2005—2024年上海市杨浦区其他感染性腹泻病及其病原体流行特征

Epidemiological characteristics of other infectious diarrhea and pathogens in Yangpu District of Shanghai from 2005 to 2024

  • 摘要: 【目的】 阐明2005—2024年上海市杨浦区除了霍乱、伤寒、副伤寒、菌痢以外的其他感染性腹泻病的流行特征、病原谱动态演变及空间分布规律,为制定精准的防控策略提供科学依据。【方法】 提取中国疾病预防控制信息系统中现住址为上海市杨浦区,发病日期为2005年1月1日—2024年12月31日的其他感染性腹泻病病例信息,收集病例的性别、年龄、职业及病原学检测结果等。采用描述性流行病学方法,分析2005—2024年杨浦区其他感染性腹泻病报告发病率的三间分布及其病原体流行特征。用莫兰指数(Moran’s I)对病毒性和细菌性腹泻病报告发病率分别进行空间自相关分析。局部空间自相关分析采用局部空间关联指标(LISA),构建一阶Queen邻接空间权重矩阵,经999次随机置换检验。用时间序列和雷达图分析主要病原体引发的其他感染性腹泻病发病的时间特征。【结果】 2005—2024年,杨浦区共报告其他感染性腹泻病病例5211例,病例以男性(2714例,占52.08%)、5岁以下儿童(1639例,占31.45%)为主。病例主要为散居儿童(1433例,占27.50%)和离退人员(1403例,占26.92%)。2005—2024年,年均报告发病率为20.36/10万,整体呈波动趋势,在2009年和2024年前后出现发病高峰。季节分布可见发病高峰为夏秋季,其中夏季(6—8月)的报告发病率最高(7.31/10万)。5岁以下儿童(116.00/10万)和60岁及以上老年人(21.39/10万)的报告发病率居年龄组前二。全局空间自相关分析显示,2020年杨浦区各街道的病毒性腹泻病报告发病率呈空间正相关性(Moran’s I=0.30,P=0.016) ,2008—2019年、2021—2024年各街道的病毒性腹泻病报告发病率空间自相关性均无统计学意义(P>0.05)。对2020年各街道的病毒性腹泻病报告发病率进行局部空间自相关分析,LISA聚类图显示,新江湾城街道的病毒性腹泻病报告发病率呈现低-低聚集趋势(局部Moran’s I=0.49,P=0.018),定海路街道的病毒性腹泻病报告发病率呈现高-高聚集趋势(局部Moran’s I=1.33,P=0.024)。2005—2024年杨浦区各街道的细菌性腹泻病报告发病率全局空间自相关性无统计学意义(均P>0.05)。5211例病例中,有明确病原学检测结果的4049例。病原体构成方面,细菌性腹泻病占比较高(55.52%,2248/4049)。构成比较高的病原体依次为轮状病毒(32.33%,1309/4049)、弧菌属细菌(31.69%,1283/4049)、沙门菌属细菌(19.63%,795/4049)、诺如病毒(9.16%,371/4049)。雷达图显示,感染诺如病毒引起的腹泻病病例无明显季节性,感染轮状病毒的病例主要集中在冬季,感染沙门菌属和弧菌属细菌的病例主要集中在夏秋季。20岁以下病例中,轮状病毒的构成比较高,尤其是5岁以下儿童; 20岁及以上病例中,弧菌属和沙门菌属细菌的构成比较高。【结论】 2005—2024年,上海市杨浦区其他感染性腹泻病在夏秋季高发,5岁以下儿童和60岁及以上老年人是高危人群,2020年定海路街道为病毒性腹泻病高风险区域。轮状病毒、弧菌属细菌、沙门菌属细菌、诺如病毒是其他感染性腹泻病的优势病原体。应针对5岁以下儿童和60岁及以上老年人等重点人群、定海路街道等高风险区域加强其他感染性腹泻病防控;在夏秋季对20岁及以上人群、尤其是60岁及以上老年人重点防控沙门菌属和弧菌属细菌性腹泻病,在冬季对20岁以下人群、尤其是5岁以下儿童重点防控轮状病毒感染引起的腹泻病。

     

    Abstract: Objective: To elucidate the epidemiological characteristics, dynamic evolution of the pathogen spectrum, and spatial distribution patterns of other infectious diarrhea (excluding cholera, typhoid fever, paratyphoid fever, and bacillary dysentery) in Yangpu District of Shanghai from 2005 to 2024, thereby providing a scientific basis for the formulation of targeted prevention and control strategies. Methods: Case information for other infectious diarrhea cases with a current address in Yangpu District of Shanghai, and onset dates from January 1, 2005 to December 31, 2024, was extracted from the Chinese Center for Disease Control and Prevention Information System. Data on cases, including gender, age, occupation, and pathogen testing results, were collected. Descriptive epidemiological methods were employed to analyze the time, place, and population distributions of reported incidence rates and the epidemiological characteristics of pathogens for other infectious diarrhea in Yangpu District from 2005 to 2024. Spatial autocorrelation analyses of reported incidence rates for viral and bacterial diarrhea were conducted using Moran’s Index (Moran’s I). Local spatial autocorrelation analysis was performed using local indicators of spatial association (LISA), with a first-order Queen contiguity spatial weight matrix, and significance was tested via 999 random permutations. Time-series and radar chart analyses were used to examine the temporal patterns of other infectious diarrhea cases caused by major pathogens. Results: From 2005 to 2024, a total of 5211 cases of other infectious diarrhea were reported in Yangpu District. The cases were predominantly males (2714 cases, accounting for 52.08%) and children under 5 years of age (1639 cases, accounting for 31.45%). The primary occupational groups were scattered children (1433 cases, accounting for 27.50%) and retired personnel (1403 cases, accounting for 26.92%). The annual average reported incidence rate was 20.36/100000, showing an overall fluctuating trend with peaks around 2009 and 2024. Peak incidence occurs in summer and autumn, with the highest reported incidence rate observed in summer (June-August) (7.31/100000). Children under 5 years of age (116.00/100000) and adults aged 60 and older (21.39/100000) were the top two age groups in terms of reported incidence. Global spatial autocorrelation analyses showed that the reported incidence rates of viral diarrhea across sub-districts in Yangpu District in 2020 exhibited a significant positive spatial correlation (Moran’s I=0.30, P=0.016). The spatial autocorrelation of reported incidence rates of viral diarrhea in each sub-district for the periods 2008-2019 and 2021-2024 was not statistically significant (all P>0.05). Local spatial autocorrelation analyses of viral diarrhea incidence in 2020 revealed that Xinjiangwancheng Sub-district exhibited a low-low clustering trend (local Moran’s I=0.49, P=0.018), while Dinghai Road Sub-district exhibited a high-high clustering trend (local Moran’s I=1.33, P=0.024). The global spatial autocorrelation of reported incidence rates of bacterial diarrhea across the sub-districts of Yangpu District from 2005 to 2024 was not statistically significant (all P>0.05). Among the 5211 cases, 4049 had definitive pathogen test results. Regarding pathogen composition, bacterial diarrhea accounted for a relatively high proportion (55.52%, 2248/4049). The pathogens with the highest proportions were rotavirus (32.33%, 1309/4049), Vibrio spp. (31.69%, 1283/4049), Salmonella spp. (19.63%, 795/4049), and norovirus (9.16%, 371/4049). The radar chart showed that diarrhea cases caused by norovirus had no obvious seasonality, rotavirus cases were mainly concentrated in winter, and cases caused by Salmonella spp. and Vibrio spp. were mainly concentrated in summer and autumn. Among cases under 20 years of age, rotavirus accounted for a relatively high proportion, especially in children under 5 years; among cases aged 20 years and older, Vibrio spp. and Salmonella spp. accounted for relatively high proportions. Conclusion: From 2005 to 2024, other infectious diarrhea in Yangpu District of Shanghai was most prevalent in summer and autumn; children under 5 years of age and adults aged 60 years and older were high-risk groups; and in 2020, Dinghai Road Sub-district was a high-risk area for viral diarrhea. Rotavirus, Vibrio spp., Salmonella spp., and norovirus were the dominant pathogens. Prevention and control efforts for other infectious diarrhea should be strengthened among key populations (e.g., children under 5 years of age and adults aged 60 years and older) and in high-risk areas such as Dinghai Road Sub-district. During summer and autumn, priority should be given to preventing and controlling bacterial diarrhea caused by Salmonella spp. and Vibrio spp., especially among individuals aged 20 years and older (particularly those aged 60 and above). During winter, priority should be given to preventing and controlling diarrhea caused by rotavirus infection among individuals under 20 years of age, particularly children under 5 years of age.

     

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