于晓楠, 忻郦菁, 张静, 杨吉星, 王斌. 2017—2019年上海市虹口区诺如病毒感染性腹泻疫情流行特征[J]. 环境与职业医学, 2021, 38(5): 511-516. DOI: 10.13213/j.cnki.jeom.2021.20462
引用本文: 于晓楠, 忻郦菁, 张静, 杨吉星, 王斌. 2017—2019年上海市虹口区诺如病毒感染性腹泻疫情流行特征[J]. 环境与职业医学, 2021, 38(5): 511-516. DOI: 10.13213/j.cnki.jeom.2021.20462
YU Xiaonan, XIN Lijing, ZHANG Jing, YANG Jixing, WANG Bin. Epidemiological characteristics of norovirus infectious diarrhea in Hongkou District, Shanghai from 2017 to 2019[J]. Journal of Environmental and Occupational Medicine, 2021, 38(5): 511-516. DOI: 10.13213/j.cnki.jeom.2021.20462
Citation: YU Xiaonan, XIN Lijing, ZHANG Jing, YANG Jixing, WANG Bin. Epidemiological characteristics of norovirus infectious diarrhea in Hongkou District, Shanghai from 2017 to 2019[J]. Journal of Environmental and Occupational Medicine, 2021, 38(5): 511-516. DOI: 10.13213/j.cnki.jeom.2021.20462

2017—2019年上海市虹口区诺如病毒感染性腹泻疫情流行特征

Epidemiological characteristics of norovirus infectious diarrhea in Hongkou District, Shanghai from 2017 to 2019

  • 摘要: 背景

    诺如病毒(NoV)感染性腹泻在世界各地多次引发大规模的暴发流行,目前已成为日益严重的公共卫生问题。

    目的

    分析上海市虹口区2017-2019年诺如病毒感染性腹泻聚集性疫情流行特征,为制定预防控制措施提供依据。

    方法

    对2017-2019年上海市虹口区发生的37起诺如病毒感染性腹泻聚集性疫情开展流行病学调查(包括时间、地区、人群、发生场所、临床特征、传播途径)。采集各类样本共699份(其中病例粪便、肛拭或呕吐物样本208份,无症状密切接触者粪便、肛拭或呕吐物样本67份,从业人员肛拭样本142份,厨房砧板等环节样本239份,留样食品样本43份),基于实时荧光定量PCR法进行NoV鉴定,并对病毒衣壳蛋白VP1和聚合酶RdRp进行基因扩增。病毒基因型别使用在线诺如病毒分型工具(http://www.rivm.nl/mpf/norovirus/typingtool/)进行分型,并比对病毒序列和构建进化树。

    结果

    37起诺如病毒感染性腹泻聚集性疫情的病例数474例,总罹患率为1.95%(474/24266)。冬春季为诺如病毒感染性腹泻高发季节,全区8个街道均有聚集性疫情报告,发病人群以幼儿园和小学生为主,不同疫情发生场所发病率为1.67%~2.94%,病例多出现呕吐症状。聚集性疫情传播途径以接触传播为主,呕吐物、排泄物处置不当可造成疫情蔓延扩散。37起诺如病毒感染性腹泻的病毒分型是NoV GⅡ型,699份样本中NoV GⅡ核酸阳性130份,阳性率为18.60%。2017年和2018年上海市虹口区诺如病毒VP1基因型为GⅡ.2,而2019年RdRp基因型为GⅡ.P17,VP1基因型为GⅡ.17。

    结论

    虹口区诺如病毒感染性腹泻的主要病原体为NoV GⅡ,基因型别多样,冬春季为高发季节,小学及幼托机构为高发场所,传播途径以接触传播为主,优势基因型在流行季有所改变,今后需加强诺如病毒感染性腹泻聚集性疫情流行病学和病原学监测。

     

    Abstract: Background

    Studies have found that norovirus (NoV) infectious diarrhea has caused many outbreaks across the world and has become an increasingly serious public health problem.

    Objective

    This study analyzes the epidemiological characteristics of NoV infectious diarrhea in Hongkou District of Shanghai from 2017 to 2019, aiming to provide evidence for making prevention and control measures.

    Methods

    An epidemiological investigation including time, region, population, occurrence site, clinical characteristics, and transmission route was carried out on reported clusters of norovirus in Hongkou, Shanghai from 2017 to 2019. A total of 699 samples (including 208 feces, anal swabs or vomit samples from infection cases, 67 feces, anal swabs or vomit samples from asymptomatic close contacts, 142 anal swab samples from practitioners of food industry, 239 kitchen cutting boards samples, and 43 reserved food samples) were collected. Real-time fluorescence quantitative PCR was used to detect the type of NoV nucleic acid and amplify the gene sequence of capsid protein VP1 and polymerase RdRp. Virus genotypes were genotyped using the online norovirus typing tool (http://www.rivm.nl/mpf/norovirus/typingtool/), and virus sequences were compared and evolutionary trees were constructed.

    Results

    From 2017 to 2019, a total of 37 norovirus infectious diarrhea clusters were reported in Hongkou District of Shanghai, with a total number of 474 cases and an overall incidence rate of 1.95% (474/24 266). In winter and spring, high incidences of norovirus infectious diarrhea were reported in 8 subdistricts in the district, with predominantly kindergarten and primary school students, and the incidence rates were 1.67%-2.94% across different school categories. The cluster epidemics were mainly transmitted by contact, e.g. improper disposal of vomit and excreta. Of the 37 clusters, NoV GⅡwas the dominant virus type, its nucleic acid was found positive in 130 of the 699 samples, and the positive rate was 18.60%. In the selected district, the genotype of VP1 detected in 2017 and 2018 was GⅡ.2, the genotype of RdRp detected in 2019 was GⅡ.P17, and the genotype of VP1 detected in 2019 was GⅡ.17.

    Conclusion

    NoV GⅡ, which contains many genotypes, is the main pathogen of the NoV infectious diarrhea reported in Hongkou District. NoV cluster epidemics most frequently occur in winter and spring, primary schools and childcare facilities, and are transmitted by contact. The dominant genotype keeps changing over epidemic seasons. Epidemiological and etiological surveillance of clustered NoV infectious diarrhea outbreaks should be strengthened in the future.

     

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