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Infectious diarrhea is a gastrointestinal infectious disease caused by a wide range of pathogens and found throughout the world. It is one of the most important public health problems in the world and the second leading cause of death among children under five years of age. The pathogens of infectious diarrhea include viral diarrhea pathogens, bacterial diarrhea pathogens, and parasites. Viruses are the most frequent pathogens, mainly including norovirus, rotavirus, astrovirus and sapovirus. The most frequently identified organisms causing bacterial diarrhea are diarrheagenic Escherichia coli, Salmonella, Shigella, Vibrio parahaemolyticus and Campylobacter. This paper provides an overview of the epidemiological trends and changes in the pathogen spectrum of infectious diarrhea for better understanding the distribution and epidemiological features of infectious diarrhea in China, and hopes to provide reference for developing prevention and control strategies and reducing the disease burden.
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This study was aimed at analyzing the molecular characteristics of enteropathogenic Escherichia coli(E.coli)strains isolated from domestic animals at a surveillance site in Jiangsu province and evaluating their potential pathogenicity,to provide evidence supporting the surveillance,prevention,and control of infectious diarrhea.Thirty-seven EPEC strains isolated from domestic animals at this surveillance site were characterized by whole genome sequencing.All EPEC strains isolated from local livestock were aEPEC,which has a variety of serotypes and carries a variety of virulence genes associated with diarrhea.Nine ST types with regional epidemic characteristics were identified.Five eae gene subtypes were found,among which β1 was dominant and was also the most common strain in patients with diarrhea.According to analysis of the characteristics of 37 EPEC strains,all EPEC strains from local livestock were aEPEC,thus posing a potential threat to public health.Monitoring of livestock feces and the breeding environment must be strengthened in the surveillance of infectious diarrhea.
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ObjectiveTo investigate the pathogenic spectrum and molecular characteristics of infectious diarrhea among children in Putuo District of Shanghai from 2018 to 2023， and to provide scientific basis for the prevention and control of infectious diarrhea in children. MethodsFecal samples from the cases visited sentinel hospitals for children’s diarrheal disease in Putuo District， Shanghai， were collected from January 2018 to December 2023. A total of 11 species of bacteria were isolated and cultured， and 5 species of viruses were detected by real-time fluorescent polymerase chain reaction （PCR）. The molecular typing of some positive strains was analyzed by the standard pulsed-field gel electrophoresis （PFGE） method. The polymerase-capsid protein linkage region of some norovirus-positive samples was amplified by reverse transcription PCR， and was sequenced and analyzed by bioinformatics software. The Chi-square test and Fisher’s exact probability test were used to compare the pathogen-positive rates in 2018‒2019 and 2020‒2023. ResultsOf the 707 cases of children with infectious diarrhea， the total positive rate was 47.67%， with a single bacterial positivity rate of 16.27%， a single viral positivity rate of 22.63%， and a mixed positivity rate of 8.77%， respectively. The dominant pathogens were rotavirus （10.75%）， norovirus （10.33%）， enteropathogenic Escherichia coli （8.06%）， Salmonella （6.36%）， enteroaggregative Escherichia coli （5.52%）， and Campylobacter （5.23%）. Bacterial infections were predominant in summer and fall， and viral infections were predominant in winter and spring. The total positive rate decreased in 2020‒2023 compared with that of 2018‒2019 （χ2=5.753，P<0.05）. Thirty-seven strains of Salmonella， 81 strains of diarrheagenic Escherichia coli， and 19 strains of Campylobacter were completed for the molecular typing analysis by PFGE， which were classified into 28， 80 and 18 banding types， respectively， with a wide range of banding similarity. Nineteen copies of norovirus GⅡ group gene sequences were analyzed and classified into 5 genotypes， which were mainly GⅡ.Pe-GⅡ.4 and GⅡ.P16-GⅡ.2 types. ConclusionRotavirus， norovirus， diarrheagenic Escherichia coli， Salmonella， and Campylobacter are the dominant pathogens of infectious diarrhea in children in Putuo District of Shanghai. The pathogen spectrum shows a trend of seasonal epidemic characteristics， with a diversity of molecular characteristics of some pathogens. Surveillance and monitoring on molecular characteristics of the pathogens of infectious diarrhea in children should be strengthened in different seasons， so as to provide a laboratory basis for the prevention and control of infectious diarrhea.
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Enterotoxigenic Escherichia coli（ETEC）infection can induce watery diarrhea，leading to dehydration，electrolyte disturbance，and even death in severe cases. Recombinant B subunit/inactivated whole-cell cholera（rBS/WC）vaccine is effective in preventing ETEC infectious diarrhea. On the basis of the latest evidence on etiology and epidemiology of ETEC，as well as the effectiveness，safety，and health economics of rBS/WC vaccine，National Clinical Research Center for Child Health（The Children’s Hospital，Zhejiang University School of Medicine）and Zhejiang Provincial Center for Disease Control and Prevention invited experts to develop expert consensus on rBS/WC vaccine in prevention of ETEC infectious diarrhea. It aims to provide the clinicians and vaccination professionals with guidelines on using rBS/WC vaccine to reduce the incidence of ETEC infectious diarrhea.
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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.
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Infectious diarrhea is an important public health problem, which has a significant impact on global disease burden. Under the background of climate change, rainstorms increase and floods occur frequently. Most studies show that the incidences of infectious diarrhea disease increase significantly after rainstorm and flood events. However, there is a lack of systematic summary on the path of rainstorm and flood events affecting the incidence of infectious diarrhea, including the key links and mechanisms underlying environmental-social interaction. This study comprehensively combed the literature from environmental factors, socio-economic and cultural factors, and population and individual susceptibility factors. The potential mechanisms of infectious diarrhea caused by rainstorm and flood events were discussed from the aspects of spreading of pathogens, affecting sanitation facilities and (or) drinking water treatment infrastructure, the regulatory role of individual and behavioral factors, and long-term effects. Based on the "pressure-state-response" model, a social driving process model of rainstorm and flood leading to incidence of infectious diarrhea was constructed. This model could provide reference for future quantitative modeling and other research directions. It is helpful to guide the public health departments to accurately identify factors affecting the incidence of infectious diarrhea after rainstorm and flood, so as to take targeted intervention measures.
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Objective:To explore the lag effect and correlation between daily average temperature and the incidence of other infectious diarrhea in Hebei Province.Methods:The data of meteorological factors (including temperature and average daily temperature) and the daily incidence of other infectious diarrhea in Zhangjiakou City, Chengde City, Tangshan City, Qinhuangdao City, Baoding City, Langfang City, Cangzhou City, Shijiazhuang City, Hengshui City, Xingtai City, and Handan City in Hebei Province from 2017 to 2020 were collected. Eleven prefecture-level cities were divided into four regions, including east, north, middle and south regions. Distributed lag non-linear model was applied to examine the non-linear associations and the lag effect of daily mean temperature on daily incidence of other infectious diarrhea. Meanwhile, the cold and hot effects were used to estinuate the lag-response relationship on the incidence of other infectious diarrhea.Results:A total of 231 008 cases of other infectious diarrhea were reported in Hebei Province. The seasonal distribution was obvious, showing a bimodal distribution of large peaks in summer and small peaks in winter. An inverse S-shaped association between average daily temperature and cumulative risk ratio ( RR) of other infectious diarrhea was observed in Hebei Province. Both high temperature (higher than 27.50 ℃) and low temperature (less than 13.67 ℃) could increase the risk of other infectious diarrhea. When the temperature was lower than 13.00 ℃, the lag time and RR had a U-shaped association (lag four to seven days, 23 to 30 days). Meanwhile, when it was higher than 13.00 ℃, it had an inverted U-shaped association (lag 5 to 21 days). A comparison of four regions of Hebei Province showed that the lag time from south to north was extended from six days to 30 days at low temperature effects with temperature P5=-7.24 ℃. When the temperature getting hot ( P95=28.25 ℃), the risk occurred at lag 0 days, and the lag time gradually got short from north to south. Thus, the high temperature effect reached maximum quickly with a relative short duration. Conclusions:The inverse S-shaped non-linear association between daily average temperature and the incidence of other infectious diarrhea in Hebei Province is observed. Both low temperature and high temperature are associated with increased risk of other infectious diarrhea. But the impact of low temperature is more notable, which has a relative long duration.
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Objective To investigate the etiology and epidemic characteristics of infectious diarrhea in children in Suzhou, and to provide a basis for accurate prevention and control. Methods Active surveillance of infectious diarrhea pathogens was carried out in a national sentinel surveillance hospital in Suzhou from 2018 to 2020. Epidemiological investigation was completed and stool samples were collected. All samples were detected and classified for 5 viruses and 6 types of bacteria. Results A total of 999 cases of infectious diarrhea were included, the detection rate of pathogen was 36.34%, virus was 31.41%, bacteria was 6.31%, and multi-pathogen mixed infection was 4.8%. The top three pathogens were rotavirus (17.92%), norovirus (12.51%) and Salmonella (3.4%). Both rotavirus diarrhea and norovirus diarrhea occurred most frequently in children aged 7-24 months, with peak incidence in winter and early spring. There was no obvious seasonal and age distribution of bacterial diarrhea. The multi-pathogen mixed infection was mainly virus-virus. G9[P]8 was the dominant genotype of rotavirus, while type 2 was the dominant type of norovirus in the cases of infectious diarrhea. Conclusion Infectious diarrhea in children under 5 years old in Suzhou area from 2018 to 2020 is mainly caused by viruses, among which rotavirus and norovirus are the dominant pathogens. Viral diarrhea has obvious population distribution and seasonal characteristics. The dominant pathogens of bacterial diarrhea are Salmonella and diarrheagenic Escherichia coli.
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Objective@#To analyze the pathogenic spectrum of infectious diarrhea among children in Zhengzhou City in 2020, so as to provide insights into the management of childhood infectious diarrhea.@*Methods@#A total of 230 stool samples were collected from children with diarrhea in the Diarrhea Clinic of Zhengzhou Municipal Children's Hospital in 2020. Diarrheagenic Escherichia coli, Salmonella, Shigella, Vibrio parahaemolyticus, Campylobacter and Aeromonas were isolated. Salmonella was typed using pulsed-field gel electrophoresis ( PFGE ) and antimicrobial resistance was tested in Salmonella. The main types and drug resistance of pathogens were descriptively analyzed.@*Results@#The 230 children with diarrhea included 152 males and 78 females, with a male to female ratio of 1.95∶1. There were 173 cases at ages of 3 years and below ( 75.22% ), and 82 cases seen between June and August ( 35.65% ). A total of 71 pathogenic bacteria strains were isolated, with a detection rate of 30.87%. Salmonella was the most frequently isolated pathogen ( 35 strains, 15.22% prevalence ), following by diarrheagenic E. coli ( 20 strains, 8.70% ). Eleven serotypes of Salmonella were identified, which mainly included S. enteritidis and S. typhimurium. PFGE typing revealed 25 band patterns of Salmonella, with a similarity ranging from 11.85% to 100%. Salmonella were sensitive to imipenem, meropenem, polymyxin B and amikacin and highly resistant to streptomycin ( 85.71% ), ampicillin ( 80.00% ) and sulfaisoxazole ( 80.00% ). A 82.86% proportion of multi-drug resistance was detected in the 29 Salmonella strains. @*Conclusions@# A wide range of pathogenic bacteria were detected from the childhood infectious diarrhea in Zhengzhou City in 2020, which mainly included Salmonella and diarrheagenic E. coli. A high polymorphism level was seen in PFGE fingerprints of Salmonella, which presented high-level resistance to antimicrobial agents.
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@# Objective: To assess the antidiarrheal effects of Terfezia claveryi methanolic extract against Escherichia coli, Salmonella typhimurium, Shigella flexneri, and Giardia lamblia. Methods: Antibacterial effects of the Terfezia claveryi methanolic extract were carried out by determining the minimum inhibitory concentration (MIC) and minimum bactericidal concentration through micro broth dilution technique. Furthermore, reactive oxygen species production and protein leakage were evaluated. To evaluate the in vitro anti-giardial effects of Terfezia claveryi methanolic extract, Giardia lamblia WB (ATCC® 30957) trophozoites were treated with various concentrations of Terfezia claveryi methanolic extract for 10-360 min. In addition, the plasma membrane permeability of trophozoites treated with Terfezia claveryi methanolic extract was determined. The cytotoxicity effects of Terfezia claveryi methanolic extract against normal (HEK293T) and cancer (MCF-7) cells were also assessed using the MTT assay. Results: The MIC and minimum bactericidal concentration of Terfezia claveryi methanolic extract against bacterial strains were in the range of 0.52-1.04 and 1.04-2.08 mg/mL, respectively. The results revealed that reactive oxygen species production and protein leakage were significantly increased after the bacteria were treated with the Terfezia claveryi methanolic extract, especially at 1/3 and 1/2 MICs (P<0.001). Furthermore, Terfezia claveryi methanolic extract decreased the viability of Giardia lamblia trophozoites in a dose-dependent manner. Terfezia claveryi methanolic extract at 1, 2, and 4 mg/mL resulted in 100% mortality in Giardia lamblia trophozoites after 360, 240, and 120 min, respectively. Moreover, Terfezia claveryi methanolic extract altered the permeability of plasma membrane of Giardia lamblia trophozoites by increasing the concentration. MTT assay revealed that the 50% cytotoxic concentrations values for HEK293T and MCF-7 cells were 4.32 mg/mL and 6.40 mg/mL, respectively, indicating that Terfezia claveryi methanolic extract had greater cytotoxicity against cancer cells than normal cells. Conclusions: Terfezia claveryi methanolic extract had potent in vitro antibacterial and anti-parasitic effects on Escherichia coli, Salmonella typhimurium, Shigella flexneri, and Giardia lamblia by affecting cell membrane permeability and reactive oxygen species generation with no significant cytotoxicity on normal cells.
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ObjectiveTo investigate the prevalence and epidemiological characteristics of norovirus in adult cases with infectious diarrhea in Putuo District of Shanghai， and provide scientific evidence for the prevention and control of infectious diarrhea caused by norovirus. MethodsFecal samples， clinical information and epidemiological data were collected from January 2013 through December 2019 in surveillance hospitals in Putuo District of Shanghai. Norovirus was examined by real-time fluorescent quantitative reverse transcription polymerase chain reaction （rRT-PCR）. ResultsIn 1 389 adult cases with infectious diarrhea， norovirus positive rate was 25.41%， which was significantly higher in male （27.16%） than female （23.89%）. Furthermore， in 353 cases positive for norovirus， GⅡ group was the most common （77.98%）.The positive rate was highest in the cases aged 30-44 years. Spring， autumn and winter were the seasons with higher incidence of norovirus （September to May）. The norovirus-infected cases had more nausea， vomiting， hyperactivity of bowel sounds， and watery stool， compared to the negative cases （P<0.05）. ConclusionThe detection rate of norovirus remains high in adult cases with infectious diarrhea in Putuo District of Shanghai， of which GII is predominant. Seasonality may be spring， autumn and winter. Therefore， it warrants the countermeasures， such as surveillance and health education， for prevention and control of norovirus in susceptible population during epidemic seasons.
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ObjectiveTo investigate the prevalence and epidemiological characteristics of norovirus in adult cases with infectious diarrhea in Putuo District of Shanghai， and provide scientific evidence for the prevention and control of infectious diarrhea caused by norovirus. MethodsFecal samples， clinical information and epidemiological data were collected from January 2013 through December 2019 in surveillance hospitals in Putuo District of Shanghai. Norovirus was examined by real-time fluorescent quantitative reverse transcription polymerase chain reaction （rRT-PCR）. ResultsIn 1 389 adult cases with infectious diarrhea， norovirus positive rate was 25.41%， which was significantly higher in male （27.16%） than female （23.89%）. Furthermore， in 353 cases positive for norovirus， GⅡ group was the most common （77.98%）.The positive rate was highest in the cases aged 30-44 years. Spring， autumn and winter were the seasons with higher incidence of norovirus （September to May）. The norovirus-infected cases had more nausea， vomiting， hyperactivity of bowel sounds， and watery stool， compared to the negative cases （P<0.05）. ConclusionThe detection rate of norovirus remains high in adult cases with infectious diarrhea in Putuo District of Shanghai， of which GII is predominant. Seasonality may be spring， autumn and winter. Therefore， it warrants the countermeasures， such as surveillance and health education， for prevention and control of norovirus in susceptible population during epidemic seasons.
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Objective To understand the epidemiological characteristics of norovirus infectious diarrhea in Pudong New Area of Shanghai, and to provide reference for prevention and control of diarrhea caused by norovirus. Methods Epidemiological data and stool samples from diarrhea cases of 15 hospitals in 2015-2019 years were collected. The two subtypes of norovirus G I and G II were detected by RT-PCR and analyzed. Results A total of 9 397 diarrhea samples were collected in 2015-2019 years, and 1 938 positive norovirus samples were detected, with a positive rate of 20.62%. The majority of serotypes were GII (88.60%). Diarrhea caused by norovirus occurs all year round, with high incidence season in 2-3and 10-12 months every year. There was no significant difference in the positive rate of norovirus between different sexes（χ2=2.611，P=0.106）. The positive rate of the 15-64 year old group was higher than that of the 0-14 year old group and the 65 year old and above group（χ2=153.634，P<0.001）. The highest positive rate was for cadres /worker/ business services / teachers / medical staff / drivers. The positive rate of norovirus in diarrhea cases with vomiting was significantly higher than that in patients without vomiting. Conclusions Diarrhea caused by norovirus is related to season, age and occupation. Because there is no effective antiviral drugs and vaccine prevention, continuous monitoring should be carried out and targeted preventive measures should be carried out according to epidemiological characteristics.
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Objective To investigate the relationship between clinical parameters related to acute bacterial dysentery and other infectious diarrhea in adults.Methods From April to October 2018,70 patients with clinical diagnosis of acute bacterial dysentery,180 patients with clinical diagnosis of infectious diarrhea and 399 patients with diarrhea to be examined were investigated retrospectively.The collected data included gender,age,time from onset to treatment,maximum body temperature,main symptoms,epidemiological history,blood routine,C-reactive protein and stool routine.Analysis of these clinical factors related to acute bacterial dysentery and other infectious diarrhea.Results A total of 70 patients with acute bacterial dysentery,180 patients with other infectious diarrhea and 399 patients with diarrhea of unknown origin were investigated.The positive rate of epidemiology in the three groups was statistically significant (P ＜0.05);the age of onset of bacterial dysentery was younger than that in patients with diarrhea of unknown orion (P＜O.05).Compared with the other two groups of patients,the onset to visit time was earlier,the number of vomiting was higher,the incidence of fever and tenesmus was higher,and the levels of white blood cells,neutrophils and C-reactive protein were significantly increased (P ＜ 0.05).Conclusions Patients with acute bacterial dysentery,other infectious diarrhea,and diarrhea of unknown origin have some differences in epidemiological history,age at onset,clinical manifestations,and laboratory tests.
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Objective@#To investigate the relationship between clinical parameters related to acute bacterial dysentery and other infectious diarrhea in adults.@*Methods@#From April to October 2018, 70 patients with clinical diagnosis of acute bacterial dysentery, 180 patients with clinical diagnosis of infectious diarrhea and 399 patients with diarrhea to be examined were investigated retrospectively. The collected data included gender, age, time from onset to treatment, maximum body temperature, main symptoms, epidemiological history, blood routine, C-reactive protein and stool routine. Analysis of these clinical factors related to acute bacterial dysentery and other infectious diarrhea.@*Results@#A total of 70 patients with acute bacterial dysentery, 180 patients with other infectious diarrhea and 399 patients with diarrhea of unknown origin were investigated. The positive rate of epidemiology in the three groups was statistically significant (P<0.05); the age of onset of bacterial dysentery was younger than that in patients with diarrhea of unknown origin (P<0.05). Compared with the other two groups of patients, the onset to visit time was earlier, the number of vomiting was higher, the incidence of fever and tenesmus was higher, and the levels of white blood cells, neutrophils and C-reactive protein were significantly increased (P<0.05).@*Conclusions@#Patients with acute bacterial dysentery, other infectious diarrhea, and diarrhea of unknown origin have some differences in epidemiological history, age at onset, clinical manifestations, and laboratory tests.
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Objective To analyze the epidemiological characteristics and its trends of other infectious diarrhea diseases in infants in Inner Mongolia Autonomous Region.Methods Statistical analysis was conducted on other infectious diarrhea cases of infants in Inner Mongolia Autonomous Region from China Information System for Disease Prevention and Control from 2005 to 2016.The main methods were descriptive epidemiology for population,area and time distribution of these registered cases in Inner Mongolia Autonomous Region.The trends were analyzed by the ratio of fixed base and ring base.Area map method was used for regional differences.Results From 2005 to 2016,17 760 other infectious diarrhea diseases of infants were reported in Inner Mongolia Autonomous Region,accounting for 58％of the total reposed cases.The cases number and incidence showed an overall upward trend.After 2011,the growth rate of case reports and incidences slowed down relatively.The peak of the incidence was in July and August(4 739 cases),accounting for27％of cases of the whole year.Seventy-three point forty-four percent of the cases were located in Hulunbeier City(5 161 cases,29.06％),Hohhot City(4 465 cases,25.14％)and Baotou City(3 417 cases,19.24％).Except for Wuhai City.the remaining 11 cities showed increased incidence of other infectious diarrhea diseases in infants.The ratio of male to female was 1.55∶1,and the incidence in males was higher than that in females every year.Twelve-month-old(5 800 cases,33％)had the greatest proportion.Clinical diagnosis(56.26％)and confirmed diagnosis(43.51％)were the main categories,but the rate of pathogen labeling was only 7.60％.Conclusions After 2011,the incidence of other infectious diarrhea diseases of infants in Inner Mongolia Autonomous Region have slowed down relatively.However,the incidence has significant time,region and population aggregation.
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Objective@#To analyze the spatial-temporal characteristics of other infectious diarrhea (OID) in Jiangsu province from 2010 to 2017, and to provide evidence for setting up prevention and control programs of the disease.@*Methods@#Data was from the Chinese Center for Disease Control and Prevention and the Statistics Bureau of Jiangsu province. Descriptive methods were used to illustrate the epidemiological characteristics of OID from 2010 to 2017. Global autocorrelation statistics method (Moran’s I) was used to detect the spatial autocorrelation of OID, annually. Kulldorff M spatiotemporal scan statistics was used to analyze the spatial-temporal clustering of OID. ArcGIS 10.0 software, SaTScan 9.4 software and Excel 2017 software were also applied.@*Results@#A total of 126 341 OID cases were found in Jiangsu province from 2010 to 2017 with an average annual incidence as 19.96/100 000. Children under five accounted for 55.08% (69 590/126 341) of the total cases. Obvious seasonal backshift with the increasing trends of the OID was noticed. There appeared four areas with high incidence of OID in the whole province, including Wuxi, Suzhou, Yancheng and Xuzhou. OID showed positive spatial autocorrelation at the county level with higher Moran’s I from 0.19 to 0.33 (P<0.01). There appeared four positive clusters, all occurred in the high incidence period of OID, including the cluster area from the intersection areas of Changzhou and Wuxi (RR=7.61, LLR=2 605.80, P<0.01), respectively.@*Conclusion@#With the increasing trends and the seasonal backshift of OID cases, pathogen surveillance programs set for those scattered children under five, in clustered regions and epidemic seasons should be strengthened.
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Objective@#To analyze the epidemiological characteristics and its trends of other infectious diarrhea diseases in infants in Inner Mongolia Autonomous Region.@*Methods@#Statistical analysis was conducted on other infectious diarrhea cases of infants in Inner Mongolia Autonomous Region from China Information System for Disease Prevention and Control from 2005 to 2016. The main methods were descriptive epidemiology for population, area and time distribution of these registered cases in Inner Mongolia Autonomous Region. The trends were analyzed by the ratio of fixed base and ring base. Area map method was used for regional differences.@*Results@#From 2005 to 2016, 17 760 other infectious diarrhea diseases of infants were reported in Inner Mongolia Autonomous Region, accounting for 58% of the total reported cases. The cases number and incidence showed an overall upward trend. After 2011, the growth rate of case reports and incidences slowed down relatively. The peak of the incidence was in July and August (4 739 cases), accounting for 27% of cases of the whole year. Seventy-three point forty-four percent of the cases were located in Hulunbeier City (5 161 cases, 29.06%), Hohhot City (4 465 cases, 25.14%) and Baotou City (3 417 cases, 19.24%) . Except for Wuhai City, the remaining 11 cities showed increased incidence of other infectious diarrhea diseases in infants. The ratio of male to female was 1.55∶1, and the incidence in males was higher than that in females every year. Twelve-month-old (5 800 cases, 33%) had the greatest proportion. Clinical diagnosis (56.26%) and confirmed diagnosis (43.51%) were the main categories, but the rate of pathogen labeling was only 7.60%.@*Conclusions@#After 2011, the incidence of other infectious diarrhea diseases of infants in Inner Mongolia Autonomous Region have slowed down relatively. However, the incidence has significant time, region and population aggregation.
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Diarrhea is one of the main disease types of illness and death in children in developing countries,and infectious diarrhea is especially harmful to children's health.A panel of multidisciplinary experts in management of infectious diarrhea in children and adults was convened in 2012.Panel participants included representatives from the Society for Healthcare Epidemiology of America (SHEA),Center for Disease Control and Prevention (CDC),and the Infectious Disease Society of America (IDSA) Standards and Practice Guidelines Committee (SPGC).In 2017,the panel issued a guideline for the diagnosis and treatment of infectious diarrhea,which was validated and recommended for the management of infectious diarrhea.Now,the part of the content on children in the guide was described.
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Objective@#To find out the source and the epidemic pattern of norovirus outbreak in July, 2016 to June, 2017 in Guangzhou.@*Methods@#The stool samples and clinical information of diarrhea cases were collected by the sentinel hospitals and CDCs; a real-time RT-PCR method was used to detect the norovirus nucleic acids from the samples, the positive ones were amplified and sequenced; the partial sequences of norovirus were aligned by an online BLAST alignment, and a phylogenetic tree was constructed by a neighbor-joining method .@*Results@#A total of 854 cases with infectious diarrhea were reported by Guangzhou diarrhea surveillance network from July, 2016 to June, 2017; the gender ratio (male versus female) was 1∶0.67; 78.33% of the cases were preschool children under the age of 7 years. Totally 220 samples were detected norovirus G II+ (25.76%, including 5 double-positive samples with G I+ ). GII.Pe-GII.4.Sydney_2012 was the prevalent genotype in the second half of 2016 (94.64%), which was replaced by GII.P16-GII.2 in the first half of 2017 (67.65%). Since September 2016, the reported number of norovirus-caused diarrhea epidemic was increased gradually; the peak of epidemic curve emerged in February to March of 2017, and the number started to decrease since April. In May to June there were only 2-3 epidemics reported monthly. All the endemics from September to November 2016 were caused by genotype GII.Pe-GII.4.Sydney_2012; the endemics from December 2016 to April 2017 were mainly caused by genotype GII.P16-GII.2. Some samples from kitchen workers and babysitters were detected GII+ , which was consistent with the result of the cases′ samples.@*Conclusions@#It was the first time that the novel GII.P16-GII.2 recombinant strain outbroke occurred in Guangzhou City and homology analysis also suggested that GII.P16-GII.2 was the main source of those epidemics in 2016 -2017 winter and spring season. Furthermore, The kitchen workers and babysitters may have played an important role in the spread of norovirus.