中国1990年与2010年感染性腹泻的疾病负担及变化研究

  目的   探讨广东省广州市感染性腹泻发病特征，评价rBS/WC霍乱疫苗的推广水平与感染性腹泻的关联性，为广州地区更有针对性地推广rBS/WC霍乱疫苗提供科学依据。  方法   根据rBS/WC霍乱疫苗的推广情况将感染性腹泻发病人群分为疫苗推广前（2015 — 2019年）和疫苗推广后（2020 — 2022年）两个群体。应用ArcGIS10.8进行空间自相关分析探索广州市感染性腹泻的空间聚集情况，运用R4.2.1 软件采用合成控制法结合贝叶斯时间序列模型（BSTS）的反事实预测方法将模型预测值与实际观测值的差值表示感染性腹泻的相对减少量来评价rBS/WC霍乱疫苗接种对感染性腹泻发病的影响。  结果   2015－2022年广州市感染性腹泻累计报告病例123582例，感染性腹泻年均报告发病率从2015 — 2019年（91.84/10万）下降到2020 — 2022年的（77.48/10万），差异明显（χ² = 13891.686，P < 0.05）。在人群分布上，性别构成比在疫苗推广前后差异不大，但0～2岁和散居儿童发病在rBS/WC霍乱疫苗推广后发生较大变化（χ²分别为1263.733和1266.090，P均 < 0.05）。空间自相关分析结果显示感染性腹泻发病情况存在空间聚集性，Moran′s I均 > 0且（均有|Z| > 1.96，P < 0.05），其空间表现趋势与rBS/WC霍乱疫苗接种水平的空间配置基本一致。BSTS模型发现自rBS/WC霍乱疫苗大规模接种计划启动以来的3年（2020 — 2022），感染性腹泻实际观测到的病例数比模型预测病例数相对减少37.18%（95%CI = 13.81%～60.07%），且保护效果因年龄和职业而异，推断rBS/WC霍乱疫苗对感染性腹泻不同病原具有一定的交叉保护作用。  结论  rBS/WC霍乱疫苗大规模推广后广州市感染性腹泻发病在时间、空间、人群中的分布都有下降趋势，一定程度上减少了广州市感染性腹泻的发病，值得继续推广应用。

Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study

  Objective  To explore incidence characteristics of infectious diarrhea and the association of recombinant B-subunit/inactivated whole cell (rBS/WC) cholera vaccination with infectious diarrhea incidence in Guangzou city, Guangdong province.   Methods  The data on reported infectious diarrhea cases and on rBS/WC cholera vaccination in Guangzhou city were extracted from Infectious Disease Monitoring and Reporting System and Immunization Planning Information Management System of Guangzhou Municipal Center for Disease Control and Prevention; the collected data were assigned into two datasets of different year period before (2015 – 2019) and after (2020 – 2022) the large-scale promotion on rBS/WC cholera vaccination. Relevant demographic data were obtained from municipal statistical yearbooks and the Seventh National Population Census. Community- and population group-specific annual and year period incidence of infectious diarrhea were calculated. ArcGIS10.8 was used to explore the spatial aggregation of infectious diarrhea incidence Guangzhou, and the effect of rBS/WC cholera vaccination on the incidence of infectious diarrhea was evaluated by using synthetic control method combined with Bayesian time series model (BSTS)-based counterfactual prediction method with R4.2.1 software.   Results   During 2015 – 2022, the cumulative number of infectious diarrhea cases was 123 582 in the city. The average annual reported incidence (1/100 000) of infectious diarrhea decreased significantly from 91.84 during 2015 – 2019 to 77.48 during 2020 – 2022 (χ² = 13 891.686, P < 0.05). In terms of subgroup populations, there was no significant gender difference in year period-specific incidence before and after rBS/WC cholera vaccination, but the incidence changed significantly after the vaccine promotion among 0 – 2 years old children (χ² = 1 263.733) and community-dwelling children (χ² = 1 266.090) (both P < 0.05). The results of spatial autocorrelation analysis showed that there were spatial clusters in annual and year period infectious diarrhea incidence, with Moran′s I values of greater than 0 (all |Z| > 1.96, P < 0.05); the spatial clustering patterns of the incidence were basically consistent with the spatial configuration of BS/WC cholera vaccination level. The BSTS model analysis revealed a deficit ratio of 37.18% (95% confidence interval: 13.81% – 60.07%) between the predicted and observed number of infectious diarrhea incidence for the period of 2020 – 2022 with large-scale promotion of rBS/WC cholera vaccination and the deficit differed by age and daily activities of subgroup populations, suggesting a possible protective effect of rBS/WC cholera vaccination against infectious diarrhea caused by other pathogens.   Conclusion  The decrease and the variation in spatial and population clustering of infectious diarrhea incidence may associate with large-scale promotion of rBS/WC cholera vaccination in Guangzhou city.