中国大规模、全国性、以家庭为基础的感染流行病学研究：改变相关疾病预防实践的时机。

Large-scale, national, family-based epidemiological study on infection in China: the time to change practice for related disease prevention.

机构信息

Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

出版信息

Gut. 2023 May;72(5):855-869. doi: 10.1136/gutjnl-2022-328965. Epub 2023 Jan 23.

DOI:10.1136/gutjnl-2022-328965

PMID:36690433

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10086479/

Abstract

BACKGROUND AND AIMS

Current practice on infection mostly focuses on individual-based care in the community, but family-based management has recently been suggested as a better strategy for infection control. However, the family-based infection status, risk factors and transmission pattern remain to be elucidated.

METHODS

From September 2021 to December 2021, 10 735 families (31 098 individuals) were enrolled from 29 of 31 provinces in mainland China to examine family-based infection, related factors and transmission pattern. All family members were required to answer questionnaires and test for infection.

RESULTS

Among all participants, the average individual-based infection rate was 40.66%, with 43.45% for adults and 20.55% for children and adolescents. Family-based infection rates ranged from 50.27% to 85.06% among the 29 provinces, with an average rate of 71.21%. In 28.87% (3099/10 735) of enrolled families, there were no infections; the remaining 71.13% (7636/10 735) of families had 1-7 infected members, and in 19.70% (1504/7636), all members were infected. Among 7961 enrolled couples, 33.21% had no infection, but in 22.99%, both were infected. Childhood infection was significantly associated with parental infection. Independent risk factors for household infection were infected family members (eg, five infected members: OR 2.72, 95% CI 1.86 to 4.00), living in highly infected areas (eg, northwest China: OR 1.83, 95% CI 1.57 to 2.13), and large families in a household (eg, family of three: OR 1.97, 95% CI 1.76 to 2.21). However, family members with higher education and income levels (OR 0.85, 95% CI 0.79 to 0.91), using serving spoons or chopsticks, more generations in a household (eg, three generations: OR 0.79, 95% CI 0.68 to 0.92), and who were younger (OR 0.57, 95% CI 0.46 to 0.70) had lower infection rates (p<0.05).

CONCLUSION

Familial infection rate is high in general household in China. Exposure to infected family members is likely the major source of its spread. These results provide supporting evidence for the strategic changes from individual-based treatment to family-based management, and the notion has important clinical and public health implications for infection control and related disease prevention.

摘要

背景与目的

目前，传染病的防控主要集中在社区层面的个体层面，但最近有人提出家庭层面的管理是控制传染病的更好策略。然而，家庭层面的感染状况、危险因素和传播模式仍有待阐明。

方法

2021 年 9 月至 2021 年 12 月，中国大陆 31 个省中的 29 个省共纳入了 10735 个家庭（31098 人），以调查家庭层面的感染情况、相关因素和传播模式。所有家庭成员都需要回答问卷并进行感染检测。

结果

在所有参与者中，个体层面的平均感染率为 40.66%，成人感染率为 43.45%，儿童和青少年感染率为 20.55%。29 个省份的家庭感染率在 50.27%至 85.06%之间，平均为 71.21%。在 28.87%（3099/10735）的家庭中，没有感染病例；其余 71.13%（7636/10735）的家庭有 1-7 名感染成员，而在 19.70%（1504/7636）的家庭中，所有成员都感染了。在 7961 对夫妻中，33.21%没有感染，但在 22.99%的夫妻中，双方都感染了。儿童感染与父母感染显著相关。家庭感染的独立危险因素包括感染家庭成员（例如，5 名感染成员：OR 2.72，95%CI 1.86 至 4.00）、生活在感染严重地区（例如，中国西北部：OR 1.83，95%CI 1.57 至 2.13）和家庭人口较多（例如，三口之家：OR 1.97，95%CI 1.76 至 2.21）。然而，教育程度和收入水平较高的家庭成员（OR 0.85，95%CI 0.79 至 0.91）、使用公用勺筷、家庭中有更多代人（例如，三代人：OR 0.79，95%CI 0.68 至 0.92）和年龄较小的家庭成员（OR 0.57，95%CI 0.46 至 0.70）感染率较低（p<0.05）。