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.     

国内外食源性疾病监测与负担估计的研究进展

食源性疾病是世界性的公共卫生问题, 不仅危害人类健康, 还对经济和社会产生不良影响。开展食源性疾病进行监测分析、负担估计和影响评估等方面的研究, 评估和对比不同病原食源性疾病的感染风险和危害程度, 可以指导国家食品安全政策制定和主动干预措施实施。本文将近年来国内外对食源性疾病的监测分析、负担估计和损失衡量等方面的研究进展进行综述, 以期为我国食源性疾病的负担估计和主动干预措施制定提供参考。     

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。     

研究表明:食源性疾病依然是我国最大的食品安全问题

近期,我国科学家在专业期刊《BMC Public Health》上发表学术论文,详细分析了我国的急性胃肠炎和食源性疾病负担状况。这项为期一年的研究由国家食品安全风险评估中心联合上海、江苏、浙江、江西、广西、四川6省的疾病预防控制中心共同完成。项目参与者、评估中心重点实验室陈艳研究员介绍说,2010~2011年,全国约有7.48亿人次发生急性胃肠炎,4.2亿人次因病就诊。这其中可能有约三分之一由食物引起,也就是说,每年全国吃出急性胃肠炎的就有2亿多人。从发病率来看,我们与发达国家并无明显差异,这也是世界卫生组织一直强调的"食源性疾病是全球性挑战"。     

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。     

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。     

2018—2019年嘉兴市社区人群急性胃肠炎疾病负担评估

目的 了解社区人群急性胃肠炎流行特征和经济负担,为评估人群食源性疾病的患病情况及单病种疾病负担提供更准确的基础数据。方法 采用分层多阶段随机抽样方法抽取秀洲区和桐乡市共10个街道(乡镇)的20个居委会(行政村)作为调查点,于2018年7月至2019年6月,每月入户问卷调查急性胃肠炎发病情况和经济负担等。结果 现场实际调查2 400户2 400人,发现急性胃肠炎病例62人次,月发病率2.58%(95%CI: 1.95%～3.22%),城镇和农村、不同年龄性别发病差异无统计学意义。根据人口性别、年龄构成调整后的月发病率为2.92%(95%CI: 2.25%～3.60%),推算年发病率为0.38次/人年(95%CI:0.36～0.40)。7～9月为高发季节,医院就诊率12.77%,72.34%的病例与不洁饮食相关,62.50%的29岁及以下年龄病例,83.33%的学龄前儿童,以及学生和办事员病例,均在食用外购食品后发病。病例次均经济负担399.62元,其中次均直接医疗费用294.61元,次均直接非医疗费用39.83元,次均间接费用65.18元,估算全市急性胃肠炎型总经济负担为7.19亿元,其中食源性急性胃肠炎总经济负担为5.20亿元。结论 嘉兴市急性胃肠炎疾病负担较重,建议加强重点人群健康教育,引导建立健康饮食行为,并持续开展相关监测。     

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。     

中国首个基于全基因组测序技术的食源性疾病分子溯源网络建成并投入使用

<正>食源性疾病是全球范围内重要的食品安全问题,早期发现和查明病因是防控食源性疾病的重要保证。随着新一代基因组测序技术的发展,基于全基因组测序(WGS)的分子分型技术在食源性疾病聚集性病例识别和暴发溯源调查中已显示出极大的应用价值和发展潜力,逐渐成为国际研究热点,欧美相关国家已相继开展研究和布局。     

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.     

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.     

地区性食源性疾病病例实时监测系统的开发与实现

开发区域性食源性疾病病例监测系统,并提供接口等解决方案在三类医院中应用,实现食源性疾病病例实时监测,提高工作效率和质量。方法 调查分析各医院的食源性疾病监测流程找出共性点,开发多客户端的B/S结构的区域性食源性疾病病例监测系统。结果 食源性疾病监测可分为病例信息采集和粪便标本采集检验和现场流调3个阶段,医院食源性疾病监测可分为2种模式和3个环节。完成3种客户端口的区域性食源性疾病病例监测系统开发,为医院提供软件接口等对接解决方案,实现食源性疾病病例实时监测。医院实际应用中效果明显。结论 区域性食源性疾病病例监测系统和提供的接口等解决方案能有效提高监测工作效率与质量。     

Beliefs about meals eaten outside the home as sources of gastrointestinal illness

In a 2002 telephone survey of 16,435 randomly selected U.S. residents, respondents answered several questions about their beliefs concerning sources of gastrointestinal illness. Of those who had experienced vomiting or diarrhea in the month before their telephone interview, 22% believed the source of their gastrointestinal illness was a meal eaten outside the home. I11 respondents who had diarrhea but not vomiting and who did not miss work because of their illness were more likely to believe the illness resulted from a specific outside meal. I11 respondents attributed their illness to a specific outside meal for several reasons, including symptom timing (43%) and illness of their meal companions (6%). Eight percent of ill respondents reported their illness to a health department or the restaurant suspected of causing the illness. Those with vomiting and those who missed work or activities because of their illness were more likely to report their illness. Most respondents (54%) who attributed their illness to a specific outside meal said their illness symptoms began within a short time (5 h) of eating that meal. The foodborne illnesses for which this is a likely time frame typically are associated with vomiting, but respondents with vomiting did not report a shorter symptom onset than respondents without vomiting. These findings suggest that ill respondents may have the misconception that foodborne illness symptoms typically occur shortly after ingestion of contaminated food. Results suggest that education efforts should focus on the nature and timing of foodborne illness symptoms and the importance of reporting suspected foodborne illnesses.     

地区性食源性疾病病例实时监测系统的 开发与实

目的 开发区域性食源性疾病病例监测系统,并实现食源性疾病病例实时监测,提高工作效率和质量。方法 调查分析各医院的食源性疾病监测流程找出共性点。开发多客户端的B/S结构的区域性食源性疾病病例监测系统。并提供接口等解决方案在三类医院中应用。结果 食源性疾病监测可分为病例信息采集和粪便标本采集检验和现场流调三个阶段,医院食源性疾病监测可分为两种模式和三个环节。完成三种客户端口的区域性食源性疾病病例监测系统开发,为医院提供软件接口等对接解决方案,实现食源性疾病病例实时监测。医院实际应用中效果明显。结论 区域性食源性疾病病例监测系统和提供的接口等解决方案能有效提高监测工作效率与质量。     

2003-2007年中国1060起细菌性食源性疾病流行病学特征分析

目的了解我国细菌性食源性疾病暴发的发生趋势、流行特征。方法根据中国食源性疾病监测网2003-2007年报告资料,分析细菌性食源性疾病发病率、住院率等流行病学指标的时间趋势、地区差异、人口学特征,以及发病人群的病原体分布、原因食品比例以及引发事件因素等特征。结果2003-2007年食源性疾病监测网报告细菌性食源性疾病暴发事件共1060起,涉及发病人数32261例,住院16426例,死亡16例。夏秋季是高发季节;6～15岁年龄组人群为重点关注人群;副溶血性弧菌为我国最主要的食源性致病菌,畜禽肉类食品是主要的原因食品,自制粮食类食品是导致死亡的最重要食品,食品加工不当是导致疾病的最主要因素。结论细菌性食源性疾病仍是我国主要的公共卫生问题,食源性疾病监测网需要进一步建设和完善。     

Cost of illness and disease burden in The Netherlands due to infections with Shiga toxin-producing Escherichia coli O157

Infections with Shiga toxin-producing Escherichia coli O157 (STEC O157) are associated with hemorrhagic colitis, hemolytic uremic syndrome (HUS), and end-stage renal disease (ESRD). In the present study, we extend previous estimates of the burden of disease associated with STEC O157 with estimates of the associated cost of illness in The Netherlands. A second-order stochastic simulation model was used to calculate disease burden as disability-adjusted life years (DALYs) and cost of illness (including direct health care costs and indirect non-health care costs). Future burden and costs are presented undiscounted and discounted at annual percentages of 1.5 and 4%, respectively. Annually, approximately 2.100 persons per year experience symptoms of gastroenteritis, leading to 22 cases of HUS and 3 cases of ESRD. The disease burden at the population level was estimated at 133 DALYs (87 DALYs discounted) per year. Total annual undiscounted and discounted costs of illness due to STEC O157 infection for the Dutch society were estimated at ?.1 million and ?.5 million, respectively. Average lifetime undiscounted and discounted costs per case were both ?26 for diarrheal illness, both ?5,713 for HUS, and ?.76 million and ?.22 million, respectively, for ESRD. The undiscounted and discounted costs per case of diarrheal disease including sequelae were ?,132 and ?,131, respectively. Compared with other foodborne pathogens, STEC O157 infections result in relatively low burden and low annual costs at the societal level, but the burden and costs per case are high.