【作者】 毛雪丹；

【导师】 胡俊峰； 刘秀梅；

【作者基本信息】 中国疾病预防控制中心 ， 流行病与卫生统计学， 2010， 博士

【摘要】 目的：通过我国食源性疾病监测网资料分析,了解我国细菌性食源性疾病暴发事件的流行特征；通过我国目前现有的腹泻调查报告资料和死亡调查资料推算我国细菌性食源性疾病以及3种主要致病菌(非伤寒沙门氏菌、副溶血性弧菌以及志贺氏菌)的疾病负担；结合我国2002年膳食调查数据推算我国细菌性食源性疾病以及3种主要致病菌的食品归因风险。方法：1.以食源性疾病监测网2003-2008年细菌性食源性疾病报告资料为基础,进行细菌性食源性疾病暴发事件的发病时间趋势、年龄分布、地区分布、病原分布、原因食品以及引发事件因素等流行病学特征进行描述和分析；2.通过文献查询等方式搜索我国目前对腹泻的发病和死亡等特征的调查报告,结合国外报告等各种来源的数据经过适当的统计处理推算获得细菌性食源性疾病的发病率、就诊率、住院率和死亡率等流行病学负担；以及门诊费用、住院费用等直接经济负担,采用人力资本法获得间接经济负担；利用国际通用公式计算我国因细菌性食源性疾病导致的伤残调整寿命年(Disability-adjusted Life Years, DALYs)损失；3.利用文献综述的方法获得腹泻患者中非伤寒沙门氏菌、副溶血性弧菌以及志贺氏菌所占比例,结合我国死因调查报告以及国外报道等资料获得3类病原菌导致的食源性疾病发病率和病死率；4.利用食源性疾病监测网报告的细菌性致病菌、非伤寒沙门氏菌、副溶血性弧菌以及志贺氏菌的原因食品构成,结合我国2002年膳食调查数据,可推算细菌性食源性疾病、非伤寒沙门氏菌、副溶血性弧菌以及志贺氏菌摄入各类食品的患病风险,并以此进行国际比较。结果：1.2003-2008年我国细菌性食源性疾病流行病学特征分析我国食源性疾病监测网2003-2008年报告细菌性食源性疾病事件1157起,涉及发病人数35208人,住院17894人,死亡16人。5-9月份是细菌性食源性疾病的高发季节；6-15岁人群的报告发病率、住院率和死亡率均为最高；副溶血性弧菌是食源性疾病暴发的首要致病菌,报告发病人数占总体发病的25.6%；畜禽肉类制品是首要的致病食品；16例死亡病例中有15例是由耶毒假单胞菌导致；交叉污染和加工、存储不当是导致发病最主要的原因。2.细菌性食源性疾病疾病负担估计流行病学负担我国人群腹泻发病率估计为0.3812次／人年,急性胃肠炎发病率为0.4795次／人年,细菌性食源性疾病发病率为0.0875次／人年。细菌性食源性疾病患者就诊比例为27.67%,住院比例为3.83%,病死率为0.0074%。按我国人口总数131448万人计算,每年因细菌性食源性疾病发病11501.7万人次,就诊达3182.5万人次,住院440.8万人次,每年因细菌性食源性疾病导致死亡大约为8530人。推算食源性疾病监测网对细菌性食源性疾病的漏报系数为12490倍,漏报率估计达99.992%。经济负担我国因细菌性食源性疾病的人均门诊费用为88.48元,人均住院费用为1114.56元,因门诊和住院合计医疗费用为77.29亿元,直接非医疗费用为16.25亿元,直接经济负担合计为93.54亿元；因生产力损失造成的间接经济负担为38.61亿元。总疾病相关成本估计为132.15亿元,占我国2006年卫生总费用的1.34%,占我国2006年国内生产总值(GDP)的0.06%。伤残调整寿命年(DALY)估计在我国每年因细菌性食源性疾病死亡导致损失178,244.17 DALYs;我国人群因感染细菌性食源性疾病导致伤残而损失100583.46 DALYs;合计损失278827.63 DALYs,为艾滋病(2007年)DALYs损失的2.6倍,是糖尿病DALYs损失的13.3%。3.特定病原体导致食源性疾病流行病负担估计我国每年因非伤寒沙门氏菌导致食源性病约1105.0万人次,导致死亡约792例；每年因副溶血性弧菌导致食源性病约857.4万人次,未导致死亡病例；因志贺氏菌每年导致食源性病约980.6万人次,导致死亡约500例。推算食源性疾病监测网对非伤寒沙门氏菌、副溶血性弧菌及志贺氏菌导致的食源性疾病漏报系数分别为8346倍、2799倍和33017倍,推算漏报率分别为99.988%、99.964%以及99.997%。4.食物归因研究畜禽肉类产品是细菌性食源性疾病最主要的致病食品,每年导致发病5140.1万人／年,占总体病例的44.69%；摄入畜禽类食品患细菌性食源性疾病的风险最高,每摄入100万份食品可导致病例160例,每摄入1餐畜禽肉类制品,患病概率为7.36×10-5；焙烤类制品的摄入风险占第二位；水产品类位居第三位,蔬菜和食用菌类的摄入风险最低。畜禽肉类制品是食源性非伤寒沙门氏菌病的首要致病食品,占病例总数的54%。焙烤类食品的摄入风险最高,每摄入100万份食品可导致病例92例,每餐摄入焙烤食品的患病概率为2.256×10-5,其次是畜禽肉和蛋类制品,蔬菜和食用菌的风险最低。水产品是食源性副溶血性弧菌病的最主要致病食品,占病例总数的37%,每摄入100万份食品可导致病例21例,每餐摄入水产类食品的患病概率为9.197×10-6；其次是畜禽肉和豆制品；粮食类制品的摄入风险最低。果汁、畜禽肉和乳制品是导致志贺氏菌感染的最主要致病食品,摄入果汁的患病风险最高,每摄入100万份果汁可导致发病306例,每餐饮用果汁的患病概率为1.299×10-4；畜禽肉类制品位于第二位；乳制品的患病风险位于第三位。结论：1.副溶血性弧菌是我国食源性疾病暴发的首要致病菌,耶毒假单胞菌是主要报告的致死病原菌,6～15岁人群是食源性疾病暴发的重点防控人群；畜禽肉类制品是最主要的原因食品；交叉污染和加工、存储不当是食源性疾病事件发生的最主要因素。2.细菌性食源性疾病对我国造成了严重的疾病负担,应加强对细菌性食源性疾病的防控工作,重点加强食源性疾病监测网的建设工作,提供监测工作能力,并加强对我国消费者和食品加工者的健康教育工作。3.非伤寒沙门氏菌、副溶血性弧菌以及志贺氏菌三种主要的食源性致病菌中,非伤寒沙门氏菌导致的实际发病人数最多,其次为志贺氏菌和副溶血性弧菌。食源性疾病监测网存在严重的漏报现象,其中志贺氏菌的漏报率最高,应加强志贺氏菌的监测报告工作。4.畜禽肉类制品是细菌性食源性疾病最主要的致病食品；摄入焙烤类食品感染非伤寒沙门氏菌而患病的概率最高；摄入水产品感染副溶血性弧菌患病的概率最高；摄入果汁类制品感染志贺氏菌而患病的概率最高。应重点加强高风险食品的卫生监管工作,并加强对消费者、食品加工者等重点人群的健康教育。更多还原

【Abstract】 Objective1. To understand epidemiological characteristics of of bacterial foodborne disease outbreak events in China by analysing Chinese foodborne monitoring network data;2. To calculate the disease burden of bacterial foodborne diseases, and three major pathogens (nontyphoidal Salmonella, Vibrio parahaemolyticus and Shigella) in China by available national data of diarrhea morbidity and mortality;3. To calculate the food-specific risk of bacterial foodborne diseases, and three major pathogens (non-typhoid Salmonella, Vibrio parahaemolyticus and Shigella) in China with national dietary survey data in 2002.Methods1. Based on the report data of bacterial foodborne disease outbreaks from foodborne disease monitoring network in 2003-2008, describe and analyze the epidemiological characteristics of bacterial foodborne outbreaks, including the incidence time trend of events, age distribution, geographical distribution, pathogens, food characteristics and causes.2. Through collecting the available literatures on the diarrhea investigation including the incidence, hospitality, in-patient and mortality rate, and the cost of illness, calculate the epidemiological and direct economic burden of bacterial foodborne disease; Calculate the indirect economic burden with human captical approach; Calculate disability-adjusted life year (Disability-adjusted Life Years, DALYs) caused by bacterial foodborne illness using of international common formula. 3. Calculate the proportions of three main foodborne pathgens with reviewing literatures, obtain the incidence and mortality of the three pathgens with the death causes report and other data.4. Calculate the food-specific risks of foodborne diseases caused by bactera and three specific pathogens including nontyphoidal Salmonella, Vibrio parahaemolyticus, and Shigella with the foodborne disease monitoring network data.Results1. Analysis of epidemiological characteristics of bacterial foodborne diseases during 2003-20081157 foodborne outbreaks were reported from national foodborne monitoring network during 2003-2008, causing 35208 cases,17894 hospitalizations and 16 deaths. May to September is the high season; The reported incidence, hospitality and mortality rate leads in 6-15 Year old; Vibrio parahaemolyticus is the most important foodborne pathogen from outbreak report, the cases caused by it composes 25.6 percent of total; poultry meat products is the primary pathogenic food; 16 cases of deaths in 15 cases caused by Pseudomonas cocovenans subsp.; cross-contamination and improper storage and processing are the main causes.2. Disease burden estimation of bacterial foodborne diseasesEpidemical disease burdenIn China, it is estimated that 0.3812 episodes of acute diarrhoea happen per person per year, 0.4795 episodes of gastroenteritis and 0.0875 episodes of bacterial foodborne disease happen per person per year. Bacterial foodborne diseases cause 27.67% cases see the doctors,3.83% hospitalization and 0.0074% deaths.Based on the population of 1314.48 millions, Annually there were 115017 thousands cases, 31825 thousands obtained medical care,4408 thousands hospitalized and 8530 deaths.It is deduced that the underreporting of bacterial foodborne disease from national foodborne disease montoring network is 12490 times, i.e.99.992% is underreported. Economic burdenThe average outpatient cost of bacterial foodborne disease is 88.48 Yuan, and inpatient cost is 1114.56Yuan. The total medical care cost is 7729 million Yuan and indirect medical cost is 1625 million Yuan each year, in total, direct economic burden is 9354 million Yuan; The indirect economic burden of lost productivity is 3861 million Yuan. Therefore, the COI is estimated to be 13215 million Yuan annually in China, consisting 1.34% of total health expenditure, and 0.06% of GDP in 2006.Disability-adusted Life Year (DALY) estimationThe health burden of bacterical foodborne disease in China is estimated 278827.63 DALYs, the death causes 178,244.17 DALYs, and illness causes 100583.46 DALYs. The total health burden is 2.6 times of that of AIDS in 2006,13.3% of diabetes.3. the epidemical burden of foodborne disease caused by specific pathogenAnnually, foodborne nontyphoidal Salmonella causes 11050 thousands incidences and 792 deaths; foodborne Vibrio parahaemolyticus causes 8574 thousands incidences and no death; foodborne Shigella causes 9806 thousands incidences and 500 deaths.It is deduced underreportings of nontyphoidal Salmonella, Vibrio parahaemolyticus and Shigella are separately 8346,2799 and 33017 times, i.e.99.988%of foodborne nontyphoidal Salmonella,99.964% of foodborne Vibrio parahaemolyticus and 99.997% of foodborne Shigella are underreported.4. Food attributionThe most important cause of bacterial foodborne diseases is poultry and meat products, leading to 51401 thousands episodes of fooeborne disease per year, accounting for 44.69% of cases overall; poultry and meat products are the highest risk food, every one million servings can lead to 160 cases, each intake a meal of meat products, the probability of illness is 7.36×10-5. Baked products ranked second; and aquatic products ranked third, intake of vegetables and edible fungi contribute the lowest risk.The most important cause of foodborne nontyphoidal Salmonella diseases is poultry and meat products, accounting for 54% of cases overall; The risk from intake of baked products is highest, every one million servings can lead to 92 cases, the illness probability of each intake a meal of baking products is 2.256×10-5. Livestock and poultry meat and egg products ranks second, and vegetables and edible fungi ranks lowest.The most important cause of foodborne Vibrio parahaemolyticus diseases is seafood, accounting for 37% of cases overall; every one million servings can lead to 21 cases, the illness probability of each intake a meal of seafood is 9.197×10-6. Livestock and poultry meat and soybean products ranks second, and vegetables and cereal products rank lowest, the main causes of foodborne Shigella disease are fruit juice, poultry and meat products, and milk products. Every one million servings of fruit juice can lead to 306 cases, the illness probability of each intake a meal of fruit juice is 1.299×10-4. poultry and meat products rank second, and milk products rank third. Conclusions1. Vibrio parahaemolyticus is the leading pathogen of foodborne diseases outbreaks in China. Pseudomonas cocovenans subsp. is the leading cause of death; 6-15 year-old group is the focus population to prevent and control of foodborne disease outbreaks; Poultry and meat product is the main reason food; Cross-contamination and improper processing, storage are the most important causes of foodborne outbreaks.2. Baterial foodborne diseases caused heavy burden on the cases and society in China. The prevention and control of bacterial foodborne disease should be strengthed, focusing on the construct of foodborne monitoring network, improving monitoring ability, and strengthing the health education to consumers and handlers.3. Nontyphoidal Salmonella, Vibrio parahaemolyticus and Shigella are the three main foodborne pathogens. Nontyphoidal Salmonella leads first and the other two pathogens rank second. The underreporting of Shigella of foodborne monitoring network is the most serious and should be improved.4. Poultry and meat products are the main cause of bacterial foodborne diseases; Intake of baked foods leads the risk of non-typhoid Salmonella infection, seafood leads the risk of Vibrio parahaemolyticus, and fruit juice shares the highest probability of infecting Shigella. It should be strengthed on the inspection and administering on risk foods and strengthing the health education to consumers and food handlers.更多还原