食源性疾病分类系统的建立及成都市食源性疾病现状研究
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摘要
目的
明确食源性疾病范围、种类、名称和编码，初步阐明成都市食源性疾病的现状和趋势。
方法
立足世界卫生组织定义，结合国内外有关食源性疾病研究进展，采用ICD-10系统建立食源性疾病数据库。综合成都市现有疾病监测、卫生监督、行政管理等系统，采用现有信息系统利用、现场调查、专家访谈等定性和定量相结合的工作方法收集目前全市所有食源性疾病病例。应用EXCEL作为统计软件，描述成都市食源性疾病的现状和趋势。
结果
食源性疾病分类系统以ICD-10为编码工具，将食源性疾病按致病因素不同分为细菌性食源性疾病、病毒性食源性疾病、化学性食源性疾病、食源性寄生虫病、食源性肠道传染病、食源性变态反应性疾病以及食源性放射病，共七类90种食源性疾病。近三年来，以成都市现有的监测能力，可监测到的食源性疾病有50种，占全部食源性疾病类别的56％，其中27种疾病三年未有病例报告。三年可监测到的食源性疾病累计发病率为65．41/10万，其发病率呈上升趋势，三年分别是59．82/10万、58．35/10万、77．88/10万。可监测到的食源性疾病以细菌性痢疾为主，占三年总发病率的79％，且细菌性痢疾三年来呈明显上升趋势。三年来食物中毒共发生93起，中毒人数1511人，各年发病率依次是5．40/10万、4．92/10万、3．59/10万，呈现下降趋势。中毒原因以细菌性为主，变形杆菌、沙门氏菌、副溶血性弧菌为主要致病菌，发生食物中毒频率最多的是餐饮企业。目前无法监测的食源性疾病有40种，占全部食源性疾病的44％。其中属于检验技术缺乏而无法监测的有34种，占无法监测食源性疾病的85％，主要是病毒和寄生虫性食源性疾病。另有6种(15％)的食源性疾病(包括全部食源性变态反应和食源性放射病)因为缺乏监测系统而无法实施常规监测。三年来，食源性疾病致死共50人，其中死于食源性肠道传染病的人数最多，甲肝和细菌性痢疾分列死因顺位的一、二位。
结论
食源性疾病分类系统的建立为成都市食源性疾病现状研究明确了食源性疾病的监测范围。近三年，食源性疾病已经成为严重威胁成都市市民公众健康的卫生问题，根据可得到的监测资料分析，食源性疾病大致呈上升趋势，间接提示近三年食品安全状况不容乐观。目前全市还缺乏食源性变态反应性疾病和放射性疾病的常规监测系统，食源性寄生虫疾病的部分监测工作亟待恢复。在检验能力上全市尚不具备以诺瓦克病毒为代表的大多数病毒和部分寄生虫的检验能力，食源性疾病的监测还有很多工作需要完成。我们建议在成都市尽快将食源疾病监测列为法定监测，明确食源性各病种的病例定义，完善现有的监测系统，搭建数据共享的信息平台，提高检验能力，切实落实现有的监测和报病系统，并通过狠抓个人健康教育、提高卫生意识，强化食品卫生监管、重点抓好餐饮业等重点环节，以有效控制食源性疾病的流行和暴发。
Objective
This study was conducted to clarify the scope, pathogens, name and codes of food borne diseases(FBD), and to understand the status and trend of FBD in Chengdu city.
Method
Based on the definition of FBD by WHO, and combining the present progresses of FBD study, the FBD data pool was established according to ICD-10 system in this study. Then all FBD cases in Chengdu city were collected from multiple sources such as disease surveillance, hygiene supervision, and managing department, by utilizing existent information systems, field investigation, and expert's interview and so on. The present state and trend of FBD in Chengdu were analyzed, and then, some suggestions about the control to FBD were put forward.
Results
According to the pathogens in ICD-10 system, 90 FBDs could be classified into 7 categories, namely bacterial FBD, viral FBD, chemical FBD, food borne parasites disease, food borne intestinal infectious disease, food borne allergic disease and food borne radiative disease.
Only 50 FBDs could be detected by existing surveillance capacity of Chengdu, accounting for 56% of the whole FBD classification system, but within the recent three years, about 27 FBDs in which have never been reported. The accumulative average incidence of known FBD within the recent three years is about 65.41/100,000, and the annual incidence is 59.82/100,000(2004), 58.35/100,000(2005), and 77.88/100,000(2006) respectively. Bacterial diarrhea accounted for 79% of known FBD, and showing the dramatically increasing tendency in the incidence. A total about 93 outbreaks and 1511 persons of food poisoning were reported in the three years. The annual incidence of food poisoning declined steadily, namely 5.4/100,000(2004), 4.92/100,000(2005), and 3.59/100,000 (2006). The major pathogens resulting in food poisoning were bacterial, including Proteus, Salmonella, and Vibrio parahaemolyticus, etc. Restaurants were of the highest frequency of food poisoning. In the 40 FBDs which could not be detected, 34(85%) were due to the insufficient test capacity, and 6(15%) were beyond the routine disease surveillance systems, which included food borne allergic and radiation diseases.
Within the recent three years, 50 deaths from FBD were-reported, and food borne intestinal infection is the most important cause. Hepatitis A and infectious diarrhea are the first and the second death cause.
Conclusion
FBD has emerged as an important and growing public health in Chengdu during the recent years, frequent prevalence and outbreaks caused by diversified pathogens increased steadily. The results of this study indicated that the condition of food safety was not very well in the recent years. The surveillance system for food borne allergic disease and food borne radiative disease in Chengdu should be built up, as well as the food borne parasites disease surveillance system need to be rebuilt too. Furthermore, most of the virus, e.g. Norwalk virus, can not be detected t in Chengdu. More efforts need to be done to improve the FBD surveillance system. It is suggested that government should regulate FBD as legally reported disease, make clear the definition of FBD scope, consummate present surveillance system, establish shared information system, build up laboratory testing capacity, carry out existing disease surveillance system step by step. To control FBD prevalence and outbreaks more effectively, personal health education and food hygienic supervision, especially that for restaurants, should also be emphasized.
明确食源性疾病范围、种类、名称和编码，初步阐明成都市食源性疾病的现状和趋势。
方法
立足世界卫生组织定义，结合国内外有关食源性疾病研究进展，采用ICD-10系统建立食源性疾病数据库。综合成都市现有疾病监测、卫生监督、行政管理等系统，采用现有信息系统利用、现场调查、专家访谈等定性和定量相结合的工作方法收集目前全市所有食源性疾病病例。应用EXCEL作为统计软件，描述成都市食源性疾病的现状和趋势。
结果
食源性疾病分类系统以ICD-10为编码工具，将食源性疾病按致病因素不同分为细菌性食源性疾病、病毒性食源性疾病、化学性食源性疾病、食源性寄生虫病、食源性肠道传染病、食源性变态反应性疾病以及食源性放射病，共七类90种食源性疾病。近三年来，以成都市现有的监测能力，可监测到的食源性疾病有50种，占全部食源性疾病类别的56％，其中27种疾病三年未有病例报告。三年可监测到的食源性疾病累计发病率为65．41/10万，其发病率呈上升趋势，三年分别是59．82/10万、58．35/10万、77．88/10万。可监测到的食源性疾病以细菌性痢疾为主，占三年总发病率的79％，且细菌性痢疾三年来呈明显上升趋势。三年来食物中毒共发生93起，中毒人数1511人，各年发病率依次是5．40/10万、4．92/10万、3．59/10万，呈现下降趋势。中毒原因以细菌性为主，变形杆菌、沙门氏菌、副溶血性弧菌为主要致病菌，发生食物中毒频率最多的是餐饮企业。目前无法监测的食源性疾病有40种，占全部食源性疾病的44％。其中属于检验技术缺乏而无法监测的有34种，占无法监测食源性疾病的85％，主要是病毒和寄生虫性食源性疾病。另有6种(15％)的食源性疾病(包括全部食源性变态反应和食源性放射病)因为缺乏监测系统而无法实施常规监测。三年来，食源性疾病致死共50人，其中死于食源性肠道传染病的人数最多，甲肝和细菌性痢疾分列死因顺位的一、二位。
结论
食源性疾病分类系统的建立为成都市食源性疾病现状研究明确了食源性疾病的监测范围。近三年，食源性疾病已经成为严重威胁成都市市民公众健康的卫生问题，根据可得到的监测资料分析，食源性疾病大致呈上升趋势，间接提示近三年食品安全状况不容乐观。目前全市还缺乏食源性变态反应性疾病和放射性疾病的常规监测系统，食源性寄生虫疾病的部分监测工作亟待恢复。在检验能力上全市尚不具备以诺瓦克病毒为代表的大多数病毒和部分寄生虫的检验能力，食源性疾病的监测还有很多工作需要完成。我们建议在成都市尽快将食源疾病监测列为法定监测，明确食源性各病种的病例定义，完善现有的监测系统，搭建数据共享的信息平台，提高检验能力，切实落实现有的监测和报病系统，并通过狠抓个人健康教育、提高卫生意识，强化食品卫生监管、重点抓好餐饮业等重点环节，以有效控制食源性疾病的流行和暴发。
Objective
This study was conducted to clarify the scope, pathogens, name and codes of food borne diseases(FBD), and to understand the status and trend of FBD in Chengdu city.
Method
Based on the definition of FBD by WHO, and combining the present progresses of FBD study, the FBD data pool was established according to ICD-10 system in this study. Then all FBD cases in Chengdu city were collected from multiple sources such as disease surveillance, hygiene supervision, and managing department, by utilizing existent information systems, field investigation, and expert's interview and so on. The present state and trend of FBD in Chengdu were analyzed, and then, some suggestions about the control to FBD were put forward.
Results
According to the pathogens in ICD-10 system, 90 FBDs could be classified into 7 categories, namely bacterial FBD, viral FBD, chemical FBD, food borne parasites disease, food borne intestinal infectious disease, food borne allergic disease and food borne radiative disease.
Only 50 FBDs could be detected by existing surveillance capacity of Chengdu, accounting for 56% of the whole FBD classification system, but within the recent three years, about 27 FBDs in which have never been reported. The accumulative average incidence of known FBD within the recent three years is about 65.41/100,000, and the annual incidence is 59.82/100,000(2004), 58.35/100,000(2005), and 77.88/100,000(2006) respectively. Bacterial diarrhea accounted for 79% of known FBD, and showing the dramatically increasing tendency in the incidence. A total about 93 outbreaks and 1511 persons of food poisoning were reported in the three years. The annual incidence of food poisoning declined steadily, namely 5.4/100,000(2004), 4.92/100,000(2005), and 3.59/100,000 (2006). The major pathogens resulting in food poisoning were bacterial, including Proteus, Salmonella, and Vibrio parahaemolyticus, etc. Restaurants were of the highest frequency of food poisoning. In the 40 FBDs which could not be detected, 34(85%) were due to the insufficient test capacity, and 6(15%) were beyond the routine disease surveillance systems, which included food borne allergic and radiation diseases.
Within the recent three years, 50 deaths from FBD were-reported, and food borne intestinal infection is the most important cause. Hepatitis A and infectious diarrhea are the first and the second death cause.
Conclusion
FBD has emerged as an important and growing public health in Chengdu during the recent years, frequent prevalence and outbreaks caused by diversified pathogens increased steadily. The results of this study indicated that the condition of food safety was not very well in the recent years. The surveillance system for food borne allergic disease and food borne radiative disease in Chengdu should be built up, as well as the food borne parasites disease surveillance system need to be rebuilt too. Furthermore, most of the virus, e.g. Norwalk virus, can not be detected t in Chengdu. More efforts need to be done to improve the FBD surveillance system. It is suggested that government should regulate FBD as legally reported disease, make clear the definition of FBD scope, consummate present surveillance system, establish shared information system, build up laboratory testing capacity, carry out existing disease surveillance system step by step. To control FBD prevalence and outbreaks more effectively, personal health education and food hygienic supervision, especially that for restaurants, should also be emphasized.
引文
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