A review of outbreaks of waterborne disease associated with ships: evidence for risk management

OBJECTIVE: The organization of water supply to and on ships differs considerably from that of water supply on land. Risks of contamination can arise from source water at the port or during loading, storage, or distribution on the ship. The purpose of this article is to review documented outbreaks of waterborne diseases associated with passenger, cargo, fishing, and naval ships to identify contributing factors so that similar outbreaks can be prevented in the future. METHODS: The authors reviewed 21 reported outbreaks of waterborne diseases associated with ships. For each outbreak, data on pathogens/toxins, type of ship, factors contributing to outbreaks, mortality and morbidity, and remedial action are presented. RESULTS: The findings of this review show that the majority of reported outbreaks were associated with passenger ships and that more than 6,400 people were affected. Waterborne outbreaks due to Enterotoxigenic Escherichia coli, noroviruses, Salmonella spp, Shigella sp, Cryptosporidium sp, and Giardia lamblia occurred on ships. Enterotoxigenic E. coli was the pathogen most frequently associated with outbreaks. One outbreak of chemical water poisoning also occurred on a ship. Risk factors included contaminated port water, inadequate treatment, improper loading techniques, poor design and maintenance of storage tanks, ingress of contamination during repair and maintenance, cross-connections, back siphonage, and insufficient residual disinfectant. CONCLUSIONS: Waterborne disease outbreaks on ships can be prevented. The factors contributing to outbreaks emphasize the need for hygienic handling of water along the supply chain from source to consumption. A comprehensive approach to water safety on ships is essential. This may be achieved by the adoption of Water Safety Plans that cover design, construction, operation, and routine inspection and maintenance.     

Investigation of multistate foodborne disease outbreaks

The U.S. food supply is characterized increasingly by centralized production and wide distribution of products, and more foodborne disease outbreaks are dispersed over broad geographic areas. Such outbreaks may present as a gradual, diffuse, and initially unapparent increase in sporadic cases. Recognition and reporting by clinicians and local public health officials and the ordering of laboratory tests by clinicians continue to be cornerstones of detecting all outbreaks. New methods--such as active laboratory-based surveillance, automated algorithms for detecting increases in infection rates, and molecular subtyping--facilitate detection of diffuse outbreaks. Routines have evolved for the investigation of multistate outbreaks; they are characterized by rapid communication between local, state, and federal public health officials; timely review of epidemiologic data by expert panels; collaboration on tracebacks with food safety regulatory agencies; and communication with the public and media. Rapid, efficient investigation of multistate outbreaks may result in control of acute public health emergencies, identification and correction of hazardous food production and processing practices, and consequent improvement in food safety.     

2019年中国大陆食源性疾病暴发监测资料分析

调查和分析浙江省湖州市1起食源性疾病暴发事件的原因,为避免此类事件的发生提供依据。

根据所制订的病例定义进行病例搜索。对事件进行现场流行病学调查,对病例组和对照组进行问卷调查。使用χ²检验、logistic回归分析食源性疾病暴发的影响因素。同时对采集的病例粪便标本、食物标本、环境标本、水标本进行实验室检测,对分离出的阳性菌株开展脉冲场凝胶电泳（PFGE）分子分型。

事件同期暴露410人,可能病例18人,罹患率为4.39%。患者症状以腹痛、腹泻为主,伴有恶心、乏力、发热等症状。纳入病例组17例和对照组19例,病例对照分析结果提示,白灼深水虾（OR=19.42,95%CI=1.06~357.02,P=0.046）、蒜蓉粉丝蒸澳龙（OR=22.01,95%CI=1.24~390.70,P=0.035）为可疑食物。经实验室检测,5例病例副溶血性弧菌（VP）阳性,血清型均为O10∶K4;留样食物中蒜蓉粉丝蒸澳龙标本和羊排标本VP阳性,血清型为O5∶Kut。

该事件是一起共同食用VP污染的婚宴所致的食源性疾病暴发事件,餐次为9月17日某酒店供应的晚餐。可疑食物为白灼深水虾和蒜蓉粉丝蒸澳龙。

     

2021年中国大陆食源性疾病暴发监测资料分析

了解上海市嘉定区2021年生禽肉中沙门菌污染状况、血清型分布及耐药性。

采集鸡、鸭、鹅和鸽4类生禽肉样本进行沙门菌分离鉴定,并对分离的沙门菌进行血清型鉴定和16种常见抗生素耐药性检测。

80份生禽肉样品中分离到沙门菌60株。鸽肉、鹅肉、鸭肉和鸡肉中沙门菌的检出率分别为86.67%、81.82%、72.73%、59.38%。冷冻、冷藏和室温存储样品中,冷藏存储的样品检出率最低,为65.63%。血清型以鼠伤寒沙门菌、肠炎沙门菌和科瓦利斯沙门菌为主。四环素、萘啶酸、氨苄西林、氯霉素4类抗生素耐药率较高,分别为60.00%、58.33%、50.00%、48.33%;头孢噻肟耐药率低,对亚胺培南完全敏感。不同类别生禽肉中检出的沙门菌及不同型别的沙门菌耐药差异明显。11.67%的沙门菌为不耐药,多重耐药菌株占比为46.67%,耐药数最多达13种。氨苄西林⁃四环素或氯霉素⁃头孢唑林耐药模式提示菌株为多重耐药菌株。

上海市嘉定区生禽肉样本沙门菌的污染状况严重,耐药性升高,应加强监测并进行控制。

     

中国2004-2011年学校食物中毒事件监测分析

了解我国学校食物中毒事件的发生规律及特点,为有效防控学校食物中毒事件的发生提供参考依据.方法 对2004-2011年突发事件报告管理信息系统报告的全国各类学校食物中毒事件进行描述性分析.结果 2004-2011年中国共报告学校食物中毒事件940起,累计报告病例31 945例,死亡40人.在致病因子明确的食物中毒事件中,微生物是主要的致病因子,事件数和病例数分别占56.17%和60.35%.化学物是引起学校食物中毒事件死亡的主要因素,占已知病因事件死亡人数的77.14%.9月是学校食物中毒事件的高发时期.食物污染或变质是学校食物中毒事件最为常见的引发原因,占明确事件总数的50.83%.结论 微生物引起的食物中毒是目前影响中国学校食物中毒事件发生的首要因素.预防化学性食物中毒是降低学校食物中毒死亡人数的关键措施.     

2014年山东省食源性疾病暴发监测资料分析

目的 了解山东省食源性疾病暴发事件流行病学特征,为制定食源性疾病预防控制措施提供依据。 方法 采用描述性流行病学方法,对2014年通过国家食源性疾病暴发报告系统上报的98起食源性疾病暴发事件进行整理分析。 结果 2014年共发生食源性疾病暴发事件98起,发病人数1 238人,死亡4人。5-9月是食源性疾病暴发高峰期,事件数和患病人数分别占总数的73.47%和83.28%;不明食品引起的暴发事件数最多,占总数的36.73%,在已经查明原因的暴发事件中,微生物是引起食源性疾病暴发事件数的主要因素;发生在餐饮服务场所的事件数最多,其次为家庭;在已经查明引发环节的暴发事件中,生产加工及误食误用是引起食源性疾病暴发事件的主要因素。63起事件由食源性疾病的哨点医院发现并报告,占全年事件报告总数的64.29%。 结论 加强对高发季节、高发因素、高发污染环节的监控;加强食源性疾病暴发事件的调查处置;加大防控食源性疾病暴发事件的宣传力度等,是预防和控制食源性疾病暴发事件的有效措施。     

2013年大连市食源性疾病暴发监测资料

目的分析2013年大连市食源性疾病暴发特征,提出防控策略和措施。方法制定食源性疾病暴发标准,利用食源性疾病暴发资料,建立数据库,进行特征分析。结果 2013年大连市食源性疾病暴发共108起,发病1 043人,死亡7人。7—8月为高发季节,发生起数占总数的84.3%;高发场所为餐饮单位和家庭内部,发生起数占总数的83.3%;高发人群为该地居民,发生起数占总数的47.2%;主要致病因素为微生物性,引发起数占总数的61.1%。结论为了有效降低本市食源性疾病的发生,应加强对中小型餐饮单位的监督检查,继续加强夏季预防细菌性和毒蘑菇中毒的宣传教育。     

Molecular diversity of noroviruses associated with outbreaks on cruise ships: comparison with strains circulating within the UK

The molecular diversity of norovirus (NV) strains associated with 26 outbreaks of NV gastroenteritis has been determined. The outbreaks occurred on 14 cruise ships from seven cruise lines, during the period from 1998 to 2002. The ships cruised in seas worldwide, including the Mediterranean, the Baltic and the Caribbean. Genogroup I NVs were more common in the cruise ship setting than in hospitals, with 38% of the cruise ship outbreaks associated with genotype I NVs, as compared to < 10% in hospital and other semi-closed institutions in the UK. Outbreaks on cruise ships were more common in the period April to September, than in the winter. Two mixed genogroup I and II outbreaks were detected, which suggested contaminated food or water as the source of the infection.     

2010-2016年广西报告的食源性疾病暴发事件分析

目的 分析2010-2016年广西食源性疾病暴发事件的流行病学特征,为政府决策提供依据。方法 对2010-2016年国家食源性疾病暴发监测系统和突发公共卫生信息报告管理系统上报的食源性疾病暴发事件进行描述性流行病学分析。结果 2010-2016年广西共报告食源性疾病暴发事件346起,累计发病5492人,死亡58人,年平均发病率为1.66/10万。微生物性因素导致的暴发事件数和发病数最多,分别占48.53%（132/272）、70.45%（3197/4538）, 以沙门菌为主（23.48%,31/132）;有毒植物导致死亡人数最多,占66.67%（36/54）,以钩吻碱（21人）和毒蘑菇（11人）死亡构成较大。。结论 加大对微生物污染和有毒植物中毒的科普宣传,加强对重点环节的监管,建立完善的食源性疾病报告机制,减少暴发事件的发生。     

A review of economic tools for the assessment of animal disease outbreaks

This paper demonstrates how currently underutilised economic modelling techniques can enrich the analysis of animal disease problems. Increasingly, analyses of animal health programmes are expected to address a range of economic and social questions. These expectations can be addressed by better integration of epidemiological modelling with economic techniques whose application to animal health has not been thoroughly discussed in past reviews. This paper describes a range of economic models that can be applied in animal health research and provides guidance for determining the appropriate method given the issues at hand. The complexity of some of these approaches underlines the importance of multidisciplinary research and education.     

2016年江苏省食源性疾病暴发事件流行病学分析

目的分析2016年江苏省食源性疾病暴发事件,为制定食源性疾病暴发防控措施提供依据。方法通过国家食源性疾病暴发监测系统,收集2016年江苏省食源性疾病暴发事件数据,并进行流行病学分析。结果 2016年江苏省共发生143起食源性疾病暴发事件,发病2 657例,无死亡。全年各月均有暴发事件发生,第三季度高发,8月份事件数和发病人数最多(占24.47%和21.45%);报告事件数最多的地区为苏州市、无锡市和南京市,3市报告数占总数的67.14%;20~59岁年龄段发病人数最多(占71.96%);发生场所主要在宾馆饭店(占37.06%)、单位食堂和农村宴席(各占18.18%);动物类食品是暴发事件的主要原因食品(占37.06%);细菌性致病因素是暴发事件的主要致病因素(占63.64%),其中副溶血性弧菌引起的事件数和发病人数最多。结论应加强食源性疾病监测、预警和系统建设,提升食源性疾病暴发事件现场流行病学调查处置能力。     

2016—2020年滨州市食源性疾病暴发事件监测分析

目的 分析滨州市2016—2020年食源性疾病暴发事件发生的流行病学特征,为发现食源性疾病的预警和防控提供理论依据。方法 收集食源性疾病暴发监测系统中2016—2020年滨州市食源性疾病暴发事件数据,并对监测到的事件进行描述性流行病学特征分析。结果 2016—2020年滨州市共发生食源性疾病暴发事件234起,共暴露11 299人,发病1 276人,无死亡病例。食源性疾病暴发事件每年的发生高峰期均为第三季度,占总起数的55.13% (129/234);家庭是食源性疾病暴发的主要发生场所,占总起数的50.43% (118/234)。报告明确或可疑致病因素的55起事件中由有毒动植物及其毒素类引起的占43.64%(24/55);在查明原因食品的221起事件中,可以明确的暴露食品主要归为动物类食品87起(39.37%)。导致暴发的污染环节多是由两种或三种以上因素混合引起的,单纯引发因素以加工不当为主。结论 滨州市食源性疾病暴发事件集中在夏秋季节,高发场所为家庭,重点防控因素为有毒动植物及其毒素类。针对本市食源性疾病暴发流行病学特征,针对性地开展食品安全知识宣教工作,提高监测预警能力,降低食源性疾病事件的发生。     

Emergence of pork carnitas as a cause of foodborne disease outbreaks in Chicago

Carnitas are fried chunks of pork frequently served in Mexican-origin households, food service establishments, and social gatherings. During 1995-2002, carnitas emerged as the most frequently implicated vehicle of transmission in foodborne disease outbreaks in Chicago. Five (6%) of 90 foodborne disease outbreaks investigated and reported in Chicago during this period were linked to carnitas, and they accounted for 108 illnesses and 11 hospitalizations. The etiologic agent in four outbreaks was Salmonella, and these outbreaks accounted for 29% of the 14 Salmonella-associated foodborne disease outbreaks in Chicago during this period. Unsafe food handling practices that occurred after cooking were identified as contributing to multiple carnitas-associated outbreaks. Local health departments that serve significant Mexican-origin populations should be aware of carnitas as a potential source of foodborne disease, particularly salmonellosis.     

2020年山东省潍坊市食源性疾病暴发事件流行病学特征

目的 分析2020年潍坊市食源性疾病暴发事件流行病学特征,为制定食源性疾病暴发事件的预防控制措施提供参考依据。方法 对2020年潍坊市通过食源性疾病暴发系统上报的食源性疾病暴发事件进行流行病学描述性分析。结果 2020年潍坊市共上报食源性疾病暴发事件59起,暴露1 064人,报告病例235例,无死亡病例。事件的发生场所以家庭为主（32起,占54.24%）,其次为餐饮服务场所（25起,占42.37%）;引发因素以不明原因为主（29起,占49.15%）,其次为2种因素及以上（15起,占25.42%）。植物类食品引起的暴发事件数最多,占32.20%(19起),其次为动物类食品（17起,占28.81%）。结论 应逐步完善潍坊市食源性疾病报告机制,建立有效的监测、预警和监管机制,以提高对食源性疾病暴发事件的敏感性,减少食源性疾病暴发事件的发生。     

2010-2016年四川省化学性食源性疾病暴发事件的流行病学分析

目的 了解四川省化学性食源性疾病暴发事件发生的规律和流行病学特征,为制定具有针对性的预防控制措施提供科学依据。方法 对2010-2016年食源性疾病暴发监测系统中报告的暴发事件流行病学特征进行分析。结果 全省共报告事件49起,发病471人,死亡15人,分别占同期的10.47%、8.37%和34.09%,病死率为3.18%,高于同期病死率0.78%(P<0.001)。亚硝酸盐引起的事件数(91.84%)、发病人数(97.66%)和死亡人数(93.33%)都最多,农药的病死率最高为11.11%,原因食品以肉与肉制品为主(24.49%),引发事件的原因以误食误用为主(48.98%),家庭的事件数最多(55.10%)。结论 四川省化学性食源性疾病暴发事件主要由亚硝酸盐、农药和毒鼠强引起,对人们健康造成的危害严重,应进一步加强对有毒化学品的监管,提高公众的卫生意识和自我保护能力,以达到预防和控制化学性食源性疾病的目的。     

中国2002-2015年学校食源性疾病暴发事件归因分析

了解2002-2015年期间发生在学校的1 291起食源性疾病暴发事件的归因分析结果,为有效防控学校食源性疾病的发生提供科学依据.方法 汇总国家监测和文献2个来源的学校食源性疾病暴发事件,剔除重复事件,选择致病因素明确的事件1 291起进行描述性分析和归因分析.结果 致病因素明确的事件中涉及发病人数58 691例,住院30 055例,死亡12例;致病因素以生物污染物为主(737起,占57.09%),居前3位的致病微生物分别是蜡样芽孢杆菌、金黄色葡萄球菌和沙门菌;原因食品主要为蔬菜类、粮食类和肉类,分别占15.49%,14.56%和8.29%;引发环节以加工不当为主(20.06%).结论 学校是食源性疾病的高发场所.应采取进一步有针对性的综合性防控措施,将学校食源性疾病暴发事件的风险降至最低.