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1.
Article in Chinese | WPRIM | ID: wpr-920532

ABSTRACT

ObjectiveTo determine the epidemiological characteristics of infectious disease related public health bud-events in Shanghai and assess the effects of bud-event surveillance, so as to provide scientific evidence for improving the surveillance system. MethodsSurveillance data of infectious disease related public health bud-events were collected from 16 districts of Shanghai from 2017 through 2020. Then the data were analyzed and compared with infectious disease related public health emergencies during the same period. ResultsA total of 6 376 infectious disease related public health bud-events were documented in Shanghai in 2017‒2020, which involved 29 792 cases. There were two seasonal peaks, April through June and November through December. Clustered events accounted for 38.85%, mainly caused by chickenpox (14.10%), hand,foot and mouth disease (11.17%) and norovirus-associated infectious diarrhea (6.54%). The 36.73% of the bud-events occurred in school settings, which involved 24 718 cases (accounting for 83.00% of all cases). Median time duration between onset date of the first cases and report date of the events was 4 days, and median duration of the events was 14 days, demonstrating positive correlation. In addition, all the infectious disease related public health emergencies(n=77) from 2017 through 2020 were classified as common events or unclassified. The proportion of infectious disease related public health emergencies in the bud-events during the same period was 1.21%, and that of infectious disease related public health emergencies in the bud-events in school settings was 2.48%. ConclusionTwo peaks of infectious disease related public health bud-events are observed in spring as well as autumn and winter in Shanghai from 2017 through 2020. Schools should be prioritized for control and prevention of infectious diseases. Bud-event surveillance system has been contributable to the prevention and control of public health emergencies, especially in the early detection, reporting and control of clustered events in schools. Bud-event surveillance system should be further improved and assessed comprehensively.

2.
Article in Chinese | WPRIM | ID: wpr-920531

ABSTRACT

In order to meet the needs of prevention and control of intestinal infectious diseases, a comprehensive surveillance for diarrheal diseases has been innovated and explored in Shanghai since 2012. The surveillance has extensive distribution of sentinel hospitals, systematic sampling, multi-pathogen collection, and hospital information system (HIS) as the basis, which has achieved “One system for surveillance of multiple diseases and one sample for detection of multiple pathogens". Continual active surveillance for the whole population has been conducted, covering demography, clinical information, epidemiology, pathogen detection, and drug sensitivity test for diarrhea cases. The surveillance has obtained preliminary achievements as follows. First, diarrheal diseases and their periodic changes have been characterized, in which the most prevalent pathogen of diarrhea is determined to be norovirus in Shanghai. Second, some rare pathogens and serotypes have been identified that may provide clues to the sources of outbreaks. Third, it facilitates the information sharing between public health institutions and clinical institutions, and provides scientific evidence for clinical diagnosis and treatment. In the future, Shanghai diarrhea comprehensive surveillance will be improved for expanding range and depth of surveillance, artificial intelligence assisted diagnosis and treatment, early warning of outbreaks, prediction of epidemic trends, and application of new detection technologies.

3.
Article in Chinese | WPRIM | ID: wpr-920530

ABSTRACT

Shanghai is a super-large metropolis with a highly developed globalization. Since the 21st century, Shanghai has experienced several threats of emerging and imported infectious diseases. Infectious disease surveillance has been established and developed from single-disease surveillances to a comprehensive surveillance network. Integration of clinical and preventive medicine has been gradually extended, which facilitates the improvement in the monitoring and early warning system. In 2020, when the COVID-19 epidemic spread, Shanghai quickly established a prevention and control expert team and a clinical medical expert team to effectively and shortly control local COVID-19 epidemic. In order to improve Shanghai’s capacity to respond to major epidemics of infectious diseases and public health emergencies, the metropolis will build and improve a three-level diagnosis and treatment system for emerging, imported, rare, and unknown infectious diseases in the next five years. Based on the big data monitoring platform of medical institutions, Shanghai will achieve the intelligence-supported diagnosis and treatment of infectious diseases, and consolidate the cooperation to implement the integration of clinical and preventive medicine.

4.
Article in Chinese | WPRIM | ID: wpr-920529

ABSTRACT

The COVID-19 epidemic fully reflects the importance of surveillance and early warning of infectious diseases, and also puts forward higher requirements for us to further improve epidemic surveillance to achieve early detection, early identification, early reporting and early disposal of various pathogens. In this paper, we reviewed the development of the integrated surveillance system for infectious diseases in Shanghai in recent years, illustrated the approach of integrated surveillance based on syndromes and events, and initially summarized the key results of the integrated surveillance, expanding the scope of surveillance, improving sensitivity and enhancing the capacity of the system. Moreover, considering the requirements regarding the public health system, we provide some thoughts and suggestions on further expanding of the integrated surveillance, continuously strengthening the integration of public health surveillance with clinical diagnosis and treatment, laboratory capacity development, and public health information technology.

5.
Chinese Journal of Epidemiology ; (12): 911-916, 2019.
Article in Chinese | WPRIM | ID: wpr-805740

ABSTRACT

Objective@#To understand the epidemiological and pathogenic characteristics of hospitalized severe acute respiratory infections (SARI) in Shanghai, China.@*Methods@#From 2015 to 2017, one Tertiary hospital and one Secondary hospital were chosen as the surveillance sites. Two respiratory tract specimens per case were collected from SARI cases aged 15 years and older. One specimen was tested for 22 respiratory pathogens by RT-PCR, and the other specimen was cultured for 6 respiratory bacteria.@*Results@#A total of 287 SARI cases were enrolled for sampling and lab testing. 70.73% of the cases were aged 60 years and older, with 41.46% (119/287) were positive for at least one pathogen. Influenza virus was the predominant pathogen, accounting for 17.77% (51/287) of all SARI cases. Human rhinovirus/Enterovirus and Coronavirus were both accounting for 7.32% (21/287), followed by Mycoplasma pneumoniae (5.57%, 16/287). The positive rates of parainfluenza virus, bocavirus, adenovirus, respiratory syncytial virus and human metapneumo virus were all less than 5%. Bacterial strains were identified in seven SARI cases, including Klebsiella pneumoniae (3 strains), Staphylococcus aureus (2 strains), Streptococcus pneumoniae (1 strain) and Pseudomonas aeruginosa (1 strain). Two or Three pathogens were co-detected from 40 cases, accounting for 33.61% of 119 positive cases. The most common co-detected pathogens were influenza virus and Mycoplasma pneumoniae (10 cases). Influenza cases peaked in winter-spring and summer. Mycoplasma pneumoniae peaked in winter-spring season and overlapped with influenza. The positive rates of pathogens were not significantly different between different age groups.@*Conclusions@#Various respiratory pathogens can be detected from SARI cases aged 15 years and older. Influenza virus was the predominant pathogen and the co-detection of influenza virus with Mycoplasma pneumoniae the most common one.

6.
Chinese Journal of Epidemiology ; (12): 904-910, 2019.
Article in Chinese | WPRIM | ID: wpr-805739

ABSTRACT

Objective@#To analyze the etiologic and epidemiological characteristics of adult acute respiratory infections in Shanghai during 2015-2017.@*Methods@#Data was collected from outpatients with acute respiratory infections who visited the Fever Clinics in three hospitals of different levels in three administrative regions of Shanghai, from 2015 to 2017. Basic information and nasopharyngeal swabs were collected from cases in line with the inclusion criteria. Multiplex RT-PCR and bacterial cultures were performed to detect the respiratory pathogens.@*Results@#A total of 806 individuals were enrolled from 2015 to 2017. Respiratory pathogens were identified in 73.45% (592/806) of the cases, with the virus detection rate as 66.75% (538/806). It was found that the major respiratory pathogens for virus detection were influenza A in 326 (40.45%), influenza B in 116 (14.39%), rhinovirus/enterovirus in 39 (4.84%) of the cases. The overall detection rate of bacteria was 16.13% (130/806), including Klebsiella pneumoniae in 90 (11.17%) cases, Staphylococcus Aureus in 46 (5.71%) cases. Other kind of bacteria were not detected in our study. The detection rates on Mycoplasma pneumoniae was 5.33% (43/806) and on Chlamydia pneumonia was 0.37% (3/806). Co-infection with multiple pathogens was detected in 18.61% (150/806) of the cases, including 135 with double infection (accounting for 90.00%), 14 with triple infection and 1 with quadruple infection (accounted for 9.33% and 0.67%, respectively). Among the 150 cases with co-infections, the main identified pathogens were influenza A, Klebsiella pneumoniae, Staphylococcus aureus, and Mycoplasma pneumoniae. Pathogens of acute respiratory infections that identified among the outpatients from the Fever Clinics at different time, region or population, the characteristics were different (P<0.001).@*Conclusions@#In 2015-2017, outpatients with acute respiratory infections in Shanghai were mainly caused by influenza virus or other viruses, however dynamically with its composition, time, region and characteristics of the population. It is necessary to strengthen and combine related medical and preventive services and to develop the appropriate strategies regarding clinical diagnosis and treatment.

7.
Chinese Journal of Epidemiology ; (12): 889-894, 2019.
Article in Chinese | WPRIM | ID: wpr-805736

ABSTRACT

Objective@#To understand the seasonality and etiological characteristics of infectious diarrhea in adults from Shanghai.@*Methods@#Adult patients with diarrhea who had visited the enteric disease clinics in 22 hospitals that carrying on the Diarrhea Comprehensive Surveillance sentinel programs in Shanghai during 2014-2017, were surveyed. Stool specimens were collected according to the different intervals of sampling and detected for 12 bacteria and 5 viruses. Concentration ratio and circular distribution method were used for data analysis.@*Results@#From 2014 to 2017, a total of 9 573 stool specimens were collected from the targeted diarrhea patients ≥18 years old (n=96 067), through the Shanghai Diarrhea Comprehensive Surveillance program. The positive rate of detection was 46.44%. Seasonal peaks of infectious diarrhea were both seen in summer (bacteria peak, diarrheagenic Escherichia coli and Vibrio parahaemolyticus, etc.) and in winter (virus peak, Norovirus, etc.). Both bacterial and viral infections presented seasonal concentration (Raleigh’s test P<0.001) but more obvious with bacterial infection. Viral infection accounted for 60.19% of the cause of infectious diarrhea. The top five predominant pathogens appeared as Norovirus, Rotavirus, diarrheagenic Escherichia coli, Vibrio parahaemolyticus, and Salmonella spp..@*Conclusions@#Among the adult outpatients with infectious diarrhea in Shanghai, obvious seasonality was seen, with peaks in both summer and winter. Viral infection with Norovirus in particular, appeared as the predominant source of infection. Active, continuous and comprehensive diarrhea-related surveillance programs would be able to monitor the changing dynamic of pathogen spectrum, and lead to the adoption of targeted preventive measures.

8.
Chinese Journal of Epidemiology ; (12): 883-888, 2019.
Article in Chinese | WPRIM | ID: wpr-805735

ABSTRACT

Objective@#To investigate the epidemiologic characteristics of Norovirus among adult patients suffering from infectious diarrhea in Shanghai, so as to provide evidence for developing related strategies on prevention and control of the disease.@*Methods@#Diarrheal outpatients were monitored at the 'Intestinal clinic’ from 22 hospitals involved in the sentinel surveillance program in Shanghai. Information on demographic and epidemiologic features of the patients was collected while data and clinical, fecal specimens were collected and sent to the district CDC for Norovirus detection. Positive rates of Norovirus were also compared in various populations and seasons during 2013-2018. Multivariate logistic regression model was adopted to fit into the comparisons between non-Norovirus and Norovirus groups.@*Results@#19.28% of the 12 083 diarrheal cases were found to have carried the Norovirus, with GⅡgroup the most commonly identified genotype. Rates of detection was seen higher in males (20.78%) than in females (17.73%). 30-44 year-old were found having the highest positive rate (21.51%). The positive rates were found the highest (23.60%) in the year of 2015. All the above shown differences were statistically significant (P<0.05). Diarrheal patients affected with Norovirus would present watery stool (75.94%) and vomiting (35.84%). Data from the multivariate logistic analysis showed that factors as: being males, 30-44 years old, officials/clerks, in winter season and with histories of travelling etc., were related to higher risks on Norovirus infection.@*Conclusions@#Infectious diarrhea caused by Norovirus occurred all year round, with seasonal peaks seen in winter and spring, in Shanghai. Specific prevention and control measures should be taken on Norovirus- caused infectious diarrhea, according to the difference on age, gender and season.

9.
Chinese Journal of Epidemiology ; (12): 1403-1408, 2019.
Article in Chinese | WPRIM | ID: wpr-801156

ABSTRACT

Objective@#To investigate the molecular characterization of adult diarrhea cases caused by enterotoxic Escherichia coli (ETEC) and explore the practical model of epidemiology for laboratory technique and data needs based on the surveillance network.@*Methods@#Epidemiological design and sampling targeted adult cases ETEC caused diarrhea in epidemic season. The enterotoxin type, serogroup, resistance, colonization factor and molecular type of ETEC were identified. Multiple dynamic phenotypic characteristics of ETEC were indicated by multidimensional and multivariable data.@*Results@#From 2016 to 2018, 84 eligible ETEC strains were detected. The dominant serums/toxins were O∶6 (STh), O∶25 (LT), O∶159 (STh), O∶153 (STh). O∶6 (STh+CS21), which replaced O∶25 and O∶159 as the popular clones in 2018. Six cases of O∶153 (STh+CFA/I+CS8+PT34) in outbreak in 2017 were imported ones. The resistance rates of ETEC strains detected in adults to sulfasoxazole, naproxinic acid, ampicillin and azithromycin were more than 30%, multidrug resistance (MDR) reached 58.3%. Serum/toxin types suggested that attenuated strains were more likely to become MDR. Molecular typing confirmed that the genetic similarity of the dominant clone of O∶6 serogroup (PT20-24) was higher than O∶25 and O∶159. There was a high correlation between the minimal inhibitory concentration (MIC) of azithromycin and the resistant gene mphA (87.5%, 28/32). O∶6 (STh+CS21+mphA) resistant clone was first detected in 2016.@*Conclusion@#A new epidemic clone in adult ETEC diarrhea cases in Shanghai was O∶6 (STh+CS21+mphA). For the first time the association between azithromycin resistance gene mphA and a serum group of ETEC was observed. Multidimensional and multivariate analysis techniques based on epidemiology can help reveal the potential transmission pattern of ETEC for the accurate surveillance and early warning of outbreaks.

10.
Chinese Journal of Epidemiology ; (12): 1291-1297, 2018.
Article in Chinese | WPRIM | ID: wpr-736672

ABSTRACT

The process of globalization increases the risk of global transmission of infectious diseases,resulting in pressure for country's prevention and control of imported infectious disease.Based on the risk assessment of disease importation and local transmission,a strategy that conducting importation prevention and routine prevention and control before the importation of disease and taking emergency control measures after the importation of disease was developed.In addition,it is important to take part in global infectious disease response action,aid the countries with outbreak or epidemic to actively decrease the risk of disease importation.

11.
Chinese Journal of Epidemiology ; (12): 1291-1297, 2018.
Article in Chinese | WPRIM | ID: wpr-738140

ABSTRACT

The process of globalization increases the risk of global transmission of infectious diseases,resulting in pressure for country's prevention and control of imported infectious disease.Based on the risk assessment of disease importation and local transmission,a strategy that conducting importation prevention and routine prevention and control before the importation of disease and taking emergency control measures after the importation of disease was developed.In addition,it is important to take part in global infectious disease response action,aid the countries with outbreak or epidemic to actively decrease the risk of disease importation.

12.
Article in Chinese | WPRIM | ID: wpr-707231

ABSTRACT

Objective To introduce the establishment of Shanghai Diarrhea Comprehensive Surveillance System ,and to analyze the epidemiological and etiological characteristics of infectious diarrhea outpatients in Shanghai based on data of Shanghai Diarrhea Comprehensive Surveillance System .Methods Diarrhea patients were surveyed according to a unified designed questionnaire ,who visited one of 22 adult sentinel hospitals and 4 children sentinel hospitals of Shanghai Diarrhea Comprehensive Surveillance during September 2013 to August 2016 .Stool specimens were collected according to different sampling intervals and detected for 12 bacteria and 5 viruses .Characteristics of diarrhea patients were compared and analyzed .Chi-square test was used for statistical analysis .Results Of 4497 infectious diarrhea patients ,the detection rate of viral infection was 29 .77% ,of which norovirus infection (16 .33% ) , rotavirus infection (7 .90% ) and sapovirus infection (1 .90% ) were dominated . The detection rate of bacterial infection was 15 .38% ,diarrheagenic E .coli (DEC) infection (5 .25% ) ,V . parahaemolyticus infection (4 .27% ) and Salmonella spp .infection (3 .13% ) .Mixed infection accounted for 11 .07% .The detection rate ,the infection types and the predominant pathogens in different age groups were statistically different (χ= 18 .11 ,61 .86 and 449 .52 ,respectively ,all P< 0 .01) .DEC ranked first in 3 - 14 years age group , and norovirus ranked first in all other age groups .The pathogen spectrum of infectious diarrhea patients≥ 15 years old showed obvious seasonal changes ,with mainly bacterial infection in summer (peaked in August ,accounting for 81 .56% ) and mainly viral infection in winter (peaked in January ,accounting for 95 .27% ) .Norovirus ranked first through the year ,except January ,June ,July and August .Among patients ≥ 15 years old , abdominal pain , fever and loose stools were main symptoms in bacterial infections .Vomiting and watery stool were main symptoms in viral infections . Loose stools appeared frequently in patients ≤ 14 years old .Conclusions Diarrhea Comprehensive Surveillance System based on scientific design and rational distribution is beneficial for understanding the epidemic trends and pathogen characteristics of diarrhea .Viral infections are predominant in infectious diarrhea patients in Shanghai . Norovirus and rotavirus are the most common diarrheal pathogens .The pathogen spectrum of infectious diarrhea patients shows obvious seasonal changes .DEC is common in diarrhea patients ≤ 14 years old . The clinical symptoms of infectious diarrhea caused by different pathogens are different . Targeted preventive measures should be taken for infectious diarrhea of different ages ,different pathogens ,and in different seasons .

13.
Article in Chinese | WPRIM | ID: wpr-809727

ABSTRACT

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.

14.
Chinese Journal of Epidemiology ; (12): 1099-1103, 2015.
Article in Chinese | WPRIM | ID: wpr-248701

ABSTRACT

Objective To understand the pathogen spectrum and epidemiological characteristics of diarrhea cases in Shanghai from August 2013 to July 2014.Methods The survey was conducted in 23 hospitals at different levels randomly selected in Shanghai,the diarrhea cases seeking medical care in these hospitals were sampled,and stool samples were collected from them for pathogen isolation.Results Among 3 467 stool samples detected,1 561 were positive for at least 1 pathogen (45.02%).A total of 6 kinds of bacteria and 5 kinds of viruses were detected.The positive rate for bacterium was 13.46%,mainly Vibrio parahaemolyticus (172 cases) and Salmonella (143 cases).The positive rate for virus was 27.75%,mainly Norovirus (471 cases) and Rotavirus (312 cases).The positive rates peaked obviously in summer and during autumn-winter.The positive rate of virus was higher than that of bacterium during autumn-winter,and the positive rate of bacterium was higher than that of virus in summer,the differences were statistically significant (P<0.05).Stratified analysis showed the constituent ratio of virus positive samples during November-February was highest among all age groups,however,the difference was not statistically significant (P>0.05).The constituent ratio of bacterium positive samples during June-September was highest in all age groups,the difference was statistically significant (P<0.05).The proportion of the cases with fever in bacterium positive group (19.06%) was higher than those in virus positive group (10.91%),the difference had statistically significance (P<0.05).Conclusion The pathogen spectrum of diarrhea was relatively wide in Shanghai and the seasonality of the incidence was obvious.Specific etiological surveillance and control strategies should be strengthened among risk groups in different seasons.

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