2014—2015年北京市房山区急性胃肠炎风险因素和负担研究

探讨北京市房山区急性胃肠炎的流行病学特征和社会经济负担。方法 开展为期12个月的社区人群横断面调查,分析急性胃肠炎的发病情况、影响因素分布、临床表现、诊治情况以及经济负担。结果 2014年4月—2015年3月共调查1 678人,急性胃肠炎月患病率为0.65%(95%CI:0.27%～1.03%),年发病率为0.085次/人(95% CI:0.017～0.098次/人),每年房山区约有8.7万人次发生急性胃肠炎,食源性比例为54.5%(6/11)。发病时间主要集中在第二季度,低年龄段、文化程度较低、家庭收入较低、居住在农村的人群,急性胃肠炎患病风险较高。72.7%(8/11)的病例进行了药物治疗,54.5%(6/11)的病例去医疗机构就诊,药物治疗的病例中87.5%(7/8)使用抗生素,急性胃肠炎造成总经济损失约为0.32亿元,占2014年房山区地区生产总值(519.3亿元)的0.62‰。结论 房山区急性胃肠炎的疾病负担值得关注,且食源性比例较高,儿童患病风险较高,抗生素使用率较高,应加强食源性疾病监测和负担评估,探索有针对性的干预措施,为减轻食源性疾病的社会经济负担,提高防控能力提供科学依据。     

北京市社区人群急性胃肠炎患病状况流行病学调查

目的了解北京市社区人群急性胃肠炎的患病状况及其流行特征。方法 2012年4月至2013年3月,采用多阶段抽样方法从北京市6个区抽取部分调查户,每月入户调查其过去4周内急性胃肠炎发病情况及危险因素等内容。结果 12个月共调查10 204人,人群急性胃肠炎月患病率为1.25%(95%CI:1.04~1.47),发病率为0.16次/人年,加权患病率为1.34%(95%CI:1.12~1.56),加权发病率为0.17次/人年,估计北京市每年有333.4万人罹患急性胃肠炎。多因素分析结果显示,年龄、文化程度和季节与急性胃肠炎发病有关。58.59%的急性胃肠炎患者怀疑其发病可能为食源性途径。结论北京市急性胃肠炎的疾病负担值得关注,且食源性比例较高,应开展进一步研究准确评估食源性疾病负担。     

黑龙江省急性胃肠炎疾病负担流行病学调查

目的了解黑龙江省急性胃肠炎流行病学负担及影响因素。方法采用多阶段分层随机抽样方法抽取调查对象,每月入户调查其过去4周内急性胃肠炎发病情况。结果共调查19 171人,人群急性胃肠炎月患病率为3.51%[95%置信区间(95%CI):3.25%～3.77%],年发病比例为37.24%,年发病率为0.466次/人,加权月患病率为3.61%,加权年发病比例为38.07%,加权年发病率为0.479次/人。估计全省急性胃肠炎平均每年1 442.3万人发病,共发病1 814.7万人次。多因素Logistic回归分析结果显示,居住地性质、季节、年龄、过去2周是否因出差旅游离开居住地、家庭年人均收入为居民急性胃肠炎患病的影响因素。58.66%的急性胃肠炎病例认为是受污染的食物导致。结论黑龙江省急性胃肠炎流行病学负担较重,食源性比例较高,应予以足够的关注和重视。     

国内外急性胃肠炎和食源性疾病负担研究进展

食源性疾病是全球重要的公共卫生问题,也是中国最大的食品安全问题.急性胃肠炎人群负担的评估是食源性疾病负担评估的一个中心问题,许多国家已开展急性胃肠炎和食源性疾病负担评估研究,我国于2010-2011年在部分省份开展了研究疾病负担的试点工作.本文对急性胃肠炎和食源性疾病负担评估国内外研究进展进行综述.     

北京市密云区居民急性胃肠炎流行病学特征与风险因素调查

目的了解北京市密云区居民急性胃肠炎患病情况、发病趋势、流行特征及其影响因素,掌握急性胃肠炎病人的月患病率、年发病率,估计急性胃肠炎的食源性比例,为预防控制食源性疾病提供依据和参考。方法采用多阶段随机抽样,开展为期12个月的回顾性横断面调查,Epi Data 3.02软件双录入数据库,利用SPSS 20.0软件分析及@risk 5.5软件进行数据模拟和推算。结果共调查1 664人,应答率99.05%,急性肠胃炎的月患病率为2.28%(95%CI:1.57%~3.00%),年发病率为0.30次/人年(95%CI:0.29次/人年~0.31次/人年)。每年约有14.37万人次罹患急性胃肠炎,食源性比例点估计值0.303 0。结论北京市密云区居民急性胃肠炎发病率较高,发病人次数较庞大,食源性引起所占比例较高,季节、文化程度和家庭人口数等为患急性胃肠炎的风险因素,应加强居民急性胃肠炎的监测并扩大监测范围,定期开展社区居民急性胃肠炎的调查并适当增加其样本量,获取更加准确、全面的调查数据,制定干预措施并加以评估。     

黑龙江省食源性非伤寒沙门菌急性胃肠炎疾病负担估计

目的 估计黑龙江省非伤寒沙门菌导致的食源性急性胃肠炎的疾病负担,为食源性疾病的管理和监测提供依据。方法 通过黑龙江省急性胃肠炎疾病负担人群调查获得急性胃肠炎的就诊率;通过食源性疾病监测系统获得黑龙江省的监测数据,从而计算非伤寒沙门菌的采样率、检测率及报告病例数。利用上述两部分数据构建金字塔模型,并估计黑龙江省由非伤寒沙门菌导致的急性胃肠炎的病例数量及发病率。利用@Risk8.2软件对非伤寒沙门菌导致的急性胃肠炎的发病数据进行概率估计以及不确定性分析,并进一步估计由非伤寒沙门菌导致的食源性急性胃肠炎发病情况。结果 估计黑龙江省由非伤寒沙门菌导致的食源性急性胃肠炎76 224人次（95%CI:60 203～96 626）,年发病率202.0/10万（95%CI:159.6/10万～256.1/10万）。结论 非伤寒沙门菌给黑龙江省造成了较大的食源性疾病负担,老年人和婴幼儿的疾病负担尤为显著。     

sQMRA在微生物定量风险评估中的应用

目的以福建省人群食用牡蛎引起副溶血性弧菌(VP)胃肠炎的风险为例,介绍一种快速的风险评估工具(sQMRA)在微生物定量风险评估中的应用。方法利用《2002年中国居民营养与健康状况调查》结果、文献报告和经验推断等方式,对福建省2008年9—11月牡蛎的消费量和零售阶段VP的污染水平、交叉污染和烹制对VP菌落数的影响等共11个参数进行了推算和引用。结果计算得到福建省2008年9—11月VP的感染人数为10 221人,其中有1 022人罹患VP胃肠炎,推算得到的VP胃肠炎的发病概率为2.8×10-5,与人群监测推算的VP胃肠炎发病概率3.8×10-5结果较为接近。结论 sQMRA是一种快速简便有效的微生物定量风险评估工具。     

杭州市流动人口急性腹泻危险因素的病例对照研究

目的了解杭州市流动人口发生急性腹泻的危险因素。方法以杭州市流动人口聚集地作为调查点,采用配对病例对照研究方法和入户调查的方式,收集流动人口急性腹泻病例和对照人群在餐厨环境、食品采购、食品加工、饮食习惯、食品储存等5部分共38个指标的情况,并对数据进行logistic回归模型多因素统计学分析。结果购买新鲜的食物(OR=0.165,95%CI:0.051~0.537)、处理食物前清洁双手(OR=0.192,95%CI:0.038~0.981)、剩余食物再次食用前充分加热(OR=0.238,95%CI:0.057~0.990)是急性腹泻的保护因素。烹调的食物有血水(OR=4.288,95%CI:1.143~16.080),在小摊、路边店、大排档用早餐(OR=31.323,95%CI:1.323~741.570),食用外购熟食(OR=4.640,95%CI:1.538~14.000)是主要的危险因素。结论良好的个人卫生和烹调习惯以及坚持在家用餐是减少流动人口急性腹泻的主要措施。     

一起误食桐油引起的食物中毒

2 0 0 3年 6月 2 2日 ,某建筑公司工地食堂发生一起误食桐油引起的 2 8人群发性急性胃肠炎 ,经治疗痊愈 ,无致残或死亡。病人以胃肠道刺激症状为主 ,其中恶心 (85 7% )、呕吐 (10 0 0 % )、腹痛 (6 0 7% )、腹泻 (5 0 0 % )和头晕 (6 7 9% )。潜伏期 1～ 3 17h ,中位数为 2 12h ,男性 2 6人 ,女性 2人 ;年龄 16～ 6 2岁 ,平均 35 6 8± 10 95岁。经调查 ,中毒食物为午餐的 2个炒菜 ,误食桐油量为 2 6 8g 人 ,油桐酸暴露量为 2 4 12g 人。     

广州市非伤寒沙门菌感染流行病学负担分析

评估广州市非伤寒沙门菌感染流行病学负担,提出食源性疾病监测策略。方法 在广州市6区设9家食源性疾病主动监测医院,调查12个月腹泻病例采样率、沙门菌检测率、实验室检测敏感度,进而推算全市医疗机构相应数据;在广州市3区开展人群腹泻随机抽样入户调查,调查腹泻病例就诊率;通过传染病报告信息管理系统获得监测医院和全市医疗机构沙门菌感染性腹泻报告率;利用食源性疾病流行病学负担金字塔模型,通过倍数校正和不确定性分析估计沙门菌感染实际发病数,比较食源性疾病主、被动监测数据用于疾病负担分析的优劣。结果 监测医院12个月腹泻病例平均采样率38.34%,沙门菌检测率28.24%,实验室检测敏感度87.5%,人群腹泻病例就诊率23.91%,沙门菌感染性腹泻报告率42.98%;全市医疗机构推算采样率38.34%,检测率28.24%,实验室检测敏感度47.5%,报告率20.94%,估计广州市沙门菌感染病例64 586例(95%CI:44 136～101 921),年发病率508.5/10万(95%CI:347.5～802.5/10万),全年全市被动报告病例仅171例,报告年发病率1.3/10万;经估算5岁以下年龄组(3 583.2/10万)年发病率最高,15～24岁年龄组(23.5/10万)最低。结论 首次验证疾病负担金字塔模型在我国食源性疾病负担研究领域的适用性;表明主动监测一定程度上提升了食源性疾病尤其是特定病原体感染采样率、检测率、实验室检测敏感度和报告率,有助于对负担作出更准确和积极有效的估计;结果提示广州市非伤寒沙门菌感染负担较重,5岁以下年龄组人群负担水平尤其显著。     

我国细菌性食源性疾病疾病负担的初步研究

目的 初步估计我国细菌性食源疾病的疾病负担.方法 利用文献综述的方法推算我国急性腹泻的发病率,综合胃肠炎患者腹泻比例、胃肠炎患者食源性比例可推算我国食源性疾病的发病率,结合食源性疾病的细菌比例可推算细菌性食源性疾病的发病率,同时推算住院率.利用卫生部调查数据获得细菌性感染性疾病的病死率,结合食源性比例,获得细菌性食源性疾病的病死率.结果 我国细菌性食源性疾病每年发病人数可达9411.7万人次,其中2475.3万患者曾就诊,335.7万患者曾因病住院,8 530例患者死亡,病死率0.009 1 % o结论我国细菌性食源性疾病的负担依然较重.我国应逐步开展覆盖全国的食源性疾病负担研究.     

Disease burden of foodborne pathogens in the Netherlands, 2009

To inform risk management decisions on control, prevention and surveillance of foodborne disease, the disease burden of foodborne pathogens is estimated using Disability Adjusted Life Years as a summary metric of public health. Fourteen pathogens that can be transmitted by food are included in the study (four infectious bacteria, three toxin-producing bacteria, four viruses and three protozoa). Data represent the burden in the Netherlands in 2009. The incidence of community-acquired non-consulting cases, patients consulting their general practitioner, those admitted to hospital, as well as the incidence of sequelae and fatal cases is estimated using surveillance data, cohort studies and published data. Disease burden includes estimates of duration and disability weights for non-fatal cases and loss of statistical life expectancy for fatal cases. Results at pathogen level are combined with data from an expert survey to assess the fraction of cases attributable to food, and the main food groups contributing to transmission. Among 1.8 million cases of disease (approx. 10,600 per 100,000) and 233 deaths (1.4 per 100,000) by these fourteen pathogens, approximately one-third (680,000 cases; 4100 per 100,000) and 78 deaths (0.5 per 100,000) are attributable to foodborne transmission. The total burden is 13,500 DALY (82 DALY per 100,000). On a population level, Toxoplasma gondii, thermophilic Campylobacter spp., rotaviruses, noroviruses and Salmonella spp. cause the highest disease burden. The burden per case is highest for perinatal listeriosis and congenital toxoplasmosis. Approximately 45% of the total burden is attributed to food. T. gondii and Campylobacter spp. appear to be key targets for additional intervention efforts, with a focus on food and environmental pathways. The ranking of foodborne pathogens based on burden is very different compared to when only incidence is considered. The burden of acute disease is a relatively small part of the total burden. In the Netherlands, the burden of foodborne pathogens is similar to the burden of upper respiratory and urinary tract infections.     

Estimating the burden of acute gastroenteritis and foodborne illness caused by Campylobacter, Salmonella, and Vibrio parahaemolyticus by using population-based telephone survey data, Miyagi Prefecture, Japan, 2005 to 2006

Most cases of acute gastroenteritis and foodborne disease are not ascertained by public health surveillance because the ill person does not always seek medical care and submit a stool sample for testing, and the laboratory does not always test for or identify the causative organism. We estimated the total burden of acute gastroenteritis in Miyagi Prefecture, Japan, using data from two 2-week cross-sectional, population-based telephone surveys conducted in 2006 and 2007. To estimate the number of acute gastroenteritis illnesses caused by Campylobacter, Salmonella, and Vibrio parahaemolyticus in Miyagi Prefecture, we determined the number of cases for each pathogen from active laboratory-based surveillance during 2005 to 2006 and adjusted for seeking of medical care and submission of stool specimens by using data from the population-based telephone surveys. Monte Carlo simulation was used to incorporate uncertainty. The prevalence of acute gastroenteritis in the preceding 4 weeks was 3.3% (70 of 2,126) and 3.5% (74 of 2,121) in the winter and summer months, yielding an estimated 44,200 episodes of acute gastroenteritis each year in this region. Among people with acute gastroenteritis, the physician consultation rate was 32.0%, and 10.9% of persons who sought care submitted a stool sample. The estimated numbers of Campylobacter-, Salmonella-, and V. parahaemolyticus -associated episodes of acute gastroenteritis were 1,512, 209, and 100 per 100,000 population per year, respectively, in this region. These estimates are significantly higher than the number of reported cases in surveillance in this region. Cases ascertained from active surveillance were also underrepresented in the present passive surveillance, suggesting that complementary surveillance systems, such as laboratory-based active surveillance in sentinel sites, are needed to monitor food safety in Japan.     

Costs of acute bacterial foodborne disease in Canada and the United States

Bacterial foodborne disease is increasing in industrialized as well as developing countries. For Canada and the United States many millions of cases are believed to occur each year, based on extrapolations of survey data, human enteric isolations and reported foodborne disease cases. The economic impact of such a large number is probably in billions of dollars but the precise figure is difficult to calculate. Medical costs and lost income are easier to determine than losses to food companies, legal awards and settlements, value of lost leisure time, pain, grief, suffering and death. The evaluation of costs at the national level for Canada and the United States based on all available costs for 61 incidents showed that company losses and legal action are much higher than medical/hospitalization expenses, lost income or investigational costs. It was reckoned that on an annual basis an estimated 1 million cases of acute bacterial foodborne illness in Canada cost nearly $1.1 billion and 5.5 million cases in the United States cost nearly $7 billion. The value of deaths was a major contributor to the overall costs especially for diseases like listeriosis, salmonellosis, Vibrio infections, and haemorrhagic colitis. Salmonellosis is the economically most important disease because it affects all parts of the food system, unlike typhoid fever and botulism, which are largely controlled by public health authorities and the food industry.     

Postinfectious irritable bowel syndrome: a long-term consequence of bacterial gastroenteritis

Irritable bowel syndrome (IBS) is a commonly diagnosed disease characterized by gastrointestinal symptoms that may be associated with psychological illness and emotional problems. The prevalence rate worldwide for IBS ranges from 10 to 20% and is higher for women than for men. IBS imposes a substantial financial burden on both patients and employers because of increased medical costs and decreased work productivity. Recent studies indicate that inflammatory processes involving the gastrointestinal tract are strongly correlated with IBS. Acute bacterial gastroenteritis has been linked with the onset of symptoms in approximately 15% of patients diagnosed with IBS; these cases have been called postinfectious IBS. Organisms commonly associated with postinfectious IBS include the foodborne pathogens Campylobacter, Escherichia coli, Salmonella, and Shigella. The pathologic changes associated with postinfectious IBS are likely due to inflammatory reactions induced by the infecting organisms. Postinfectious IBS should be recognized as a potential long-term consequence of foodborne gastroenteritis.