Epidemiological features of and changes in incidence of infectious diseases in China in the first decade after theSARSoutbreak: an observational trend study

SARS後的中國的第一個十年，傳染病流行病學特點的變化：一項觀察性研究

Background

The model of infectious disease prevention and control changed significantly in China after the outbreak in 2003 of severe acute respiratory syndrome (SARS), but trends and epidemiological features of infectious diseases are rarely studied. In this study, we aimed to assess specific incidence and mortality trends of 45 notifiable infectious diseases from 2004 to 2013 in China and to investigate the overall effectiveness of current prevention and control strategies.

中國在2003年嚴重急性呼吸綜合症(SARS)爆發後，傳染病的預防與控製有了明顯的變化，但對其趨勢和傳染病流行特征的研究很少。這項研究探討中國從2004到2013年45種法定傳染病的防控策略的整體有效性，評估其具體的發病率和死亡率趨勢。

Methods

Incidence and mortality data for 45 notifiable infectious diseases were extracted from a Chinese public health science data centre from 2004 to 2013, which covers 31 provinces in mainland China. We estimated the annual percentage change in incidence of each infectious disease using joinpoint regression.

從中國公共衛生科學數據中心將中國大陸31個省2004-2013年45種法定傳染病的發病率和死亡率數據進行提取，采用Joinpoint回歸率估計每種傳染病的年度變化百分比。

Findings

Between January, 2004, and December, 2013, 54 984 661 cases of 45 infectious diseases were reported (average yearly incidence 417·98 per 100 000). The infectious diseases with the highest yearly incidence were hand, foot, and mouth disease (114·48 per 100 000), hepatitis B (81·57 per 100 000), and tuberculosis (80·33 per 100 000). 132 681 deaths were reported among the 54 984 661 cases (average yearly mortality 1·01 deaths per 100 000; average case fatality 2·4 per 1000). Overall yearly incidence of infectious disease was higher among males than females and was highest among children younger than 10 years. Overall yearly mortality was higher among males than females older than 20 years and highest among individuals older than 80 years. Average yearly incidence rose from 300·54 per 100 000 in 2004 to 483·63 per 100 000 in 2013 (annual percentage change 5·9%); hydatid disease (echinococcosis), hepatitis C, and syphilis showed the fastest growth. The overall increasing trend changed after 2009, and the annual percentage change in incidence of infectious disease in 2009–13 (2·3%) was significantly lower than in 2004–08 (6·2%).

在2004年1月和2013年12月，共報告45種傳染病54 984 661例(發病率平均每年417.98每100 000)。每年的發病率最高的傳染病是手足口病(114.48每100 000)、乙型肝炎(81.57每100 000)和肺結核(80.33每100 000)。報道54 984 661例中共死亡132 681人(平均年死亡率1.01人每100 000;平均病死率2.4每1000)。每年感染性疾病的發病率男性高於女性，10歲以下兒童發病率最高。20歲以上年總死亡率男性比女性高，年齡在80歲以上的人最高。年平均發病率從300.54每100 000 (2004) 上升483.63每100 000(2013)(年度百分比變化5.9%);細粒棘球蚴病(包蟲病)、丙型肝炎、梅毒和呈現增長最快。總的增長趨勢在2009年後發生變化，2009～2013年間(2.3%)傳染病發病率年變化率明顯低於2004～2008(6.2%)。

Interpretation

Although the overall incidence of infectious diseases was increasing from 2004, the rate levelled off after 2009. Effective prevention and control strategies are needed for diseases with the highest incidence—including hand, foot, and mouth disease, hepatitis B, and tuberculosis—and those with the fastest rates of increase (including hydatid disease, hepatitis C, and syphilis).

雖然傳染病的總發病率從2004年起呈上升趨勢，但2009年以後趨於平穩。發病率最高的疾病為手足口病、乙型肝炎和肺結核，增長率最快的為包蟲病、丙型肝炎和梅毒，必須采取有效的預防和控製策略。

翻譯：張雅芝

審校：曹廣慧