Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Surgery, Infectious Disease Hospital Affiliated to Nanchang University (Nanchang Ninth Hospital), Nanchang, China.
Front Public Health. 2022 Apr 15;10:889793. doi: 10.3389/fpubh.2022.889793. eCollection 2022.
Infectious etiology of acute appendicitis is a current hot topic. The most of study on appendicitis came from sporadic patients and focused on clinical treatment rather than control and prevention of appendicitis in the population. The present study aims to investigate the epidemiological features of cluster of acute appendicitis, risk factors, and evaluate effectiveness of control and prevention in population.
We conducted longitudinal study on a cluster of acute appendicitis among Tibetan students at a high school in eastern China, which was divided into three stages: 1. We retrospectively collected epidemiological data and clinical data to explore risk factor and possible transmission route in August of 2005; 2. We conducted targeted measures from August of 2005 and analyzed incidence trend from 2000 to 2010; 3. Since no new patients occurred in 2011, we conducted surveillance from the beginning of 2012 until July 2018.
Among 973 Tibetan students, there were 120 patients with more female patients (102 of 499, 20.4%) than male patients (18 of 474, 3.8%) from January of 2000 to December of 2010. The 4-year cumulative incidence rates in female students enrolled in 2001, 2002, 2003, 2004, 2005, 2006 were 26.8% (11 of 41), 27.1% (13 of 48), 44.7% (21 of 47), 42.4% (14 of 33), 23.1% (9 of 39), and 19.3% (11 of 57), respectively before their graduation. There was a clustering feature. Mutual contact with patients before the onset of symptoms was an important risk factor (Adjusted OR 4.89, 95% CI: 1.67-14.35). Transmission route may be fecal-oral infection. Before conducting targeted measures, the incidence rate increased from 2000 and peaked in 2005. After conducting targeted measures, the incidence rate decreased year by year until 2010. Under surveillance from January of 2012 to July of 2018, only four sporadic patients occurred at this school.
This cluster of acute appendicitis had features of an infectious disease in epidemiology, which can be controlled and prevented by targeted measures. Our study may also be used for prevention of sporadic patients and be generalized in general population as cluster of appendicitis occurred in many provinces of China.
急性阑尾炎的感染病因是当前的热门话题。大多数关于阑尾炎的研究来自散发性患者，侧重于临床治疗，而不是人群中阑尾炎的控制和预防。本研究旨在调查急性阑尾炎聚集的流行病学特征、危险因素，并评估人群中控制和预防的效果。
我们对中国东部一所高中的藏族学生急性阑尾炎聚集进行了纵向研究，分为三个阶段：1. 我们在 2005 年 8 月回顾性收集流行病学数据和临床数据，以探讨危险因素和可能的传播途径；2. 我们从 2005 年 8 月开始采取有针对性的措施，并分析 2000 年至 2010 年的发病趋势；3. 由于 2011 年没有新发病例，我们从 2012 年初开始进行监测，直到 2018 年 7 月。
在 973 名藏族学生中，2000 年 1 月至 2010 年 12 月，女性患者（102/499，20.4%）多于男性患者（18/474，3.8%）。2001 年、2002 年、2003 年、2004 年、2005 年和 2006 年入学的女学生的 4 年累积发病率分别为 26.8%（11/41）、27.1%（13/48）、44.7%（21/47）、42.4%（14/33）、23.1%（9/39）和 19.3%（11/57）。发病前与患者有相互接触是一个重要的危险因素（调整后的 OR=4.89，95%CI：1.67-14.35）。传播途径可能是粪-口感染。在采取有针对性的措施之前，发病率从 2000 年开始上升，并在 2005 年达到高峰。在采取有针对性的措施后，发病率逐年下降，直到 2010 年。自 2012 年 1 月至 2018 年 7 月监测期间，该校仅发生了四起散发性病例。
该急性阑尾炎聚集具有传染病的流行病学特征，可以通过有针对性的措施进行控制和预防。我们的研究也可以用于预防散发性病例，并在一般人群中推广，因为中国许多省份都发生了阑尾聚集性病例。
