文章摘要
林声,宫霄欢,肖文佳,俞晓,潘浩,吴寰宇.2016-2021年上海市儿童感染性腹泻哨点监测分析[J].中华流行病学杂志,2023,44(2):243-249
2016-2021年上海市儿童感染性腹泻哨点监测分析
Epidemiological characteristics of children infectious diarrhea in Shanghai, 2016-2021
收稿日期:2022-05-26  出版日期:2023-02-15
DOI:10.3760/cma.j.cn112338-20220417-00667
中文关键词: 儿童  感染性腹泻  流行特征  腺病毒
英文关键词: Children  Infectious diarrhea  Epidemiological characteristics  Adenovirus
基金项目:新型冠状病毒肺炎血清流行病学及感染传播风险研究(20JC1410200)
作者单位E-mail
林声 上海市疾病预防控制中心传染病防治所, 上海 200336  
宫霄欢 上海市疾病预防控制中心传染病防治所, 上海 200336  
肖文佳 上海市疾病预防控制中心传染病防治所, 上海 200336  
俞晓 上海市疾病预防控制中心传染病防治所, 上海 200336  
潘浩 上海市疾病预防控制中心传染病防治所, 上海 200336 panhao@scdc.sh.cn 
吴寰宇 上海市疾病预防控制中心, 上海 200336 wuhuanyu@scdc.sh.cn 
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中文摘要:
      目的 了解2016-2021年上海市儿童感染性腹泻的流行特征及病原谱特征,为上海市儿童感染性腹泻防控策略的制定提供科学依据。方法 采用多阶段系统抽样方法,在上海市5家儿童感染性腹泻监测点医疗机构的儿科肠道门诊或儿科门/急诊中开展腹泻症状监测,收集患者人口学信息和流行病学资料等,同时采集患者粪便标本,送至医疗机构所在区CDC开展12种细菌和5种病毒的病原学检测,分析比较2016-2021年不同人群、季节和时期的病原谱等特征。统计学分析采用χ2检验。结果 2 456例感染性腹泻患者中,常见肠道病原总阳性率为45.11%(1 108/2 456),单一细菌感染阳性率为16.00%(393/2 456),单一病毒感染阳性率为20.81%(511/2 456),混合感染为8.31%(204/2 456)。以致病性大肠埃希菌(12.95%,318/2 456)、诺如病毒(10.91%,268/2 456)、轮状病毒(7.49%,184/2 456)、沙门菌(5.82%,143/2 456)和空肠弯曲菌(4.68%,115/2 456)为主。儿童感染性腹泻病患者病原谱呈现明显的季节变化,夏季以细菌感染为主,6月达到高峰(34.50%,69/200),冬季以病毒感染为主,1月达到高峰(48.10%,101/210)。不同年龄组、人群和季节检出阳性率差异有统计学意义(χ2=160.53,P<0.001;χ2=14.80,P=0.003;χ2=27.21,P<0.001)。2020-2021年儿童感染性腹泻年均病例数(284例)较2016-2019年大幅下降(472例);病原谱发生了显著的变化(χ2=39.02,P=0.001),细菌(χ2=11.73,P<0.001)与病毒(χ2=14.22,P<0.001)的阳性率均明显下降;但腺病毒阳性率上升。结论 上海市儿童感染性腹泻患者的病原谱呈现明显的季节变化,以致病性大肠埃希菌、诺如病毒和轮状病毒为主要的腹泻病原。近年来肠道腺病毒腹泻增多,2020-2021年儿童感染性腹泻就诊数及阳性率均显著下降。应针对不同年龄、季节、病原和时期的感染性腹泻采取特异性的防控措施。
英文摘要:
      Objective To investigate the epidemiological and pathogenic characteristics of children's infectious diarrhea in Shanghai to provide evidence for developing strategies related to the control of the disease. Methods Diarrhea outpatients were under surveillance at the pediatric intestinal clinic at five sentinel hospitals in Shanghai, with demographic, clinical, and epidemiological information collected. Fecal specimens were collected and detected for 12 bacteria and 5 viruses by district center for disease control and prevention. Characteristics of diarrhea patients were compared and analyzed from 2016 to 2021. Multi-stage systematic sampling method was adopted. The Chi-square test was used for statistical analysis. Results Of 2 456 infectious diarrhea patients, the positive rate was 45.11% (1 108/2 456), 16.00% (393/2 456), 20.81% (511/2 456), 8.31% (204/2 456), for all pathogens, single bacteria, single virus, and diverse infections respectively. The prevalent detected pathogens were pathogenic Escherichia coli (12.95%, 318/2 456), norovirus (10.91%, 268/2 456), rotavirus (7.49%, 184/2 456), Salmonella (5.82%, 143/2 456) and Campylobacter jejuni (4.68%, 115/2 456). The pathogen spectrum of childhood infectious diarrhea patients showed noticeable seasonal changes, with a prevalent bacterial infection in summer[peaked in June, the positive rate was 34.50% (69/200)] and a prevalent viral infection in winter[peaked in January, the positive rate was 48.10% (101/210)]. The positive rates in different age groups, populations, and seasons were statistically different (χ2=160.53,P<0.001; χ2=14.80, P=0.003; χ2=27.21,P<0.001). During 2020-2021, the number of cases of infectious diarrhea in children (284 cases/year) dropped significantly compared with the number in 2016-2019 (472 cases/year), the pathogen spectrum changed significantly (χ2=39.02, P=0.001), and the positive findings of bacteria (χ2=11.73, P<0.001) and viruses (χ2=14.22, P<0.001) decreased significantly. However, the positive rate of enteric adenovirus increased. Conclusions The pathogen spectrum of children's infectious diarrhea patients shows noticeable seasonal changes in Shanghai. Pathogenic Escherichia coli, norovirus, and rotavirus are the most common diarrheal pathogens. In recent years, the detection of adenovirus in children with infectious diarrhea has increased. The number of children with infectious diarrhea and the positive rate have decreased significantly during 2020-2021. Specific prevention and control measures should be taken for infectious diarrhea of different ages, pathogens, and seasons.
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