2012年广东省食源性疾病监测结果分析

Surveillance of foodborne disease in Guangdong,2012

目的通过对2012年广东省食源性疾病监测结果进行分析,探讨食源性疾病综合监测模式。方法对2012年广东省收集的所有发病人数在2例及以上（或死亡1例及以上）的食源性疾病（含食物中毒）事件,在12个地市27家监测医院开展的疑似食源性异常病例/异常健康事件,以及在监测医院收集的以腹泻症状为主诉的疑似食源性就诊个案和病例粪便/肛拭标本病原菌监测的所有监测结果,采用描述性流行病学方法进行分析。结果 2012年广东省共报告96起食源性疾病（含食物中毒）事件,共计发病1 037例,死亡6例,病死率5.8‰。食源性疾病（含食物中毒）的发生,以第三季度的发生起数和中毒人数最多,占全年总起数的35.4%（34/96）和中毒总人数的37.1%（385/1 037）;发生场所以宾馆饭店最多,发生起数和中毒人数分别占31.3%（30/96）及32.9%（341/1 037）,其次为家庭（19起115例）和单位食堂（17起260例）;发病年龄以16~60岁组为主,占77.0%（798/1 037）;由微生物污染引发的事件共发生49起600例,其中以副溶血性弧菌（17起193例）和沙门菌（11起155例）为主;引发食源性疾病（含食物中毒）事件的前3位食品分别是肉与肉制品（23.8%,19/80）、豆类及其制品（13.8%,11/80）、海产品（10.0%,8/80）及毒蕈（10.0%,8/80）。全省12个地市27家监测医院均无疑似食源性异常病例/异常健康事件报告。2012年全省共收集到2 192例疑似食源性疾病个案,病例主要集中在5—8月（60.9%,1 334/2 192）,主要症状为腹泻（55.2%,1 211/2 192）、发热（28.5%,625/2 192）和呕吐（16.4%,360/2 192）。从主动监测医院上送的21 358份粪便/肛拭标本中共分离到790株沙门菌、9株志贺菌以及32株副溶血性弧菌;沙门菌主要血清型包括鼠伤寒沙门菌（26.1%,206/790）、鼠伤寒沙门菌变种（I 4,5,12：i：-）（15.6%,123/790）、肠炎沙门菌（14.7%,116/790）及斯坦利沙门菌（10.6%,84/790）;沙门菌对磺胺甲二唑、四环素、氨苄西林、萘啶酸、链霉素的耐药率分别为62.4%、59.5%、58.4%、57.5%、50.8%,对头孢他啶、头孢吡肟、头孢噻肟、环丙沙星的敏感率分别为88.9%、86.3%、79.7%、65.9%。广东省全年共发现9起疑似食源性病例聚集事件,经调查核实1起沙门菌感染,其余8起未能明确感染原因。结论 2012年广东省食源性疾病（含食物中毒）的发生呈季节性波动,致病因素以微生物污染为主。广东省食源性疾病监测能一定程度地反映出目前的食源性疾病发生状况,较客观地达到预期的监测目的,但仍存在不少问题与较大的改进空间,高效的综合监测模式有待进一步探讨与研究。

Objective To analyze foodborne disease surveillance results of Guangdong in 2012 and explore the foodborne disease surveillance strategies. Methods Descriptive epidemiological method was used to analyze data collecting from active symptom surveillance of foodborne disease （ including food poisoning） reports of outbreaks with two and more patients （or 1 and more deaths） from 27 hospitals in 12cities, suspected cases of foodborne disease and abnormal health event report, and pathogen testing results of stool/anus swabs of patients with diarrhea as main symptom in the surveillance hospitals. Results A to- tal of 96 outbreaks of foodborne diseases （including food poisoning） were reported. These outbreaks caused a reported 1 037 persons to become ill and 6 deaths. The case fatality rate was 5.8 per thousand. Food poi- soning occurred mainly in the third quarter of 2012. The number of poisoning outbreaks accounted for 35.4% （34/96） of the yearly total outbreaks and the number of cases accounted for 37.1% （385/1 037） of the total number of poisoning. Restaurants, families and canteens were main places of high incidence. In total, 600 patients in 49 outbreaks were caused by microbial contamination, of which 193 patients in 17 outbreaks were caused by Vibrio parahaemolyticus and 155 patients in 11 outbreaks by Salmonella. The top four foods causing food poisoning were meat and its products （23.8%, 19/80） , legumes and their prod- ucts （ 13.8% , 11/80） , seafood （ 10. 0% , 8/80） , and toadstool （ 10. 0% , 8/80）. No suspected cases of foodborne disease and abnormal health incident were reported. A total of 2 192 cases were collected, main- ly concentrating from May to August, and their main symptoms were diarrhea （55.2% , 1 211/2 192） , fe- ver （28.5%, 625/2 192）, and vomiting （16.4%, 360/2 192）. Totally, 790 strains of Salmonella, 9 strains of Shigella and 32 strains of Vibrio parahaemolyticus were isolated from 21 358 stool/anus swabs sent by surveillance hospitals. Salmonella serotypes mainly included Typhimurium （26. 1% , 206/790） , Typhi- murium variant （ I 4,5,12 ： i：-） （ 15.6% , 123/790） , Enteritidis （ 14. 7% , 116/790）, and Stanley （10. 6% ,84/790）. Salmonella was resistant to sulfamethizole, tetracycline, ampicillin, nalidixic acid, and streptomycin, but sensitive to ceftazidime, cefotaxime, cefepime, ciprofloxacin. Nine suspected food- borne disease gathering events were found through the surveillance system, of which, one was verified as salmonella infection, and the others were unclear. Conclusion Foodborne disease （ including food poison- ing） in Guangdong showed seasonal fluctuations and mainly caused by microbial contamination. The sur- veillance of foodborne disease generally reflected foodborne disease outbreak situation in Guangdong, but the defining objects of surveillance and report quality should be improved.