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There are two main types of mosquito-borne infectious diseases. One is infected by the anthroponotic pathogens with human to mosquito to human transmission cycle. Human is the amplifying host, including malaria, dengue fever, chikungunya, Zika, yellow fever, etc. These mosquito-borne infectious diseases are mainly prevalent in tropical and subtropical areas. Another is caused by the zoonotic pathogens with mosquito to animal to mosquito to human transmission cycles. Animal is the amplifying host, including: Japanese encephalitis, West Nile virus infection, Eastern Equine encephalitis, Western Equine encephalitis, and St. Louis encephalitis. Japanese encephalitis is mainly prevalent in the tropical, subtropical and temperate regions of the Asia-Pacific, and West Nile virus infection, Eastern equine encephalitis, Western equine encephalitis, and St. Louis encephalitis are mainly prevalent in the temperate and tropical regions of North America, Central America, Caribbean and Europe. In the context of globalization, the past decade, the annual arrivals and departures in China have reached 670 million in 2019, and due to the impact of COVID-19 pandemic, 116 million in 2022. The number of migrant workers leaving the country is 562 000 in 2014 and 259 000 in 2022, mainly to Asia and Africa. Dengue fever, yellow fever, Zika, chikungunya and malaria, which are endemic in Asia and Africa have high risk to be imported into China. Large numbers of people moving and migrating for work does not cause cross-border transmission of the zoonotic mosquito-borne infectious diseases. The focus of prevention and control of mosquito-borne diseases is to strengthen the health quarantine of entry personnel, carry out surveillance of symptoms, events and mosquito vectors, to detect imported cases early and timely, reduce the density of mosquito by government departments and community residents jointly participating in mosquito control and prevent the local outbreak of mosquito-borne diseases.

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全球流行的主要蚊媒传染病有两类,一类是传播循环为人-蚊-人的人源性病原体引起的,主要包括:疟疾、登革热、基孔肯雅热、寨卡、黄热病等,这类蚊媒传染病主要在热带和亚热带地区流行。另一类是传播循环为蚊-动物-蚊-人的动物源性病原体引起的,包括:日本脑炎、西尼罗病毒感染、东方马脑炎、西方马脑炎和圣路易斯脑炎等,日本脑炎主要在亚太地区的热带、亚热带和温带流行,西尼罗病毒感染、东方马脑炎、西方马脑炎和圣路易斯脑炎主要在北美、中美洲、加列比地区和欧洲的温带和热带流行。全球化背景下人员流动频繁,中国近十年来出入境人数大多都在4亿人次以上,2019年出入境最高达6.7亿人次,受COVID-19大流行影响,2022年最低也有1.16亿人次。出境务工人员2014年最高达56.2万人,2022年最少也25.9万人,主要在亚洲和非洲。亚洲和非洲流行的登革热、黄热病、寨卡、基孔肯雅热和疟疾等输入中国风险较高,并引起了登革热、基孔肯雅热本地传播。大量人员流动和出境务工并没有造成动物源性蚊媒传染病的跨境传播。蚊媒传染病的防控重点是加强入境人员的卫生检疫,开展症候群、事件和蚊媒监测,及时发现输入病例,政府部门和社区居民共同参与蚊媒控制,降低蚊媒密度,防止蚊媒传染病的暴发流行。

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柯昌文,E-mail:
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毛锐坤(2002—),男,硕士在读,研究方向:病原微生物

柯昌文,主任技师,广东省疾病预防控制中心病原微生物领域首席科学家,广东省医学领军人才,广东省特支计划领军人才。主要研究方向为登革热病毒、流感病毒、戊肝病毒、肠道病毒的分子流行病学、各类突发事件的病原学诊断技术和新发和再发传染病的病原学监测等。承担国家和省级课题30多项,承担和参加国际合作项目10多项。以第一或通讯作者发表文章120多篇,其中SCI收录期刊100余篇,中文核心期刊20篇;主编/主译著作2部,参编2部,牵头或参与获广东省科学技术奖二等奖2项,三等奖2项。担任中华预防医学会常务理事、广东省预防医学会病原微生物与生物安全专业委员会主任委员、广东省病原微生物实验室生物安全专家委员会主任委员。

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柯昌文,主任技师,广东省疾病预防控制中心病原微生物领域首席科学家,广东省医学领军人才,广东省特支计划领军人才。主要研究方向为登革热病毒、流感病毒、戊肝病毒、肠道病毒的分子流行病学、各类突发事件的病原学诊断技术和新发和再发传染病的病原学监测等。承担国家和省级课题30多项,承担和参加国际合作项目10多项。以第一或通讯作者发表文章120多篇,其中SCI收录期刊100余篇,中文核心期刊20篇;主编/主译著作2部,参编2部,牵头或参与获广东省科学技术奖二等奖2项,三等奖2项。担任中华预防医学会常务理事、广东省预防医学会病原微生物与生物安全专业委员会主任委员、广东省病原微生物实验室生物安全专家委员会主任委员。

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柯昌文,主任技师,广东省疾病预防控制中心病原微生物领域首席科学家,广东省医学领军人才,广东省特支计划领军人才。主要研究方向为登革热病毒、流感病毒、戊肝病毒、肠道病毒的分子流行病学、各类突发事件的病原学诊断技术和新发和再发传染病的病原学监测等。承担国家和省级课题30多项,承担和参加国际合作项目10多项。以第一或通讯作者发表文章120多篇,其中SCI收录期刊100余篇,中文核心期刊20篇;主编/主译著作2部,参编2部,牵头或参与获广东省科学技术奖二等奖2项,三等奖2项。担任中华预防医学会常务理事、广东省预防医学会病原微生物与生物安全专业委员会主任委员、广东省病原微生物实验室生物安全专家委员会主任委员。

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[2025-04-13]. https://www.ecdc.europa.eu/en/infectious-disease-topics/west-nile-virus-infection/surveillance-and-disease-data/monthly-updates., articleTitle=Monthly updates: 2024 West Nile virus transmission season, refAbstract=null)], funds=[Fund(id=1240996917690290922, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, awardId=0620220104, language=CN, fundingSource=广东卫生健康平台科技创新人才项目(0620220104), fundOrder=null, country=null), Fund(id=1240996917858063086, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, awardId=2023B1212010010, language=CN, fundingSource=广东省科技计划项目(2023B1212010010), fundOrder=null, country=null), Fund(id=1240996917962920693, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, awardId=B2023032, language=CN, fundingSource=广东省医学科学技术研究基金项目(B2023032), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240996911340114222, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, xref=1., ext=[AuthorCompanyExt(id=1240996911344308527, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, companyId=1240996911340114222, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China), AuthorCompanyExt(id=1240996911348502832, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, companyId=1240996911340114222, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.广东省疾病预防控制中心,广东 广州 511400)]), AuthorCompany(id=1240996911428194619, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, xref=2., ext=[AuthorCompanyExt(id=1240996911432388924, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, companyId=1240996911428194619, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.广州中医药大学中药学院)]), AuthorCompany(id=1240996911520469319, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, xref=3., ext=[AuthorCompanyExt(id=1240996911524663626, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, companyId=1240996911520469319, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.香港中文大学(深圳)医学院)])], figs=[ArticleFig(id=1240996916612354712, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, language=EN, label=Fig.1, caption=The Situation of China’s Entry and Exit Personnel and Overseas Labor Service Personnel from 2014 to 2023, figureFileSmall=zRLzdAJvuR1rumY1iO8l0A==, figureFileBig=4xwl1TYgfP6b3FPJ3iLjdQ==, tableContent=null), ArticleFig(id=1240996916713018017, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, language=CN, label=图1, caption=2014—2023年我国出入境与派出和在留境外劳务人员情况, figureFileSmall=zRLzdAJvuR1rumY1iO8l0A==, figureFileBig=4xwl1TYgfP6b3FPJ3iLjdQ==, tableContent=null), ArticleFig(id=1240996916901761712, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, language=EN, label=Fig.2, caption=The number of dispatching various types of labor personnel to different overseas regions yearly from 2013 to 2022, figureFileSmall=sBydpc2Ls5oA5ZyYpvuqNA==, figureFileBig=0jRRwk1rhsFdpqTlTfDrNQ==, tableContent=null), ArticleFig(id=1240996917010813625, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, language=CN, label=图2, caption=2013—2022每年向境外不同地区派出各类劳务人员情况

注:实线为人数,虚线为构成比。

, figureFileSmall=sBydpc2Ls5oA5ZyYpvuqNA==, figureFileBig=0jRRwk1rhsFdpqTlTfDrNQ==, tableContent=null), ArticleFig(id=1240996917119865539, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, language=EN, label=Fig.3, caption=The number of overseas labor personnel remaining in the dispatched regions at the end of each year from 2013 to 2022, figureFileSmall=xQHIrxk4UJqNpGY/ShFYlQ==, figureFileBig=oYTddPRZbJZzuoXxdQglzw==, tableContent=null), ArticleFig(id=1240996917228917451, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, language=CN, label=图3, caption=2013—2022年每年末在留境外派出地区的各类劳务人员情况

注:实线为人数,虚线为构成比。

, figureFileSmall=xQHIrxk4UJqNpGY/ShFYlQ==, figureFileBig=oYTddPRZbJZzuoXxdQglzw==, tableContent=null), ArticleFig(id=1240996917363135185, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, language=EN, label=Table 1, caption=

The importing areas of malaria cases reported in five provinces[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
感染来源地区山西省河南省许昌市山东省福建省安徽省滁州市
亚洲2(3.9)0(0)29(3.5)51(6.2)0(0)
非洲49(96.1)61(93.8)786(95.9)748(90.7)35(100)
南美洲0(0)0(0)1(0.1)2(0.2)0(0)
大洋洲0(0)0(0)4(0.5)24(2.9)0(0)
东地中海0(0)3(4.6)0(0)0(0)0(0)
西太平洋0(0)1(1.5)0(0)0(0)0(0)
), ArticleFig(id=1240996917467992794, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977221427450344, language=CN, label=表1, caption=

山西等五省报告的输入疟疾病例地区来源 [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
感染来源地区山西省河南省许昌市山东省福建省安徽省滁州市
亚洲2(3.9)0(0)29(3.5)51(6.2)0(0)
非洲49(96.1)61(93.8)786(95.9)748(90.7)35(100)
南美洲0(0)0(0)1(0.1)2(0.2)0(0)
大洋洲0(0)0(0)4(0.5)24(2.9)0(0)
东地中海0(0)3(4.6)0(0)0(0)0(0)
西太平洋0(0)1(1.5)0(0)0(0)0(0)
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毛锐坤 1, 2 , 汤莉 1 , 彭晓放 1 , 邓小玲 1 , 柳正 3 , 柯昌文 1
现代预防医学 | 重大疾病防控专栏 2025,52(10): 1729-1734
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现代预防医学 | 重大疾病防控专栏 2025, 52(10): 1729-1734
全球化背景下主要蚊媒传染病的流行趋势与防控
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毛锐坤1, 2, 汤莉1, 彭晓放1, 邓小玲1, 柳正3, 柯昌文1
作者信息
  • 1.广东省疾病预防控制中心,广东 广州 511400
  • 2.广州中医药大学中药学院
  • 3.香港中文大学(深圳)医学院
  • 毛锐坤(2002—),男,硕士在读,研究方向:病原微生物

    柯昌文,主任技师,广东省疾病预防控制中心病原微生物领域首席科学家,广东省医学领军人才,广东省特支计划领军人才。主要研究方向为登革热病毒、流感病毒、戊肝病毒、肠道病毒的分子流行病学、各类突发事件的病原学诊断技术和新发和再发传染病的病原学监测等。承担国家和省级课题30多项,承担和参加国际合作项目10多项。以第一或通讯作者发表文章120多篇,其中SCI收录期刊100余篇,中文核心期刊20篇;主编/主译著作2部,参编2部,牵头或参与获广东省科学技术奖二等奖2项,三等奖2项。担任中华预防医学会常务理事、广东省预防医学会病原微生物与生物安全专业委员会主任委员、广东省病原微生物实验室生物安全专家委员会主任委员。

通讯作者:

柯昌文,E-mail:
Epidemic trends and control of major mosquito-borne infectious diseases in the context of globalization
Rui-kun MAO1, 2, Li TANG1, Xiao-fang PENG1, Xiao-ling DENG1, Zheng LIU3, Chang-wen KE1
Affiliations
  • Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China
出版时间: 2025-05-25 doi: 10.20043/j.cnki.MPM.202412470
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全球流行的主要蚊媒传染病有两类,一类是传播循环为人-蚊-人的人源性病原体引起的,主要包括:疟疾、登革热、基孔肯雅热、寨卡、黄热病等,这类蚊媒传染病主要在热带和亚热带地区流行。另一类是传播循环为蚊-动物-蚊-人的动物源性病原体引起的,包括:日本脑炎、西尼罗病毒感染、东方马脑炎、西方马脑炎和圣路易斯脑炎等,日本脑炎主要在亚太地区的热带、亚热带和温带流行,西尼罗病毒感染、东方马脑炎、西方马脑炎和圣路易斯脑炎主要在北美、中美洲、加列比地区和欧洲的温带和热带流行。全球化背景下人员流动频繁,中国近十年来出入境人数大多都在4亿人次以上,2019年出入境最高达6.7亿人次,受COVID-19大流行影响,2022年最低也有1.16亿人次。出境务工人员2014年最高达56.2万人,2022年最少也25.9万人,主要在亚洲和非洲。亚洲和非洲流行的登革热、黄热病、寨卡、基孔肯雅热和疟疾等输入中国风险较高,并引起了登革热、基孔肯雅热本地传播。大量人员流动和出境务工并没有造成动物源性蚊媒传染病的跨境传播。蚊媒传染病的防控重点是加强入境人员的卫生检疫,开展症候群、事件和蚊媒监测,及时发现输入病例,政府部门和社区居民共同参与蚊媒控制,降低蚊媒密度,防止蚊媒传染病的暴发流行。

全球化  /  蚊媒传染病  /  流行特征  /  人源性和动物源性病原体  /  控制

There are two main types of mosquito-borne infectious diseases. One is infected by the anthroponotic pathogens with human to mosquito to human transmission cycle. Human is the amplifying host, including malaria, dengue fever, chikungunya, Zika, yellow fever, etc. These mosquito-borne infectious diseases are mainly prevalent in tropical and subtropical areas. Another is caused by the zoonotic pathogens with mosquito to animal to mosquito to human transmission cycles. Animal is the amplifying host, including: Japanese encephalitis, West Nile virus infection, Eastern Equine encephalitis, Western Equine encephalitis, and St. Louis encephalitis. Japanese encephalitis is mainly prevalent in the tropical, subtropical and temperate regions of the Asia-Pacific, and West Nile virus infection, Eastern equine encephalitis, Western equine encephalitis, and St. Louis encephalitis are mainly prevalent in the temperate and tropical regions of North America, Central America, Caribbean and Europe. In the context of globalization, the past decade, the annual arrivals and departures in China have reached 670 million in 2019, and due to the impact of COVID-19 pandemic, 116 million in 2022. The number of migrant workers leaving the country is 562 000 in 2014 and 259 000 in 2022, mainly to Asia and Africa. Dengue fever, yellow fever, Zika, chikungunya and malaria, which are endemic in Asia and Africa have high risk to be imported into China. Large numbers of people moving and migrating for work does not cause cross-border transmission of the zoonotic mosquito-borne infectious diseases. The focus of prevention and control of mosquito-borne diseases is to strengthen the health quarantine of entry personnel, carry out surveillance of symptoms, events and mosquito vectors, to detect imported cases early and timely, reduce the density of mosquito by government departments and community residents jointly participating in mosquito control and prevent the local outbreak of mosquito-borne diseases.

Globalization  /  Mosquito-borne infectious diseases  /  Epidemic trend  /  Anthroponotic and zoonotic pathogens  /  Control
毛锐坤, 汤莉, 彭晓放, 邓小玲, 柳正, 柯昌文. 全球化背景下主要蚊媒传染病的流行趋势与防控. 现代预防医学, 2025 , 52 (10) : 1729 -1734 . DOI: 10.20043/j.cnki.MPM.202412470
Rui-kun MAO, Li TANG, Xiao-fang PENG, Xiao-ling DENG, Zheng LIU, Chang-wen KE. Epidemic trends and control of major mosquito-borne infectious diseases in the context of globalization[J]. Modern Preventive Medicine, 2025 , 52 (10) : 1729 -1734 . DOI: 10.20043/j.cnki.MPM.202412470
全球化是当今时代的基本特征,随着全球化程度不断加深,特别是“一带一路”倡议的推进,合作国家和地区的不断增多,我国对外经济交流与合作也进一步加强,除了物资贸易数量的增加外,还表现在我国口岸出入境人数的不断飙升,以及对外劳务输出人数的增加。
蚊媒传染病一直是世界各地公众健康的严重威胁,主要蚊媒传染病的疾病负担约占全球传染病疾病负担的17%,每年夺去70多万人的生命[1]。全球化在带来社会经济和科学技术高速发展的同时,也使我国蚊媒传染病的防控面临新的挑战。全球流行的主要蚊媒传染病有两类,一类是传播循环为人-蚊-人的人源性病原体引起的,包括:疟疾、登革热、基孔肯雅热、寨卡、黄热病等,这类蚊媒传染病主要在热带和亚热带地区流行。另一类是传播循环为蚊-动物-蚊-人的动物源性病原体引起的,包括:日本脑炎、西尼罗病毒感染、东方马脑炎、西方马脑炎和圣路易斯脑炎等,日本脑炎主要在亚太地区流行,西尼罗病毒感染、东方马脑炎、西方马脑炎和圣路易斯脑炎主要在北美、中美洲和加列比地区流行,近年来欧洲多个国家报告了本土西尼罗病毒感染的病例。
经济全球化促进了世界各国间的贸易往来、文化交流和探亲旅游,国际间人员交往更加频繁。中国与世界各国的文化、旅游和商务来往也更加密切,国家移民管理局数据显示,2014至2019年我国出入境人数逐年上升分别达4.90、5.23、5.70、5.98、6.50、6.70亿人次,2020至2022年受COVID-19大流行影响,出入境人数有明显下降,分别为2.58,1.28和1.16亿人次; 2023年快速回升到4.24亿人次,其中外国人出入境达到3 547.8万人次,同比上升693.1%[2]。2014—2019年,我国境外劳务输出人数每年都在50万以上,年末境外劳务输出人员数维持在100万以上(见图1)。2020—2022年受COVID-19大流行影响劳务输出人数明显下降,每年约 30万左右,年末在留境外人数也明显下降,约60万左右。这些劳务输出人员主要从事建筑、采矿和伐木等劳务工作,少部分从事服务行业,工作和居住环境差,大多生活在农村地区、城市郊区,以及一些矿区和林区,容易感染当地的流行性传染病或地方性传染病,特别是蚊媒传播的疾病。
国家统计局数据显示,2014年至2019年每年向境外派出的务工人员主要分布在亚洲、非洲、拉丁美洲,欧洲、北美洲和大洋洲及太平洋岛屿的人数较少(见图2图3)。2020年后,劳务输出人数大幅减少,务工地主要在亚洲和非洲,分别占73%和16%,其它大洲仅占10%,亚洲主要分布东南亚的缅甸、柬埔寨和泰国[3-4]
人源性病原体引起的蚊媒传染病的地理范围正随着人员流动、城市化、气候变化、病原体对媒介的适应性突变,以及蚊媒种群不受控制的扩张等而不断扩大。一些地方性流行的人源性病原体引起的蚊媒传染病不断被输入到非流行地区。
登革热是由登革病毒通过埃及伊蚊或白纹伊蚊叮咬传播而引起的急性传染病,自2023年初以来,世界卫生组织(WHO)五个区(非洲、美洲、东南亚、西太平洋和东地中海)的80多个国家和地区报告了500多万例登革热和5 000多例登革热相关死亡,接近历史最高水平[5]。2023年,非洲区国家报告了171 991例登革热,753例死亡;美洲区42个国家和地区共报告了410万例疑似登革热,其中重症6 710例,2 049例死亡。东南亚区的印度、印度尼西亚、缅甸、斯里兰卡和泰国位列世界上30个登革热流行强度最高的国家,2023年该区域的孟加拉国和泰国分别报告了308 167例和136 655例登革热。西太平洋区8个国家和地区报告了超过50万例登革热和750例死亡,太平洋岛屿国家报告了登革热样病例13 339例。登革热在欧洲区域不是地方病,病例主要与旅行有关。2023年意大利、法国和西班牙分别报告了82例、43例和3例本土登革热。东地中海区于1998年首次报告了登革热和重症登革热疫情,目前该区的9个国家都有暴发疫情。
中国2005—2023年输入登革热病例14 376例,来自全球79个国家和地区,东南亚区输入7 489例,占52.09%;西太平洋区输入6 178例,占42.97%,非洲区输入239例,占 1.66%,美洲区输入74例,占 0.51%;东地中海区输入62例,占0.43%[6]。输入病例以男性青壮年为主,与出境务工人员人群特征一致;职业以农民、民工、商业服务为主。输入病例的来源地与我国劳务输出的主要区域为东南亚一致,同时也与东南亚和西太平洋区登革热流行强度高一致,虽然南美洲报告的登革热病例在全球占比最高,但到美洲务工人员较少,输入风险相对较低。中国登革热疫情主要是输入病例引起的本地传播,2019—2023年出现本地感染疫情的省份有云南、广东、福建、浙江、广西、重庆、江西、河南和山东[7]。云南和广西与东南亚国家有陆路入境口岸,人员交流和出境务工便捷;广东省对外贸易活跃,经口岸出入境人数较多;三地地处热带和亚热带,是登革热输入和流行的高风险地区。其他省因劳务输出和对外贸易活跃,有输入的风险,但地处温带,引起暴发流行的风险较低。
黄热病是由黄热病毒引起,主要通过埃及伊蚊传播。尽管有安全有效的疫苗,黄热病暴发每年仍造成10.9万例严重感染和5.1万例死亡。21世纪初,西非黄热病疫情推动了流行国家的免疫规划行动,黄热病疫苗纳入儿童常规免疫,危险地区开展大规模预防接种运动,并成功消除了西非的黄热病疫情。2015年12月安哥拉报告了首次发生的黄热病本地病例,随后蔓延到18个省,共报告4 347例疑似或确诊病例,其中377例死亡[8]。2016年4月刚果(金)民主共和国发生黄热病疫情。2017和2018年巴西和尼日利亚也先后发生黄热病暴发流行[9]
中国在安哥拉务工人员较多,受2015年安哥拉黄热病疫情影响,2016年3月中国报告了首例输入黄热病病例,2016—2019年共报告11例输入病例,均来自安哥拉,北京入境7例,上海入境4例,目的地分别是福建7人,江苏2人,浙江和四川各一人[10-13]。调查发现病例在安哥拉从事的工作包括:建筑工人、超市或公司雇员、服装零售人员等,属长期居住的务工人员。入境卫生检疫发现6例,占54.55%,其中主动申报2例、入境后检测发现2例、医学巡查发现1例、体温监测发现1例。地方医疗机构诊治发现5例。黄热病属卫生检疫传染病,传播媒介埃及伊蚊在中国分布局限,输入并造成本地传播的风险低。
基孔肯雅热也是由埃及伊蚊和白纹伊蚊传播的蚊媒传染病。基孔肯雅病毒首先于1952年在坦桑尼亚联合共和国被发现,随后在非洲和亚洲的其他国家也有发现。1967年在泰国,以及1970年代在印度首次记录了城市中的基孔肯雅热暴发[14]。2005年以来,该病毒在非洲、南亚、东南亚和印度洋群岛再次出现并导致多起暴发[15],全球范围内基孔肯雅热的发病率与病死率不断上升,可能与病毒适应变异增强了白纹伊蚊传播效率有关,白纹伊蚊已成为亚洲传播基孔肯雅病毒的优势媒介。在欧洲和美洲大部分地区,由于去热带流行地区旅行者增多以及白纹伊蚊孳生地的扩大,基孔肯雅病毒本地化传播的风险不断增加。
2008年中国发现首例来自斯里兰卡的输入性病例,2010年广东省东莞市发生了中国首起基孔肯雅热社区暴发,确诊病例数282人[16]。2010—2019年输入病例分别为1、1、3、0、0、0、5、14、8和62例,共94例[17]。近年有增多趋势,特别是2019年病例数突增为62例。2017年浙江衢州报告了一起输入病例引起的本地传播,确诊病例4人,病例局限在一个村。2019年报告2起本地暴发疫情,其中云南省瑞丽市孟卯镇确诊病例170人,广东省顺德市北滘镇确诊4例。4起本地聚集性疫情,不管病例多少都有明显的地域聚集性,病例集中在一个社区、一个村或一个乡镇。输入病例大多数为归国后自行就医发现,从发病到诊断间隔较长,发现和诊断不及时是造成疫情在社区扩散,并传播到周边乡镇的原因。输入病例主要出现在夏末和秋季,分布在西南、东南和华南[18-21]。来源国主要为缅甸、泰国、孟加拉国、印度等,也有来自非洲和南美洲国家的输入病例。基孔肯雅热的输入和亚洲、非洲和南美洲本病的流行相关,也与我国劳务输出人数最多的亚洲地区输入为主一致。基孔肯雅热在我国属于输入性传染病,尚未形成地方性流行,人群普遍易感,发生本地暴发疫情的风险较高。
寨卡病毒感染是由寨卡病毒引起,主要通过埃及伊蚊传播。1947年寨卡病毒在乌干达的一只恒河猴身上首次被发现,20世纪50年代在一些非洲国家发现有人感染并患病。20世纪60年代到80年代非洲和亚洲有散发病例报告。2007年太平洋岛国出现暴发疫情,2013—2014年法属波利尼西亚报告病例约10 000例;2015年蔓延至拉丁美洲及加勒比地区。北美洲、亚洲及欧洲部分国家有输入性病例报告。2015年巴西首次发现新生儿小头畸形与寨卡病毒感染相关。2016年WHO宣布小头症及其他神经系统疾病和寨卡病毒感染相关为国际关注的突发公共卫生事件,寨卡病毒与先天性畸形之间的因果关系很快得到证实[22]。2017年以来,全球报告的寨卡病例有所下降,由于各国对该病的监测不足,缺少传播风险评估的准确信息。
中国2016—2017年共报告了25例输入寨卡病例,全部来自南美洲[23]职业分布以商业服务者为主,占48.0%;其次是散居儿童,占20.0%。2—9月均有输入病例报告,广东报告15例,浙江4例、北京3例、江苏、河南和江西各1例。委内瑞拉、美属萨摩亚、苏里南、危地马拉和厄瓜多尔分别输入17、3、2、2和1例。入境检疫发现9例、随访发现9例,入境后就医发现7例。2019年云南报告了1例缅甸输入的寨卡病例,为在缅甸务工的云南昭通人。寨卡病毒感染近年在全球处于低流行水平,主要传播媒介埃及伊蚊在我国分布局限,输入病例引起本地流行的风险很低。
全球很多国家仍受到疟疾的威胁。WHO数据显示,2022年非洲区估计有2.33亿例疟疾,约占全球病例总数的94%[24],东南亚区500万例,东地中海区830万例,西太平洋区190万例,美洲区60万例,欧洲区自2015年以来一直无疟疾。
2016中国已经取得了消除疟疾的成果,全球化背景下,中国出入境人数和出境务工人数不断升高,增加了疟疾输入风险。2019—2023年共报告境外输入疟疾病例7千多例,80%以上自非洲国家输入[24]。分析山西、河南、山东、福建和安徽等5省疟疾输入病例的特点,发现中国输入病例90%以上是从非洲回国的出境务工人员,亚洲、大洋洲、东地中海地区和南美洲输入的病例占比较低,与全球疟疾的流行地区一致(见表1[25-29]。鉴于疟疾仍在全球多个大洲流行,疟疾输入风险很高。
动物源性病毒通过多种蚊媒、鸟类或啮齿动物宿主保持在自然界的传播循环,人类是这类病原的终端宿主,不参与传播循环,人口流动和国际旅行不增加传播风险。动物源性病毒蚊媒传染病包括:乙型脑炎、西尼罗病毒感染、圣路易斯脑炎、东方马脑炎、西方马脑炎和拉克罗斯脑炎等。
乙型脑炎是以携带乙型脑炎病毒的三带喙库蚊为主要传播媒介,猪、马、牛、羊等为动物宿主,猪是主要的扩增宿主。主要发生在亚洲和西太平洋地区。全球 2019 年约40 亿人口居住于乙型脑炎流行地区,报告144.47万例病例和8.99 万例死亡[30]
我国曾经是乙型脑炎流行地区,高峰期为夏秋季,主要发病人群为儿童,1971年达到20.92/10万的发病率高峰。随着乙型脑炎疫苗的广泛应用,1998年后发病率均在1/10 万以下[31]。加上家畜饲养方式由散养向规模化养殖的转变,乙型脑炎发病率大幅下降,2022年降至0.01/10 万。
西尼罗病毒在蚊虫(尤其是库蚊)和鸟类之间循环。受感染的鸟类血液中会出现高滴度病毒,蚊虫通过叮咬受感染的鸟而被感染,并将病毒传播给更多的鸟类。携带病毒的蚊虫也可通过叮咬感染人、马和其他哺乳动物。然而,人类、马和其他哺乳动物是终端宿主,不会将病毒再传给蚊虫[32]
1999年美国东北部暴发了人间脑炎疫情,病因是西尼罗病毒感染,病毒与1998年从以色列一只死鹅中分离出的西尼罗病毒同源[33]。1999—2008年美国共报告28 961例西尼罗病毒感染病例,神经系统感染病例11 822例(41%)[34]。2009—2018年美国报告21 869例,神经系统感染病例12 835例(59%)[35]。2024年欧洲有19个国家报告了1 375例本土西尼罗病毒感染病例,同时,欧洲还报告了483起马科动物和435起鸟类西尼罗病毒暴发事件[36]
圣路易斯脑炎、东方马脑炎、西方马脑炎和拉克罗斯脑炎与乙型脑炎和西尼罗病毒感染的传播途径相似,人作为终端宿主不能作为传染源传播病毒,因此人员流动不能传播病毒,加上动物宿主活动范围和媒介蚊虫分布的局限性,这类蚊媒传染病输入我国的风险很低。
防控蚊媒传染病主要通过加强入境人员检疫、开展症候群和事件监测,及时发现和控制输入病例和本土病例,对蚊虫媒介进行监测与控制[10],开展健康教育,提高社区人群防蚊灭蚊意识。
检疫部门除做好检疫传染病卫生检疫外,还要根据全球人源性蚊媒传染病流行情况,按入境来源地加强人员检疫,严防蚊媒传染病输入,阻断输入再传播。
入境飞机和轮船也有输入蚊虫风险,如果蚊虫已感染病原就会造成病原体输入,因此对入境飞机、轮船进行灭蚊是避免或减少蚊媒和蚊媒传染病输入的重要措施。
症候群监测应鼓励医生结合病人的临床体征和症状,以及流行病学史,在没有实验室诊断依据的情况下,及时在传染病网络直报系统报告临床诊断疟疾、登革热、基孔肯雅热、黄热病和寨卡病例,实现早期预警。事件监测应鼓励疾控机构有组织地收集、监控、评估和解释可能对人类健康构成潜在风险的卫生事件的实时信息,实现早期预警和快速反应。实验室是监测的关键组成部分,实验室必须负责对症候群监测的部分疑似病例和所有需要住院治疗的重症病例进行检测确认。
应通过监测确定蚊媒传染病流行的昆虫学指数阈值,开展伊蚊媒介传染病登革热、基孔肯雅热、黄热病和寨卡的预测预警。蚊媒控制是预防疟疾的重要措施,通过实施综合的按蚊控制措施成功地阻断了疟疾的本土传播。预防人源性蚊媒传染病也完全取决于埃及伊蚊和白纹伊蚊的控制。政府部门要确保储备充足的杀虫剂和应急设备,并确保有资金应对可能暴发的蚊媒传染病疫情。
通过采用电视、报纸、网络新媒体等形式,开展蚊媒传染病防控健康教育,及时发布蚊媒传染病监测信息,开展风险提示,引导社区群众及时清除家庭及周边地区的各种积水,防止蚊虫孳生。提示人们在前往公园、山林等蚊虫聚集地点前做好个人防护措施,穿长袖衣服和长裤,使用蚊虫趋避剂,居家安装防蚊纱窗和门,尽量减少和蚊虫接触。
全球化背景下,经济发展不平衡和人员跨境流动增加了蚊媒传染病的全球流行风险,特别是人源性病原体引起的疟疾、登革热、基孔肯雅热、黄热病和寨卡等蚊媒传染病将在经济不发达、生活水平落后的热带和亚热带地区国家持续流行。在北美和欧洲流行的西尼罗病毒感染、东方马脑炎、圣路易斯脑炎等动物源性蚊媒传染病经人员跨境流动传播的风险很低。
  • 广东卫生健康平台科技创新人才项目(0620220104)
  • 广东省科技计划项目(2023B1212010010)
  • 广东省医学科学技术研究基金项目(B2023032)
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2025年第52卷第10期
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doi: 10.20043/j.cnki.MPM.202412470
  • 接收时间:2024-12-26
  • 首发时间:2026-03-18
  • 出版时间:2025-05-25
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  • 收稿日期:2024-12-26
基金
广东卫生健康平台科技创新人才项目(0620220104)
广东省科技计划项目(2023B1212010010)
广东省医学科学技术研究基金项目(B2023032)
作者信息
    1.广东省疾病预防控制中心,广东 广州 511400
    2.广州中医药大学中药学院
    3.香港中文大学(深圳)医学院

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genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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