Analysis of foodborne disease outbreaks and influencing factors in schools in Liaoning Province, 2011-2021
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摘要:
目的 了解辽宁省学校食源性疾病暴发的流行特征,为今后有效防控学校食源性疾病暴发提供科学依据。 方法 对辽宁省2011—2021年上报国家食源性疾病暴发监测系统报告的学校食源性疾病暴发事件进行流行病学研究,采用二元Logistic回归分析学校食源性疾病暴发事件的影响因素。 结果 2011—2021年辽宁省共报告学校食源性暴发事件29起,累计病例1 003例,住院218例,无死亡病例。2020年暴发事件数和病例数均最多(7起,320例)。全年发病呈双峰分布,发病高峰为3和12月,其中3月学校暴发事件数最多(8起,27.59%)。中小学上报事件数、病例数、住院数均最多(12起,555人,97人)。专科院校暴发报告时间间隔均值最长(32.01 h),大学暴发持续时间均值最长(52.33 h)。病例呕吐症状人数最多(536人,53.44%)。金黄色葡萄球菌毒素、蜡样芽孢杆菌毒素和诺如病毒引发事件较多(各3起)。除引发原因不明的事件外,加工不当与交叉污染为主要引发原因(各6起)。头痛指标与学校暴发规模呈正相关(OR=9.78),临床症状发热和暴露持续事件指标与学校暴发事件报告时间间隔呈正相关(OR值分别为7.08,22.40)(P值均 < 0.05)。 结论 应加强冬春季学校餐饮机构的管理与监督,点面防控,优化上报流程,有效降低学校食源性疾病暴发规模。 Abstract:Objective To understand the epidemiological characteristics of school foodborne disease outbreaks in Liaoning Province, and to provide scientific basis for effective prevention and control of school foodborne disease outbreaks in the future. Methods An epidemiological study was conducted on the school foodborne disease outbreaks reported by the National Foodborne Disease Outbreak Surveillance System in Liaoning Province from 2011 to 2021. The influencing factors of school foodborne disease outbreaks were analyzed by binary Logistic regression. Results From 2011 to 2021, a total of 29 school foodborne outbreaks were reported in Liaoning Province, with accumulative cases of 1 003, 218 hospitalized cases and no death cases. The number of outbreaks and cases were the highest in 2020(7 cases, 320).The incidence of the disease showed a bimodal distribution throughout the year, with the peak in March and December, and the number of outbreaks in schools in March was the largest(8 cases, 27.59%). Primary and secondary schools reported the largest number of incidents, cases and hospitalizations(12 cases, 555, 97). The mean interval of outbreak reporting was longest in junior college (32.01 h), while the mean duration of outbreak was longest in university (52.33 h). Most of cases (536, 53.44%) had vomiting symptoms. Staphylococcus aureus toxin, Bacillus cereus toxin and Norovirus caused more incidents(3 cases for each one). In addition to the unknown causes, improper processing and cross contamination were the main causes(6 cases for each one). Headache index was positively correlated with outbreak size in schools (OR=9.78). Clinical symptoms fever and exposure duration event indexes were positively correlated with the reporting time interval of school outbreak events (OR=7.08, 22.40)(P < 0.05). Conclusion It is necessary to strengthen the management and supervision of school catering institutions in winter and spring, optimize the reporting process, and effectively reduce the scale of outbreaks of foodborne diseases in schools. -
Key words:
- Food contamination /
- Disease outbreaks /
- Regression analysis /
- Epidemiologic studies
1) 利益冲突声明 所有作者声明无利益冲突。 -
表 1 辽宁省不同年份、地区和学校类型2011—2021年学校食源性疾病暴发事件发生情况分布及罹患率
Table 1. Distribution and incidence rate of school foodborne disease outbreaks in different years, regions and school types in Liaoning Province, 2011-2021
因素 选项 事件起数 暴露人数 病例数 住院例数 罹患率/% 年份 2011 2(6.90) 565(1.37) 43(4.29) 22(10.09) 7.62 2012 0 0 0 0 0 2013 0 0 0 0 0 2014 1(3.45) 2 318(5.63) 56(5.58) 23(10.55) 2.42 2015 4(13.79) 6 086(14.79) 282(28.12) 100(45.87) 4.63 2016 3(10.34) 10 687(25.97) 119(11.86) 8(3.67) 1.11 2017 2(6.90) 240(0.58) 31(3.09) 5(2.29) 12.92 2018 6(20.69) 1 963(4.77) 92(9.17) 28(12.84) 4.69 2019 2(6.90) 36(0.09) 30(2.99) 20(9.17) 83.33 2020 7(24.14) 18 900(45.94) 320(31.90) 12(5.50) 1.69 2021 2(6.90) 350(0.85) 30(2.99) 0 8.57 地区 沈阳 6(20.69) 16 234(39.46) 366(36.49) 77(35.32) 2.25 辽阳 5(17.24) 396(0.96) 64(6.38) 26(11.93) 16.16 朝阳 5(17.24) 1 706(4.15) 46(4.59) 24(11.01) 2.70 丹东 4(13.79) 3 616(8.79) 171(17.05) 66(30.28) 4.73 葫芦岛 3(10.34) 14 056(34.16) 50(4.99) 1(0.46) 0.36 大连 2(6.90) 565(1.37) 43(4.29) 22(10.09) 7.61 本溪 1(3.45) 4 405(10.71) 227(22.63) 0 5.15 抚顺 1(3.45) 96(0.23) 17(1.69) 2(0.92) 17.71 锦州 1(3.45) 55(0.13) 9(0.90) 0 16.36 铁岭 1(3.45) 16(0.04) 10(1.00) 0 62.50 学校类型 托幼机构 9(31.03) 1 130(2.75) 141(14.06) 29(13.30) 12.48 中小学 12(41.38) 11 230(27.29) 555(55.33) 97(44.50) 4.94 专科院校 4(13.79) 3 743(9.10) 151(15.05) 64(29.36) 4.03 大学 4(13.79) 25 042(60.86) 156(15.55) 28(12.84) 0.62 注: ()内数字为构成比或罹患率/%。 表 2 辽宁省2011—2021年不同类型学校食源性疾病暴发应对情况[M(P25, P75),h]
Table 2. Response to foodborne disease outbreaks in different types of schools in Liaoning Province during 2011-2021[M(P25, P75), h]
学校类型 报告时间间隔 暴发持续时间 托幼机构 8.03(4.08, 18.83) 15.50(4.98, 26.00) 中小学 17.69(5.97, 29.79) 22.75(2.42, 24.00) 专科院校 21.71(14.62, 59.70) 18.25(3.37, 25.63) 大学 19.50(7.50, 19.50) 48.00(15.50, 48.00) 表 3 辽宁省2011—2021年学校食源性疾病致病原因特征分布
Table 3. Characteristics and distribution of causes of school foodborne diseases in Liaoning Province during 2011-2021
因素 选项 上报事件数
(n=29)发病人数
(n=1 003)住院人数
(n=218)致病因素 金黄色葡萄球菌毒素 3(10.34) 117(11.67) 5(2.29) 沙门菌 1(3.45) 91(9.07) 0 致泻大肠埃希菌 1(3.45) 28(2.79) 20(9.17) 蜡样芽孢杆菌毒素 3(10.34) 118(11.76) 16(7.34) 产气荚膜梭菌 1(3.45) 227(22.63) 0 诺如病毒 3(10.34) 50(4.99) 14(6.42) 不明因素 17(58.62) 372(37.09) 163(74.77) 原因食品 粮食制品 2(6.90) 114(11.37) 16(7.34) 肉与肉制品 2(6.90) 8(0.80) 4(1.83) 蔬菜与蔬菜制品 1(3.45) 25(2.49) 0 水产品 1(3.45) 4(0.40) 2(0.92) 豆制品 3(10.34) 118(11.76) 61(27.98) 蛋与蛋制品 1(3.45) 91(9.07) 0 糕点面制品 2(6.90) 19(1.89) 0 混合食品 9(31.03) 445(44.37) 126(57.80) 不明食品 8(27.59) 179(17.85) 9(4.13) 引发原因 加工不当 6(20.69) 158(15.75) 67(30.73) 原料(辅料)污染或变质 3(10.34) 241(24.03) 0 存储不当 2(6.90) 95(9.47) 2(0.92) 交叉污染 6(20.69) 234(23.33) 49(22.48) 原因不明 12(41.38) 275(27.42) 100(45.87) 注: ()内数字为构成比/%。 -
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