目的分析大型水利工程对血吸虫病传播的影响,评估血吸虫病潜在流行区的疾病传播风险。方法2008-2010年,在三峡库区和南水北调等大型水利工程途经的江苏省盱眙县、洪泽县、金湖县和高邮县,山东省微山县,湖北省潜江市和宜昌市夷陵区,安徽省巢湖市居巢区,重庆市万州区和开县,以及长江下游河口段的张家港市等5省(市)11个县(市、区),选择血吸虫病潜在流行区开展传播风险相关因素监测并进行风险评估分析。每个县(市、区)至少设立1个固定监测点和3个流动监测点。2008年随机抽取当地6~65岁常住居民,2008-2010年每年对监测县(市、区)内的当地暂住流动人口,采用间接红细胞凝集试验或酶联免疫吸附试验进行筛查,血检阳性者用改良加藤法或尼龙绢集卵孵化法进行病原学检查。2008-2010年每年对居巢、潜江、高邮和万州等4个县(市、区)的家畜开展血吸虫感染情况调查。此外,对危险地带和可疑环境开展钉螺孳生分布调查和水体漂浮物的监测,并在江苏省盱眙县、洪泽县、金湖县和高邮县的通江河道采用稻草帘诱螺法开展钉螺扩散调查。结果监测点共8 256名当地居民接受了血清学检查,抗体阳性率为0.7%(60/8 256),60例抗体阳性者中55例接受了病原学检查,均为阴性。2008-2010年流动人口的抗体阳性率分别为2.0%(53/2 611)、1.4%(56/3 944)和1.7%(74/4 581),3年间差异无统计学意义(χ2=3.57,P>0.05);在抗体阳性者中,居巢区连续3年均查获了粪检阳性者,共22例,另于2010年在金湖县检获1例粪检阳性。除在金湖和高邮的可疑环境检获钉螺外,其他监测点均未查获钉螺,检获的钉螺中未发现感染性钉螺。水体漂浮物和稻草帘诱螺监测,检获大量水生贝类和螺,但未检获钉螺。结论尚未发现三峡库区和南水北调相关工程引起钉螺扩散和血吸虫病传播的情况,但存在相关风险,有必要建立长期血吸虫病监测预警体系,不同类型地区血吸虫病传播因素监测的重点可不同。 Objective To analyze the impact of large water projects on the spread of schistosomiasis and assess the risk of disease transmission in potentially epidemic areas of schistosomiasis. Methods From 2008 to 2010, in Qionglai County, Hongze County, Jinhu County and Gaoyou County in Jiangsu Province, Weishan County in Shandong Province, Qianjiang City in Hubei Province and Yiling City in Yichang City, the Three Gorges Reservoir Area and South-North Water Diversion Project, (Cities, districts) of 5 provinces (cities) in Juchao District of Chaohu City in Anhui Province, Juchao District of Chaohu City in Anhui Province, Kajian County of Wanzhou District in Chongqing Municipality and Zhangjiagang City at the estuary of the lower reaches of the Yangtze River. Risk-related areas of schistosomiasis were selected Factors monitoring and risk assessment analysis. Each county (city, district) at least set up a fixed monitoring point and three mobile monitoring points. In 2008, local residents aged 6 ~ 65 were selected randomly. Between 2008 and 2010, local transient floating population in the counties (cities / districts) was screened by indirect hemagglutination test or enzyme-linked immunosorbent assay. Positive person with improved Kato method or nylon silk hatching method of etiological examination. 2008-2010 An annual survey of schistosomiasis prevalence in domestic animals in four counties (cities and districts) such as Juchao, Qianjiang, Gaoyou and Wanzhou. In addition, surveys of distribution of snail breeding and monitoring of floating bodies in dangerous areas and suspicious environments were conducted, and snail diffusion was carried out using straw curtain lure in Tongjiang River Road in Xuyi County, Hongze County, Jinhu County and Gaoyou County of Jiangsu Province survey. Results A total of 8 256 local residents were serologically tested. The positive rate of antibody was 0.7% (60/8 256). 55 of the 60 antibody positive patients underwent etiological examination, all of which were negative. The positive rates of antibody in floating population in 2008-2010 were 2.0% (53/2 611), 1.4% (56/3 944) and 1.7% (74/4 581), respectively, with no significant difference in three years (χ2 = 3.57 , P> 0.05). Among the antibody-positive individuals, all of them were seized positive for stool for 3 years in a row in Juchao District for a total of 22 cases. Another case of stool seized in Jinhu County in 2010 was positive. In addition to the snail seizures in suspicious environments in Jinhu and Gaoyou, no snails were detected at other monitoring sites and no infectious snails were found in the seized snails. Water floats and straw curtains were snail-monitored and large numbers of aquatic shellfish and snails were seized but snails were not seized. Conclusion The Three Gorges Reservoir Area and the South-to-North Water Diversion Project have not yet been found to cause the spread of snail and schistosomiasis. However, there are risks associated with this. It is necessary to establish a long-term monitoring and warning system for schistosomiasis. The focus of monitoring schistosomiasis transmission in different types of areas may differ.