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目的评价江滩型流行区实施血防中长期规划控制血吸虫病的效果,探讨进一步巩固血防成果的对策,为江滩地区阻断和消除血吸虫病提供有效路径。方法采用前瞻性现场研究方法,选取江滩型血吸虫病流行区镇江市丹徒区,根据其血吸虫病流行程度,实施渐进式的“重点村→重点环境→重点水域”血防综合治理。连续开展居民病情、家畜病情和环境螺情调查,并收集防治措施实施情况。分析比较实施中长期规划前后病情和螺情控制效果,并绘制居民感染率、家畜感染率和钉螺感染率的变化图。结果 2005-2014年丹徒区共实施河道混凝土硬化护坡16.84 km,修建沉螺池9个,改建涵闸10座,建设家畜圈养畜舍3.85 hm2,开展家畜查治2.95万头次,淘汰耕牛170头,养鱼灭螺4 930 hm2,整理与涝渍改良土地1 560.00 hm2,建设抑螺防病林376.00 hm2,开展钉螺调查19 364.80 hm2,药物灭螺4 694.60 hm2,查、治病20.79万人次,建造三格式无害化厕所6.91万座,发放血防宣传材料28.22万份,防护用品1.97万人份,树立血防警示标志958个,张贴或悬挂血防宣传标语5 425条。血防中长期规划项目实施后居民感染率、牛感染率和钉螺感染率呈逐年下降态势,分别由2005年的0.08%、1.28%和0.13%下降为0;钉螺面积和感染螺面积由2005年的284.34 hm2和55.10 hm2下降到73.60 hm2和0,分别下降了74.12%和100%。2005-2014年羊的感染率呈波动状态,2005年粪检阳性率为1.13%,2007-2008年为0,2009-2012年回升到0.25%~0.95%,2013-2014年为0。2005-2010年牛的存栏数逐年减少,2011年后小幅增加,总体平稳;2006年后羊的存栏数逐年增加,到2010年达最高峰,2011年起呈下降趋势,与当地羊的血吸虫感染率波动基本一致。结论江滩地区采取持续、渐进式的“重点村→重点环境→重点水域”血防综合治理是控制血吸虫病的有效路径,但这类地区疫情极易反复,要进一步巩固血防成果,必须加强防控羊和滩地野生动物等传染源对血吸虫病传播的影响。
Objective To evaluate the long-term effect of schistosomiasis control in schistosomiasis endemic areas in Jiangtan-type endemic areas and to explore ways to further consolidate schistosomiasis control so as to provide an effective pathway for blocking and eliminating schistosomiasis in the river beach area. Methods A prospective field research method was used to select the Dantu District of Zhenjiang City, where the endemic area of schistosomiasis is endemic to rivers. According to the prevalence of schistosomiasis, a gradual “key village → key environment → key waters” was implemented. Continue to carry out the investigation of resident’s condition, domestic animal’s condition and environmental snail, and collect the implementation of prevention and control measures. Analysis and comparison before and after the implementation of long-term planning conditions and snail control effects, and draw residents infection rate, livestock infection rate and snail infection rate changes. Results From 2005 to 2014, Dantu implemented a total of 16.84 km of river concrete hardening revetment, built 9 sinkhole units, rebuilt 10 culverts, built 3.85 hm2 livestock breeding houses, conducted 29,500 livestock surveys and deal with the slaughter of cattle 170 Head and fish snails 4 930 hm2, land consolidation and waterlogging improvement 1 560.00 hm2, construction of snail prevention and control forest 376.00 hm2, investigation of snails 19 364.80 hm2, medicine snail 4 694.60 hm2, investigation and treatment of 207,900 person-times , Built 69,100 sanitary toilets in three formats, distributed 282,200 copies of blood prevention materials, 19,700 protective equipment, established 958 blood warning signs and posted 5 425 articles on blood protection slogans. Residents infection rates, bovine infection rates and snail infection rates declined year by year after the long-term planning of blood-borne diseases was implemented, decreasing from 0.08%, 1.28% and 0.13% respectively in 2005 to 0. The areas of snails and infected snails were increased from 2005 284.34 hm2 and 55.10 hm2 decreased to 73.60 hm2 and 0, decreasing by 74.12% and 100% respectively. The prevalence of sheep infection fluctuated between 2005 and 2014, with a positive rate of 1.13% in 2005 and 0 in 2007-2008, a return to 0.25% -0.95% in 2009-2012 and 0.2005-95% in 2013-2014. The number of cows in 2010 decreased year by year and slightly increased after 2011, which was generally stable. After 2006, the number of sheep in the population increased year by year and reached the peak in 2010, with a downward trend since 2011, and the prevalence of schistosomiasis in domestic sheep fluctuated Basically the same. CONCLUSIONS: The comprehensive prevention and control of schistosomiasis is an effective and effective way to control schistosomiasis in Jiangtan area with continuous and gradual “key village → key environment → key waters”. However, the epidemic in such areas is extremely easy to be repeated. To further consolidate the results of schistosomiasis control, we must strengthen Prevention and control of sheep and beach wildlife and other sources of infection on the spread of schistosomiasis.