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1987－2023年浙江省杭州市职业人群布鲁氏菌病监测及流行趋势分析

Surveillance and analysis of the epidemic trend of brucellosis in population with occupational exposure in Hangzhou, Zhejiang, 1987−2023

    摘要
  • 摘要:
    目的 对1987—2023年浙江省杭州市职业人群布鲁氏菌病（布病）监测情况及近20年疫情流行趋势进行分析，为做好职业人群布病防控工作提供参考。
    方法 收集1987—2023年杭州市职业人群的监测信息和疫情资料，对血清学监测阳性率变化情况进行趋势分析，对自开展人间布病监测工作后首次报告布病以来2004—2023年前后十年确诊的职业人群布病病例三间分布、感染源、感染地及临床症状体征等进行对比分析。
    结果 1987—2023年杭州市职业人群布病血清学监测平均阳性率为1.56%（229/14663），2015年达到最高（6.32%），后呈缓慢下降趋势（趋势χ2 =6.905，P=0.009）；比较2004—2023年前后十年血清学阳性率发现，后十年（2014—2023年）（3.02%，118/3907）明显高于前十年(1.78%，97/5452) （χ2 =15.618，P<0.001）；2004—2023年共确诊病例142例，新发感染者87例。 病例集中在年龄40～69岁的男性（63.38%，90/142），高发职业前3位分别为羊屠宰或贩卖（45.07%，64/142）、乳肉加工销售（26.06%，37/142）及羊饲养（18.31%，26/142）。 前后十年确诊的病例中从事羊饲养、乳肉加工销售构成比明显上升，从事羊屠宰或贩卖、牛饲养则明显下降（χ2＝24.947，P<0.001），且出现犬屠宰、羊油收购、动物无害化处理等新型职业。 冬春季是职业人群发病的高峰期（69.01%，98/142），疫区范围逐年扩大，疫区由羊屠宰场、奶牛场聚集地向羊养殖场聚集地扩散。
    结论 职业人群血清学监测阳性率近年呈缓慢下降趋势，说明目前采取的防控措施取得一定成效，但随着家畜饲养量不断增加，产业链的不断转型导致布病高发人群职业构成有所改变，重点地区需结合本地疫情特点扩大职业人群监测范围，在流行季节加大职业人群主动监测力度。

     

    Abstract:
    Objective To understand the epidemiological characteristics of brucellosis in the population with occupational exposures to Brucella in Hangzhou, Zhejiang province, in the past 20 years and provide reference for prevention and control of brucellosis in population with occupational exposures.
    Methods Brucellosis surveillance information and incidence data in the population with occupational exposures in Hangzhou from 1987 to 2023 were collected. The trend of Brucella positive rate in serological surveillance during this period and the distributions of brucellosis cases, the source of infection, the place of infection and the clinical symptoms and signs from 2004 (when the first brucellosis case was reported) to 2023 were analyzed.
    Results The average positive rate of Brucella in serological surveillance was 1.56% (229/14663) in Hangzhou from 1987 to 2023.The positive rate during 2014−2023 (the second 10 years) (3.02%, 118/3907) was significantly higher than that during 2004−2013 (the first 10 years) (1.78%, 97/5452) (χ2=15.618, P<0.001) .The positive rate reached the highest in 2015 (6.32%) , and then showed a slow downward trend (trend χ2 =6.905, P=0.009) . There were 142 cases and 87 new infections from 2004 to 2023. The cases were mainly men aged 40−69 years with occupational exposures (63.38%, 90/142) . They were mainly engaged in sheep slaughtering or trading (45.07%, 64/142), milk and meat processing and trading (26.06%, 37/142) and sheep raising (18.31%, 26/142). In the diagnosed cases from 2004 to 2023, the proportion of those due to sheep raising, milk and meat processing and trading increased obviously, the proportion of those due to sheep slaughtering or trading, cattle raising decreased obviously (χ2=24.947, P<0.001) .New occupations such as dog butchering, sheep oil buying, and harmless animal disposal emerged. Winter and spring were the peak periods of the incidence of brucellosis (69.01%, 98/142) . The area affected by the epidemic expanded year by year, from sheep slaughterhouses and dairy farms to sheep farms.
    Conclusion The positive rate of Brucella in serological surveillance in population with occupational exposures showed a slowly decreasing trend in Hangzhou in recent years, indicating the achievement in the prevention and control of human brucellosis. However, with the increase of livestock production and the transformation of industrial chain, the composition of occupations with high risk for Brucella exposures has changed. Therefore, it is necessary to expand the surveillance in population with occupational exposure according to the characteristics of local brucellosis situation in key areas, and strengthen the active surveillance in the season with high incidence of brucellosis.

     

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