Abstract
林声,郑雅旭,宫霄欢,肖文佳,俞晓,潘浩,陈健.上海市2014-2021年肠道门诊15岁及以上感染性腹泻病例中致泻性大肠埃希菌流行特征分析[J].Chinese journal of Epidemiology,2024,45(3):339-346
上海市2014-2021年肠道门诊15岁及以上感染性腹泻病例中致泻性大肠埃希菌流行特征分析
Epidemiological characteristics of diarrheagenic Escherichia coli infection in infectious diarrhea outpatients aged 15 years and older in Shanghai, 2014-2021
Received:October 08, 2023  
DOI：10.3760/cma.j.cn112338-20231008-00209
KeyWord: 哨点监测  肠道门诊  感染性腹泻  致泻性大肠埃希菌  流行特征
English Key Word: Sentinel surveillance  Diarrhoeal disease clinic  Infectious diarrhea  Diarrheagenic Escherichia coli  Epidemiological characteristics
FundProject:上海市加强公共卫生体系建设三年行动计划（2023-2025年）优青项目（GWVI-11.2-YQ11）；第六轮三年行动计划重点学科（GWVI-11.1-01）；上海市卫生健康委员会卫生行业临床研究专项青年项目（20224Y0332）
Author NameAffiliationE-mail
Lin Sheng Institute for Communicable Disease Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China  
Zheng Yaxu Institute for Communicable Disease Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China  
Gong Xiaohuan Institute for Communicable Disease Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China  
Xiao Wenjia Institute for Communicable Disease Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China  
Yu Xiao Institute for Communicable Disease Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China  
Pan Hao Shanghai Institutes of Preventive Medicine, Shanghai 200336, China panhao@scdc.sh.cn 
Chen Jian Institute for Communicable Disease Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China chenjian@scdc.sh.cn 
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Abstract:
      目的 了解上海市肠道门诊≥15岁感染性腹泻病例中致泻性大肠埃希菌（DEC）流行特征，为DEC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22家监测点医疗机构的肠道门诊开展腹泻症状监测，收集病例的人口学、临床和流行病学资料，同时采集病例粪便标本，送至医疗机构所在区CDC开展DEC检测及鉴定分型，分析比较2014-2021年不同人群和季节的DEC阳性率。统计学分析采用χ2检验。结果 在15 185例感染性腹泻病例中，DEC的总阳性率为8.05%（1 222/15 185）。其中男性阳性率（8.74%，684/7 824）高于女性（7.31%，538/7 361），15~29岁组人群阳性率最高（9.14%，335/3 665），2021年阳性率最高（10.21%，83/813），以上差异有统计学意义（均P<0.05）。DEC阳性PCR菌型鉴定分离出菌株1 264株中，肠产毒性大肠埃希菌为主（50.24%，635/1 264），其次是肠黏附性大肠埃希菌（27.93%，353/1 264）和肠致病性大肠埃希菌（21.36%，270/1 264）。DEC存在明显季节性流行特征，夏季阳性率最高（13.92%，774/5 562）（χ2=495.73，P<0.001）。结论DEC是2014-2021年上海市感染性腹泻患者重要病原体之一，引起的感染性腹泻全年均可发生，夏秋季高发，流行型别为肠产毒性大肠埃希菌、肠黏附性大肠埃希菌和肠致病性大肠埃希菌。应针对不同年龄、不同季节和不同型别的DEC感染性腹泻采取特异性的防控措施。
English Abstract:
      Objective To understand the epidemiological characteristics of diarrheagenic Escherichia(E.) coli infection in infectious diarrhea outpatients aged 15 years and older in Shanghai and provide evidence for the development of disease control strategies. Methods Based on multistage systematic sampling, diarrhea surveillance was conducted in 22 sentinel hospitals in Shanghai, the information about cases' demographic, clinical, and epidemiological characteristics were collected. Stool samples were collected for the detection and typing of diarrheagenic E. coli by local centers for disease control and prevention. The positive rate of diarrheagenic E. coli in different populations and seasons from 2014 to 2021 were analyzed. Statistical analysis was conducted by using χ2 test. Results In 15 185 diarrhea cases, 8.05% (1 222/15 185) were positive for diarrheagenic E. coli. The positive rate was higher in men (8.74%, 684/7 824) than in women (7.31%, 538/7 361). The positive rate was highest in age group 15-29 years (9.14%, 335/3 665) and the annual positive rate was highest in 2021 (10.21%, 83/813), the differences were all significant (P<0.05). In the 1 264 strains of diarrheagenic E. coli analyzed through PCR, enterotoxingenic E. coli was the most frequently identified pathogen (50.24%, 635/1 264), followed by enteroadhesive E. coli (27.93%, 353/1 264), and enteropathogenic E. coli (21.36%, 270/1 264). The positive rate of diarrheagenic E. coli showed obvious seasonality with peak in summer (13.92%, 774/5 562) (χ2=495.73, P<0.001).Conclusions Diarrheagenic E. coli has become a prominent pathogen in infectious diarrhea cases in Shanghai, the disease can occur all the year round with incidence peak during summer and autumn. Predominant subtypes included enterotoxingenic E. coli, enteroadhesive E. coli and enteropathogenic E. coli. Targeted prevention and control strategies are needed for diarrheagenic E. coli-induced infectious diarrhea in different age groups, seasons and for different types of infections.
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