论文部分内容阅读
目的评估基层公共卫生机构基于实验室监测腹泻病例和食源性沙门菌的能力。方法 2010-2014年,遴选辖区内2家临床医院和固定农贸市场、大型超市和自然水体等进行连续性主动监测和环境背景监测。分析沙门菌的年度流行曲线和菌型特征,回顾性评估监测系统中流行病学和实验室的能力。结果 2010-2014年,监测病例和食源环境沙门菌阳性率为6.9%(269/3898)和5.3%(99/1885)。标本量最多的21~60岁组阳性率(6.2%,168/2714)显著低于标本量最少的<12岁组(40.6%,39/96),确诊病例男女性别比为1.3∶1。食源带菌以猪肉最高(26.2%,44/168),其次为禽肉:鸡肉(7.8%,9/116)和鸭肉(14.3%,4/28)。人源的优势型依次为鼠伤寒、肠炎、婴儿、汤卜逊和山夫登堡沙门菌,食源菌型较人源更具多样性。人源菌株耐药特征稳定,对环丙沙星和头孢菌素的耐药率低,食源株的耐药率略高于人源,但有下降趋势。监测数据中2010年和2011年较其后的几年更能体现真实的沙门菌年度流行特征。结论上海市宝山区的沙门菌病例以青壮年居多,食源暴露以肉制品最高,流行曲线真实但存在偏倚,应加强监测过程的分段评估和质量控制。基层公共卫生机构开展食源性主动监测需投入更多人力、物力,建议借助国家网络实验室平台集成暴发应对和分子分型的能力建设。
Objective To assess the capacity of grassroots public health agencies to detect diarrhea cases and food-borne Salmonella based on laboratory tests. Methods From 2010 to 2014, two clinical hospitals in selected districts, fixed farmer’s markets, large supermarkets and natural water bodies were selected to carry out continuous monitoring and environmental background monitoring. An analysis of the annual prevalence and bacteriological characteristics of Salmonella and a retrospective review of the epidemiological and laboratory capabilities of the surveillance system. Results From 2010 to 2014, the positive rates of Salmonella in monitoring cases and food-borne environments were 6.9% (269/3898) and 5.3% (99/1885) respectively. The positive rate (6.2%, 168/2714) in the 21-60 age group with the largest amount of specimens was significantly lower than that in the <12 age group (40.6%, 39/96) with the least amount of specimens. The sex ratio of the diagnosed patients was 1.3:1. Foodstuffs were the highest in pork (26.2%, 44/168), followed by poultry: chicken (7.8%, 9/116) and duck (14.3%, 4/28). Human dominance followed by typhoid fever, enteritis, infants, Thompson and Salmonella of Sandvig, Salmonella, the source of bacteria more diverse than the human source. The drug-resistant strains of human strains were stable, the drug resistance rate to ciprofloxacin and cephalosporin was low, and the drug-resistant rate of food-source strains was slightly higher than that of human sources, but there was a downward trend. Monitoring data in 2010 and 2011 more than the subsequent years to reflect the true annual Salmonella epidemic characteristics. Conclusion The population of Salmonella in Baoshan District of Shanghai is mostly young, with the highest exposure to food products. The epidemic curve is true but biased, and the sub-evaluation and quality control of monitoring process should be strengthened. Grass-roots public health agencies need to devote more manpower and material resources to actively carry out food-source monitoring, and it is proposed to use the national network laboratory platform to integrate outbreak response and molecular typing capacity-building.