Infectious Diarrhea Prevention And Control Measures And Laboratory Monitoring

Effective surveillance system is the base of infectious diarrhea prevention and control, and laboratory surveillance is critical part of controlling infectious diarrhea epidemic or outbreak. Many countries, such as USA, they prevent and control infectious diarrhea through FoodNet, WBDOSS and other lab surveillance systems. So a infectious diarrhea laboratory surveillance network was created according to the international standard theories and experiences of surveillance lab system in this study, in order to find some ways and pattern of laboratory surveillance for preventing and controlling infectious diarrhea, even for other infectious diseases in the future.The frameworks of this infectious diarrhea surveillance network based on one centre lab and three different grades hospitals and clinics as sentinel loci, and which were located in different area, such as city, countryside and suburb. The surveillance network was composed by surveillance locus, centre lab, technicians and doctors, equipments and reagents, samples collecting, carrying and saving, and safety management of lab. The surveillance lab system uniformed diagnosis standard, methods of sample collection, investigation ways, detection methods, then each critical point was done quality control. The centre lab collected the infectious diarrhea patients information, the diarrhea pathogens, percents and antibiotics resistances and risk factors analysis, then all information were feed back to each surveillance loci, so as to educate and direct. The lab surveillance network has run two years under lesser funds supporting, formed the infectious diarrhea laboratory surveillance pattern, and acquired some results.The first result was the epidemic of infectious diarrhea in some areas in Beijing, the epidemic seasons were summer and autumn, the populations from 20 to 49 years which was the mainly populations.The second result was the infectious diarrhea pathogens and variational trends. In 2005, 480 feces samples were collected, the total positive rate was 54.79%, include pathogens bacteria were 47.1%, condition pathogens bacteria was 25.9%, and rotavirus positive samples were 22.1%, and mixed infection was 4.9%. Shigella had different types and serotypes, the B serotype of Shigella flexneri, especial F4 serotype was high positive rate than other Shigella types. The proportion of conditioned pathogens was ascended, and the rotavirus infection happened not only in children, also the proportion of adults infection was more than before data .The surveillance results of 2006 which collected about 450 feces samples, the component pathogens were similar to those results of 2005, but the positive rate only 28.89%.The third result was the antibiotics resistant pattern of the infectious diarrhea main pathogens bacteria. Twenty-four specific antibiotics were selected for determining the susceptibility of bacterial pathogens isolated from feces samples. The results showed that all most bacterial isolates were susceptible to meropenem, fosfomycin, cefotaxime- clavulanic acid, ceftazidime and aztreonam, but resistant to teicoplanin, vancomycin, rifampin, erythromycin, tetracycline, ampicillin and trimethoprin.The forth result was a retrospective study, which found some independent variables associated with positive stool culture were: fever, duration of abdominal pain, and requirement of IV fluid therapy. Neither bloody diarrhea nor persistent diarrhea was associated with positive stool culture.The fifth result was an case-control (1:1) study and an accident of food poisoning happened in the period of surveillance process, some risk factors of infectious diarrhea were found, the conditional logistic analysis results showed that the protective factor were washing hands in time with soap, and having dinner in some restaurants and eating fresh seafood were risk factors, another risk factor which food processing without heating will induce infectious diarrhea.Based on some results and experiences of this surveillance system, some strategies and suggestions were advanced, the strategies included developing infectious diarrhea lab surveillance network, strengthening diarrhea patients surveillance and report, educating the technicians who work in clinic and clinic department in community, disseminating knowledge about preventing diarrhea, and typing pathogens bacteria of diarrhea with new and standard method, such as PFGE. At the same time, some suggestions were advanced from lab surveillance, included improving consciousness and management in clinic department, developing some new researches about infectious diarrhea prevention, control, and improving society sanitation habits and conception.According to the projects, the surveillance lab composes by different grades clinic lab can develop surveillance effectively. After two years development, the surveillance results suggested the infectious diarrhea epidemic in Beijing area, and the clinical analysis and lab results also offer theories, technology bases and basic laboratory surveillance pattern for prevention and control infectious diarrhea and other infectious diseases in the future.