2008—2014年天津市细菌性痢疾流行病学特征及志贺菌检测结果分析

Analysis on epidemiological characteristics of bacterial dysentery and Shigella detection results in Tianjin city during 2008-2014

目的了解天津市细菌性痢疾流行病学和志贺菌病原学特征,为提出预防和控制措施提供依据。方法利用2008—2014年"疾病监测信息报告管理系统"数据,回顾性分析患病人群的流行特征。按照分层抽样的方法抽取天津市市区、近郊地区、滨海新区和远郊地区的监测哨点医院,按照一定的抽样间隔对2008年—2014年的5—10月间的细菌性痢疾临床诊断病例采集粪便标本3 955份,进行志贺菌培养及菌群检测。结果 (1)流行特征。2008—2014年天津市报告65 179例细菌性痢疾病例,年均发病率72.00/10万,年发病率呈现逐年下降趋势。市区(120.28/10万)、近郊地区(70.36/10万)、滨海新区(64.22/10万)和远郊地区(19.39/10万)发病率呈依次下降的趋势。发病时间主要集中在6—9月,发病高峰出现在8月份。发病率以5岁以下和85岁以上人群较高。0~24岁和≥75岁组男性年均发病率高于女性,50~74岁年龄组的女性年均发病率高于男性(P<0.05)。职业分布以散居儿童和离退休人员发病较多。(2)菌型分布。志贺菌阳性229株(5.79%),其中宋内志贺菌136株(59.39%),福氏志贺菌93株(40.61%)。89株福氏志贺菌(4株未检出)中检出8种亚型,以F2a(49.44%)、F2b(22.47%)和FX(13.48%)为主。检出福氏志贺菌的亚型种类在2008—2014年逐年减少,呈现亚型单一化。在10~19岁人群志贺菌检出率最高(9.55%)。市区宋内志贺菌阳性率最高(5.09%),福氏志贺菌阳性率最高的地区为近郊地区(3.09%)。结论天津市细菌性痢疾防控的重点人群为散居儿童和老年人群,应加强宣传与健康教育,提高重点人群及其日常护理人员的卫生意识。志贺菌属菌群在不断变迁,需继续开展长期监测,摸清志贺菌的变迁规律。

Objective To understand the epidemiological characteristics of bacillary dysentery and etiologicalcharacteristics of Shigella in Tianjin,and to provide evidence for the prevention and control measures.Methods The dataof disease surveillance information reporting system from2008to2014were analyzed retrospectively.A total of3955stoolsamples came from the clinically diagnosed cases of bacillary dysentery were collected,according to the extraction method ofstratified sampling in Tianjin city,suburban area,Binhai New Area and suburban area sentinel hospitals,and according to the sampling interval for the May to October from2008to2014.Samples were detected and cultured for Shigella flora.Results(1)Epidemiological characteristics:from2008to2014,a total of65179cases of bacillary dysentery were reportedin Tianjin city,with an average annual incidence of72.00/100thousand.The annual incidence rate showed a downwardtrend year by year.The incidence was a downward trend,including urban(120.28/100thousand),suburban areas(70.36/100thousand),Binhai New Area(64.22/100thousand)and the outer suburbs(19.39/100thousand).The onset time was mainlyconcentrated in June-September,and the peak incidence occurred in August.The incidence rate was higher in people below5years old and above the age of85.The annual incidence rate was higher in male patients of0to24years old and above75years old than that of female.The annual incidence rate was higher in female patients of50to74years old age group thanthat of male(P<0.05).The distribution of occupation was scattered among children and retirees.(2)Distribution of bacteria:the229Shigella strains were positive(5.79%),including136strains of Shigella sonnei(59.39%),93strains of Shigellaflexneri(40.61%).The89strains of Shigella flexneri(4strains were not detected)were detected in8subtypes,F2a(49.44%),F2b(22.47%)and FX(13.48%).The subtypes of Shigella flexneri were detected decreased year by year from2008to2014,showing a single subtype.The highest detection rate of Shigella was found in10-19years old(9.55%).The S.sonnei positiverate was the highest in urban(5.09%),and the Shigella flexneri positive rate was the highest in suburban areas(3.09%).Conclusion The key population for the prevention and control of bacillary dysentery in Tianjin is scattered children andold people.It is necessary to strengthen the propaganda and health education to improve the health consciousness of the keypopulation and their daily nursing staff.With the continuous changes of Shigella flora,it is necessary to carry out long-termmonitoring to find out the regularity of shigella.