Public Health Agency of Catalonia, Generalitat of Catalonia, Roc Boronat 81-95, Barcelona 08005, Spain;, Email:
J Food Prot. 2013 Oct;76(10):1810-6. doi: 10.4315/0362-028X.JFP-12-544.
Infectious acute gastroenteritis (AGE) is a major health problem worldwide. Salmonella is a leading cause of AGE outbreaks, but viruses may be responsible for up to 80% of cases. We compared the frequency and characteristics of AGE out breaks in Catalonia due to norovirus and Salmonella and the changes in these outbreaks from 2000 through 2010. In 2006 through 2010, we also investigated the distribution by season, setting, and implicated food, the incidence rates of cases associated, and the hospitalization rates. Differences in proportions were estimated by Pearson's chi-square test, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. In 2000 through 2010, the number of AGE outbreaks caused by Salmonella decreased and those caused by norovirus significantly increased. From 2006 onward, norovirus was the most common etiology in AGE outbreaks, but in foodborne outbreaks, Salmonella was the more common cause until 2010. The incidence rate per 10(5) inhabitants was greater for norovirus (20.81 versus 3.97, P < 0.001), and the hospitalization rate was lower for norovirus (0.84 versus 4.69, P < 0.001). Salmonella infections occurred more frequently in the warmer months, and norovirus infections were more common in the colder months, both in terms of total outbreaks (OR = 4.50; 95% CI, 2.85 to 7.11; P < 0.001) and foodborne outbreaks (OR = 4.38; 95% CI, 2.42 to 7.95; P < 0.001). Norovirus infections were less common in private homes (OR = 0.08; 95% CI, 0.04 to 0.14; P < 0.001) and more common in nursing homes (P < 0.001) and hospitals or long-term care facilities (OR = 14.09; 95% CI, 3.35 to 59.33; P < 0.001). Foods most frequently implicated in norovirus infection outbreaks were seafood (22% ; OR = 7.89; 95% CI, 2.59 to 24.3; P < 0.001), and those most common in Salmonella infection outbreaks were mayonnaise and similar items (30.2%; OR = 0.05; 95% CI, 0.01 to 0.22; P < 0.001). Foodborne outbreaks in which the vehicle was not identified were more frequent in cases of norovirus infection (OR = 4.59; 95% CI, 2.54 to 8.30; P < 0.001). Our results indicate that norovirus rather than Salmonella is the most common cause of AGE outbreaks in Catalonia. Foodborne AGE outbreaks were more commonly caused by norovirus than by Salmonella only in 2010, the last year of the study.
感染性急性胃肠炎 (AGE) 是全球范围内的一个主要健康问题。沙门氏菌是 AGE 暴发的主要原因，但病毒可能导致多达 80%的病例。我们比较了 2000 年至 2010 年期间由于诺如病毒和沙门氏菌引起的加泰罗尼亚 AGE 暴发的频率和特征，以及这些暴发的变化。2006 年至 2010 年，我们还调查了季节、环境和涉及的食物、相关病例的发病率和住院率的分布情况。通过皮尔逊卡方检验估计比例差异，计算优势比 (OR) 和 95%置信区间 (CI)。2000 年至 2010 年，由于沙门氏菌引起的 AGE 暴发数量减少，而由于诺如病毒引起的 AGE 暴发显著增加。从 2006 年开始，诺如病毒是 AGE 暴发的最常见病因，但在食源性暴发中，沙门氏菌是更常见的原因，直到 2010 年。每 10(5)居民的发病率更高诺如病毒 (20.81 比 3.97，P < 0.001)，诺如病毒的住院率较低 (0.84 比 4.69，P < 0.001)。沙门氏菌感染更常发生在温暖的月份，而诺如病毒感染更常见于寒冷的月份，无论是总暴发 (OR = 4.50; 95%CI，2.85 至 7.11; P < 0.001)还是食源性暴发 (OR = 4.38; 95%CI，2.42 至 7.95; P < 0.001)。诺如病毒感染在私人住宅中较少见 (OR = 0.08; 95%CI，0.04 至 0.14; P < 0.001)，而在养老院 (P < 0.001)和医院或长期护理机构中更常见 (OR = 14.09; 95%CI，3.35 至 59.33; P < 0.001)。与诺如病毒感染暴发最相关的食物是海鲜 (22% ; OR = 7.89; 95%CI，2.59 至 24.3; P < 0.001)，而与沙门氏菌感染暴发最相关的是蛋黄酱和类似物品 (30.2%; OR = 0.05; 95%CI，0.01 至 0.22; P < 0.001)。在诺如病毒感染病例中，未确定食源的食源性暴发更为频繁 (OR = 4.59; 95%CI，2.54 至 8.30; P < 0.001)。我们的结果表明，诺如病毒而不是沙门氏菌是加泰罗尼亚 AGE 暴发的最常见原因。只有在 2010 年，即研究的最后一年，食源性 AGE 暴发才更常由诺如病毒引起，而不是由沙门氏菌引起。
