2020年中国食源性疾病爆发的场所及病原特征

原文作者 Hongqiu Li¹; Weiwei Li¹; Yue Dai²; Yuyan Jiang³; Junhua Liang⁴; Santao Wang⁵; Maoqiang Zhuang⁶; Zheng Huang⁷; Lizi Xu⁸; Bo Xue⁹; Jikai Liu¹; Haihong Han¹; Sara M. Pires¹⁰; Ping Fu1; Yunchang Guo1 单位 中国疾病预防控制中心

摘要： 引言：食源性疾病是一个日益严重的公共卫生问题，在中国造成了巨大的疾病负担。分析2020年我国食源性疾病流行特征，为制定防控措施提供科学依据。方法：通过国家食源性疾病暴发监测系统，收集中国大陆31个省级行政区（西藏自治区除外）中30个行政区的数据。计算按环境、病原体-食物类别对和病原学分类的暴发、疾病、住院、死亡的数量和比例。结果：2020年，报告了7073起食源性疾病暴发，导致37454人患病和143人死亡。在确定的病原体中，微生物病原体是最常见的确诊病因，占疾病的41.7%。毒蘑菇造成的比例最大爆发（58.0%）和死亡（57.6%）。对于发生食源性疾病暴发的场所，家庭爆发次数最多（4140次），死亡人数最多（128人），餐饮服务场所引起的疾病比例最大（59.9%）。发生在6月至9月的疫情占总疫情的 62.8%。结论：食源性疾病暴发主要发生在家庭中。微生物病原体仍然是暴发相关疾病的首要原因。在中国，毒蘑菇是导致私人家庭死亡的首要原因。加强食品安全监督管理和健康宣教，减轻食源性疾病负担。应加大宣传力度，减少蘑菇中毒事件在家庭中的发生，同时加强对食品的监督管理，减少微生物污染。

关键词：食源性疾病；流行病特征；

介绍

食源性疾病暴发是指因摄入同一食物而出现两个或两个以上类似疾病的病例。¹.这是一个对人类有害的全球性健康问题。食源性疾病包括多种疾病，包括由微生物引起的传染病和主要由化学和有毒制剂引起的中毒性疾病。据世界卫生组织估计，2010年全球共发生6亿起食源性疾病，造成42万人死亡².美国疾病预防控制中心估计，美国每年有4800万例食源性疾病（每6个美国人中就有1例）发生，导致12800人住院治疗，3000人死亡。³.在包括中国在内的西太平洋地区，每年有1.25亿人患病，5万多人死于食源性疾病⁴.食源性疾病给人类带来巨大的经济负担。根据《中华人民共和国食品安全法》的要求，建立了国家食源性疾病暴发监测系统，连续、系统地收集2010年食源性疾病暴发数据。因此，本研究的目的是了解我国食源性疾病的流行现状，分析高风险食品的分布和致病因素，为食品安全风险评估、标准制修订和风险管理提供技术支持。

方法

该研究获得了2020年1月1日至2020年12月31日通过国家食源性疾病暴发监测系统报告的食源性疾病病例数据。数据来自中国大陆31个省级行政区中的30个，不包括西藏自治区。为每次爆发请求的数据报告包括各个疾病预防控制中心报告的疫情、发生日期、患病人数、住院人数和死亡人数、病原学、相关食物和环境。所有变量值均以计数或比例（%）报告。号码和疫情、疾病和死亡的比例，按计算病因、环境和食物类别。使用SPSS（版本21.0， IBM公司，芝加哥，美国）进行统计分析。

结果

大多数疫情（97.5%）、疾病（98.0%）和死亡（99.1%）与家庭和餐饮服务场所有关。家庭和饮食服务地点是报告暴发的最常见环境。2020年，发生疫情最多的是家庭（4140起），其次是餐饮服务场所（2719起）和校园（27起）。大多数疾病（59.9%）是在餐饮业报告的服务地点，其次是家庭（37.6%），以及校园内为0.5%。在餐饮服务场所中，街头摊点占发病比例最大（26.2%），学校食堂占发病比例最大（13.6%）。然而，家庭的死亡人数最多，占所有死亡人数的89.5%（桌子 1);毒蘑菇（79人死亡）、乌头（10人死亡）、Bongkrek酸（11例死亡）和甲醇（8例死亡）是最常见的死亡原因，在私人家庭环境中死亡的总人数中占84.4%。2020年，有4662起确认病因的疫情。毒蘑菇是暴发和死亡的最常见原因，占暴发总数的58.0%和死亡总数的57.6%；细菌的病原体是最常见的致病原因。 (41.7%);在有毒动植物及其毒素中，未煮熟的菜豆是导致暴发比例最大的最常见原因。（31.2%）和疾病（33.3%）；乌头死亡病例最多，占57.1%。在微生物病原体中，沙门氏菌（286次爆发和3，446次疾病）是与疾病暴发和疾病相关的最常见细菌病原体，其次是副溶血弧菌（128次暴发和1848例疾病）和金黄色葡萄球菌（75次暴发和954例疾病）。Bongkrek酸占最大比例死亡比例（75.0%）和最高死亡率（52.2%）。在化学制剂中，亚硝酸盐是与暴发（49.1%）和疾病（49.6%）相关的最常见致病因素，其次是农药（32.5%的暴发和27.7%的疾病）；甲醇的死亡率和致死率最高，分别为63.6%和25.0%，其次是亚硝酸盐，分别为22.7%和1.1%（表2). 2020年，发生在家庭的疫情病例（7073）超过发生在餐饮单位的疫情病例（5652），沙门氏菌引起的暴发（485）和暴发相关疾病病例（6661）超过副溶血性弧菌引发的病例。通过对发生在学校食堂食源性疾病（5081）。分析了导致暴发、暴发相关疾病和死亡的前10个病原体-食品类别对。鸡蛋中沙门氏菌检出率最高，占32.8%（75/229）爆发，随后是酱汁中的沙门氏菌。表(3).酱汁腌肉中的沙门氏菌患病比例最高（21.7%），住院比例最高（23.2%），其次是鸡蛋中的沙门氏菌。

表1 2020年中国食源性疾病暴发、患病和死亡的数量和比例

*死亡率=死亡人数/患病人

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Vital Surveillances

Characteristics of Settings and Etiologic Agents of Foodborne Disease Outbreaks — China, 2020

Hongqiu Li1; Weiwei Li1; Yue Dai2; Yuyan Jiang3; Junhua Liang4; Santao Wang5; Maoqiang Zhuang6; Zheng Huang7; Lizi Xu8; Bo Xue9; Jikai Liu1; Haihong Han1; Sara M. Pires10; Ping Fu1,#; Yunchang Guo1

ABSTRACT

Introduction: Foodborne diseases are a growing public health problem and have caused a large burden of disease in China. This study analyzed epidemiological characteristics of foodborne diseases in China in 2020 to provide a scientific basis for prevention and control measures.

Methods: Data were collected from 30 of 31 provincial-level administrative divisions (PLADs) in the mainland of China, excluding Xizang (Tibet) Autonomous Region, via the National Foodborne Disease Outbreaks Surveillance System. The number and proportion of outbreaks, illnesses, hospitalizations, deaths by setting, pathogen-food category pairs and etiology were calculated.

Results: In 2020, 7,073 foodborne disease outbreaks were reported, resulting in 37,454 illnesses and 143 deaths. Among the identified pathogens, microbial pathogens were the most common confirmed etiology, accounting for 41.7% of illnesses. Poisonous mushrooms caused the largest proportion of outbreaks (58.0%) and deaths (57.6%). For venues where foodborne disease outbreaks occur, household had the highest number of outbreaks (4,140) and deaths (128), and catering service locations caused the largest proportion of illnesses (59.9%). Outbreaks occurring between June and September accounted for 62.8% of total outbreaks.

Conclusions: Foodborne disease outbreaks mainly occurred in households. Microbial pathogens remained the top cause of outbreak-associated illnesses. Poisonous mushrooms were ranked the top cause of deaths in private homes in China. The supervision and management of food safety and health education should be strengthened to reduce the burden of foodborne diseases. Publicity should be increased to reduce the incidence of mushroom poisonings in families, and supervision and management of food should be strengthened to reduce microbial contamination.

INTRODUCTION

An outbreak of foodborne disease is defined as the occurrence of two or more cases of a similar illness resulting from ingestion of a common food (1). It is a global health problem that is harmful to humans. Foodborne diseases encompass a wide spectrum of illnesses, including infectious diseases caused by microorganisms and toxic diseases mainly caused by chemical and toxic agents. The World Health Organization estimated that 600 million foodborne diseases occurred globally in 2010, causing 420,000 deaths (2). The US CDC estimated that 48 million foodborne diseases (1 in 6 Americans) occur each year in the USA, resulting in 12,800 hospitalizations and 3,000 deaths (3). In the Western Pacific Region, including China, 125 million people get sick and more than 50,000 die every year due to foodborne diseases (4). Foodborne diseases bring huge economic burdens to human beings. According to the requirements of Food Safety Law of the Peoplersquo;s Republic of China, the National Foodborne Disease Outbreaks Surveillance System was established to continuously and systematically collect data on foodborne disease outbreaks in 2010.

Therefore, the objectives of this study were to characterize the epidemiological status of foodborne diseases in China and to analyze the distribution of high-risk foods and pathogenic factors to provide technical support for food safety risk assessment, formulation and revision of standards, and risk management.

METHODS

The study obtained data on foodborne disease cases reported through the National Foodborne Disease Outbreaks Surveillance System from January 1, 2020 to December 31, 2020. Data were collected from 30 of 31provincial-level administrative divisions (PLADs) in the mainland of China, excluding Xizang (Tibet) Autonomous Region. Data requested for each outbreak

report included the individual CDC reporting the outbreak, date of occurrence, number of illnesses, hospitalizations, and deaths, etiology, implicated food(s) and setting. All variable values were reported as counts or proportions (%). The number and proportion of outbreaks, illnesses, and deaths by etiology, setting, and food categories were calculated. The statistical analysis was performed using SPSS (version 21.0, IBM Corp, Chicago, USA).

RESULTS

Most outbreaks (97.5%), illnesses (98.0%), and deaths (99.1%) were linked to households and catering service locations. Households and catering service locations were the most common settings of reported outbreaks. In 2020, the highest number of outbreaks occurred in households (4,140), followed by catering service locations (2,719), and school campuses (27). Most illnesses (59.9%) were reported in catering service locations, followed by households (37.6%), and 0.5% in campuses. Within catering service locations, street stalls accounted for the largest proportion (26.2%) of outbreaks, and school canteens accounted for the largest proportion (13.6%) of illnesses. However, households had the most deaths, accounting for 89.5% of all deaths (Table 1); poisonous mushrooms (79 deaths), aconite (10 deaths), bongkrek acid (11 deaths), and methanol (8 deaths) were the most common causes of deaths, accounting for 84.4%

of total deaths in private home settings.

In 2020, there were 4,662 outbreaks with confirmed etiology. Poisonous mushrooms were the most common cause of outbreaks and deaths, accounting for 58.0% of outbreaks and 57.6% of deaths; bacteri

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