Chen Jiaqi, Huang Linlin, An Hongli, Wang Zining, Kang Xiamei, Yin Rui, Jia Chenghao, Jin Xiuyan, Yue Min
Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, Hangzhou; University of Chinese Academy of Sciences, China.
Department of Veterinary Medicine, Zhejiang University College of Animal Sciences, Hangzhou, China.
J Glob Health. 2024 Dec 2;14:04256. doi: 10.7189/jogh.14.04256.
Zoonotic infections, particularly those caused by non-typhoidal Salmonella (NTS), pose a significant disease burden. However, there is a notable lack of comprehensive and integrated studies employing the One Health approach to address Salmonella prevalence. In this study, we aimed to analyse NTS spatiotemporal prevalence, serovar distribution, and antimicrobial resistance (AMR) across China.
We conducted a systematic review and meta-analysis to understand the dynamics of NTS in a One Health context in China. We searched the CNKI, Wanfang, and PubMed databases for Chinese and English peer-reviewed articles published before 1 January 2022 dealing with Salmonella in the context of China. We examined the dynamic prevalence along the food chain, the risk of dominant serovars and the carriers' regional contribution by principal component analysis, and the AMR burden before and after the ban on using antimicrobials as feed additives across five decades. We used the inverse variance index as an indicator of the inconsistency across studies, and we adopted the restricted maximum likelihood model due to high heterogeneity for analysis with a 95% confidence level for the pooled prevalence estimate.
Based on 562 retrieved high-quality studies during 1967-2021, representing 5 052 496 samples overall and 80 536 positive samples for NTS isolates, the overall average prevalence was 7.35% (95% confidence interval (CI) = 0.069-0.087), which was regionally relatively higher in northern China (8.19%; 95% CI = 0.078-0.117) than in southern China (6.94%; 95% CI = 0.067-0.088). Poultry was the primary vehicle for serovars Enteritidis and Indiana (especially in the north), while swine and ruminants for Typhimurium and Derby were the first to highlight the regional livestock contribution to serovar prevalence. The overall AMR rate was 73.63% (95% CI = 0.68-0.99), decreasing after the ban on excessive use of feed-based antibiotics in livestock since 2020, with a relatively low resistance towards front-line and last-resort drugs.
Our study emphasises the importance of adopting a One Health framework to better understand the zoonotic nature of human NTS and highlights the dominant serovars on food contamination and human infection. The similarity in AMR patterns between poultry and human isolates further emphasises the integrated approach for evaluating disease burden and implementing targeted interventions.
人畜共患感染，尤其是由非伤寒沙门氏菌（NTS）引起的感染，构成了重大的疾病负担。然而，采用“同一健康”方法来研究沙门氏菌流行情况的全面综合研究显著不足。在本研究中，我们旨在分析中国各地NTS的时空流行情况、血清型分布及抗菌药物耐药性（AMR）。
我们进行了一项系统综述和荟萃分析，以了解中国“同一健康”背景下NTS的动态变化。我们在中国知网、万方和PubMed数据库中检索了2022年1月1日前发表的关于中国沙门氏菌的中英文同行评议文章。我们通过主成分分析研究了沿食物链的动态流行情况、优势血清型的风险以及携带者的区域贡献，以及五十年来禁止将抗菌药物用作饲料添加剂前后的AMR负担。我们使用逆方差指数作为研究间不一致性的指标，由于异质性高，我们采用限制最大似然模型进行分析，合并患病率估计的置信水平为95%。
基于1967 - 2021年期间检索到的562项高质量研究，总体代表5052496个样本以及80536个NTS分离株阳性样本，总体平均患病率为7.35%（95%置信区间（CI）= 0.069 - 0.087），在中国北方地区相对较高（8.19%；95% CI = 0.078 - 0.117），高于中国南方（6.94%；95% CI = 0.067 - 0.088）。家禽是肠炎血清型和印第安纳血清型的主要传播载体（尤其是在北方），而猪和反刍动物是鼠伤寒血清型和德比血清型的主要传播载体，这首先凸显了区域家畜对血清型流行率的贡献。总体AMR率为73.63%（95% CI = 0.68 - 0.99），自2020年禁止在牲畜中过量使用饲料型抗生素后有所下降，对一线和最后手段药物的耐药性相对较低。
我们的研究强调了采用“同一健康”框架以更好地理解人类NTS人畜共患性质的重要性，并突出了食物污染和人类感染中的优势血清型。家禽和人类分离株AMR模式的相似性进一步强调了评估疾病负担和实施针对性干预措施的综合方法。
