| Objective:1.To understand the epidemiological changes in the pathogenic spectrum of adult infectious diarrhoea in the Wusong area and to grasp the epidemiological features of adult infectious diarrhoea in the area.2.To analyse the results,develop predictive models and identify priorities and directions for infection prevention and control.To provide a reference for relevant authorities in the prevention and control of infectious diarrhoea in adults.Methods:Case information was collected from patients who attended the two diarrhoeal disease sentinel hospitals in the region between June 1,2016 and December 31,2019and stool specimens were collected to establish a database.Patients’stool specimens were collected from the two sentinel hospitals at sampling intervals of 1:8 and 1:5,respectively,according to the Shanghai Diarrhoeal Disease Surveillance System protocol,and all were tested for bacteria and viruses.The current situation of infectious diarrhoea in adults in the region was described,and the epidemiological characteristics of infectious diarrhoea were described by analysing the different ages,seasons,pathogen detection and occupational distribution of infectious diarrhoea,and compared with other regions for discussion.A risk prediction model for infectious diarrhoea was constructed,and a SARIMA model was built using R x64 4.0.3 software to discuss relevant prevention and control measures.Results:1.Basic characteristics of research objects:A total of 2914 subjects were included in this study,including 1546 males accounting for 53.05%and 1368 females accounting for 46.95%,with a male-to-female ratio of 1.13:1.There was no statistically significant difference between men and women(?~2=0.022,P=0.883).In terms of occupational distribution,retirees account for the highest proportion,as high as 42.38%(1235/2914),followed by cadres,accounting for 18.50%(539/2914).All age groups of the cases ranged from 18 to 95 years old,among which the age group above 60 years old had the highest proportion,accounting for 33.39%,followed by 18 to 30 years old and 30 to 40years old,accounting for 23.03%and 22.10%,respectively.2.Clinical characteristics of the subjects:Among the 2914 subjects,the frequency ofdiarrhea was mainly concentrated in 1-10 times,and 1352 cases were 1-10 times,accounting for 46.40%.5～1426 cases,accounting for 48.94%;111 cases(3.81%)were treated 10～10 times.25 cases were≥15 times,accounting for 0.86%.The number of diarrhea days from 1 to 1 day was the most,2532 cases,accounting for 86.89%,followed by 5 to 10 days,accounting for 9.20%and 3.91%,respectively.The number of watery and soft stools in diarrhea patients was 2149,accounting for 73.75%,followed by watery stools and mucous stools,accounting for 10.50%and 8.85%,respectively;black stools,accounting for 2.02%in 59 cases;blood stools,accounting for 0.21%in 6 cases.Other clinical features of diarrhea included abdominal pain in1896 cases(65.07%),nausea in 598 cases(20.52%),fever in 453 cases(15.55%),vomiting in 411 cases(14.10%),posterior weight in 330 cases(11.32%)and abdominal distension in 321 cases(11.02%).3.Virus detection:The virus positive rate from high to low was norovirus GⅡ(8.71%),Rotavirus group A(4.20%),Norovirus GⅠ(2.85%),astrovirus(2.55%).Among the 2914 fecal samples,141 samples were detected as virus positive,including137 single virus positive specimens and 4 mixed infection specimens with two viruses.The total virus positive rate was 4.98%.The positive rate(2.78%)and composition ratio(55.86%)of norovirus were the highest among the five viruses.Rotavirus(1.03%)and astrovirus(0.58%)followed,and the detection rate and composition ratio of Jaruvirus and enteric adenovirus were lower.The infection rate of mixed virus was 2.84%(4/141),and there were 4 mixed infected specimens.The highest positive rate was 7.30 percent in people over 60 years old,and the lowest was in people between 30 and 40 years old,mainly norovirus G-ⅱinfection.There was a statistically significant difference in the detection rate among different age groups(?~2=20.518,P=0.000).In terms of occupational distribution,retirees and cadres account for a higher proportion.Monthly distribution,throughout the year all sick strain detection,presents a certain characteristics of the season,peak appeared in the spring,which in November-April next year.4.The positive rate of bacteria was ETEC(5.70%),Campylobacter jejuni(2.95%),Salmonella non-typhoid(2.51%),Vibrio parahaemolyticus(2.51%).A total of 493bacterial positive specimens were detected,including 481 single bacterial positive specimens and 12 double bacterial mixed infection specimens.The total bacterial positive rate was 17.33%.The enterocathartic Escherichia coli in this study included EPEC,ETEC and EAGGEC.The positive rate(5.70%)and constituent ratio(32.87%)of ETEC were the highest among the 8 bacteria in this study.Campylobacter jejuni(2.95%),Vibrio parahaemolyticus(2.51%),non-typhoid Salmonella(2.51%),and Shigella(0.41%)had the lowest positive rate.The infection rate of mixed bacteria was2.43%(12/493),and there were 12 mixed infected specimens.The age group with the highest positive rate was 18-30 years old(21.95%),and the age group with the lowest positive rate was over 60 years old(14.79%).All ages between pathogen detection rate was statistically difference(?~2=23.552,P=0.000).In terms of occupational distribution,retirees and cadres account for a higher proportion.Pathogenic bacteria were detected throughout the year,and bacterial diarrhea showed certain seasonal characteristics,the peak appeared in summer,that is,the highest positive detection rate from July to September.5.SARIMA model building:SARIMA(0,0,1)×(0,1,1)12 had a good effect on the prediction of the number of adult infectious diarrhea in this region.The mean error of ME was 0.92,the root mean square error of RMSE was 0.53,the mean absolute error of MAE was 2.17,and the MAPE value was 17.28%.Conclusion:1.The subjects of this study are mainly retirees,most of whom are over 60 years old,with more men than women.Among 2914 fecal samples,634 were positive,with a total detection rate of 21.76%.There were 338 males,accounting for 53.31%,and 296females,accounting for 46.69%.The dominant viruses were norovirus,Rotavirus group A and astrovirus.The age group with the highest virus detection rate was over 60 years old,and the peak of infection occurred in winter and spring,that is,from November to April,showing seasonal characteristics.The dominant bacteria were ETEC,Campylobacter jejuni,non-typhoid Salmonella and Vibrio parahaemolyticus.The highest number of bacteria detected was between 18 and 30 years old,and the peak of bacterial infections occurred in summer,from July to September.2.The SARIMA model was established based on the number of cases in each month from June 2016 to June 2019,and it was considered that model SARIMA(0,0,1)×(0,1,1)12 was suitable for predicting the incidence of infectious diarrhea in this region,with good prediction ability. |
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