Expert Consensus and Call on Actions for Weight Management in China: Advancing Healthy China Initiative Through Strategic Actions

Xiaomin Sun^1,2,&; Zhaozhang Sun^1,2,3,&; Wen Peng^4,5; Jianduan Zhang⁶; Bo Gou⁷; Xiangyang Tian⁸; Yuexin Yang⁹; Youfa Wang^1,2,#; Expert Author Group

1. Global Health Institute, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an City, Shaanxi Province, China;

2. International Obesity and Metabolic Disease Research Center, Xi'an Jiaotong University, Xi’an City, Shaanxi Province, China;

3. Department of Culture, Media and Creative Industries, King's College London, London, UK;

4. Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, Xining City, Qinghai Province, China;

5. Qinghai Provincial Key Laboratory of Prevention and Control of Glucolipid Metabolic Diseases with Traditional Chinese Medicine, Xining City, Qinghai Province, China;

6. School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China;

7. School of Exercise and Health Sciences, Xi'an Physical Education University, Xi’an City, Shaanxi Province, China;

8. Chinese Center for Health Education, Beijing, China;

9. National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.

^& Joint first authors.

^# Corresponding author: Youfa Wang, youfawang@xjtu.edu.cn.

Author group: Expert Author Group including Chun Chang; Wei Cui; Zijian Feng; Linong Ji; Hongjuan Li; Ailing Liu; Yingying Luo; Yanan Ma; Bingyin Shi; Yi Song; Deliang Wen; Qingli Xu; Juhong Yang; Yinkun Yan; Qian Zhang; Yaling Zhao; Zhirong Zeng.

China faces a critical public health challenge with obesity rates exceeding 50% among adults and 20% among children. In response, the National Health Commission launched a comprehensive three-year "Year of Weight Management" initiative in March 2024, further emphasized by the 36th Patriotic Health Month's theme "Healthy Towns - Healthy Weight" in April 2024. These initiatives underscore the urgent necessity for implementing comprehensive strategies to combat obesity and its associated non-communicable diseases. To catalyze these national efforts, the Obesity Prevention and Control Section of the Chinese Nutrition Society, in collaboration with the Chinese Society of Behavioral Health of the Chinese Preventive Medicine Association, the International Center for Obesity and Metabolic Diseases Research, the Global Health Institute at Xi'an Jiaotong University, and other partnering institutions, issued the Expert Consensus of "China Healthy Weight Management Action Initiative" during the March 4, 2024 World Obesity Day campaign. This paper presents and analyzes the initiative's systematic strategy, which integrates ten strategic recommendations across five key domains: 1) strategic policy and guideline implementation, 2) strengthening healthcare systems and public awareness, 3) collaborative and international engagement, 4) building health-conducive environments, and 5) data-driven approaches and technological solutions. The initiative establishes a comprehensive framework for addressing obesity through an integrated approach encompassing public policy, healthcare systems, and community engagement. Implementation of these strategic recommendations is expected to significantly enhance public health outcomes and accelerate progress toward achieving the "Healthy China 2030 Initiative" objectives.

中国健康体重管理行动倡议书：以策略行动推进健康中国

孙晓敏^1，2，&；孙照彰^{1，2，3，&}；彭雯^4，5；张建端⁶；苟波⁷；田向阳⁸；杨月欣⁹；王友发^1，2，#；专家作者组

1. 全球健康研究院，公共卫生学院, 西安交通大学，西安市，陕西省，中国；

2. 国际肥胖与代谢性疾病研究中心，西安交通大学，西安市，陕西省，中国；

3. 文化、传媒与创意产业系，伦敦国王学院，伦敦，英国；

4. 营养与健康促进中心，医学院公共卫生系，青海大学，西宁市，青海省，中国；

5. 青海省糖脂代谢疾病防控中医药重点实验室，西宁市，青海省，中国；

6. 公共卫生学院，同济医学院，华中科技大学，武汉市，湖北省，中国；

7. 运动与健康科学学院，西安体育学院，西安市，陕西省，中国；

8. 中国健康教育中心，北京，中国；

9. 营养与健康所，中国疾病预防控制中心，北京，中国

^& 共同第一作者。

^# 通信作者: 王友发，youfawang@xjtu.edu.cn。

集体作者：专家作者组成员包括常春；崔巍；冯子健；纪立农；李红娟；刘爱玲；罗樱樱；马亚楠；施秉银；宋逸；闻德亮；许庆丽；杨菊红；闫银坤；张建端；张倩；赵亚玲；曾志嵘。

在我国，超过50%的成年人和约20%的儿童超重肥胖，已成为重大公共卫生问题。为应对这一挑战，国家卫健委于2024年3月启动了为期三年的“体重管理年”活动，并在同年4月通过第36个爱国卫生月主题活动“健康城镇-健康体重”进一步强调了该计划。这些措施凸显了采取综合战略应对肥胖及其相关慢性病的紧迫性和重要性。为进一步推进国家层面的行动，中国营养学会肥胖防控分会、中华预防医学会行为健康分会、西安交通大学国际肥胖与代谢病研究中心和全球健康研究所联合其他合作机构，于2024年3月4日“世界肥胖日”系列活动中发布了《中国居民健康体重管理行动倡议》。该倡议整合了国内外在体重管理领域的最新研究成果和相关实践指南，提出五个关键领域十条行动建议，包括政策战略和指南实施、全社会参与及国际协作、构建健康促进环境、数据驱动方法及技术解决方案、增强卫生系统建设及公众体重管理意识等。《倡议书》特别强调通过健康教育、社区参与和技术创新，推动健康饮食和增加身体活动，以有效防控肥胖，促进“健康中国2030”的实现。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.268

Epidemiological Characteristics of Sporadic Foodborne Diseases Caused by Vibrio parahaemolyticus — China, 2013–2022

Danjie Jiang^1,&; Haihong Han^2,&; Yunchang Guo²; Ronghua Zhang³; Li Zhan³; Yijing Zhou⁴; Xin Qiao⁴; Hong Liu⁵; Xiaochen Ma⁶; Jikai Liu²; Ping Fu²; Weiwei Li^2,#

1. Ningbo Municipal Center for Disease Control and Prevention, Ningbo City, Zhejiang Province, China.

2. NHC Key Laboratory of Food Safety Risk Assessment, Food Safety Research Unit (2019RU014) of Chinese Academy of Medical Science; China National Center for Food Safety Risk Assessment, Beijing, China;

3. Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou City, Zhejiang Province, China;

4. Jiangsu Provincial Center for Disease Control and Prevention, Nanjing City, Jiangsu Province, China;

5. Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China;

6. Beijing Municipal Center for Disease Control and Prevention, Beijing, China;

^& Joint first authors.

^# Corresponding author: Weiwei Li, weiweili@cfsa.net.cn.

Vibrio parahaemolyticus (V.parahaemolyticus) is a common foodborne pathogen in coastal areas of China. Most epidemiological studies on V. parahaemolyticus have focused on foodborne disease outbreaks, with fewer studies based on longterm, continuous, and systematic sentinel surveillance. Data were collected from the national foodborne disease active surveillance program in 31 provincial-level administrative divisions (PLADs) in China from 2013 to 2022. V. parahaemolyticus-positive cases were collected for further analysis in this study. From 2013 to 2022, the National Foodborne Disease Case Surveillance System identified 23,818 cases of V. parahaemolyticus foodborne infection in China. Patient ages ranged from 2 months to 100 years, with an average age of 38.41 years. These cases primarily occurred in coastal areas during summer. A new serotype, O10:K4, emerged in 2020 and has become the dominant serotype over O3:K6. V. parahaemolyticus infection is common in the eastern coastal areas of China and strongly associated with aquatic food consumption. This study recommends that food regulatory authorities increase routine surveillance and inspection during high-risk periods and in high-risk areas. Authorities should also use social media platforms to conduct extensive public education campaigns on the prevention and control of V. parahaemolyticus associated foodborne disease.

副溶血性弧菌引起的散发食源性疾病的流行特征研究 — 中国，2013–2022年

蒋丹捷^1,&；韩海红^2,&；郭云昌²；章荣华³；占利³；周翌婧⁴；乔昕⁴；刘弘⁵；马晓晨⁶；刘继开²；付萍²；李薇薇^2,#

1. 宁波市疾病预防控制中心，宁波市，浙江省，中国；

2. 食品安全风险评估重点实验室，中国医学科学院食品安全创新单元（2019RU014），国家食品安全风险评估中心，北京，中国；

3. 浙江省疾病预防控制中心，杭州市，浙江省，中国；

4. 江苏省疾病预防控制中心，南京市，江苏省，中国；

5. 上海市疾病预防控制中心，上海，中国；

6. 北京市疾病预防控制中心，北京，中国；

^# 通信作者: 李薇薇，weiweili@cfsa.net.cn 。

副溶血性弧菌是中国沿海地区常见的食源性疾病致病菌。关于副溶血性弧菌的流行病学研究大多集中于食源性疾病的暴发事件，而基于长期、连续和系统的哨点监测研究较少。从2013年至2022年在中国31个省级行政区开展的国家食源性疾病主动监测工作中收集数据。本研究收集副溶血性弧菌阳性病例进行进一步分析。从2013年到2022年，在国家食源性疾病病例监测系统中共发现23,818例副溶血性弧菌食源性疾病病例。患者年龄范围为2个月到100岁，平均年龄为38.41岁。这些病例主要发生在夏季的沿海地区。2020年出现了一种新的血清型O10:K4，并逐渐替代O3:K6而成为主要的流行血清型。副溶血性弧菌感染在中国东部沿海地区很常见，与食用水产食品密切相关。本研究建议食品监管部门在高风险时期和高风险地区加强日常监测和检查。有关部门还应利用社交媒体平台开展广泛的公众教育活动。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.269

Detection and Identification in Reported Mushroom Poisoning Incidents — China, 2012–2023

Yuan Yuan^1,2; Yizhe Zhang²; Jing Zhou^1,2; Nan Lang²; Shaofeng Jiang²; Haijiao Li^1,2; Qian He²; Yutao Zhang²; Bowen Cheng²; Jiaju Zhong²; Jiaqi Liang²; Yu Yin²; Yifan Liang²; Hongshun Zhang^1,2; Chengye Sun^1,2,#

Author Affiliation

1. State Key Laboratory of Trauma, Burn and Combined Injury, Third Military Medical University, Chongqing, China

2. National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China

^# Corresponding author: Chengye Sun, suncy@chinacdc.cn

The detection and identification characteristics in reported mushroom poisoning incidents were analyzed to provide the basic data of prevention, and control strategy in China. According to the report information from China CDC’s “Public Health Emergency Reporting Management Information System”, descriptive epidemiological methods were used to analyze the distribution of detection year, region, detection department, identification method and the poisonous mushroom species from 2012 to 2023. The scientific naming of poisonous mushroom species were based on the List of Poisonous Mushrooms in China, and the clinical types were compared with the Identification and Poisoning Control of Poisonous Mushrooms. From 2012 to 2023, the number of reported mushroom poisoning incidents, poisonings and deaths accounted for 21.87% (653/2,986), 4.33% (3,229/74,586), and 54.20% (710/1,310) of reported foodborne poisoning incidents, poisonings and deaths, respectively. The fatality rate was 21.99% (710/3,229). There were 102 incidents (15.62%) were tested for poisoning-related toxicants, of which 92 poisonous mushroom incidents had toxicant detection or identification results, except for 10 cases in which no detection and identification results were issued in the final report, accounting for 14.08% of mushroom poisoning incidents. A total of 13 provincial-level administrative divisions (PLADs) participated in the detection and identification in China, and the top 5 detection incidents were Hunan, Yunnan, Guangdong, Sichuan and Guizhou PLADs, with 25 (27.17%), 22 (23.91%), 17 (18.48%), 9 (9.78%), and 6 (6.52%) incidents, respectively. The distribution of detection and identification methods in the top 5 PLADs was different. In Hunan Province, morphological identification was the predominant method (88.00%). Yunnan Province had the highest proportion of toxin detection (27.28%). However, Sichuan and Guizhou provinces used molecular biology detection rather than toxin detection. Yunnan Province employed the widest variety of detection and identification methods. The departments involved in the detection and identification of poisonous mushroom were CDCs, universities, multi-department cooperation (including public security department, agricultural department), scientific research institutes, and hospitals, with the ratios of 63.04%, 16.30%, 9.78%, 6.52% and 4.35%. Among the 92 reported incidents with the results of detection and identification, the largest number of incidents and poisonings were acute liver failure, rhabdomyolysis, gastroenteritis, psycho-neurological disorder and acute renal failure. The largest number of deaths was caused by acute liver failure mushrooms, accounting for 55.17% (64/116) of all clinical types of mushroom poisoning incidents. Twenty-five species were involved in the 92 mushroom poisoning incidents, Amanita exitialis and Russula subnigricans were responsible for the most incidents, both of which accounted for 17.39% (16/92) of all species. Amanita exitialis and Amanita fuliginea caused the largest number of poisonings and deaths, accounting for 13.32% (55/413) and 18.10% (21/116) respectively. Research on detection and identification of poisonous mushrooms needs to be strengthened. The detection ability of primary medical and health institutions as well as the diagnosis and treatment of mushrooms poisoning in primary hospitals need to be improved.

毒蘑菇中毒报告事件检测鉴定分析 — 中国，2012–2023年

袁媛^1,2；章轶哲²；周静^1,2；郎楠²；蒋绍锋²；李海蛟^1,2；何仟²；张驭涛²；程博文²；钟加菊²；梁嘉祺²；尹萸²；梁一帆²；张宏顺^1,2；孙承业^1,2,#

1. 第三军医大学创伤、烧伤与复合伤国家重点实验室，重庆，中国

2. 中国疾病预防控制中心职业卫生与中毒控制所，北京，中国

^# 通信作者：孙承业，suncy@chinacdc.cn。

通过分析中国毒蘑菇中毒事件检测鉴定情况，为毒蘑菇中毒预防控制策略提供依据。应用描述流行病学方法，从中国疾病预防控制中心的国家“突发公共卫生事件管理信息系统”中，对2012年-2023年我国蘑菇中毒事件的检测年份分布、地区分布、检测部门分布、鉴定方法分布以及鉴定的毒蘑菇种类进行分析。毒蘑菇种类中文名称对照《中国毒蘑菇名录》，临床分型对照《毒蘑菇识别与中毒防治》。2012年-2023年，报告毒蘑菇中毒事件、中毒人数和死亡人数分别占报告的食物中毒事件数、中毒人数和死亡人数的21.87%（653/2,986）、4.33%（3,229/74,586）和54.20%（710/1,310）。病死率为21.99%（710/3,229）。有102起（15.62%)的毒蘑菇中毒事件进行了中毒相关毒物检测，其中，除去在结案报告未出具检测鉴定结果的10起事件外，有92起毒蘑菇中毒事件有毒物检测或鉴定结果，占毒蘑菇中毒事件数的14.08%。全国共有13个省级行政单位参与检测鉴定，检测事件数量前5位的依次是湖南、云南、广东、四川和贵州，分别检测鉴定了25起（27.17%）、22起（23.91%）、17起（18.48%）、9起（9.78%）和6起（6.52%）。检测鉴定毒蘑菇中毒事件数排名前5位的省检测鉴定方法分布不同。形态学鉴定是各省份最主要的方法，该方法占到湖南省检测鉴定方法的88.00%；毒素检测在云南省开展的比例最高，达到27.28%；四川、贵州并未将毒素检测方法用于毒蘑菇事件中，而采用分子生物学检测；云南省是采用检测鉴定方法种类最多的省份。参与毒蘑菇中毒事件检测鉴定的部门有疾控中心、高等学校、多部门（包括公安、农业）合作、科研院所、医院，构成比分别是63.04%、16.30%、9.78%、6.52%和4.35%。在92起报告了毒物检测鉴定结果的事件中，事件数和中毒人数最多的依次为急性肝损害型、横纹肌溶解型、胃肠炎型、神经精神型和急性肾衰竭型毒蘑菇。死亡人数最多的为急性肝损害型毒蘑菇，占所有临床类型毒蘑菇的55.17%（64/116）。这些事件中，涉及25个种属，致命鹅膏和亚稀褶红菇事件数最多，均占所有鉴定毒蘑菇中毒事件的17.39%（16/92）；致命鹅膏导致的中毒人数最多，灰花纹鹅膏导致死亡人数最多，分别占所有鉴定毒蘑菇中毒事件的13.32%（55/413）和18.10%（21/116）。毒蘑菇检测鉴定研究需要加强,各级医疗卫生机构的检测能力和基层医院该类毒物的诊断救治水平亟待提高。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.270

Dietary Vitamin Intake Among Chinese Adults — 10 PLADs, China, 2022–2023

Xiaofan Zhang^1,2; Chang Su^1,2; Jiguo Zhang^1,2; Feifei Huang^1,2; Wenwen Du^1,2; Xiaofang Jia^1,2; Yifei Ouyang^1,2; Li Li^1,2; Jing Bai^1,2; Yanli Wei^1,2; Fangxu Guan^1,2; Yuna He^1,2; Bing Zhang^1,2; Huijun Wang^1,2,#

1. National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.

2. Key Laboratory of Public Nutrition and Health, National Health Commission of the People's Republic of China, Beijing, China.

^# Corresponding authors: Huijun Wang, wanghj@ninh.chinacdc.cn.

Vitamins are essential micronutrients for maintaining physiological function and overall health. According to the 2015–2017 Chinese Nutrition and Health Surveillance report, Chinese residents generally face risks of insufficient dietary intake of vitamins A, B₁, B₂, and C. With ongoing urbanization, Chinese dietary patterns are transitioning from traditional plant-based diet toward modern western diet. This study analyzed data from 10 provincial-level administrative divisions (PLADs), including Heilongjiang, Liaoning, Shandong, Henan, Hunan, Hubei, Jiangsu, Shaanxi, Guangxi, and Guizhou, during 2022–2023 to characterize current dietary vitamin intakes among Chinese adults. The median daily intakes were 467.8 μg RE for vitamin A, 27.3 mg for vitamin E, 0.7 mg for vitamin B₁, 0.7 mg for vitamin B₂, 12.9 mg for niacin, and 51.2 mg for vitamin C among adults aged 18 years and above. The risk of insufficient intake was particularly concerning for vitamins B₂ (84.2%), B₁ (78.0%), C (76.4%), and A (52.6%), with elevated risks observed among males, rural residents, and older adults. Notably, only 1.6% of adults achieved the proposed intakes for preventing non-communicable chronic diseases (PI-NCD) for vitamin C intake. These findings highlight the urgent need to strengthen dietary guidance for Chinese adults and implement effective nutrition policies and interventions to address vitamin insufficiency, particularly targeting males, elderly individuals, and rural populations.

成人膳食维生素摄入现状 — 十省份，中国，2022–2023年

张晓帆^1，2；苏畅^1，2；张继国^1，2；黄绯绯^1，2；杜文雯^1，2；贾小芳^1，2；欧阳一非^1，2；李丽^1，2；白晶^1，2；魏艳丽^1，2；关方旭^1，2；何宇纳^1，2；张兵^1，2；王惠君^1，2,#

1.营养与健康研究所，中国疾病预防控制中心，北京,中国；

2.国家卫生健康委公共营养与健康重点实验室，北京，中国；

^# 通信作者：王惠君：wanghj@ninh.chinacdc.cn。

维生素是维持生理功能和健康所必需的微量营养素。根据2015-2017年中国居民营养与健康状况监测报告，中国居民普遍面临维生素A、B₁、B₂和C摄入不足的风险。随着城镇化进程的加快，中国居民的膳食模式正在从传统的植物性饮食向现代西方饮食转变。本研究分析了2022-2023年间来自10个省级行政区划（PLADs）的膳食数据，包括黑龙江、辽宁、山东、河南、湖南、湖北、江苏、陕西、广西和贵州，旨在描述中国成年人膳食维生素的摄入现状。研究结果显示，18岁及以上的成年人每日膳食维生素A、维生素E、维生素B₁、维生素B₂、烟酸和维生素C的摄入量中位数分别为467.8微克视黄醇当量、27.3毫克、0.7毫克、0.7毫克、12.9毫克和51.2毫克。维生素B₂（84.2%）、维生素B₁（78.0%）、维生素C（76.4%）和维生素A（52.6%）的摄入不足风险较高，尤其是男性、农村居民和老年人的风险较高。值得注意的是，只有1.6%的成年人达到了预防非传染性慢性疾病（PI-NCD）建议的维生素C摄入量。这些发现强调了加强对中国成年人的膳食指导，实施有效的营养政策和干预措施来解决维生素摄入不足的迫切需要，特别是针对男性、老年人和农村居民。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.271

Diarrheagenic Escherichia coli Outbreak Reporting to Foodborne Disease Outbreaks Surveillance System — China, 2011–2022

Tongyu Wang¹; Yangbo Wu¹; Weiwei Li²; Ping Fu²; Hongqiu Li²; Ning Li²; Yue Dai³; Junhua Liang⁴; Xiaochen Ma^1,#; Yunchang Guo^2,#

1. Institute for Nutrition and Food Hygiene, Beijing Center for Disease Prevention and Control, Beijing, China

2. Division of Foodborne Disease Surveillance, China National Center for Food Safety Risk Assessment, Beijing, China

3. Jiangsu Provincial Center for Disease Prevention and Control, Nanjing City, Jiangsu Province, China

4. Guangdong Provincial Center for Disease Prevention and Control, Guangzhou City, Guangdong Province, China.

# Corresponding author: Yunchang Guo, gych@cfsa.net.cn; Xiaochen Ma,maxch@bjcdc.org.

Outbreaks of foodborne diarrheal Escherichia coli (DEC) remain a major public health problem in China. This study systematically analyzed the occurrence, trend, and epidemiological characteristics of foodborne diarrheal Escherichia coli outbreaks in the past 10 years.  The DEC outbreak data collected by the Chinese Foodborne Disease Outbreak Surveillance System from 2011 to 2022 were analyzed. A total of 413 DEC outbreaks occurred in China from 2011–2022, resulting in 8,127 morbidities, 2,565 hospitalizations, and 1 death. Enteroaggregate adhesive Escherichia coli was the most common pathogen causing foodborne outbreaks (48.82%), and the most common outbreak occurred in school canteens (21.79%). Foodborne DEC outbreak reports provide detailed information on the pathogens and food species that caused the outbreak. We also need to continuously track and analyze the causes of outbreaks to guide the implementation of preventive measures.

食源性疾病暴发监测系统报告的致泻大肠埃希氏菌暴发事件分析 — 中国，2011–2022年

王同瑜¹；吴阳博¹；李薇薇²；付萍²；李红秋²；李宁²；戴月³；梁骏华⁴；马晓晨^1，#；郭云昌^2，#

1. 营养与食品卫生所，北京市疾病预防控制中心，北京，中国；

2. 国家食品安全风险评估中心，北京，中国；

3. 江苏省疾病预防控制中心，南京市，江苏省，中国；

4. 广东省疾病预防控制中心，广州市，广东省，中国。

^# 通信作者：郭云昌，gych@cfsa.net.cn；马晓晨，maxch@bjcdc.org。

食源性致泻性大肠埃希菌（DEC）的暴发在中国仍然是一个重大的公共卫生问题。本研究系统分析了近10年中国食源性致泻大肠埃希菌暴发事件的发生情况、变化趋势及流行病学特征。这将有助于提高暴发事件的调查和处置能力，并明确引起暴发的病因及高危食品。对2011–2022年中国食源性疾病暴发监测系统收集的DEC暴发疫情数据进行分析。2011–2022年中国大陆共发生413起DEC暴发疫情，导致8,127例发病、2,565例住院和1例死亡。肠聚集性黏附性大肠埃希菌是引起食源性暴发最常见的病原（48.82%），最常发生暴发事件的场所为学校食堂（21.79%）。食源性DEC疫情报告提供了有关引起暴发事件的病原体和食品种类的详细信息。我们还需要持续跟踪和分析暴发事件的原因，以指导预防措施的实施。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.272

An Outbreak of Foodborne Botulism Caused by Clostridium botulinum BoNT/A3 in Pickled Eggs — Weihai City, Shandong Province, China, July 2024

Tingting Miao¹; Xiang Li¹; Bin Hu²; Huajiang Zhang¹; Li Xu¹; Dongfang Zhang³; Miaomiao Sui¹; Xiao Han¹; Ling Li¹; Deyu Zhuang¹; Dahai Yu⁴; Zhenghui Yang^5,#; Jinbo Zhang^1,#

1 Weihai Center for Disease Control and Prevention, Weihai City, Shandong Province, China.

2 Shandong Center for Disease Control and Prevention, Jinan City, Shandong Province, China

3 Weihai Municipal Hospital, Weihai City, Shandong Province, China

4 Huancui District Center for Disease Control and Prevention, Weihai City, Shandong Province, China

5 Weihai Health Commission, Weihai City, Shandong Province, China.

# Corresponding author: Zhenghui Yang, whsjkzxbgs@wh.shandong.cn; Jinbo Zhang, whsjkzxsys@wh.shandong.cn.

Clostridium botulinum is a strictly anaerobic, Gram-positive bacterium whose spores are ubiquitous in soil and livestock feces. When foods such as fruits, vegetables, meat, and grains are contaminated by C. botulinum spores, the bacteria can proliferate rapidly and produce toxins under anaerobic conditions. In this study, we reported an outbreak of foodborne botulism caused by C. botulinum in pickled eggs in Weihai, China. On July 15, 2024, two patients suspected of foodborne botulism presented to the Emergency Department of Hospital with same symptoms such as difficulty breathing and ptosis. Both patients had consumed homemade pickled eggs. From July 16 to 17, the hospital admitted three additional patients with the same food exposure history and similar symptoms. Epidemiological investigation revealed that a total of 8 people consumed homemade pickled eggs, among which 5 developed symptoms such as ptosis and dyspnea, while 3 remained asymptomatic. All cases showed improvement after receiving botulinum antitoxin treatment, and no deaths occurred. We isolated 12 C. botulinum strains in this study. The phylogenetic analysis results revealed that the 12 C. botulinum isolates came from the same origin. With the complete genome of C. botulinum, The results of BLAST and arrangement of bont gene clusters indicated that the isolated strains belonged to the BoNT/A3 type. In conclusion, this outbreak was a case of foodborne botulism caused by homemade pickled eggs contaminated with C. botulinum producing BoNT/A3.This investigation revealed that foodborne botulism remains a public health issue in China. Therefore, strengthening education regarding the health risks of consuming homemade, traditionally pickled foods is critical to safeguarding public health.

一起食用腌鸡蛋导致的A3型肉毒毒素（BoNT/A3）中毒事件的调查报告 — 威海市，山东省，中国，2024年7月

苗婷婷¹；李祥¹；胡彬²；张化江¹；徐莉¹；张东方³；隋苗苗¹；韩笑¹；李羚¹；庄德宇¹；于大海⁴；杨正辉^5，#；张金波^1，#

1．威海市疾病预防控制中心，威海市，山东省，中国；

2．山东省疾病预防控制中心，济南市，山东省，中国；

3. 威海市立医院，威海市，山东省，中国；

4. 环翠区疾病预防控制中心，威海市，山东省，中国；

5. 威海市卫生健康委员会，威海市，山东省，中国。

^# 通信作者：杨正辉, whsjkzxbgs@wh.shandong.cn; 张金波, whsjkzxsys@wh.shandong.cn。

肉毒梭状芽孢杆菌是一种严格的厌氧性革兰氏阳性细菌，其孢子广泛存在于土壤和牲畜粪便中。当水果、蔬菜、肉类和谷物等食物被肉毒梭状芽孢杆菌孢子污染时，这些细菌可在厌氧条件下迅速繁殖并产生毒素。本研究报道了中国威海一起由自制腌鸡蛋中肉毒梭状芽孢杆菌引起的食源性肉毒中毒事件。2024年7月15日，两名疑似食源性肉毒中毒患者因呼吸困难和眼睑下垂等症状被送往医院急诊科就诊。这两名患者都曾食用过自制腌鸡蛋。7月16日至17日，医院又收治了三名有相同食物接触史和类似症状的患者。流行病学调查显示,共有8人食用自制腌鸡蛋，5人出现眼睑下垂、呼吸困难等中毒症状，3人无症状。经肉毒毒素抗毒素治疗后均好转，无死亡病例。本次暴发中共分离得到12株肉毒梭菌，系统发育分析表明他们都属于同一来源。通过全基因组测序技术获得肉毒杆菌全基因组序列，Blast和bont基因簇共线性分析结果表明分离得到的肉毒梭菌属于BoNT/A3型。

总之，本次暴发事件是由食用被BoNT/A3肉毒毒素污染的腌鸡蛋导致的食源性暴发事件。本次调查表明，食源性肉毒中毒在中国仍是一个公共卫生问题。因此，加强关于食用自制传统腌制食品健康风险的教育对于保障公众健康至关重要。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.273