肯尼亚马萨比特县内脏利什曼病疫情的特征，2014 年。
Characterization of visceral leishmaniasis outbreak, Marsabit County, Kenya, 2014.
机构信息
Kenya Field Epidemiology and Laboratory Training Program, Nairobi, Kenya.
Ministry of Health, Nairobi, Kenya.
出版信息
BMC Public Health. 2020 Apr 5;20(1):446. doi: 10.1186/s12889-020-08532-9.
BACKGROUND
Visceral leishmaniasis (VL) is caused by protozoa of the Leishmania donovani complex. Annually, an estimated 500,000 cases of VL are reported globally posing a public health challenge. The objectives of our study were to confirm and determine the magnitude of VL outbreak, characterize the outbreak clinically and epidemiologically and evaluate the county preparedness and response in Marsabit County, Kenya.
METHODS
A retrospective review of laboratory registers and patients' clinical notes was done at Marsabit County Hospital. Cases were persons with confirmed VL diagnosis either by microscopy, serology or molecular technique coming from Marsabit County from May to October 2014. Cases were interviewed using structured questionnaire to collect clinical and epidemiologic information. Blood samples were collected from cases for laboratory confirmation.
RESULTS
A total of 136 cases were confirmed of which 77% (105) were male with a median age of 17 (IQR: 22) years and 9.6% (13) case fatality rate. All cases were admitted at Marsabit County Referral Hospital, Kenya. Medical records of 133 cases were retrieved. Of the 133 cases, 102 (77%) presented with fever, 43 (32%) with splenomegaly, 26 (20%) with hepatomegaly and 96 (72%) were managed with Sodium stibogluconate (SSG) monotherapy. Thirty-four cases (26%) received Full haemogram (FHG) test and none had more than one Liver Function Tests (LFTs) in a span of 6 months. Presenting with headache (OR: 4.21, 95% CI: 1.10-16.09) and hepatomegaly (OR: 4.2, 95% CI: 1.30-14.11) were associated with VL death. No VL case management training had been conducted nor VL treatment guidelines distributed among health care workers (HCWs) in the last 1 year.
CONCLUSIONS
VL cases were confirmed. Inadequate case monitoring and management was evident. VL case management sensitization training was conducted. The County health department should put in place one health VL surveillance and facilitate periodic case management trainings.
背景
内脏利什曼病（VL）由利什曼原虫复合体引起。全球每年估计有 50 万例 VL 报告，对公共卫生构成挑战。我们研究的目的是确认和确定 VL 爆发的规模，对其临床和流行病学特征进行描述，并评估肯尼亚马萨比特县的准备和应对情况。
方法
对马萨比特县医院的实验室登记册和患者临床记录进行回顾性审查。2014 年 5 月至 10 月，来自马萨比特县的经显微镜、血清学或分子技术确认的 VL 诊断病例均为病例。对病例采用结构化问卷进行采访，以收集临床和流行病学信息。从病例中采集血液样本进行实验室确认。
结果
共确诊 136 例，其中男性占 77%（105 例），中位年龄为 17 岁（IQR：22 岁），病死率为 9.6%（13 例）。所有病例均入住肯尼亚马萨比特县转诊医院。检索到 133 例病例的医疗记录。在 133 例病例中，102 例（77%）表现为发热，43 例（32%）表现为脾肿大，26 例（20%）表现为肝肿大，96 例（72%）采用葡甲胺锑酸钠（SSG）单药治疗。34 例（26%）进行了全血细胞计数（FHG）检查，在 6 个月内无一人进行了超过一次肝功能检查（LFTs）。头痛（OR：4.21，95%CI：1.10-16.09）和肝肿大（OR：4.2，95%CI：1.30-14.11）与 VL 死亡相关。在过去一年中，没有针对 VL 病例管理的培训，也没有向卫生保健工作者（HCWs）分发 VL 治疗指南。
结论
已确诊 VL 病例。明显存在病例监测和管理不足的情况。已开展 VL 病例管理宣传培训。县卫生部门应建立一个综合卫生 VL 监测系统，并定期开展病例管理培训。
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