| Study backgroundAs an essential public health issue worldwide, Diarrhea disease is a global illness that threats people’s health seriously. According to statistical data, there are about 1.7 billion diarrhea cases worldwide each year and about 48 million diarrhea cases are reported yearly in USA. In the year of 2012, more than 1.1 million diarrhea diseases were reported in China through the’national notifiable infectious disease report system’, but the actual number of diarrhea cases could be much larger due to mountainous of the undiagnosed cases and un-hospitalized cases. Shanghai has initiated the single disease surveillance based on diarrhea related infectious disease since 1990s, but the surveillance system had some weakness such as the character of affected population, clinical presentations and pathogens of diarrhea cases could not be integrated. In this study, we aimed to describe the epidemiologic characteristics of diarrhea through an integrated surveillance system in Songjiang district, Shanghai, and to provide fundamental data for diarrhea diseases control and prevention.ObjectivesThe objectives of this study were to describe the epidemiologic distribution of diarrhea cases, and to know the pathogen spectrum of diarrhea diseases; further, to understand the extent of drug resistance in identified pathogens,, and to find out strength and weakness of the integrated surveillance system with regard to promptness, accuracy, feasibility and operability.Study design1. Source of materialsData were collected through the diarrhea comprehensive surveillance system, which including demographic information, clinical symptom and signs, exposure status before onset, lab results and drug susceptibility testing results of pathogen. Quantitative data were collected by indepth interviews with staffs involved in the surveillance system.2. Analysis methodDescriptive epidemiology was applied to analyze the demographic character, clinical symptom character, pathogen test result of diarrhea cases and related influential factors, drug resistance pathogen distribution. Chi-square test was used to compare the differentiation of proportions, a was 0.05 which means P value less than 0.05 was statistically significant. Excel 2007 and SPSS 19.0 software was applied to summarize and analyze data.Summarize subjects’ viewpoint and opinion according to interview materials of different themes.Results1. Epidemiological and symptomatic characterIn total 6466 adult diarrhea cases were reported. the gender ratio was 0.92:1, the average age of diarrhea cases was 40 years old and most of their occupations were workers and retired staff. The incidence of diarrhea case showed a kind of seasonal trend which reached a peak in July and August in summer.2. Pathogen character489 feces were collected to undertake bacterium and virus detection. Pathogens were detected in 154 feces and the positive rate was 31.49%, norovirus G II, group A rotavirus, Salmonella and vibrio parahemolyticus were 4 types of dominant pathogens which accounted for 38.22%,20.38%,16.56% and 15.92%, respectively. Pathogens showed some seasonal characteristics, norovirus G II could be detected in the whole year, Salmonella and vibrio parahemolyticus were detected mainly during April to November, and group A rotavirus had a higher detection rate in chilly winter. In the aspect of relationship between demography, symptom and pathogen, Salmonella was more common among diarrhea cases in the 45-59 age group compared with cases in 15-44 age group and elder age group who was over 60 years old. Norovirus GⅡ was common in patients who had nausea, abdominal distension, watery stool, and over 5 times of diarrhea in 24 hours. Cases that had nausea were more likely to be detected vibrio parahemolyticus positive in their feces.3. Influential factors of pathogen detectionThe detection rate reached up to 40.63%, and it was relatively higher among patients who saw the doctor on the first day of disease onset. The detection rate of various pathogens decreased obviously after more than 5 days delay of hospitalization. This study did not identify the difference of detection rate between antibiotic treated patients and untreated patients. The detection rate of vibrio parahemolyticus was extremely high among patients who had a contaminated diet intake history.4. drug-resistance conditionSalmonella was 100% sensitive to Norfloxacin, chloramphenicol, compound new Ming, ciprofloxacin, levofloxacin, cefuroxime and cefoxitin, but less sensitive to gentamicin, cefotaxime, norfloxacin, nalidixic acid, and only 68.42% of salmonella was sensitive to nalidixic acid. Vibrio parahemolyticus was 100% sensitive to cefotaxime, gentamicin, norfloxacin, tetracycline, chloromycetin, ciprofloxacin and levofloxacin, but was sensitive rate was gradually lower to nalidixic acid, compound new Ming, cefoxitin and cefuroxime, the rate was 95.45%,95.45%,75.00%,36.84%, respectively.5. Integrated surveillance system running conditionIn the aspect of promptness of information report, the integrated surveillance system was convenient and timesaving to collect information and provide feedback service by using the computer software, but timely data submission would be seriously impacted by occasional instability of the computer servicer. In the aspect of availability of information collection, this system could comprehensively collect patients’ information, and information could be used to describe the epidemiologic characteristic of the entire diarrhea patients, but we should strengthen the repeated training among staff in the survey hospital, unify their understanding of the questionnaire, in order to improve the validity of collected information. In the aspect of feasibility of the survey work, due to the huge workload, the stable operation of this system required policy support and the guarantee of human resource, property and logistics, so it was preferable to appropriately adjust etiological detection items according to the results, which was also resource saving. In the aspect of operability of this system, timely checkup and preserve and renewal should be implemented, and we also should pay attention to enhance the stability of the computer servicer.Conclusion1. The epidemic of adult diarrhea disease pathogen shows a kind of seasonal trend in Songjiang district, which is important for the guidance of diarrhea clinical diagnosis and prevention.2. The clinical features of various pathogens show no specificity, so it’s less possible to identify the pathogen only according to its clinical symptom. The dominant pathogens of diarrhea are salmonella and vibrio parahemolyticus, and both of them are sensitive to drugs, but some pathogens are resistant to several drugs.3. The improvement and adjustment of the comprehensive surveillance system on the server could improve the work efficiency of staff. Some pathogen test items should be adjusted according to the diarrhea spectrum which could increase the resource utilization rate.4. The comprehensive surveillance system can completely collect demographic information, symptoms and signs, suspicious diet or water exposure information of all cases, and can be used to describe the epidemiological feature comprehensively, but its stable operation needs policy support and people, money and material guarantee. |
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