上海市2008—2017年霍乱流行病学特征分析

Epidemiological characteristics of cholera in Shanghai city, 2008 – 2017

目的了解上海市霍乱发病的流行病学规律、耐药特点及可能的危险因素。方法对2008—2017年上海市发现和报告的霍乱病例开展流行病个案调查,在19家监测点开展霍乱弧菌水源、食品和外环境调查,对采集的标本进行霍乱弧菌分离培养,并应用纸片扩散法(K-B法)对阳性菌株开展12种抗生素耐药检测,研究霍乱发病的流行病学特征、耐药特性等。结果本市霍乱病例以本市居民居多,郊区占90.48%;临床表现以腹泻、呕吐为主,其中腹泻≥10次占61.9%、呕吐≥3次占45.45%;病例发病前1周均有可疑饮食史,其中有聚餐史占76.19%;霍乱弧菌水源、食品和外环境低水平污染状况与本市病例发病情况相符;阳性菌株均对头孢曲松敏感,耐药率最高的为磺胺类药,达74.07%。结论上海市霍乱在过去的10年期间一直处于较低的发病水平,而高危食品、发病前1周聚餐史可能是主要的危险因素,霍乱弧菌耐药情况较为普遍。

Objective To examine the incidence and risk factors of cholera and drug resistance of isolated Vibrio cholerae strains in Shanghai city.Methods The collected data for the study included all registered cholera cases and their case survey reports, the isolatios of pathogens from drinking water, food and environment specimens at 19 monitoring sites, and the results of drug resistance to 12 antibiotics of the isolated Vibrio cholerae strains during the period from 2008 to 2017 in Shanghai city. Paper diffusion method (Kirby-Bauer, K-B) was used in drug resistance test.Results The majority of the cholera cases reported during the 10-year period were local residents and 90.48% of cases dwelled in suburb regions of Shanghai. The main clinical manifestations of the cases were diarrhea and vomiting, with 61.9% of the cases reporting diarrhea of 10 times or more and 45.45% reporting vomiting of 3 times or more. Almost all the cases reported suspicious incidence related-dietary history during one week before the onset of the disease, of which 76.19% reported the history of dinner party. Vibrio cholera contamination to water, food and external environment were at a very low level based on the monitoring data and it was consistent with the low incidence of cholera during the period. All isolated Vibrio cholera strains were sensitive to ceftriaxone and the observed highest resistance rate (74.07%) of the isolated strains was to nudic acid.Conclusion The cholera incidence was at a low level in Shanghai city from 2008 to 2017. Food contamination and the history of dinner party one week before the disease incidence were main risk factors of cholera epidemic. Antibiotic resistance is prevalent for Vibrio cholera strains isolated from monitoring specimens in the city.