2012年全国伤寒和副伤寒重点监测数据分析

Key surveillance for typhoid / paratyphoid fever in China,2012

目的了解2012年中国(未含香港、澳门、和台湾地区,以下同)伤寒和副伤寒国家监测点的优势菌型、菌株耐药变化情况以及脉冲场凝胶电泳(pulsed-field gel electrophoresis,PFGE)优势带型变化特征。方法用描述流行病学方法对伤寒、副伤寒国家监测点2012年伤寒和副伤寒重点监测结果进行描述,并与法定报告数据进行比较和分析。结果 13个监测点伤寒和副伤寒总报告发病率为7.86/10万,其中实验室诊断病例(510例)中副伤寒占56.08%。重点监测显示:13个监测点共分离出147株病原菌,阳性检出率为2.55%;分离的病原以甲型副伤寒沙门菌为主(占73.47%),显著高于法定报告数据中副伤寒的比例。不同监测点病原阳性检出率差异很大,病原构成比差异也很大。2012年伤寒、甲型副伤寒沙门菌株对萘啶酸和环丙沙星的耐药率均有所上升。PFGE分析表明,2012年伤寒沙门菌监测菌株出现了3种新的优势带型,而JKPX01.CN0001仍为甲型副伤寒沙门菌监测菌株的优势流行带型。结论伤寒和副伤寒重点监测系统是法定报告的补充,监测点病原以甲型副伤寒为主,需阶段性地对该系统进行评估以保证监测质量。

Objective To understand the predominant serotypes,the change in drug resistance of Salmonella typhi and Salmonella paratyphi and the change of related pulsed-field gel electrophoresis（ PFGE） pattern in surveillance areas in the mainland of China. Methods Descriptive epidemiological analysis w as conducted on the surveillance data of typhoid /paratyphoid fever in key surveillance areas in China in 2012. The results w ere compared w ith those reported to national disease reporting information system. Results The overall incidence of typhoid / paratyphoid fever in 13 surveillance areas w as 7. 86 / lakh. Among 510 laboratory confirmed cases,paratyphoid fever cases accounted for 56. 08%,significantly low er than the national average level（ 63. 14%）. The surveillance results show ed that 147 S. typhi and S. paratyphi strains w ere isolated. The positive detection rate w as 2. 55%. The predominated pathogen w as S. paratyphi A,accounting for 73. 47%. This proportion w as much higher than that reported to national disease reporting information system. The positive detection rate and the pathogens detected varied w ith the surveillance area. The drug-resistance rates of S. typhi and S. paratyphi A to nalidixic acid and ciprofloxacin increased in 2012. PFGE analysis show ed there w ere 14 patterns of S. typhi detected in 2012,in w hich 3 w ere new predominant patterns,w hile JKPX01. CN0001 w ere still the predominant pattern of S. paratyphi A. Conclusion S. paratyphi A is the major pathogen in the surveillance areas. Surveillance for typhoid / paratyphoid fever in key areas can provide more information about the incidence of typhoid / paratyphoid fever in China,but the regular evaluation on the surveillance quality is needed.