天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (6): 651-656.doi: 10.11958/20170143

• 流行病学调查 • 上一篇    下一篇

2008—2014 年天津市细菌性痢疾流行病学特征及 志贺菌检测结果分析

高璐，张维   

  1. 天津市疾病预防控制中心（邮编 300011）
  • 收稿日期:2017-02-06 修回日期:2017-05-04 出版日期:2017-06-15 发布日期:2017-07-05
  • 作者简介:高璐（1978），女，硕士，主要从事传染病预防与控制研究
  • 基金资助:
    天津市卫生计生委科技基金项目（2014KY22）

Analysis on epidemiological characteristics of bacterial dysentery and Shigella detection results in Tianjin city during 2008-2014

GAO Lu, ZHANG Wei   

  1. Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
  • Received:2017-02-06 Revised:2017-05-04 Published:2017-06-15 Online:2017-07-05

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摘要： 目的 了解天津市细菌性痢疾流行病学和志贺菌病原学特征，为提出预防和控制措施提供依据。方法 利用 2008—2014 年“疾病监测信息报告管理系统”数据，回顾性分析患病人群的流行特征。按照分层抽样的方法抽 取天津市市区、近郊地区、滨海新区和远郊地区的监测哨点医院，按照一定的抽样间隔对 2008 年—2014 年的 5—10 月间的细菌性痢疾临床诊断病例采集粪便标本 3 955 份，进行志贺菌培养及菌群检测。结果 （1）流行特征。 2008—2014 年天津市报告 65 179 例细菌性痢疾病例，年均发病率 72.00/10 万，年发病率呈现逐年下降趋势。市区 （120.28/10 万）、近郊地区（70.36/10 万）、滨海新区（64.22/10 万）和远郊地区（19.39/10 万）发病率呈依次下降的趋 势。发病时间主要集中在 6—9 月，发病高峰出现在 8 月份。发病率以 5 岁以下和 85 岁以上人群较高。0～24 岁 和≥75 岁组男性年均发病率高于女性，50～74 岁年龄组的女性年均发病率高于男性（P＜0.05）。职业分布以散居儿 童和离退休人员发病较多。（2）菌型分布。志贺菌阳性 229 株（5.79%），其中宋内志贺菌 136 株（59.39%），福氏志贺 菌 93 株（40.61%）。89 株福氏志贺菌（4 株未检出）中检出 8 种亚型，以 F2a（49.44%）、F2b（22.47%）和 FX（13.48%） 为主。检出福氏志贺菌的亚型种类在 2008—2014 年逐年减少，呈现亚型单一化。在 10~19 岁人群志贺菌检出率最 高（9.55%）。市区宋内志贺菌阳性率最高（5.09%），福氏志贺菌阳性率最高的地区为近郊地区（3.09%）。结论 天津 市细菌性痢疾防控的重点人群为散居儿童和老年人群，应加强宣传与健康教育，提高重点人群及其日常护理人员的 卫生意识。志贺菌属菌群在不断变迁，需继续开展长期监测，摸清志贺菌的变迁规律。

关键词: 志贺菌, 痢疾, 疾病暴发流行, 天津

Abstract: Objective To understand the epidemiological characteristics of bacillary dysentery and etiological characteristics of Shigella in Tianjin, and to provide evidence for the prevention and control measures. Methods The data of disease surveillance information reporting system from 2008 to 2014 were analyzed retrospectively. A total of 3 955 stool samples came from the clinically diagnosed cases of bacillary dysentery were collected, according to the extraction method of stratified sampling in Tianjin city, suburban area, Binhai New Area and suburban area sentinel hospitals, and according to the sampling interval for the May to October from 2008 to 2014. Samples were detected and cultured for Shigella flora. Results (1) Epidemiological characteristics: from 2008 to 2014, a total of 65 179 cases of bacillary dysentery were reported in Tianjin city, with an average annual incidence of 72.00/100 thousand. The annual incidence rate showed a downward trend year by year. The incidence was a downward trend, including urban (120.28/100 thousand), suburban areas (70.36/100 thousand), Binhai New Area (64.22/100 thousand) and the outer suburbs (19.39/100 thousand). The onset time was mainly concentrated in June-September, and the peak incidence occurred in August. The incidence rate was higher in people below 5 years old and above the age of 85. The annual incidence rate was higher in male patients of 0 to 24 years old and above 75 years old than that of female. The annual incidence rate was higher in female patients of 50 to 74 years old age group than that of male (P< 0.05). The distribution of occupation was scattered among children and retirees. (2) Distribution of bacteria: the 229 Shigella strains were positive (5.79% ), including 136 strains of Shigella sonnei (59.39% ), 93 strains of Shigella flexneri (40.61%). The 89 strains of Shigella flexneri (4 strains were not detected) were detected in 8 subtypes, F2a (49.44%), F2b (22.47%) and FX (13.48%). The subtypes of Shigella flexneri were detected decreased year by year from 2008 to 2014, showing a single subtype. The highest detection rate of Shigella was found in 10-19 years old (9.55%). The S.sonnei positive rate was the highest in urban (5.09%), and the Shigella flexneri positive rate was the highest in suburban areas (3.09%). Conclusion The key population for the prevention and control of bacillary dysentery in Tianjin is scattered children and old people. It is necessary to strengthen the propaganda and health education to improve the health consciousness of the key population and their daily nursing staff. With the continuous changes of Shigella flora, it is necessary to carry out long-term monitoring to find out the regularity of shigella.

Key words: shigella dysenteriae, disease outbreaks, Tianjin