登革熱流行病學－登革熱在台灣的流行

Epidemiology of Dengue Fever in Taiwan

葛應欽(Ying-Chin Ko)

《The Kaohsiung Journal of Medical Sciences》 5卷1期 (1989/01) Pp. 1-11

https://doi.org/10.6452/KJMS.198901.0001

摘要

登革熱 (dengue或dengue fever)是由登革病毒引起的傳染病，又名斷骨熱 (break bone fever)。從前在台灣民間稱為斑疹或天狗熱。近100多年來，在台灣曾有週期性的流行，但自1942年造成全島性流行之後，幾乎未見報告病列。直到1981年才在屏東縣琉球鄉再度出現爆發病例，侵襲率為80%，且由實驗室証實分離出病毒株為登革2型病毒。此後在1987年秋季於高屏地區爆發流行，至年底有1387位報告病例，其中以高雄市三民區報告病例最多 (約500位)，指標病例在9月初於該區發現，該區累積發生率為0.2%，但調查侵襲率估計為2.9%。病毒分離結果顯示，除了5位病例為登革2型病毒感染之外，其餘皆為登革1型病毒。於1988年又繼續造成更擴大的流行，估計到11月底報告病例將超過10,000位。以高雄市報告病例為主，佔50%以上，高雄市累積發生率為0.5%，但根據調查成人的侵襲率在5%上上。症狀輕微及不明顯感染者，估計應在數倍，但仍可能有不少易感染人群。病毒分離仍然是登革1型病毒，但也有2位是登革4型病毒，換言之，至1988年11月中旬，在台灣地區至少已有登革1、2、4型等3種登革病毒型在循環。
分析登革熱爆發流行的相關因素，初步結果顯示高密度人口具有較高相對危險度。此外，在埃及斑蚊密度、降雨量均與登革熱積發生率有正相關，以逐步複迴歸分析，發現前一個月的降雨量為最佳可預測解釋登革熱傳染的高峯。
因控制疫情效果不彰，且尚有眾多的易感染人群，預計隔年雨季來臨仍會造成蔓延流行。

並列摘要

Dengue fever, a tropical communicable disease, is caused by an infectious viral disease. It is also known as break bone fever. There have been a number of epidemics over the last century in Taiwan. Following an islandwide epidemic in 1942, dengue fever had not been presented on the island for about forty years. In 1981, an outbreak of dengue occurred in Liuchiu Hsiang, a small off-shore island of Pingtung county. The estimated attack rate was 80%. DEN-2 was isolated during that outbreak. Another occurrence occurred in the fall of 1987 in the southern part of Taiwan. The accumulated reported cases reached 1,387 at the end of that year. A majority of cases were reported in the Sanmin district of Kaohsiung city. The reported cumulative incidence was 0.2% in Sanmin. However, according to one survey, the attack rate in that area was 2.9%. DEN-1 was most commonly isolated but DEN-2 was also found in five cases. The lastest outbreak took place in 1988. The estimation of reported cases exceeded 10,000 at the end of November, 1988. Two cases of dengue haemorrhagic fever were confirmed. More than fifty percent of the report case came from Kaohsiung city. The reported cumulative incidence rate was 0.5% in that area. Another survey reported that the adult attack rate exceeded 5% in the same area. It is estimated that the number of patients with mild symptoms and those without any symptoms would be a few times more than the number of those actually reported. However, a large space of herd immunity for susceptible hosts has remained. DEN-1 was isolated from all of the reported cases except two in which DEN-4 were isolated.
Among the various variables which would effect the proliferation of disease, such as Aedes aegypti density, precipitation, and temperature, only a prior month of precipitation can explain the outbreak of dengue by stepwise multiple regression. Besides this, there was also a higher relative risk due to a higher population density with a trend correlation. Because of the ineffectiveness of the present control program, it is predicted that there may be yet another outbreak in the following year effecting those susceptible when the rainfall season comes.

並列關鍵字

dengue fever ； Aedes aegypti ； Aedes albopictus