National Institute of Health Sciences, Tokyo, Japan.
J Food Prot. 2011 Oct;74(10):1592-8. doi: 10.4315/0362-028X.JFP-10-387.
Most cases of acute gastroenteritis and foodborne disease are not ascertained by public health surveillance because the ill person does not always seek medical care and submit a stool sample for testing, and the laboratory does not always test for or identify the causative organism. We estimated the total burden of acute gastroenteritis in Miyagi Prefecture, Japan, using data from two 2-week cross-sectional, population-based telephone surveys conducted in 2006 and 2007. To estimate the number of acute gastroenteritis illnesses caused by Campylobacter, Salmonella, and Vibrio parahaemolyticus in Miyagi Prefecture, we determined the number of cases for each pathogen from active laboratory-based surveillance during 2005 to 2006 and adjusted for seeking of medical care and submission of stool specimens by using data from the population-based telephone surveys. Monte Carlo simulation was used to incorporate uncertainty. The prevalence of acute gastroenteritis in the preceding 4 weeks was 3.3% (70 of 2,126) and 3.5% (74 of 2,121) in the winter and summer months, yielding an estimated 44,200 episodes of acute gastroenteritis each year in this region. Among people with acute gastroenteritis, the physician consultation rate was 32.0%, and 10.9% of persons who sought care submitted a stool sample. The estimated numbers of Campylobacter-, Salmonella-, and V. parahaemolyticus -associated episodes of acute gastroenteritis were 1,512, 209, and 100 per 100,000 population per year, respectively, in this region. These estimates are significantly higher than the number of reported cases in surveillance in this region. Cases ascertained from active surveillance were also underrepresented in the present passive surveillance, suggesting that complementary surveillance systems, such as laboratory-based active surveillance in sentinel sites, are needed to monitor food safety in Japan.
大多数急性胃肠炎和食源性疾病病例并未通过公共卫生监测确定，因为患者并非总是就医并提交粪便样本进行检测，且实验室也并非总是检测或鉴定致病病原体。我们利用 2006 年和 2007 年进行的两项为期两周的基于人群的横断面电话调查数据，估算了日本宫城县的急性胃肠炎总负担。为了估算宫城县由弯曲菌、沙门氏菌和副溶血性弧菌引起的急性胃肠炎病例数，我们根据 2005 年至 2006 年基于主动的实验室监测确定了每种病原体的病例数，并利用基于人群的电话调查数据对就医和提交粪便样本情况进行了调整。采用蒙特卡罗模拟法纳入了不确定性。在过去 4 周内，冬季和夏季的急性胃肠炎患病率分别为 3.3%（2126 人中 70 例）和 3.5%（2121 人中 74 例），表明该地区每年约有 44200 例急性胃肠炎发作。在患有急性胃肠炎的人群中，医生就诊率为 32.0%，10.9%的就诊者提交了粪便样本。在该地区，估计每年每 10 万人中有 1512 例、209 例和 100 例与弯曲菌、沙门氏菌和副溶血性弧菌相关的急性胃肠炎病例。这些估计值明显高于该地区监测报告的病例数。在目前的被动监测中，主动监测确定的病例也代表性不足，这表明需要建立补充监测系统，如在哨点进行基于实验室的主动监测，以监测日本的食品安全。
