Objective To introduce the establishment of Shanghai Diarrhea Comprehensive Surveillance System ,and to analyze the epidemiological and etiological characteristics of infectious diarrhea outpatients in Shanghai based on data of Shanghai Diarrhea Comprehensive Surveillance System .Methods Diarrhea patients were surveyed according to a unified designed questionnaire ,who visited one of 22 adult sentinel hospitals and 4 children sentinel hospitals of Shanghai Diarrhea Comprehensive Surveillance during September 2013 to August 2016 .Stool specimens were collected according to different sampling intervals and detected for 12 bacteria and 5 viruses .Characteristics of diarrhea patients were compared and analyzed .Chi-square test was used for statistical analysis .Results Of 4497 infectious diarrhea patients ,the detection rate of viral infection was 29 .77％ ,of which norovirus infection (16 .33％ ) , rotavirus infection (7 .90％ ) and sapovirus infection (1 .90％ ) were dominated . The detection rate of bacterial infection was 15 .38％ ,diarrheagenic E .coli (DEC) infection (5 .25％ ) ,V . parahaemolyticus infection (4 .27％ ) and Salmonella spp .infection (3 .13％ ) .Mixed infection accounted for 11 .07％ .The detection rate ,the infection types and the predominant pathogens in different age groups were statistically different (χ= 18 .11 ,61 .86 and 449 .52 ,respectively ,all P< 0 .01) .DEC ranked first in 3 - 14 years age group , and norovirus ranked first in all other age groups .The pathogen spectrum of infectious diarrhea patients≥ 15 years old showed obvious seasonal changes ,with mainly bacterial infection in summer (peaked in August ,accounting for 81 .56％ ) and mainly viral infection in winter (peaked in January ,accounting for 95 .27％ ) .Norovirus ranked first through the year ,except January ,June ,July and August .Among patients ≥ 15 years old , abdominal pain , fever and loose stools were main symptoms in bacterial infections .Vomiting and watery stool were main symptoms in viral infections . Loose stools appeared frequently in patients ≤ 14 years old .Conclusions Diarrhea Comprehensive Surveillance System based on scientific design and rational distribution is beneficial for understanding the epidemic trends and pathogen characteristics of diarrhea .Viral infections are predominant in infectious diarrhea patients in Shanghai . Norovirus and rotavirus are the most common diarrheal pathogens .The pathogen spectrum of infectious diarrhea patients shows obvious seasonal changes .DEC is common in diarrhea patients ≤ 14 years old . The clinical symptoms of infectious diarrhea caused by different pathogens are different . Targeted preventive measures should be taken for infectious diarrhea of different ages ,different pathogens ,and in different seasons .%目的 介绍上海市腹泻病综合监测体系的构建,并对2013年至2016年监测数据进行分析,了解上海市感染性腹泻的流行病学特征和病原学特征.方法 对2013年9月至2016年8月上海市腹泻病综合监测的22家成人监测点医院和4家儿童监测点医院的腹泻病例进行主动监测,根据统一设计的调查问卷通过访谈形式开展流行病学调查,并间隔抽样采集病例的腹泻物标本,送至监测点医院所在区CDC开展12种细菌和5种病毒的病原学检测.分析比较感染性腹泻病例的时间分布及病原谱等特征.统计学分析采用卡方检验.结果 4497例感染性腹泻患者中,病毒感染检出率为29.77％,以诺如病毒(16.33％)、轮状病毒染(7.90％)和札如病毒(1.90％)感染为主;细菌感染检出率为15.38％,以致泻大肠埃希菌(5.25％)、副溶血性弧菌(4.27％)和沙门菌(3.13％)感染为主;混合感染占11.07％.不同年龄组腹泻检出阳性率 、感染种类及主要感染病原构成均差异有统计学意义(χ2值分别为18.11、61.86和449.52,均P<0.01),3～14岁年龄组中致泻大肠埃希菌感染居首位,其他年龄组中诺如病毒感染均居首位.≥15岁感染性腹泻病患者病原谱呈现明显的季节变化,夏季以细菌感染为主8月达到高峰(占81.56％),冬季以病毒感染为主1月达到高峰(占95.27％);除1月和6至8月以外,诺如病毒感染均居首位.≤14岁感染性腹泻患儿的病原谱季节变化不明显.≥15岁患者中细菌感染出现腹痛 、发热 、稀软便的比例较高,病毒感染出现呕吐 、水样便的比例较高.结论 科学设计 、合理布局的腹泻病综合监测体系有利于掌握疾病的流行趋势和病原特征.上海市感染性腹泻病例以病毒感染为主,诺如病毒和轮状病毒为最主要的腹泻病原;感染性腹泻患者的病原谱呈现明显的季节变化,致泻大肠埃希菌为 ≤14岁儿童的常见腹泻病原;不同病原引起的感染性腹泻的临床症状有差异.应针对不同年龄 、不同季节 、不同病原的感染性腹泻采取特异性的防控措施.
展开▼
