Objective: To analyze the pathogen spectrum and epidemiological characters of infectious diarrhea cases in Shanghai from July 2013 to June 2015. Methods: From July 2013 to June 2015, using multi-stage sampling to select 22 hospitals as adult diarrhea surveillance sentinels, and 3 district central hospitals together with Shanghai municipal children's hospital as children diarrhea surveillance sentinels. A total of 6 267 diarrhea cases were sampled. The demographic characters, main clinical manifestations and signs of cases were investigated, and stool specimens were collected to conduct the bacteria culture and virus nucleic acid detection. The difference of positive rate of bacteria and virus in different seasons, and age difference of relevant pathogens were compared. Results: Among 6 267 cases, 3 262 (52.05%) were male, and most of them were in 50-69 years group (1 999 cases, 31.90%) and 30-49 years group (1 691 cases, 26.98%). Totally, 2 783 positive specimens were detected out of 6 267 specimens with the positive rate being 44.41%. A total of 7 kinds of bacteria and 5 kinds of viruses were detected. The positive rate for bacterium was 12.61%(790 cases), mainly being vibrio parahaemolyticus (256 cases), diarrheagenic E.coli (239 cases) and salmonella (209 cases). The positive rate for virus was 31.80% (1 993 cases), mainly being norovirus (1 172 cases) and rotavirus (546 cases). The positive rates of viruses in winter of 2013 and 2014 were 57.89%(429 cases) and 62.14%(522 cases) respectively, higher than those of bacterium in the same periods which were 2.43% (18 cases) and 2.86% (24 cases) respectively. The positive rates of bacterium in summer of 2013, 2014 and 2015 were 14.56% (97 cases), 25.29%(258 cases) and 21.21% (49 cases), also higher than those of viruses in the same periods which were 7.51% (50 cases), 8.43%(86 cases) and 11.69% (27 cases) respectively, all of the above differences were statistically significant (P<0.05). The cases of 50-69 years group had the highest positive rate of pathogen, which was 47.57% (951/1 999). Secondly was those of 30-49 years group with 47.13% (797/1 691). Positive rate of pathogen for cases of 0-2 years group was 35.74% (213/596). Conclusion: The pathogen spectrumes of infectious diarrhea in Shanghai are mainly vibrio parahaemolyticus, diarrheagenic E.coli, salmonella, norovirus and rotavirus. The summer and winter season peak was obvious. Specific etiological surveillance and control strategies should be strengthened aiming at focus groups including children and the elderly in different seasons.
目的： 了解2013—2015年上海市感染性腹泻病例的病原流行病学特征。 方法： 于2013年7月至2015年6月，采用多阶段随机抽样方法，以上海22所医院为成年人腹泻监测点，3所区中心医院以及1所市儿童医院作为儿童腹泻监测点医院，共抽取6 267例研究对象。收集人口学特征、主要症状与体征等信息，并采集粪便标本进行细菌培养和病毒核酸检测。比较不同季节细菌与病毒阳性率的差异，以及不同性别和不同年龄组相关细菌和病毒的构成差异。 结果： 6 267例病例中，男性3 262例（52.05%）；50~69岁（1 999例，31.90%）、30~49岁组（1 691例，26.98%）为主；检出病原体阳性者2 783例，阳性率为44.41%，检出细菌7种、病毒5种。细菌阳性率为12.61%（790例），主要为副溶血性弧菌（256例）、致泻性大肠埃希菌（239例）、沙门菌（209例）；病毒阳性率为31.80%（1 993例），主要为诺如病毒（1 172例）、轮状病毒（546例）。2013、2014年冬季病毒阳性率分别为57.89%（429例）和62.14%（522例），分别高于同期细菌2.43%（18例）和2.86%（24例）的阳性率；2013—2015年夏季细菌阳性率依次为14.56%（97例）、25. 29%（258例）和21.21%（49例），分别高于同期病毒7.51%（50例）、8.43%（86例）和11.69%（27例）的阳性率，以上P值均<0.05。50~69岁组病原体阳性率最高，为47.57%（951/1 999）；其次为30~49岁组，阳性率47.13%（797/1 691）；0~2岁组阳性率为35.74%（213/596）。 结论： 上海地区感染性腹泻病原谱以副溶血性弧菌、致泻性大肠埃希菌、沙门菌、诺如病毒与轮状病毒为主，夏季与冬季季节性高峰较明显，应针对婴幼儿及老年人等重点人群在不同季节对病原体加强相应的监测与防控。.
Keywords: Diarrhea; Epidemiologic studies; Pathogen spectrum; Population surveillance.