地方性食源性肉毒中毒在阿拉斯加原住民中的流行——阿拉斯加，1947-2007 年。

Endemic foodborne botulism among Alaska Native persons--Alaska, 1947-2007.

机构信息

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

出版信息

Clin Infect Dis. 2011 Mar 1;52(5):585-92. doi: 10.1093/cid/ciq240.

DOI:10.1093/cid/ciq240

PMID:21292663

Abstract

BACKGROUND

Foodborne botulism resulting from consumption of uncooked aquatic game foods has been an endemic hazard among Alaska Native populations for centuries. Our review was conducted to help target botulism prevention and response activities.

METHODS

Records of Alaska botulism investigations for the period 1947-2007 were reviewed. We used the Centers for Disease Control and Prevention case definitions for foodborne botulism and linear regression to evaluate incidence trends and χ(2) or Fisher's Exact tests to evaluate categorical data.

RESULTS

A total of 317 patients (61% of whom were female) and 159 outbreaks were reported. Overall mean annual incidence was 6.9 cases per 100,000 Alaska Native persons; mean incidence was lower in 2000 (5.7 cases per 100,000 Alaska Native persons) than in any period since 1965-1969 (0.8 cases per 100,000 Alaska Native persons). Age-specific incidence was highest (26.6 cases per 100,000 Alaska Native persons) among persons aged ≥60 years. The overall case-fatality rate was 8.2%, and the case-fatality rate was ≤4.0% since 1980. Misdiagnosis was associated with a higher case-fatality rate and delayed antitoxin administration.

CONCLUSIONS

Foodborne botulism remains a public health problem in Alaska. Incidence might be decreasing, but it remains >800 times the overall US rate (0.0068 cases per 100,000 persons). Prevention messages should highlight the additional risk to female individuals and older persons. Early diagnosis is critical for timely access to antitoxin and supportive care.

摘要

背景

几个世纪以来，食用未煮熟的水生野味导致的食源性肉毒中毒一直是阿拉斯加原住民群体的地方病隐患。我们进行此项综述旨在帮助明确肉毒中毒的预防和应对重点。

方法

对 1947 年至 2007 年期间阿拉斯加肉毒中毒调查记录进行了回顾。我们使用美国疾病控制与预防中心（Centers for Disease Control and Prevention）的食源性肉毒中毒病例定义和线性回归来评估发病率趋势，使用卡方检验（χ(2)）或 Fisher 确切概率法（Fisher's Exact tests）来评估分类数据。

结果

共报告了 317 例患者（61%为女性）和 159 起暴发事件。总体年平均发病率为每 10 万阿拉斯加原住民 6.9 例；2000 年的平均发病率（每 10 万阿拉斯加原住民 5.7 例）低于 1965-1969 年以来的任何时期（每 10 万阿拉斯加原住民 0.8 例）。年龄别发病率在≥60 岁人群中最高（每 10 万阿拉斯加原住民 26.6 例）。总体病死率为 8.2%，自 1980 年以来病死率≤4.0%。误诊与较高的病死率和延迟使用抗毒素相关。