目的 探讨2014－2023年云南省楚雄彝族自治州（楚雄州）肾综合征出血热（HFRS）报告发病时空分布特征,为其精准防控提供科学依据。方法 通过中国疾病预防控制信息系统收集2014－2023年楚雄州HFRS发病数据,研究对象为临床诊断和实验室确诊病例。使用Geoda 1.22软件开展全局和局部空间自相关分析,运用SaTScan 10.12软件进行时空扫描分析,应用R 4.3.2软件建立季节性差分自回归滑动平均（SARIMA）模型预测发病趋势。以乡（镇）为最小统计单位,计算报告发病率并进行时空分布特征分析。结果 2014－2023年楚雄州共报告HFRS 1 106例,死亡2例,年平均报告发病率为4.19/10万。报告发病数有显著上升趋势（Z=2.683,τ=0.689,P=0.007）,呈现明显的季节性,以4月为高峰、6月为次峰。病例以男性（性别比2.31∶1）、农民（74.05%）为主,≥60岁年龄组报告发病数构成比逐年上升（Z=3.041,τ=0.778,P<0.002）。空间自相关分析显示,2014－2023年存在空间聚集性,热点区域由楚雄州中部（2014－2016年）向西北部地区（2020年后）移动。时空扫描分析发现,聚集区呈现范围缩小、聚集程度加深的特点。2014－2018年探测到3个聚集区[涉及31个乡（镇）]；2019－2023年探测到2个聚集区[涉及13个乡（镇）],分别以姚安县栋川镇（LLR=476.245,P<0.001,RR=19.51）和楚雄市子午镇（LLR=19.739,P<0.001,RR=3.25）为中心。SARIMA（1,0,0）（0,1,2）12模型预测2024年疫情仍将处于相对高位。结论 楚雄州肾综合征出血热疫情呈上升趋势,发病具有明显的时空聚集性,应针对重点地区采取综合防控措施。
Objective To explore the temporal and spatial distribution characteristics of reported hemorrhagic fever with renal syndrome (HFRS) cases in Chuxiong Yi Autonomous Prefecture (Chuxiong Prefecture), Yunnan Province, China, 2014-2023, so as to provide scientific evidence for precise prevention and control. Methods The HFRS data, including both clinically diagnosed and laboratory-confirmed cases, were collected from the China Disease Prevention and Control Information System. Global and local spatial autocorrelation analyses were conducted using Geoda 1.22 software, spatiotemporal scan statistics was performed using SaTScan 10.12 software, and a seasonal autorgressive integrated moving average (SARIMA) model was established using R 4.3.2 software for incidence prediction. The reported incidence rates were calculated and the spatiotemporal distribution characteristics were analyzed at the township level. Results A total of 1 106 HFRS cases and 2 deaths were reported in Chuxiong Prefecture during 2014-2023, with an average annual reported incidence rate of 4.19/100 000. The reported incidence showed a significant increase (Z=2.683, τ=0.689, P=0.007) and marked seasonality, with the primary peak in April and secondary peak in June. Males (male-to-female ratio 2.31:1) and farmers (74.05%) accounted for the majority of cases, with the proportion of cases in the ≥60 age group showing a yearly increase (Z=3.041, τ=0.778, P<0.002). Spatial autocorrelation analysis revealed significant spatial clustering during 2014-2023, with hotspots shifting from the central area (2014-2016) to the northwestern area (post-2020) of Chuxiong Prefecture. Spatiotemporal scan statistics identified a pattern of narrowing spatial range and increasing clustering intensity. Three clusters involving 31 townships were identified during 2014-2018, while two clusters involving 13 townships were identified during 2019-2023, centered in the Dongchuan Township of Yao'an County (log-likelihood ratio=476.245, P<0.001, relative risk=19.51) and the Ziwu Township of Chuxiong City (log-likelihood ratio=19.739, P<0.001, relative risk=3.25), respectively. The SARIMA(1,0,0)(0,1,2)12 model predicted that the HFRS epidemic would remain at a relatively high level in 2024. Conclusions The HFRS epidemic in Chuxiong Prefecture shows an increasing trend with significant spatiotemporal clustering. Comprehensive prevention and control measures should be implemented in key areas.
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