| 汤泓,李勇,张平平,郭家胤,黄峥,许浩,侯琦,王传清,曾玫,金汇明,胡家瑜,史贤明,张建民,阚飙,熊衍文,赵爱兰,冉陆,许学斌.上海市2012－2013年4种致泻性大肠埃希菌监测[J].Chinese journal of Epidemiology,2015,36(11):1263-1268 |
| 上海市2012－2013年4种致泻性大肠埃希菌监测 |
| Surveillance for diarrheagenic Escherichia coli in Shanghai, 2012-2013 |
| Received:March 18, 2015 |
| DOI：10.3760/cma.j.issn.0254-6450.2015.11.016 |
| KeyWord: 致泻性大肠埃希菌 肠产毒性大肠埃希菌 人群监测 暴发 |
| English Key Word: Diarrheagenic Escherichia coli Enterotoxigenic Escherichia coli Population- based surveillance Potential outbreak |
| FundProject:国家“863”项目(2012AA101601); 国家科技重大专项(2012ZX10004215-003, 2012ZX10004201); 中美新发和再发传染病合作项目(1U2GGH000961-01,5U2GGH000961-02); 上海市长宁区卫生和计生委课题(20134GW24001); 上海市普陀区卫生和计生委课题(普KW12314) |
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| Abstract: |
| 目的 基于临床医院开展4种致泻性大肠埃希菌(DEC)人群监测,探讨公共卫生实验室对临床实验室需求的直接技术指导的实践模式。方法 设立哨点医院,以标准化方法筛选和鉴定DEC菌型;构建DEC流行特征基线;对疑似暴发病例开展基于实验室和流行病学调查。结果 2012－2013年选择上海地区4家哨点医院检测7 204份腹泻标本确认的712例DEC感染病例,阳性率为9.9%。其中肠致病性大肠埃希菌(EPEC)感染351例;肠产毒性大肠埃希菌(ETEC)感染292例;肠侵袭性大肠埃希菌(EIEC)感染32例;产志贺样毒素大肠埃希菌(STEC/EHEC)感染6例;DEC混合感染31例。EPEC感染以1～5岁儿童最多见,菌型均为aEPEC;ETEC流行峰值在8月,阳性率>20%,感染病例2012年聚集于1～28日龄和2013年的20～60岁人群(P< 0.05),菌型以耐热肠毒素(ST)型最多(59.6%),其次为不耐热肠毒素(LT)型(27.8%)和ST/LT型(12.6%);2013年儿童感染EIEC病例明显增加(P< 0.01);未监测到EHEC O157 : H7,但确认2例EHEC O26 : H11(eae-hlyA-stx1a)儿童病例;调查确认2012年上海地区15例新生儿ETEC聚集性感染病例与四川省自贡市新生儿病例属于同一克隆(STh-CS21-CFA/I-ClyA-EatA-ST2332- SHNL0005)。结论 上海地区DEC型谱特征已发生改变,ETEC对新生儿院内感染和食源性感染性腹泻构成潜在暴发风险,需加强实验室主动监测。 |
| English Abstract: |
| Objective To understand the distribution of diarrheagenic Escherichia (E.) coli in population in Shanghai and discuss the practice model of cooperation in enteric infectious disease prevention and control between public health institution and hospital. Methods Sentinel hospitals were assigned, standard detection and identification of diarrheagenic E. coli were conducted, incidence curve of diarrheagenic E. coli infection was drawn and epidemiologic survey and laboratory detection were conducted for suspect diarrheagenic E. coli infection outbreaks. Results A total of 7 204 stool specimens were collected from diarrhea patients in 4 hospitals during 2012-2013, in which 712 (9.9%) were diarrheagenic E. coli positive, including 351 enteropathogenic E. coli (EPEC) strains, 292 enterotoxigenic E. coli (ETEC) strains, 32 enteroinvasive E. coli (EIEC) strains and 6 Shiga toxin-producing E. coli (STEC/EHEC) strains, as well as 31 mixed strains. EPEC infection mainly occurred in children aged 1-5 years; and all of these infections were caused by aEPEC. The incidence peak of ETEC infection was during August, the positive rate was >20%. The ETEC infection mainly occurred in infants aged 1-28 days in 2012 and in people aged 20-60 years in 2013 (P< 0.05). ST was the major type (59.6%), followed by LT (27.8%) and ST/LT (12.6%). EIEC infection increased in children obviously in 2013 (P< 0.01). No EHEC O157 : H7 case was detected, but two EHEC O26:H11 (eae-hlyA-stx1a) cases in children were reported for the first time in Shanghai. The survey result indicated that the multidrug-resistant ETEC (STh-CS21-CFA/I-ClyA- EatA-ST2332-SHNL0005) strain causing outbreak in 15 newborns in Shanghai in 2012 was in the same clone as the strain detected in Zigong in Sichuan province. Conclusion Significant change has occurred in diarrheagenic E. coli distribution in Shanghai in recent years, ETEC has potential risk to cause outbreak of hospital acquired infection in neonates and food borne infection. The active surveillance on ETEC and other enteric pathogens by both public health institutions and hospitals need to be improved. |
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