2010-2018年四川省沙门菌食源性疾病暴发分析

目的 分析2010-2018 年四川省沙门菌所致的食源性疾病暴发事件的流行病学特征,为制定防控策略和干预措施提供依据。方法 对2010-2018年四川省各级疾控中心上报的沙门菌引起食源性疾病暴发资料进行回顾性分析。结果 2010-2018年四川省共上报124起由沙门菌引起的暴发,患病人数1 514人。其中由皮蛋引起的起数最多为72起,占58.06%;有93起发生5~8 月,占75%;发生场所在家庭最多为79起,占63.71%。结论 四川省沙门菌引起的食源性疾病暴发高发场所是家庭,主要的原因食品皮蛋,应广泛开展个人卫生和高危食品皮蛋食用的宣传教育,以有效防控沙门菌引起食源性疾病暴发。     

Egg-related Salmonella enteritidis, Italy, 1991

In recent years, Salmonella enteritidis has become an increasingly important public health problem in Italy. In some parts of the country, the fraction of total human salmonella isolates accounted for by S. enteritidis has risen from 3-4% in the mid-1980s to more than 30% in 1990. Between 1990 and 1991, the number of reported S. enteritidis outbreaks increased more than sixfold. The 33 outbreaks reported in 1991 occurred in seven contiguous regions in northern and central Italy and were clustered in time between June and October; in the majority, products containing raw or undercooked shell eggs were implicated. Five of the egg-related outbreaks that occurred within a 30 kilometre radius over a 7-week period were investigated in detail. A phage type 1 strain containing a 38·9 MDa plasmid appeared responsible for three of the outbreaks, while in the remaining two a phage type 4 strain, also with a 38·9 MDa plasmid was isolated. Efforts are being made to enhance epidemiological surveillance and laboratory evaluation, and the use of pasteurized eggs has been recommended for high-risk populations.     

Food borne disease outbreaks caused by Salmonella enteritidis

OBJECTIVE: It is to describe outbreaks of salmonellosis reported from July 1993 through June 1997 in the Northwest region of S. Paulo State, Brazil, one of the areas where several foodborne outbreaks of salmonellosis have been recently detected. METHOD: Data of 19 epidemiological investigations were analysed; 87 stool specimens and 38 food samples (including 12 of shell eggs) were processed for microbiological analysis. Salmonella strains were identified by serotyping, phagetyping and antimicrobial susceptibility testing. RESULTS: There were 906 ill persons including 295 hospitalized patients. Phage type 4 (PT 4) Salmonella Enteritidis strains were isolated from 80.5% of stool samples, from all food samples and from 41.7% of eggs. Of the outbreaks, 95.7% were associated with the consumption of food containing raw or undercooked eggs. All strains were susceptible to the 13 antimicrobials, except the strains from the nosocomial outbreak. CONCLUSIONS: The results obtained show the need for the implementation of control measures regarding egg and storage, as well as for guidance to the public as to the risks involved in the consumption of inadequately prepared eggs.     

2010-2018年四川省家庭内食源性疾病暴发事件分析

目的 了解四川省家庭内食源性疾病暴发事件的流行病学特征,为相关部门制定相应的预防控制措施提供科学依据。〖HTH〗方法 收集2010-2018年四川省食源性疾病暴发监测系统中报告的家庭内食源性疾病暴发事件的数据进行分析。〖HTH〗结果 2010-2018年全省共报告家庭内食源性疾病暴发事件645起,发病3154人,死亡46人。菌类及其制品中因毒蘑菇引起的事件数最多,有337起(61.50%);其次是蛋与蛋制品被沙门氏菌污染所致事件数,有66起(12.04%);其他植物类因其他植物毒素引起的事件数居第3位有19起(3.47%)。引起死亡的致病因素主要是毒蘑菇、亚硝酸盐和河鲀毒素,分别占50.00%、30.43%和6.52%。2018年各发生一起因误食白果和蟾蜍死亡的事件。引发事件原因的环节主要是自采占45.53%,引发事件原因的因素主要是误食误用占64.69%。〖HTH〗结论 建议进一步加强健康教育,提高人们对野生蘑菇、来路不明的食盐、白糖、鱼干等海产品、自制蛋与蛋制品、白果和蟾蜍危害的认识,相关部门要加强市场上对这些食品的监督检查,加强餐饮服务环节禁用亚硝酸盐的宣传和监督,通过培训提高医疗救治和现场处置能力。     

Foodborne disease outbreaks, 5-year summary, 1983-1987

This report summarizes data from foodborne disease outbreaks reported to CDC from 1983 through 1987. With a few exceptions, an outbreak is defined as an incident in which two or more persons experience a similar illness and food is implicated. During this period, 2,397 outbreaks of foodborne disease were reported, representing 91,678 cases. Among outbreaks in which the etiology was determined, bacterial pathogens caused the largest number of outbreaks (66%) and cases (92%). Chemical agents caused 26% of outbreaks and 2% of cases. Parasites caused 4% of outbreaks and less than 1% of cases, and viruses caused 5% of outbreaks and 5% of cases. The discrepancies between the number of outbreaks and the number of cases attributed to each etiologic agent emphasizes the importance of evaluating both numbers before drawing conclusions. The etiologic agent was not determined in 62% of outbreaks, reflecting the need for improved investigative skills. The number of outbreaks reported by this surveillance system is only a small fraction of the true number that occur. The likelihood of an outbreak's being reported depends on many factors, such as ease of recognition and ease of laboratory confirmation. Sporadic foodborne illness is far more common and is not included in this report.     

Foodborne disease outbreaks in Australia, 1995 to 2000.

Health agencies are increasingly conducting systematic reviews of foodborne disease outbreak investigations to develop strategies to prevent future outbreaks. We surveyed state and territory health departments to summarise the epidemiology of foodborne disease outbreaks in Australia from 1995 to 2000. From 1995 through 2000, 293 outbreaks were identified, with 214 being of foodborne origin. One hundred and seventy-four (81%) had a known aetiology, and accounted for 80 per cent (6,472/8,124) of illnesses. There were 20 deaths attributed to foodborne illness. Of the 214 outbreaks, bacterial disease was responsible for 61 per cent of outbreaks, 64 per cent of cases and 95 per cent of deaths. The most frequent aetiology of outbreaks was Salmonella in 75 (35%) outbreaks, Clostridium perfringens in 30 (14%), ciguatera toxin in 23 (11%), scombrotoxin in 7 (3%) and norovirus in 6 (3%). Salmonellosis was responsible for eight of the 20 (40%) deaths, as was Listeria monocytogenes. Restaurants and commercial caterers were associated with the highest number of outbreak reports and cases. Outbreaks in hospitals and aged care facilities were responsible for 35 per cent of deaths. The most frequently implicated vehicles in the 173 outbreaks with known vehicles were meats 64 (30%), fish 34 (16%), seafood 13 (6%), salad 12 (6%), sandwiches 11 (5%) and eggs 9 (4%). Chicken, the most frequently implicated meat, was associated with 27 (13%) outbreaks. This summary demonstrates the serious nature of foodborne disease and supports the move to risk-based food safety interventions focusing on mass catering and hospital and aged care facilities.     

2010-2018年四川省有毒动植物性食源性疾病暴发事件分析

目的 了解四川省有毒动植物性食源性疾病暴发事件的发生规律及流行病学特点,为制定相应的预防和控制措施提供科学依据。方法 对2010-2018年食源性疾病暴发监测系统中报告的有毒动植物性食源性疾病暴发事件的流行病学特征进行描述性分析。结果 2010-2018年全省共报告有毒动植物性食源性疾病暴发事件151起,发病1020人,死亡8人,病死率为0.78%,年平均发病率为每百万人口1.4人;5月事件数最多,占21.19%,成都市的事件数最多,占19.87%,雅安市年平均发病率最高为每百万人口8.1人;家庭是主要的疾病暴发场所,占51.66%;引起有毒植物中毒前三位的是豆类、曼陀罗和桐油与油桐籽,分别占21.19%、13.25%和11.26%,川乌草乌附子的死亡人数最多,占25.00%;引起有毒动物中毒最多的是织纹螺,占1.32%,河豚鱼干的死亡人数最多,占37.50%;主要引发事件的环节和因素分别是自采(54.76%)和误食误用(67.97%)。结论 要在重点季节加强对重点地区、重点人群的健康教育,相关部门要加强市场监管,通过培训提高医务工作者抢救有毒动植物中毒患者的能力。     

Foodborne disease outbreaks of chemical etiology in the United States, 1970-1974

In the United States between 1970 and 1974 there was an increase each year both in the absolute number of foodborne diseases outbreaks of chemical etiology reported to the Center for Disease Control and in the proportion of these outbreaks in the total reported foodborne disease outbreaks. Nearly half (48.9%) of these foodborne disease outbreaks of chemical origin were caused by toxic fish or shellfish. Of the rest, 16.5% were caused by poisonous mushrooms, 10.9% by heavy metal poisoning, 7.2% by excessive use in food of monosodium glutamate (the etiologic agent of Chinese Restaurant Syndrome) and 16.5% by miscellaneous chemicals. Practices that contributed to the occurrence of these outbreaks included the inadvertent selection for consumption of toxic fish, shellfish, or mushrooms, storage of fish at improper temperatures, storage of acidic liquids in metal containers, and addition of excessive amounts of monosodium glutamate to foods. Commercially-processed foods were responsible for outbreaks of scombroid fish poisoning, shellfish poisoning, and heavy metal poisoning. Because outbreaks of chemical etiology due to contaminated commercial products do occur, prompt recognition and reporting of outbreaks to public health personnel are essential so that epidemiologic investigations can be conducted and effective control measures promptly initiated.     

Foodborne outbreaks of campylobacteriosis: the United States experience, 1980-1982

During 1980-1982, 23 foodborne outbreaks of diseases caused by Campylobacter were reported to the Centers for Diseases Control through the National Foodborne Surveillance Program, which collects reports from state and territorial epidemiologists throughout the United States. These outbreaks involved 748 ill persons, of whom 4% were hospitalized. For outbreaks with six or more ill persons, the median attack rate was 41%, the mean or median incubation periods ranged from 66 to 120 hours, and the mean duration of symptoms ranged from three to seven days. Raw milk was implicated or suspected in 14 outbreaks. In four of the other outbreaks, food handling errors were identified, and in five outbreaks, poultry, eggs, or beef were implicated or suspected. In three of four outbreaks in which Campylobacter was recovered from cows at the implicated dairies, some isolates from cows were serotypically identical to isolates from ill persons. In one egg-associated outbreak, one of the isolates of Campylobacter recovered from hens at the implicated egg farm was serotypically identical to an isolate recovered from an ill person. These findings underscore the hazard of eating undercooked or raw foods of animal origin such as raw milk. Raw milk contaminated by infected cows is a major cause of foodborne campylobacteriosis in the United States.     

Increase in poisoning deaths caused by non-illicit drugs--Utah, 1991-2003

Deaths caused by drug poisoning of unintentional and undetermined intent are an increasing problem in Utah and elsewhere in the United States. To characterize the trend in drug-poisoning deaths in Utah, CDC and the Utah Department of Health analyzed medical examiner (ME) data for 1991-1998 and 1999-2003. This report summarizes the results of that analysis, which determined that, during 1991-2003, the number of Utah residents dying from all drug poisoning increased nearly fivefold, from 79 deaths in 1991 (rate: 4.4 per 100,000 population) to 391 deaths in 2003 (rate: 16.6). This increase has been largely the result of the tripling of the rate (from 1.5 during 1991-1998 to 4.4 during 1999-2003) in poisoning deaths of unintentional or undetermined intent caused by non-illicit drugs (i.e., medications that can be legally prescribed). Further study is needed to understand these trends and to develop strategies to prevent deaths of unintentional or undetermined intent from non-illicit drug poisoning.     

Hospitalization and antimicrobial resistance in Salmonella outbreaks, 1984-2002

Few studies have evaluated the health consequences of antimicrobial-resistant Salmonella strains associated with outbreaks. Among 32 outbreaks occurring in the United States from 1984 to 2002, 22% of 13,286 persons in 10 Salmonella-resistant outbreaks were hospitalized, compared with 8% of 2,194 persons in 22 outbreaks caused by pansusceptible Salmonella strains (p<0.01).     

2006年中国食源性疾病暴发的监测资料分析

目的分析2006年中国食源性疾病暴发事件的流行病学特征。方法对全国食源性疾病监测网收集的2006年食源性疾病资料进行统计分析。结果2006年,18个监测地区共上报594起食源性疾病暴发事件,累计发病13849人,死亡67人。在病因清楚的事件中,微生物引起的食源性疾病暴发事件数和患者数最多,分别占48.3%和63.3%;化学物引起的暴发事件数和患者数分别占24.8%和15.5%;动植物引起的暴发事件数和患者数分别占23.5%和17.7%。结论全国食源性疾病监测网发现,微生物性食源性疾病是中国重要的公共卫生问题,今后仍然需要强化食源性疾病的报告意识。     

Chikungunya outbreaks caused by African genotype, India

Chikungunya fever is reported in India after 32 years. Immunoglobulin M antibodies and virus isolation confirmed the cause. Phylogenic analysis based on partial sequences of NS4 and E1 genes showed that all earlier isolates (1963-1973) were Asian genotype, whereas the current and Yawat (2000) isolates were African genotype.     

Antimicrobial resistance in Salmonella enteritidis, southern Italy, 1990-1998

During 1990 to 1998, we identified multidrug-resistant isolates of Salmonella Enteritidis in southern Italy. Plasmids containing class I integrons and codifying for synthesis of extended- spectrum beta-lactamases were detected. Active surveillance for resistance to antimicrobial agents is needed to guard against the possible spread of resistant clones.     

2012-2014年广东省哨点医院诺如病毒GII.4 Sydney变异株流行状况及暴发疫情特征分析

目的：分析2012年1月至2014年6月广东省哨点医院诺如病毒GII.4 Sydney变异株流行状况,以及由诺如病毒GII.4 Sydney变异株感染引起的暴发疫情特征。方法2012年1月至2014年6月在广东省选取22家医院的门诊科室为监测哨点,将采集的腹泻病例粪便样本（共10750份）送至市级CDC,进行病毒核酸提取及诺如病毒核酸检测,所有阳性样本递送至广东省CDC,并按照随机数字法抽取了855份进行诺如病毒基因分型,共成功测序样本690份。采用χ2检验比较不同年龄组、不同时期内腹泻病例诺如病毒感染情况。通过广东省突发公共卫生事件管理信息系统,收集2012年1月至2014年6月广东省13起由诺如病毒GII.4 Sydney变异株感染引起的社区暴发疫情数据,进行社区流行病学分析。结果2012年8月首次检出诺如病毒GII.4 Sydney变异株,2012年11月检出比例为13/15。2012年11月至2013年1月（T1时期）,各月份中腹泻病例诺如病毒感染阳性率分别为23.8%（100/421）、15.9%（61/383）、19.2%（95/495）,2013年11月至2014年1月（T2时期）,各月份中腹泻病例诺如病毒感染阳性率分别为17.0%（90/529）、8.7%（37/426）、11.2%（46/409）,均低于T1时期（χ2值分别为6.65、9.93、10.74,P值分别为0.010、0.002、0.001）。T1时期内≥15、<15岁组腹泻病例诺如病毒感染阳性率分别为26.3%（143/543）、14.9%（113/756）（χ2=25.90,P<0.001）;T2时期≥15、<15岁组阳性率分别为10.1%（52/516）、14.3%（121/848）（χ2=5.09,P=0.024）。13起暴发疫情中,食源性传播占10/13。结论广东省2012年8月首次检出诺如病毒GII.4 Sydney变异株,2012年11月起呈现社区流行,流行1年后,强度降低;由诺如病毒GII.4 Sydney变异株引起的暴发疫情主要以食源性传播为主。     

Waterborne-disease outbreaks, 1989-1990.

For the 2-year period 1989-1990, 16 states reported 26 outbreaks due to water intended for drinking; an estimated total of 4,288 persons became ill in these outbreaks. Giardia lamblia was implicated as the etiologic agent for seven of the 12 outbreaks in which an agent was identified. The outbreaks of giardiasis were all associated with ingestion of unfiltered surface water or surface-influenced groundwater. An outbreak with four deaths was attributed to Escherichia coli O157:H7, the only bacterial pathogen implicated in any of the outbreak investigations. An outbreak of remitting, relapsing diarrhea was associated with cyanobacteria (blue-green algae)-like bodies, whose role in causing diarrheal illness is being studied. Two outbreaks due to hepatitis A and one due to a Norwalk-like agent were associated with use of well water. Eighteen states reported a total of 30 outbreaks due to the use of recreational water, which resulted in illness for an estimated total of 1,062 persons. These 30 reports comprised 13 outbreaks of whirlpool- or hot tub-associated Pseudomonas folliculitis; 13 outbreaks of swimming-associated gastroenteritis, including five outbreaks of shigellosis; one outbreak of hepatitis A associated with a swimming pool; and three cases of primary amebic meningoencephalitis caused by Naegleria. The national surveillance of outbreaks of waterborne diseases, which has proceeded for 2 decades, continues to be a useful means for characterizing the epidemiology of waterborne diseases.     

Acinetobacter outbreaks, 1977-2000.

This review of Acinetobacter outbreaks summarizes factors related to the presence and recognition of organism transmission and describes the implementation of control and prevention measures directed at limiting spread. Exogenous transmission of Acinetobacter should be considered when infections are endemic and when case rates increase. Increasing or new antimicrobial resistances in a collection of isolates also suggest transmission, and transmission can be definitively confirmed when isolates are found to be indistinguishable from or related to one another by a discriminatory genotyping test. An investigation for a common source should be conducted. When a common source cannot be found and eliminated, or once an endemically transmitted organism is established, containment or prevention efforts may require aggressive interventions, complex interventions, or both. Colonization at multiple sites, the relative ease of induction of antibiotic resistance in the organism following patient exposure to multiple drugs, and long-term environmental survival provide enhanced opportunities for the transmission of Acinetobacter between and among patients. New approaches and interventional trials are needed to define effective measures for the prevention and control of Acinobacter infections.     

Foodborne outbreak and nonmotile Salmonella enterica variant, France

We report a food-related outbreak of salmonellosis in humans caused by a nonmotile variant of Salmonella enterica serotype Typhimurium in France in 2009. This nonmotile variant had been circulating in laying hens but was not considered as Typhimurium and consequently escaped European poultry flock regulations.