2013年江苏省食源性非伤寒沙门菌疾病负担研究

目的估计江苏省食源性非伤寒沙门菌发病情况及疾病负担。方法根据全省监测点哨点医院主动监测和社区人群急性胃肠炎入户调查,采用疾病负担研究金字塔法,计算食源性非伤寒沙门菌疾病负担。结果 2013年采集感染性腹泻标本6 775例,检出非伤寒沙门菌113株,检出率为1.67%;入户调查10 802人,急性胃肠炎月发病率为4.43%,年发病率为0.59次/人年,病例就诊率为45.09%,标本采集率为45.37%;推算出江苏省2013年食源性非伤寒沙门菌疾病负担是454 614例病例。结论非伤寒沙门菌是重要的食源性致病菌,可造成较重的疾病负担。     

杭嘉湖地区食源性副溶血性弧菌、非伤寒沙门菌发病率的研究

目的了解杭州、嘉兴、湖州(简称"杭嘉湖")地区副溶血性弧菌、非伤寒沙门菌导致的食源性疾病发病率,了解该两种致病菌感染所造成的该地区人群疾病负担。方法对杭嘉湖地区食源性疾病哨点医院主动监测和社区人群急性胃肠炎调查结果进行分析,根据《2013年国家食源性疾病监测工作手册》规定的方法对腹泻病例样本进行副溶血性弧菌、非伤寒沙门菌检测,综合社区人群急性胃肠炎发病率及各项乘数,计算杭嘉湖地区食源性副溶血性弧菌、非伤寒沙门菌的发病率。结果杭嘉湖地区哨点医院2013年累计采集6 346例腹泻病例粪便或者肛拭样本,检出副溶血性弧菌阳性菌株292株、非伤寒沙门菌阳性菌株145株,检出率分别为4.60%和2.28%;调查9 548例,杭嘉湖地区急性胃肠炎月患病率为2.95%(95%CI:2.61%~3.29%),年发病率为0.39次/人年(95%CI:0.34次/人年~0.43次/人年);感染低估系数为1 002.84,推算出杭嘉湖地区副溶血性弧菌和非伤寒沙门菌的食源性感染发病率分别为1 220.27/10万、837.64/10万。结论副溶血性弧菌和非伤寒沙门菌食源性感染造成浙江省杭嘉湖地区较为严重的疾病负担,应加强以实验室为基础的食源性疾病主动监测。     

南京市主要细菌性病原体食源性疾病负担研究

目的 研究南京市主要细菌性病原体致食源性疾病负担,提出食源性疾病监测策略。方法 根据南京市11个区17家食源性疾病哨点医院主动监测和食源性疾病负担调查结果,结合各主要细菌性病原体的食源性比例等各项乘数,获得人群中各主要细菌性病原体的发病率及疾病负担。结果 2015年全市共采集1 208份食源性疑似病例生物标本,检出非伤寒沙门氏菌31株、副溶血性弧菌20株、致泻大肠埃希氏菌15株,检出率分别为2.57%、1.66%、2.56%;全市疾病负担调查3 600人,急性胃肠炎的月患病率为3.9%,年发病率为0.55次/人年;推算出南京市非伤寒沙门氏菌食源性感染发病率为1 292/10万,0~4岁年龄组发病率最高(3 481/10万);副溶血性弧菌食源性感染发病率为619/10万,15~24岁年龄组发病率最高(2 076/10万),致泻性大肠埃希氏菌的食源性感染发病率为1 653/10万,5~14岁年龄组发病率最高(5 263/10万)。结论 南京市非伤寒沙门氏菌、副溶血性弧菌、致泻性大肠埃希氏菌感染负担较重,儿童非伤寒沙门氏菌和致泻性大肠埃希氏菌、青壮年副溶血性弧菌的感染负担尤为突出,针对不同人群加强相应病原体的监测,同时应进一步完善相关监测及研究,为制定相应的风险控制措施提供科学依据。     

用文献综述法估计我国食源性非伤寒沙门氏菌病疾病负担

目的估计我国食源性非伤寒沙门氏菌病造成的疾病负担,为我国食源性疾病主动监测网络的建立提供依据。方法利用文献综述方法估计我国急性腹泻发病率以及腹泻人群中非伤寒沙门氏菌的比例,利用食源性疾病监测网获得非伤寒沙门氏菌感染患者的腹泻发生比例,利用文献综述获得非伤寒沙门氏菌的食源性比例。综合腹泻发病率及各项乘数获得食源性非伤寒沙门氏菌病的发病率。利用卫生部第三次死因调查报告及文献资料,估计非伤寒沙门氏菌导致的死亡病例。结果 2000-2009年,每年因非伤寒沙门氏菌导致急性腹泻823.5万人次,导致急性胃肠炎病例估计为987.4万人次。利用食源性比例91.5%,估计我国食源性非伤寒沙门氏菌病每年发病约903.5万人次,每年死亡估计792人。结论在我国非伤寒沙门氏菌是重要的食源性致病菌,可能造成较重的疾病负担。我国非伤寒沙门氏菌感染占急性胃肠炎的比例与发达国家类似,病死率低于美国、新西兰,文献综述的方法与国外的科学设计仍有一定差距,应加强我国食源性疾病主动监测网的建立,完善实验室监测网络。     

北京市食源性胃肠炎的疾病负担

目的 了解北京市食源性胃肠炎的疾病负担,为食源性疾病的防治提供依据。方法 采用多阶段分层随机抽样方法,选取北京市6个监测地区内9885人,进行入户面对面调查,了解其过去4周急性胃肠炎的发病、就诊情况以及因急性胃肠炎产生的各类费用,计算急性胃肠炎的疾病负担;根据文献报道的急性胃肠炎的食源性比例,推算食源性胃肠炎疾病负担。结果 急性胃肠炎的年发病率为0.15次/人年(95%CI 0.13～0.16),估算调查期间北京市食源性胃肠炎发病人数为911 975人次。每年约有290 190人次就诊,9120人住院。北京市食源性胃肠炎的总经济负担为1.47亿元,约占全市年生产总值的0.07‰;其中直接费用1.07亿元(医疗费用0.94亿元,非医疗费用0.12亿元),间接费用0.40亿元。结论 北京市人群食源性胃肠炎的疾病负担不容忽视,应进一步完善食源性疾病主动监测体系,更准确地评估食源性疾病对社会和健康造成的影响。     

实用儿科诊疗规范——儿科：感染性疾病（五）——第二节 细菌感染 非伤寒沙门菌感染

1概述 非伤寒沙门菌感染是指伤寒、副伤寒以外的沙门菌引起的急性感染性疾病，简称沙门菌感染。近10余年来，沙门菌感染明显增加，多见于婴幼儿。本病主要通过粪-口途径传播，任何年龄均可患病。细菌内毒素为主要的致病因素，有些沙门菌可产生肠毒素。临床表现分为胃肠炎型、败血症型和伤寒型三型。     

综合医院非伤寒沙门菌感染腹泻患者病原学分析

目的了解综合医院腹泻患者非伤寒沙门菌感染情况,分析非伤寒沙门菌的血清分型、耐药性和分子特征。方法对2009年9月-2011年6月腹泻病患者送检的767份粪便标本进行非伤寒沙门菌检测,对分离到的菌株进行血清分型、药物敏感性试验和脉冲场凝胶电泳(PFGE)分型。结果从767份腹泻粪便标本中分离到36株非伤寒沙门菌,阳性检出率为4.56%;以儿童为主,占65.71%;共分为10种血清型,主要以鼠伤寒沙门菌和肠炎沙门菌为主,分别占37.14%和28.57%;10个血清型非伤寒沙门菌对头孢类和环丙沙星的敏感率>84.00%,除斯坦利沙门菌和山夫登宝沙门菌外,其他血清型均对多种抗菌药物产生不同程度的耐药或交叉耐药;将13株鼠伤寒沙门菌和10株肠炎沙门菌共分离出19个PFGE分型,其中2株肠炎沙门菌PFGE同型,3株鼠伤寒沙门菌PFGE同型,存在不同耐药谱。结论综合医院引起感染性腹泻的非伤寒沙门菌主要为鼠伤寒沙门菌和肠炎沙门菌,儿童多见;非伤寒沙门菌多药耐药严重,临床在应用氟喹诺酮类治疗非肠外沙门菌属感染时,应根据药敏结果慎重选择。     

江苏省伤寒/副伤寒流行现况、菌株耐药及其分子分型

目的 掌握江苏省伤寒/副伤寒流行现况、病原菌耐药性以及分子分型特征,以确定监测重点.方法 对2007-2011年江苏省伤寒/副伤寒疫情采用描述流行病学回顾性分析;210株伤寒/副伤寒沙门菌耐药性测定采用K-B纸片扩散法;81株伤寒沙门菌分子分型运用脉冲场凝胶电泳(PFGE).结果 近5年江苏省伤寒/副伤寒年均报告发病率为0.47/10万,呈总体下降趋势.人群年龄别发病以0岁组(1.70/10万)高发.病原谱以伤寒沙门菌为主(66.19%),其次为甲型副伤寒沙门菌(23.81%).伤寒/副伤寒沙门菌对萘啶酸耐药率最高(66.19%),对环丙沙星等6种抗生素耐药率低于10.00%,多重耐药率为30.00%.近3年伤寒沙门菌分属4个克隆群37个PFGE型,优势带型为JPPX01.JS0027(11.11%),JPPX0 1.JS0001为地区独特性菌型,JPPX01.JS0014、JPPX01.JS0018和JPPX01.JS0024为扩散性菌型.特征菌型成簇分析发现3起病例具有聚集性特征.结论 江苏省伤寒/副伤寒发病率维持在较低水平,婴儿高发.菌株对多数抗生素较敏感,但部分药物耐药性在增加.由于近年伤寒呈现高度散发状态,未出现占绝对优势的菌型,推测近期发生大规范流行的可能性较小.     

上海市虹口区2010—2012年腹泻病例沙门菌监测及分子型特征

[目的]研究基于公共卫生实验室主动监测哨点医院沙门菌腹泻及优势菌型的耐药性和分子型特征。[方法]选择辖区内2家医院作为主动监测哨点,甄别食源性感染性腹泻的病例并采集粪便标本进行沙门菌培养、血清型鉴定和抗菌药物耐药性试验,通过脉冲场凝胶电泳（ PFGE ）分析优势菌型的遗传同源性。[结果]2010—2012年,共检测2579份标本,分离沙门菌185株（年度阳性率分别为9．1％、6．8％、5．1％,总阳性率为7．2％）,涵盖23种不同血清型,最常见的为肠炎和鼠伤寒沙门菌。所有沙门菌感染病例的男女性别比为0．9∶1;肠炎和鼠伤寒沙门菌感染均以21～60岁（68．9％）和60岁以上（21．4％）者居多。肠炎和鼠伤寒沙门菌对萘啶酸、磺胺异噁唑、链霉素、甲氧嘧啶、庆大霉素、四环素等6种抗菌药物的耐药率分别为27．7％～96．9％和2．6％～63．2％,且肠炎沙门菌的耐药率显著高于鼠伤寒沙门菌（P值均＜0．05）。22株肠炎和20株鼠伤寒沙门菌经PFGE各自分为11个和6个分子型。[结论]肠炎和鼠伤寒是区域内最常见的沙门菌腹泻菌型,分子分型提示存在优势克隆的聚集性爆发和分散爆发,应警惕多重耐药的肠炎沙门菌克隆株形成潜在爆发的风险。加强以实验室为基础的主动监测对控制食源性感染性腹泻具有重要的公共卫生意义。     

玉林市婴幼儿腹泻感染非伤寒沙门菌分子分型和耐药情况分析

目的了解婴幼儿感染的非伤寒沙门菌的分子分型和耐药情况。方法收集了2018年玉林市中医医院综合儿科门诊3岁以下腹泻患儿401份粪便标本,按照《2018年食源性疾病监测工作手册》进行沙门菌增菌、分离鉴定、分子分型及药物敏感试验。同时,把检出优势的非伤寒沙门菌血清型通过脉冲场凝胶电泳分析技术(PFGE)进行分子分型;把优势血清型与其他血清型沙门菌的药敏结果进行比对来了解其不同之处。结果腹泻患者共分离出29株非沙伤寒沙门菌,检出率为7.2%(29/401)。血清型主要为鼠伤寒沙门菌,占非伤寒沙门菌总数的62.1%(18/29)。18株鼠伤寒沙门菌可分为17个PFGE型别,其中2株为同一PFGE型,4株PFGE带型相近。药敏结果显示所有非伤寒沙门菌菌株均对亚胺硫霉素、头孢西丁、环丙沙星、氨苄西林/舒巴坦、阿奇霉素敏感,对其余9种抗菌药物产生不同程度的耐药。29株非伤寒沙门菌总体耐药率为96.6%(28/29),其中氨苄西林耐药率为86.2%(25/29),四环素为75.9%(22/29),氯霉素为69.0%(20/29),甲氧苄氨嘧啶/磺胺甲噁唑为62.1%(18/29)。鼠伤寒沙门菌四环素耐药率高于其他血清型非伤寒沙门菌四环素耐药率;多重耐药方面:鼠伤寒沙门菌以4、5种耐药占比大,1或2种耐药占比较少,尤其是2种耐药比率明显低于其他血清型非伤寒沙门菌(P值=0.014)。结论婴幼儿感染的非伤寒沙门菌部分菌株高度同源且耐药情况相当严重。     

The human health burden of foodborne infections caused by Campylobacter, Salmonella, and Vibrio parahaemolyticus in Miyagi Prefecture, Japan

To estimate the human health burden of foodborne infections caused by Campylobacter, Salmonella, and Vibrio parahaemolyticus in Japan, an epidemiological study was conducted in Miyagi Prefecture. Laboratory-confirmed infections among patients with diarrhea caused by the three pathogens were ascertained from two clinical laboratories in the prefecture from April 2005 to March 2006. To estimate the number of ill persons who were not laboratory-confirmed, we estimated physician-consultation rates for patients with acute diarrhea by analyzing foodborne outbreak investigation data for each pathogen and the frequency at which stool specimens were submitted from a physician survey. Each factor was added to a Monte-Carlo simulation model as a probability distribution, and the number of laboratory-confirmed cases was extrapolated to estimate the total number of ill persons. The estimated incidence of foodborne infections per 100,000 per year in this region estimated by this model was 237 cases for Campylobacter, 32 cases for Salmonella, and 15 cases for V. parahaemolyticus. Simulated results indicate a significant difference between our estimated incidence and the reported cases of food poisoning in this region. An enhanced surveillance system is needed to complement the present passive surveillance on foodborne illnesses in Japan to identify food safety issues more precisely, and to monitor the effectiveness of risk management options.     

Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--selected sites, United States, 2003

In the United States, an estimated 76 million persons contract foodborne and other acute diarrheal illnesses each year. CDC's Emerging Infections Program Foodborne Diseases Active Surveillance Network (FoodNet) collects data on diseases caused by enteric pathogens transmitted commonly through food in nine U.S. sites. FoodNet quantifies and monitors the incidence of these infections by conducting active surveillance for laboratory-diagnosed illness. This report describes preliminary surveillance data for 2003 and compares them with 1996-2002 data. The data indicate substantial declines in the incidence of infections caused by Campylobacter, Cryptosporidium parvum, Escherichia coli O157, Salmonella, and Yersinia enterocolitica. These data represent progress toward meeting the 2010 national health objectives of reducing the incidence of foodborne infections (objective nos. 10.1a, 10.1b, and 10.1d). However, increased efforts are needed to reduce further the incidence of foodborne illnesses, particularly among children.     

Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 sites, United States, 2004

Foodborne illnesses are a substantial health burden in the United States. The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program collects data from 10 U.S. sites on diseases caused by enteric pathogens transmitted commonly through food. FoodNet quantifies and monitors the incidence of these infections by conducting active, population-based surveillance for laboratory-diagnosed illness. This report describes preliminary surveillance data for 2004 and compares them with baseline data from the period 1996-1998. The 2004 data indicate declines in the incidence of infections caused by Campylobacter, Cryptosporidium, Shiga toxin-producing Escherichia coli (STEC) O157, Listeria, Salmonella, and Yersinia. Declines in Campylobacter and Listeria incidence are approaching national health objectives (objectives 10-1a through 1d); for the first time, the incidence of STEC O157 infections in FoodNet is below the 2010 target. However, further efforts are needed to sustain these declines and to improve prevention of foodborne infections; efforts should be enhanced to reduce pathogens in food animal reservoirs and to prevent contamination of produce.     

Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 States, United States, 2005

Foodborne illnesses are a substantial health burden in the United States. The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program collects data from 10 U.S. states regarding diseases caused by enteric pathogens transmitted commonly through food. FoodNet quantifies and monitors the incidence of these infections by conducting active, population-based surveillance for laboratory-confirmed illness. This report describes preliminary surveillance data for 2005 and compares them with baseline data from the period 1996-1998. Incidence of infections caused by Campylobacter, Listeria, Salmonella, Shiga toxin-producing Escherichia coli O157 (STEC O157), Shigella, and Yersinia has declined, and Campylobacter and Listeria incidence are approaching levels targeted by national health objectives. However, most of those declines occurred before 2005, and Vibrio infections have increased, indicating that further measures are needed to prevent foodborne illness.     

Incidence of self-reported acute gastrointestinal infections in the community in Poland: a population-based study

A retrospective cross-sectional survey of self-reported acute gastrointestinal infection (AGI) incidence in the community was performed in Poland, from December 2008 to November 2009. The aim of the study was to estimate the magnitude and distribution of self-reported AGI, in order to calibrate the routine AGI surveillance system in Poland. The study population were randomly selected residents of all Polish regions, having a fixed telephone line. An equal number of telephone interviews were collected each month, requesting the interviewee to identify gastrointestinal symptoms that had occurred in the previous 4 weeks. The international AGI case definition was used. In total 3583 complete interviews were obtained. The compliance ratio was 26%. Of 3583 respondents, 240 (6.7%) individuals fulfilled the AGI case definition. The annualized incidence of acute gastroenteritis was 0.9/person-year (95% confidence interval 0.8-1.0). Comparison of the obtained annual AGI estimate (33.3 million infections) with the number of cases reported to national surveillance during the corresponding period (73 512), yielded an underreporting factor of 453 cases occurring in the community for each reported case. Of the 240 AGI cases, 30.4% consulted a general practitioner, and 4.6% were admitted to hospital. Samples for microbiological confirmation were collected from four (1.6%) cases. This first population-based study in eastern Europe has confirmed that AGI places a high burden on Polish society, which is underestimated by national surveillance data. Efforts are necessary to improve AGI reporting and diagnostic practices in order to increase the effectiveness of the Polish surveillance system in detecting threats related to new AGI pathogens, new routes of transmission or the potential for international spread.     

Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 states, 2006

Foodborne illnesses are a substantial health burden in the United States. The Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program collects data from 10 U.S. states regarding diseases caused by enteric pathogens transmitted commonly through food. FoodNet quantifies and monitors the incidence of these infections by conducting active, population-based surveillance for laboratory-confirmed illnesses. This report describes preliminary surveillance data for 2006 and compares them with baseline data from the period 1996-1998. Incidence of infections caused by Campylobacter, Listeria, Shigella, and Yersinia has declined since the baseline period. Incidence of infections caused by Shiga toxin-producing Escherichia coli O157 (STEC O157) and Salmonella, however, did not decrease significantly, and Vibrio infections have increased, indicating that further measures are needed to prevent foodborne illness and achieve national health objectives.     

Preliminary FoodNet data on the incidence of foodborne illnesses--selected sites,United States, 2002

In the United States, an estimated 76 million persons contract foodborne illnesses each year. CDC's Emerging Infections Program Foodborne Diseases Active Surveillance Network (FoodNet) collects data on 10 foodborne diseases in nine U.S. sites. FoodNet follows trends in foodborne infections by using laboratory-based surveillance for culture-confirmed illness caused by several enteric pathogens commonly transmitted through food. This report describes preliminary surveillance data for 2002 and compares them with 1996-2001 data. The data indicate a sustained decrease in major bacterial foodborne illnesses such as Campylobacter and Listeria, indicating progress toward meeting the national health objectives of reducing the incidence of foodborne infections by 2010 (objectives 10-1a to 10-1d). However, the data do not indicate a sustained decline in other major foodborne infections such as Escherichia coli O157 and Salmonella, indicating that increased efforts are needed to reduce further the incidence of foodborne illnesses.     

2016 - 2017年成都市学生及家庭成员急性胃肠炎疾病负担情况调查

目的 了解成都市学生及家庭成员急性胃肠炎的患病情况和流行趋势,为建立和完善食源性疾病预测预警体系提供科学依据。方法 以学校为切入点,采用多阶段分层抽样方法抽取调查对象,于2016 - 2017年分4个季节对成都市17万余名学生及家庭成员,以自填问卷的形式了解调查对象4周内急性胃肠炎的发病情况、就诊情况等。结果 成都市学生及家庭成员急性胃肠炎月患病率为4.46%,年患病率为0.53次/人年。学龄期儿童青少年（7.61%）患病率高于学龄前期（5.17%）,老年期（3.34%）高于成年期（2.88%）,郊区（4.94%）高于城区（4.02%）,夏季（6.52%）高于其他季节,差异均具有统计学意义（P＜0.05）;发病人群中,有53.31%的人接受治疗;在急性胃肠炎的治疗中,家庭成员（13.06%）抗生素使用频率高于学生（10.92%）,差异具有统计学意义（P＜0.05）。结论 成都市学生及家庭成员急性胃肠炎负担较重,建议开展进一步研究来准确评估成都市急性胃肠炎的负担及其食源性比例。