我国湖区血吸虫病消除途径的研究 ——以鄱阳湖区为例

Schistosomiasis, a major zoonotic infectious diseases, is one of the China's major public health problems that have been doing serious harm to human health and affecting the economic and social development. "Health China 2030 Plan" proposed that China should to achieve the goal of schistosomiasis elimination by 2030. However, the practice has proved that there are some limitations and shortcomings in the current control strategy, so that the infection source is difficult to control, which is an urgent problem to be solved in the processing of achieving schistosomiasis elimination in the lake regions. Considering the bottleneck problem for the schistosomiasis elimination, such as it is difficult to prohibit the grazing of cattle in the marshland, the species change of livestock grazed in the marshland, lack of sensitivity and specificity of the current diagnostic method, and the difficulty of changing people’s behavior of contacting infected water, this research will be implemented by multi-disciplinary theory and methods of epidemiology, health education, precise medicine and molecular detection technology etc and intends to study on the approach of schistosomiasis elimination in lake endemic area with schistosomiasis, which takes infection source elimination as the core and health promotion as guide. Three kinds of approaches of schistosomiasis elimination, i.e. "The approach of infection source elimination", "The approach of health promotion plus with control" and "The approach of precision control for high risk population", will be created and their control effects will be compared. Finally, optimization strategy of schistosomiasis elimination and its matching techniques in lake regions will be proposed. The research results not only provide important technical supports for schistosomiasis elimination in China's lake regions, but also have very important application value and guiding significance to improve the level and ability of schistosomiasis control in our country.

血吸虫病是危害严重的重大人畜共患传染病，是我国主要公共卫生问题之一。《“健康中国2030”规划纲要》提出到2030年全国要实现血吸虫病消除，但实践证明现行防治策略存在一定局限和缺陷，传染源难以控制，是我国湖沼型流行区实现消除过程中迫切需要解决的难题。本研究拟针对湖区草洲放牧难以禁止和放牧畜种改变、现行诊断方法敏感性和特异性欠缺、人群疫水接触行为难以改变等 “瓶颈”问题，以鄱阳湖区为研究现场，运用流行病学、健康教育学、精确医学和分子检测技术等多学科理论和技术，开展以健康促进为引导、传染源消除为核心的湖区血吸虫病消除途径的研究，创建并比较“传染源消除防控途径”、“‘健康促进+’防控途径”、“重点人群精准防控途径”等三种途径防控效果，最终提出湖区血吸虫病消除优化策略及配套适宜技术。研究成果不仅为我国湖区实现消除目标提供重要技术支撑，同时对提高我国血吸虫病防控水平和能力具有重要的应用价值和指导意义

本研究针对目前湖区血吸虫病流行水平逐渐下降，现行诊断方法敏感性和特异性欠缺，漏检病人仍然存在；人群疫水接触行为难以改变和湖区草洲放牧难以禁止和畜种改变等实现血吸虫病消除的“瓶颈”问题，通过在鄱阳湖血吸虫病流行区研究现场，依托“健康中国”战略以健康促进为引导，以“精确防治，消除传染源”为核心，运用流行病学、健康教育学、精确医学和分子检测技术等多学科理论和技术，探讨湖区血吸虫病消除策略及其配套适宜技术，为实现我国湖区血吸虫病消除提供技术支撑。通过本研究获得以下重要结果及其科学意义：① 血防新策略在推动鄱阳湖区血吸虫病疫情持续下降，实现血吸虫病传播控制目标发挥了巨大的作用，但最终实现鄱阳湖区血吸虫病消除需调整优化策略；② 我省实现血吸虫虫病传播阻断和消除目标仍面临巨大挑战，必须充分利用现有平台优势，寻求机遇，提高血防服务能力，巩固血防成果，推进血防进程；③ 生态环境改造对鄱阳湖区血吸虫病控制提供了有利条件，但在今后生态建设过程中应平衡好生态、经济发展与群众健康之间关系，使经济发展与环境健康相互促进；④ 浅显易懂、直观、贴近流行区居民的生产、生活特点的血防信息和平面印刷类血防健教材料是今后血防健教材料设计开发及血防健教传播策略制定的方向；⑤ 血吸虫病防治工作从粗放型防控向精准防控的转变，才能最大程度地控制和消除血吸虫病的发生，最终实现消除血吸虫病的目标；⑥ 鄱阳湖区钉螺消长受水位、草洲高程和人工干预灭螺等综合因素的影响；湖区适宜钉螺孳生、繁殖生境已向鄱阳湖北部及下高程区移动；通过高程换算模型进行数据校正可以提高钉螺分布高程值的精度，可较准确反映实际地貌；⑦ 目前鄱阳湖区血吸虫病流行水平总体呈下降趋势，但流行因素依然存在，且北湖区的流行水平高于南湖区；在牛等家畜传染源控制较好状况下，野生动物在血吸虫病传播中的作用和潜在风险不可忽视，其可通过粪便对草洲污染而引起血吸虫病传播扩散；⑧ 以化疗为主的综合防治策略难以控制居民血吸虫感染，无论居民血吸虫感染率水平多低，再感染仍有可能发生，以传染源控制为主的综合防治策略可有效控制血吸虫病传播， 血吸虫病流行区居民血吸虫病肝脏损伤呈慢性化过程。