OBJECTIVETo analysis the etiological and epidemiological characteristics of the reported infectious diarrhea (other than cholera, dysentery, typhoid and paratyphoid) cases in China in 2011.

METHODSA total of 836 591 reported infectious diarrhea cases were collected from "China Information System for Disease Prevention and Control" since first week to fifty-second weeks in 2011, 59 929 out of which were laboratory-confirmed. The information of thirty public health emergencies relevant with infectious diarrhea was collected from "Emergency Public Reporting System" between first week and fifty-second weeks in 2011. The epidemiological characteristics of reported cases, confirmed cases and outbreaks, and the pathogenic spectrum of confirmed cases were then analyzed.

RESULTSIn 2011, 836 591 infectious diarrhea cases (other than cholera, dysentery, typhoid and paratyphoid) were reported, and the incidence rate was 62.39/100 000. More than half patients were children aged under 5 year-old, accounting for 52.13% (436 098/836 591) and the incidence rate was 447.06/100 000 (436 098 cases). Most of the ill children were scattered, accounting for 50.53% (422 752/836 591). Reported cases showed two incidence peaks, with a summer peak from twenty-third weeks to thirty-fifth weeks, accounting for 34.33% (287 231/836 591) and a winter peak from forty-third weeks to fifty-second weeks, accounting for 23.54% (196 939/836 591). Cases distributed all over China, the incidence in Beijing (253.00/100 000 (49 619 cases)), Tianjin (244.34/100 000 (31 614 cases)), Zhejiang (204.42/100 000 (111 257 cases)), Ningxia (132.16/100 000 (9328 cases)) and Guangdong (127.40/100 000 (132 880 cases)) ranked the top five. Among the 30 public health emergencies, 5 outbreaks had lab tested pathogenic results, including 4 were norovirus-induced. Laboratory-confirmed cases accounted for 7.16% (59 929/836 591) of the case reported, including 56 687 viral cases and 3242 bacterial cases. Rotavirus cases took the highest proportion of viral cases, at 97.35% (53 612/55 185); and 97.15% (53 612/55 185) of which were children aged under 5 year-old. 82.42% (45 480/55 185) of the cases distributed in Guangdong and Zhejiang province, with the incidence peak from fiftieth weeks to fifty-first weeks, accounting for 15.42% (8508/55 185) of the whole year cases. The main pathogens of bacterial diarrhea were Salmonella, Vibrio parahaemolyticus and Escherichia coli, accounting for 48.43% (1570/3242), 32.20% (1044/3242) and 8.57% (278/3242) respectively, with the incidence peak from thirty-first weeks to thirty-fifth weeks, accounting for 23.01% (746/3242). Salmonella infection patients were mainly from Shanghai, Guangdong and Zhejiang province (91.59% (1438/1570)), Vibrio parahaemolyticus patients were mainly from Shanghai (80.94% (845/1044)), and Escherichia coli patients were mainly from Guangdong province (84.17% (234/278)). Salmonella patients were concentrated in 0-9 years group, accounting for 42.36% (665/1570), while Vibrio parahaemolyticus patients in 20-39 years group, accounting for 81.99% (856/1044), and Escherichia coli patients in under 1 year old and 20-39 years group, accounting for 63.67% (177/278).

CONCLUSIONIn China, children aged under 5 year-old should be the priority population in surveillance of infectious diarrhea. Rotavirus is the main pathogen causing infectious diarrhea. The lab-testing and case-reporting capabilities differed greatly among areas.

Child, Preschool ; China ; epidemiology ; Cholera ; epidemiology ; Diarrhea ; epidemiology ; microbiology ; virology ; Dysentery ; epidemiology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Rotavirus Infections ; epidemiology ; Typhoid Fever ; epidemiology

When cholera was first detected in Papua New Guinea (PNG) in mid-2009, national diagnostic capacity faced many challenges. This was in part due to the non-endemic status of the outbreak, resulting in few local staff experienced in Vibrio cholerae detection and poor access to the required consumables. The PNG Institute of Medical Research conducted culture on specimens from suspected cholera patients in Madang Province, with presumptive V. cholerae isolates sent to Goroka for confirmation. Of 98 samples analysed 15 were culture positive, with V. cholerae detected by polymerase chain reaction (PCR) in an additional 3 samples. Further analyses were conducted to identify other pathogenic bacteria from thiosulphate citrate bile salt sucrose (TCBS) agar. Molecular-based assays detected enteropathogenic (n = 1) and enterotoxigenic (n = 1) strains of Escherichia coli. No other major enteric pathogens were detected. The low detection rate of V. cholerae at the provincial level reflects challenges in the laboratory diagnosis of cholera and in-country challenges in responding to an outbreak of a non-endemic disease, such as lack of in-country diagnostic expertise and available consumables in the early stages. It also suggests that full aetiological investigations are warranted in future outbreaks of acute watery diarrhoea in PNG to fully elucidate the potentially complex aetiology, which could in turn guide diagnostic, treatment and prevention measures.
Cholera/*epidemiology/*microbiology ; *Disease Outbreaks ; Enterobacteriaceae/isolation & purification ; Feces/microbiology ; Humans ; Immunoassay ; Papua New Guinea/epidemiology ; Polymerase Chain Reaction ; Vibrio cholerae/*isolation & purification

OBJECTIVETo understand the genetic structures and variations of the superintegron (SI) in Vibrio cholerae isolated in the seventh cholera pandemic.

METHODSPolymerase chain reaction scanning and fragment sequencing were used. Sixty toxigenic V. cholerae O1 El Tor strains isolated between 1961 and 2008 were analyzed.

RESULTSSome variations were found, including insertions, replacements, and deletions. Most of the deletions were probably the result of recombination between V. cholerae repeat sequences. The majority of the variations clustered together. The SIs of the strains isolated in the 1960s and 1970s showed more diversity, whereas SI cassette variations in strains isolated in the 1990s and after were lower, with ∼24 kb signature sequence deletion. This indicates the predominant SI in the host during the epidemic in the 1990s and after. The insertion cassettes suggested the mobilization from the SIs of other V. cholerae serogroups and Vibrio mimicus.

CONCLUSIONThe study revealed that structural variations of SIs were obvious in the strains isolated in epidemics in different decades, whereas the divergence was based on syntenic structure of SIs in these El Tor strains. Also, the continuing cassette flows in the SIs of the host strains during the seventh cholera pandemics were displayed.

Cholera ; epidemiology ; microbiology ; Chromosomes, Bacterial ; genetics ; ultrastructure ; Cluster Analysis ; DNA, Bacterial ; genetics ; Electrophoresis, Gel, Pulsed-Field ; Gene Deletion ; Gene Flow ; Genetic Variation ; Humans ; Integrons ; genetics ; Mutagenesis, Insertional ; Open Reading Frames ; genetics ; Polymerase Chain Reaction ; Tandem Repeat Sequences ; Vibrio cholerae O1 ; classification ; genetics ; isolation & purification ; ultrastructure

OBJECTIVETo understand the epidemic condition, distribution and biological characteristics of non-O1/non-O139 Vibrio cholerae from 2001 to 2009 in Haizhu District, to provide a scientific basis for the prevention and control of acute diarrhea.

METHODSReferring to the detecting method written in "Cholera control handbook" in the fifth edition, 764 specimens from outside environment (including the water in the Pearl River, drinking water, water for breeding fish, aquatic products and delicatessen foods), 189 specimens of healthy population and 3398 intestinal samples of patients with diarrhea, summing up to 4351 specimens for non-O1/non-O139 Vibrio cholerae test.

RESULTS4,351 specimens were detected of 101 strains of non O1/non O139 Vibrio cholerae, the total detection rate was 2.32%; 66 strains were identified by serotyping and grouped into 26 different serotypes, the typing rate was 65.3%. The strains VBO9, VBO38 and VBO76 were the dominant bacteria.Nine strains of the same type of non-O1/non-O139 Vibrio cholerae were found from external environments also from patients with diarrhea, suggesting that there might be a correlation between the two.

CONCLUSIONNon-O1/non-O139 Vibrio cholerae have diversified serotypes, causing certain infection rate among the population in this region. These bacteria exist extensively in external environment and they are the potential hazard to the citizens.

China ; epidemiology ; Cholera ; epidemiology ; microbiology ; Humans ; Serotyping ; Vibrio cholerae ; classification ; isolation & purification

OBJECTIVETo analyze the molecular characteristics and genetic correlations of Vibrio cholerae isolates in Hainan in 2008, so as to provide pathogenic proof to diagnose the plague.

METHODSSeventy six cholera strains were isolated from this cholera epidemic.69 strains were obtained from patients, 7 were isolated from external environment, among which, one was from patient's toilet, one from water sample, three were isolated from fish pond near patient's home, one came from swab of the patient vomit on the ground of health center and one from swab of kitchen knife from Hainan University canteen respectively. With conventional aetiological methods, pulse-field gel electrophoresis was conducted and the patterns of the 76 isolates were analyzed. The PFGE image was analyzed using BioNumerics (Version4.0, Applied Maths BVBA, Belium). Image bands were identified and similarity coefficient was automatically generated.

RESULTSSeventy six strains were isolated from Vibrio cholerae outbreaks in Hainan in 2008.5 PFGE patterns of patient's isolates in June were the same, sharing a similarity coefficient of 100%. 70 PFGE patterns of patients and water in October and November were completely same, the similarity coefficient being 100%. But they were not same as that of June. 1 PFGE pattern of isolate from the sample in Hainan University was different, only sharing a similarity coefficient of 79.7%, which showed no correlation with the outbreak.

CONCLUSIONDifferent outbreaks of Vibrio cholera occurred in Hainan in 2008. The epidemic in October and November at different counties was one outbreak. The pollution of water in environment was an important factor for outbreak.

Bacterial Typing Techniques ; methods ; China ; epidemiology ; Cholera ; epidemiology ; microbiology ; DNA, Bacterial ; Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; methods ; Humans ; Vibrio cholerae ; classification ; isolation & purification

INTRODUCTIONWe carried out an epidemiological review of cholera in Singapore to determine its trends and the factors contributing to its occurrence.

MATERIALS AND METHODSEpidemiological data of all notified cases of cholera maintained by the Communicable Diseases Division, Ministry of Health, for the period 1992 to 2007 were collated and analysed. Case-control studies were carried out in outbreaks to determine the source of infection and mode of transmission. Linear patterns in age and ethnic distribution of cholera cases were assessed using chi2 test for trend.

RESULTSThere were a total of 210 cholera cases reported between 1992 and 2007. The incidence of cholera declined from 17 cases in 1992 to 7 cases in 2007. About a quarter of the cases were imported from endemic countries in the region. Between 76% and 95% of the reported cases were local residents. Four elderly patients with comorbidities and who sought medical treatment late died, giving a case-fatality rate of 1.9%. Vibrio cholerae 01, biotype El Tor, serotype Ogawa, accounted for 83.8% of the cases. The vehicles of transmission identified in outbreaks included raw fi sh, undercooked seafood and iced drinks cross-contaminated with raw seafood.

CONCLUSIONWith the high standard of environmental hygiene and sanitation, a comprehensive epidemiological surveillance system and licensing and control of food establishments, cholera could not gain a foothold in Singapore despite it being situated in an endemic region. However, health education of the public on the importance of personal and food hygiene is of paramount importance in preventing foodborne outbreaks. Physicians should also maintain a high level of suspicion of cholera in patients presenting with severe gastroenteritis, especially those with a recent travel history to endemic countries.

Adolescent ; Child ; Child, Preschool ; Cholera ; microbiology ; mortality ; Disease Outbreaks ; statistics & numerical data ; Female ; Foodborne Diseases ; epidemiology ; prevention & control ; Humans ; Incidence ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Population Surveillance ; Singapore ; epidemiology ; Vibrio cholerae O1 ; isolation & purification ; Young Adult

OBJECTIVETo investigate the molecular characteristics of phage-type 6b isolates emerging in 1998-2001 cholera epidemics in Sichuan province.

METHODSIsolates were analyzed by phage-typing, pulsed field gel electrophoresis (PFGE) and ompW gene sequencing.

RESULTSAll phage-type 1b and 6b isolates in Sichuan province from 1998 to 2001 were toxigenic. A total of 24 patterns were identified after PFGE analysis, and one predominant pattern consisted of 13 isolates. Several 1b and 6b isolates from Sichuan and isolates of the 1b from other provinces showed the same PFGE pattern. Mutation in ompW gene was found in 6b isolates.

CONCLUSIONV.cholerae O1 6b isolates in Sichuan province from 1998 to 2001 have special genetic markers, and might genetically correlate with contemporaneous 1b isolates.

Bacterial Typing Techniques ; Bacteriophage Typing ; China ; epidemiology ; Cholera ; epidemiology ; microbiology ; DNA, Bacterial ; genetics ; Electrophoresis, Gel, Pulsed-Field ; Genes, Bacterial ; Genotype ; Vibrio cholerae ; classification ; genetics ; isolation & purification

OBJECTIVETo study the correlation between Vibrio cholerae strains isolated from natural enviroment and fishery products and the source of infection during V. cholerae outbreaks.

METHODSCholera toxin gene was detected by polymerase chain reaction (PCR) amplification. Pulsed-field gel electrophoresis (PFGE) was used to subtype the isolates. Results of PFGE were analyzed and clustered by BioNumerics software (Version 4.0).

RESULTSDuring the outbreaks, a total number of thirty O139 V. cholerae related serogroups were collected from patients, carriers, sewage and fishery products were identified and proved to be toxigenic. They could be clustered into four PFGE patterns when digested by Not I. These two V. cholerae outbreaks were caused by the same source of infection because of the following reasons: (1) PFGE patterns of the predominant strains isolated from two outbreaks were identical; (2) they were identical to the PFGE patterns of the strains isolated from the green turtle and rana catesbiana which were bought from the same wholesale store.

CONCLUSIONGreen turtle and rana catesbiana that were contaminated by toxigenic O139 V. cholerae strains seemed to be the source of infection causing the O139 V. cholerae outbreaks in Jiangxi province. Rapid laboratory surveillance and epidemiologic investigation were important in identifying the source of infection during the outbreaks of V. cholera.

Animals ; China ; epidemiology ; Cholera ; epidemiology ; Cluster Analysis ; Disease Outbreaks ; Disease Reservoirs ; microbiology ; Electrophoresis, Gel, Pulsed-Field ; methods ; Fisheries ; Humans ; Ranidae ; microbiology ; Sewage ; microbiology ; Turtles ; microbiology ; Vibrio cholerae O139 ; isolation & purification

OBJECTIVETo apply pulse-field gel electrophoresis analysis(PFGE) in the analysis of cholera outbreak events and to determine the molecular epidemiological characteristics of Vibrio cholerae ( V. cholerae) isolates.

METHODSPFGE using restriction enzyme Not I was employed in the molecular subtyping of forty-one strains of V. cholerae isolated in cholera outbreak events from 2003 to 2005 in Guangzhou area and PFGE patterns were analyzed by BioNumerics Version 4.0 software to perform cluster analysis. Pattern profiles were compared by utilizing of Dice coefficient and UPGMA(unweighted pair group method with arithmetic averages). Comparison of PFGE typing results was performed with phage-biological typing and pathogenicity-associated genes typing.

RESULTSIn cholera outbreak events, PFGE could discriminate epidemiologically related and unrelated strains, having more discriminatory power than phage-biological typing and pathogenicity-associated genes-typing.

CONCLUSIONSMolecular sub-typing by PFGE could disclose the epidemiological relationships of strains from humans and the environment, providing molecular epidemiological evidence and support for the source-tracking of cholera outbreak events.

Bacterial Typing Techniques ; methods ; Cholera ; epidemiology ; microbiology ; Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Molecular Epidemiology ; Vibrio cholerae ; classification ; genetics ; isolation & purification

OBJECTIVETo determine the genetic relationships between different Vibrio cholerae isolates in Shenzhen from 1993 to 2002.

METHODSChromosomal DNA from 60 isolates was digested in seakem gold agrose with restriction enzyme Not I and plugs were then analyzed by pulsed-field gel electrophoresis. Pulsed-field gel electrophoresis (PFGE) patterns of V. cholerae isolates were clustered using BioNumerics software.

RESULTS39 distinctive PFGE patterns were identified with each pattern having 20 to 30 bands. Most PFGE patterns were divided into cluster A or cluster B.

CONCLUSIONThe closely related pandemic clone clusters of V. cholerae strains did exist in Shenzhen. PFGE of V. cholerae could be used for active surveillance and tracking for cholerae.

China ; epidemiology ; Cholera ; epidemiology ; microbiology ; Electrophoresis, Gel, Pulsed-Field ; methods ; Humans ; Phylogeny ; Vibrio cholerae ; classification ; genetics