云南省丘北县麻风持续传播影响因素的研究

翁小满; 李康; 温艳; 邢燕; 刘健; 洪炳和; 李桓英; VaralakshmiVissa

Abstract

翁小满,李康,温艳,邢燕,刘健,洪炳和,李桓英,VaralakshmiVissa.云南省丘北县麻风持续传播影响因素的研究[J].Chinese journal of Epidemiology,2011,32(6):559-564

云南省丘北县麻风持续传播影响因素的研究

Study on the factors influencing steady transmission of leprosy in Qiubei county, China WENG

Received:January 04, 2011

DOI：

KeyWord: 麻风传播病例发现

English Key Word: Leprosy Transmission Case-finding

FundProject:国家自然科学基金(3067111);美国国立卫生研究院资助课题(NIH/NIAID,R01-A1-63457)

Author Name	Affiliation	E-mail
WENG Xiao-man	Beijing Friendship Hospital Affiliate of Capital University of Medical Sciences, Beijing Tropical Medicine Research Institute, Beijing 100050, China	wengxiaoman@sina.com
LI Kang	Prevention and Control Station of Dermatology,Qiubei County,Yunnan
WEN Yan	Beijing Friendship Hospital Affiliate of Capital University of Medical Sciences, Beijing Tropical Medicine Research Institute, Beijing 100050, China
XING Yan	Beijing Friendship Hospital Affiliate of Capital University of Medical Sciences, Beijing Tropical Medicine Research Institute, Beijing 100050, China
LIU Jian	Beijing Friendship Hospital Affiliate of Capital University of Medical Sciences, Beijing Tropical Medicine Research Institute, Beijing 100050, China
HONG Bing-he	Prevention and Control Station of Dermatology,Qiubei County,Yunnan
LI Huan-ying	Beijing Friendship Hospital Affiliate of Capital University of Medical Sciences, Beijing Tropical Medicine Research Institute, Beijing 100050, China
Varalakshmi Vissa	Department of Microbiology, Immunology and Pathology, Colorado State University, USA

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Abstract:

目的探讨云南省丘北县多种药物联合化疗实施25年后麻风仍持续传播的影响因素.方法分别采用ELISA、PCR检测高流行区患者与家庭内接触者、普通人群血清中麻风菌特异性PGL-1抗体以及鼻分泌物中的麻风菌,采用PCR方法检测疫村环境水中的麻风菌.采用数目可变的串联重复序列基因分型方法探讨麻风菌传播途径及传播链等.结果在2001年以前从麻风患者家庭成员中检测到的比例低,而延迟期>2年患者的检出比例高.2001年后防治工作加强使这两个指标改进,但麻风发现率仍一直维持在4/10万至5/10万.疫村人群PGL-1抗体阳性率为20%～30%,主要感染人群为青少年;不仅从患者、家内接触者的鼻分泌物与环境水中检出麻风菌,且与未经治疗患者的皮肤组织和鼻分泌物中麻风菌基因型一致.菌株分型证实该县北部地区不仅有多个高发家庭聚集,而且家庭内患者的菌株基因型一致.在北部地区基因型匹配菌株的比例高于南部地区.结论丘北县麻风在家庭内和疫村中的传播严重,疫村环境水中存在麻风菌等是影响该病持续传播的重要因素.

English Abstract:

Objective To explore the factors influencing the steady transmission of leprosy as indicated by new case detection rate in Qiubei county, Yunnan province, China despite the implementation of MDT for the last 25 years. Methods Information related to case-finding was collected. ELISA and PCR were applied to detect anti-PGL-1 antibody in sera and Mycobacterium leprae in nasal secretions respectively, in leprosy patients, their household contacts and the general population. M. leprae by PCR was also detected from water in the highly endemic villages. VNTR typing was performed to explore the mode and chain of transmission of M. leprae. Results Prior to 2001, the proportion of new cases detected from the examination of household contacts of leprosy patients was low (number, compared to), while the proportion of patients whose identification was delayed by more than 2 years, was high (number, compared to). Qualities of these two indicators has been improved, along with the improvement of leprosy control program since 2001, but the detection rates has been steady at 4-5/ 100 000 during 1986-2010. The PGL-1 seropositivity rate was 20%-30% in general population, with the peak rate (30%) detected in the teenage population in the endemic villages. In addition to the fact that M. leprae was detected in nasal secretion from patients, their contacts and from water, the M. leprae VNTR genotypes were found to be highly similar between skin biopsy and nasal secretion in untreated cases. Families with multi-cases were clustered and located in the Northern part of the County, and the genotypes of M. leprae were identical within those families. The percentage of clusters was considerably higher in Northern rather than Southern parts of the County. Conclusion Results from this molecular study demonstrated evidence that transmission of leprosy within the families and in the endemic-villages was severe. M. leprae were detected in waters from the endemic villages and others areas which might have a relation to the continued transmission of leprosy.

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