～4.56）0.474
（0.270～0.831）2011—2012 2.26
（0.98～3.54）1.000 2.70
（1.49～3.91）1.177
（0.579～2.395）3.00
（2.37～3.64）1.284
（0.709～2.324）3.42
（1.92～4.92）1.490
（0.738～3.011）2013—2014 0.56
（0.00～1.19）1.000 0.99
（0.26～1.72）1.617
（0.455～5.751）2.49
（1.91～3.06）3.834
（1.311～11.21）2.71
（1.38～4.04）4.284
（1.352～13.577）2015—2016 0.74
（0.01～1.46）1.000 0.42
（0.00～0.89）0.587
（0.145～2.372）2.84
（2.23～3.46）3.441
（1.332～8.886）4.20
（2.55～5.84）5.150
（1.890～14.029）2017—2018 0.18
（0.00～0.54）1.000 0.55
（0.01～1.10）2.264
（0.357～14.368）2.17
（1.64～2.71）7.945
（1.574～40.109）4.48
（3.08～6.60）17.873
（3.465～92.182）2019—2020 0.19
（0.00～0.56）1.000 0.00
（0.00～0.00）0.252
（0.010～6.174）2.34
（1.77～2.90）8.320
（1.649～41.968）2.92
（1.53～4.30）10.603
（2.001～56.181）趋势χ2=576.032，P<0.001 趋势χ2=297.157，P<0.001 趋势χ2=94.626，P<0.001 趋势χ2=7.936，P=0.338 注：RR. 相对危险度， CI. 置信区间 
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表 2 2005－2020年玉溪市甲型病毒性肝炎发病时空扫描分析
Table 2. The spatio-temporal scanning analysis of the incidence of hepatitis A in Yuxi prefecture, 2005−2020
时间阶段（年） 聚集区域 乡 镇 聚集时间（年） RR值 LLR值 P值 2005－2008 Ⅰ类 羊街乡、那诺乡、澧江街道、咪哩乡、红河街道、洼垤乡、龙潭乡 2007 2.592 9.216 0.003 Ⅱ类 河西镇、兴蒙乡、九龙街道、四街镇、纳古镇、研和街道、高仓街道、九溪镇、小街街道 2007 1.759 7.364 0.017 2009－2020 Ⅰ类 河西镇、兴蒙乡、九龙街道、四街镇、纳古镇、研和街道、高仓街道、九溪镇、小街街道 2010 6.232 43.520 <0.001 Ⅱ类 富良棚乡、塔甸镇、双江街道、大龙潭乡、岔河乡、甸中镇、洛河乡、桂山街道、新化乡、古城街道、平甸乡、老厂乡、扬武镇、绿汁镇、浦贝彝族乡 2010 2.316 6.907 0.017 注：RR. 相对危险度，LLR. 对数似然比
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