2018-2022年山东省威海市食源性疾病流行特征分析

Analysis on etiology and epidemiological characteristics of foodborne diseases in Weihai city, Shandong province from 2018 to 2022

目的探讨2018-2022年山东省威海市食源性疾病的流行情况,为食源性疾病预防和控制提供参考依据。方法收集2018-2022山东省威海市立医院1311例食源性疾病患者的信息,采集其粪便或肛拭子进行食源性疾病相关病原体检测。采用χ^(2)检验比较不同组别的病原体检出率差异,采用多因素logistic回归分析病原体检出的危险因素。结果监测病原体总检出率为19.37%(254/1311),其中诺如病毒为10.22%、沙门氏菌为4.96%、副溶血弧菌为4.20%、致泻大肠埃希氏菌为0.23%、志贺氏菌为0.15%。从季度上看,诺如病毒感染第一季度和第四季度高发(χ^(2)=23.40,P<0.001);副溶血弧菌第三季度检出率最高(χ^(2)=44.37,P<0.001)。诺如病毒、沙门氏菌、副溶血弧菌阳性病例主要临床症状为腹泻(98.03%)、恶心(51.97%)、呕吐(48.03%)、腹痛(35.83%)和发热(25.20%)。诺如病毒型别以GⅡ型(55.22%,74/134)为主;沙门氏菌优势血清型为肠炎沙门(60.0%,39/65)和鼠伤寒沙门氏菌(12.31%,8/65);副溶血弧菌优势血清型由O3:K6(2018-2022年血清型构成比分别为71.43%、59.09%、75.00%、25.00%、0)转变为O10:K4(2018-2022年血清型构成比分别为0、0、0、66.67%、55.56%)。多因素logistic回归结果显示,职业中与农民相比,工人(OR=4.865,95%CI:1.449~16.334,P<0.05)、学龄前儿童(OR=4.271,95%CI:1.202~15.178,P<0.05)、学生(OR=3.884,95%CI:1.136~13.283,P<0.05)、家务或待业(OR=4.257,95%CI:1.283~14.125,P<0.05)更易检出病原体。食品种类中,多种食品病原体检出率高(OR=2.811,95%CI:1.737~4.549,P<0.05)。结论诺如病毒是2018-2022年威海市食源性疾病主要病原体,其次为沙门氏菌和副溶血弧菌。威海市食源性疾病流行病原体检出处于较高水平,职业和食品种类是病原体检出的影响因素。

Objective To explore the etiology and epidemiological characteristics of foodborne diseases pathogens in Weihai city of Shandong province, so as to provide reference basis for the prevention and control of foodborne diseases. Methods Information on active surveillance cases of foodborne diseases at Weihai Municipal Hospital from 2018 to 2022 were collected, and stool or anal swab samples were tested for relevant pathogens.The χ^(2) test was used to compare the differences in pathogen detection rates among different groups, and logistic regression was used to analyze the risk factors for pathogen detection. Results A total of 1 311 cases were collected, with a total pathogen detection rate of 19.37%(254/1311),including Norovirus(10.22%),Salmonella(4.96%),Vibrio parahaemolyticus(4.20%),Diarrheagenic Escherichia coli(DEC)(0.23%),and Shigella(0.15%).In terms of seasonal distribution, Norovirus had a high detection rate in the first and fourth quarters(χ^(2)=23.40,P<0.001);and that of Vibrio parahaemolyticus was the highest in the third quarter(χ^(2)=44.37,P<0.001).The most common clinical symptom of positive cases of Norovirus, Salmonella,and Vibrio parahaemolyticus was diarrhea(98.03%),followed by nausea(51.97%),vomiting(48.03%),abdominal pain(35.83%),fever(25.20%).The main viral pathogen of Norovirus was GII(55.22%,74/134);The dominant serotypes of Salmonella were Salmonella Enteritidis(60.0%,39/65) and Typhimurium(12.31%,8/65).The dominant serotype of Vibrio parahaemolyticus was changed from O3:K6(serotype composition ratio in 2018-2022,were respectively 71.43%,59.09%,75.00%,25.00%,0.00%) to O10:K4(serotype composition ratio in 2018-2022,were respectively 0.00%,0.00%,0.00%,66.67%,55.56%).Multivariate logistic regression analysis showed that workers(OR=4.865,95%CI:1.449-16.334),preschool children(OR=4.271,95%CI:1.202-15.178),students(OR=3.884,95%CI:1.136-13.283),household chores, or unemployed individuals(OR=4.257,95%CI:1.283-14.125) had a higher risk of detecting pathogen compared with farmers in different professions;A higher risk of detecting pathogens were found in various foods(OR=2.811,95%CI:1.737-4.549). Conclusion Norovirus is the main pathogen of foodborne diseases in Weihai city, followed by Salmonella and Vibrio parahaemolyticus.The prevalence of foodborne disease pathogens in WeiHai is relatively high.The occupation of the patients, and food types are influencing factors for pathogen detection.