城市钩端螺旋体病病例聚集性的检测与建模
Detection and modelling of case clusters for urban leptospirosis.
作者信息
Tassinari Wagner S, Pellegrini Debora C P, Sá Claudio B P, Reis Renato B, Ko Albert I, Carvalho Marilia S
机构信息
National School of Public Health, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rio de Janeiro, Brazil.
出版信息
Trop Med Int Health. 2008 Apr;13(4):503-12. doi: 10.1111/j.1365-3156.2008.02028.x. Epub 2008 Feb 27.
OBJECTIVE
To analyse the epidemiological profile of 488 cases of leptospirosis in Rio de Janeiro, Brazil between 1997 and 2002, using a variety of methods of spatial epidemiology, to establish alert guidelines in general hospitals, which might be a tool to improve diagnosis and treatment of leptospirosis to reduce lethality rates.
METHODS
Scan statistics identified six space-time clusters, which comprised a range of 2 to 28 cases per cluster. Generalized linear mixed models were used to evaluate risk factors for a cluster case which incorporated individual characteristics and spatial information on environmental and climactic factors in a single model frame.
RESULTS
Cluster case events were associated with heavy rainfall (OR 3.71; 95% CI 1.83-7.51). The model did not identify socioeconomic or environmental covariates that significantly influence the risk of developing a cluster rather than non-cluster case.
CONCLUSION
Clustering of leptospirosis in this urban setting appears to be due to transmission during heavy rainfall.
目的
运用多种空间流行病学方法，分析1997年至2002年巴西里约热内卢488例钩端螺旋体病病例的流行病学特征，制定综合医院的预警指南，该指南可能成为改善钩端螺旋体病诊断和治疗以降低致死率的工具。
方法
扫描统计法确定了6个时空聚集区，每个聚集区包含2至28例病例。广义线性混合模型用于评估聚集区病例的危险因素，该模型在单一模型框架中纳入了个体特征以及环境和气候因素的空间信息。
结果
聚集区病例事件与暴雨相关（比值比3.71；95%置信区间1.83 - 7.51）。该模型未识别出对发生聚集区病例而非非聚集区病例风险有显著影响的社会经济或环境协变量。
结论
在这个城市环境中，钩端螺旋体病的聚集现象似乎是由于暴雨期间的传播所致。
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