1993-2002年拉脱维亚蜱传疾病的媒介和流行病学情况

Antra Bormane , Irina Lucenko , Arnis Duks , Violeta Mavtchoutko , Renate Ranka , Kristine Salmina , Viesturs Baumanis
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引用次数: 83

摘要

1993-2002年期间,蜱传脑炎(TBE)和莱姆病(LB)的发病率以及媒介物种的年度活动都有所增加和显著变化。1994年和1995年拉脱维亚的脑炎发病率增幅最大,1998年也有所减少,随后几年大幅下降。然而,LB发病率的最高峰出现在1998年,在随后的几年中只有轻微的下降。两种具有流行病学意义的伊蚊蜱在拉脱维亚很常见。蓖麻伊蚊(Ixodes ricinus L.)在拉脱维亚西部和中部蔓延;但很少,而且在东部也有少量。似只在该国东部占优势。在位于拉脱维亚中部的两类监测点——森林和住宅周围,观察到了蓖麻依虫的季节和年度活动变化。在东部地区进行了观察。比较3个蜱虫分布区(蓖麻蜱为主区、过土蜱为主区和混合区)蜱传疾病(TBD)的地理分布数据,发现近10年各地区蜱传疾病发病率的年变化趋势基本一致。而在1994年和1995年,几乎只在蓖麻伊虫占多数的地区观察到极端病例。1993 - 2002年野外采集的成年蓖麻蜱和过硫蜱的TBEV感染率分别为1.7% ~ 26.6%和0% ~ 37.3%。从人类身上移除的蜱的感染率要高得多,从1998年到2002年超过了30%。2002年对摘除的成虫和若虫进行的热带病病毒调查发现,蓖麻螨若虫的热带病病毒感染率也很高(43%)。与德国和瑞典病毒学家合作,对从蜱虫和患者血清样本中分离的TBE病毒进行分型,结果显示所有三种TBE病毒亚型在拉脱维亚共同传播。用巢式聚合酶链反应法分析1999 ~ 2001年蜱虫感染伯氏疏螺旋体的年平均感染率,蓖麻蜱为18% ~ 38%,过溶蜱为25% ~ 51%。对伯氏疏螺旋体阳性DNA样本进行分型,结果表明,伯氏疏螺旋体阳性的蓖麻螺旋体和过硫螺旋体螺旋体中,阿夫泽利螺旋体占优势(64.9%),过硫螺旋体占81.2%,其次是加里氏螺旋体(24.3%);在I. persulcatus: 14.5%)。对拉脱维亚中部产蓖麻伊氏体嗜吞噬细胞埃利希氏体基因群的调查(采用巢式PCR方法针对16S rRNA基因)显示,该病毒存在埃利希氏体。过去十年中获得的关于TBD病媒和流行病学情况的数据表明,影响拉脱维亚TBE和LB发病率的不同因素具有复杂的影响。
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Vectors of tick-borne diseases and epidemiological situation in latvia in 1993–2002

During the period of 1993–2002 an increase and the remarkable changes in the incidence of tick-borne encephalitis (TBE) and Lyme borreliosis (LB) as well as annual activities of vector species were noticed.

The highest increase of TBE morbidity in Latvia has been observed in 1994 and 1995, and less expressed also in 1998 which was followed by a significant decrease during subsequent years. Whereas the highest peak of LB morbidity has been noticed in 1998 with only a minor decrease during subsequent years.

Two epidemiologically significant Ixodes tick species are common in Latvia. Ixodes ricinus L. spread in the western and central part of Latvia; but rarely and in small numbers also in the eastern part. Ixodes persulcatus P. Sch. seems to dominate only in the eastern part of the country. The changes of seasonal and annual activities of I. ricinus were observed in two types of monitoring sites — sylvatic and peridomestic, located in the central part of Latvia. Observations of I. persulcatus were made in the eastern districts.

Comparing geographically the Tick-borne diseases (TBD) incidence data for three tick distribution regions (I. ricinus dominated, I. persulcatus dominated and mixed regions), it was observed that the trend of annual changes in LB incidence during the last decade is almost of the same kind for all regions. Whereas TBE incidence extremes in 1994 and 1995 were observed almost only in I. ricinus dominated region.

The annual field-collected adult tick infection rate with TBE virus (TBEV) from 1993 to 2002 for I. ricinus adults varied between 1.7% and 26.6% and for I. persulcatus — between 0% and 37.3%. The infection level in ticks removed from humans was much higher and from 1998 to 2002 surpassed 30%. TBEV investigations of removed adults and nymphs in 2002 discovered a high TBEV prevalence also in I. ricinus nymphs (43%). Typing of TBE virus isolated from ticks and patient serum samples in collaboration with German and Swedish virologists revealed that all three TBEV subtypes were co-circulating in Latvia.

The mean annual tick infection rate with Borrelia burgdorferi s.l. analysed by means of a nested polymerase chain reaction of OspA gene fragment during the period of 1999–2001 was 18%–38% for I. ricinus adults and 25%–51% for I. persulcatus adults. Typing of Borrelia-positive DNA samples indicated that B. afzelii was dominant in Borrelia-positive I. ricinus (64.9%) and I. persulcatus (81.2%) followed by B. garinii (I. ricinus: 24.3%; in I. persulcatus: 14.5%).

Investigations of Ehrlichia phagocytophila genogroup (by nested PCR targeted the 16S rRNA gene) revealed the presence of Ehrlichia sp. in I. ricinus from the central part of Latvia. Obtained data on TBD vectors and the epidemiological situation during the last decade indicates the complex impact of different factors influencing TBE and LB morbidity in Latvia.

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