对高流行区多种传染病(包虫病、结核病）快速联合预警方案研究

A key strategy for infectious disease control is to design an effective and early warning proposal. Southern Ningxia (Xiji County), is a high incidence of many infectious diseases,particularly two types of hydatidosis (alveolar / cystic echinococcosis, AE/CE) and tuberculosis (TB), which significantly impacted on local public health and economic development.A study based on a combination of the various straightforward methods to monitor the exposure rates of different pathogens (Echinococcus spp.eggs/Mycobacteriuml tuberculinum,MTB) among adolescents is proposed. Outcomes indirectly provide evidences that the living environmental contamination density of studied pathogens. After baseline survey with imaging techniques (ultrasound/x-ray) helps for determination of either AE/CE or TB morbidity, apart from cases to let seek consultation in hospital,remaining participants are recruited to attend cohort follow-up in subsequent year for two times annually.Disclosure of different incidences of pathogen-exposure among teenagers is compared to verify the proposed warning-indicators effectively.In addition, risk factors of susceptibility to infections in students influenced by multiple pathogens are identified by multivariate analysis.This is the important information for targeting at preventive measures to protect young people healthy growth in high prevalence area. The study design represents a big saving of manpower, time and resources, is based on accumulation of our previous work, and is the first combination of urgent need to develop the early warning measures for a variety of infectious diseases.Results serve many preventions/ controls of pathogen-infections in comparable endemic areas globally,prospects are bright.

传染病控制关键策略之一是早而快预警,从而防患于未然。宁夏南部(尤其西吉县)是多种传染病的高发区,尤其是两种包虫病(细粒棘球和泡球蚴)和结核病的重灾区,给当地人民的健康和经济发展造成严重危害。本课题拟联合不同简单易行检查方法 (血清包虫抗体检查和结核菌素实验)监测两种病原体(包虫卵和结核菌)在青少年中暴露情况(率)，以此间接提供病原体对生活环境污染密度/范围。结合影像学技术在基线调查后连续两年随访,比较不同暴露人群的发病率,不但达到验证预警监测指标的时效和实用性，而且能通过多因素分析找出人群暴露于多病原体侵袭情况下所致易感性增加的风险因素，有的放矢设计预防措施保护高流行区青少年的健康成长。本课题基于前期的工作积累,结合流行区对多种传染病预警措施的迫切需要而设计的既节约资源又简单特异的全新联合预警方案，研究结果服务于多种传染病流行区的防控工作, 前景广阔。

宁夏地处中国西北部，经济发展落后，是多种传染病的高流行区。两种包虫病包括单房或囊型(cystic echinococcosis, CE)和多房包虫或泡型(alveolar echinococcosis, AE)；也是结核病的高流行区。本研究对生活在传染病重流行区 （西吉县）的青少年人群（随机抽样）用简单易行而且特异的检查方法（TST和血液检查抗包虫抗体，结核病感染人体产生的各种免疫因子）结合影像检查，对多病原体暴露情况调查，以此提供被调查病原体在高发区青少年中的传播暴露情况，从而达到快速预警的目的。基于本次调查的青少年感染分布区与前期对流行区中两种包虫病对人造成传染的传染源调查发现其分布区域有高度的重合性。因此，间接反映了本课题所设计的包虫传播预警方案能够及时反映当地传染源的分布和污染密度，即传播给人的强度。从而间接证明了预警方案的实用性和时效性。调查比较青少年人群中TST阳性和阴性血中的各种免疫因子。解释了潜伏期结核病人和急性发作的病人的免疫因子的变化。对比由基线调查发现的早期结核病病人血中的各种免疫因子治疗前后的不同点。解释了早期发现的病人的免疫因子在及时用抗结核治疗后的变化。为及时有效发现病菌传播和制止传播提供了快速诊断依据。比传统细菌培养（耗时间1.5月）诊断优化为用少量血样检查，并1-2天出结果, 实现了准确快速且降低诊断成本的目的。为结核病传播状态的快速预警提供了可靠的技术支持。由课题实施培养出5名硕士和1名博士，并已经产出十余篇有影响力的科技论文（7SCI，8核心刊）；三人次国内会议交流，一项省级科技进步奖，后续有数篇综合分析论文待发表。课题产出结果为设计实施多种传染病在高流行区联合预警方案提供了可靠的技术保证，必将服务于传染病的预防控制工作。为健康中国，健康人类做出贡献。