Background In the United States, Yersinia enterocolitica causes a diarrheal disease historically associated with winter months and understood to predominantly occur among Black or African American infants and Asian children. Clinical laboratory adoption of culture-independent diagnostic tests (CIDTs), in place of culture methods has led to marked increases in diagnoses. Methods We describe laboratory-diagnosed infections caused by Y. enterocolitica in 10 state health departments of the Foodborne Diseases Active Surveillance Network. A counterfactual random forest model was used to identify individual, and community-level social determinants of health associated with the type of test used to detect Y. enterocolitica. Results Annual reported incidence of Y. enterocolitica infection increased from 0.3 per 100,000 in 2010 to 1.3 per 100,000 in 2021. The proportion of infections detected by CIDT increased from 3% in 2012 to 89% in 2021. Nearly all (97%) CIDT-positive infections were detected by commercially available syndromic gastrointestinal panel tests. Reported incidence increased for adults ≥18 years, regardless of race and ethnicity. Nearly half of infections occurred during May to September in 2016–2021. The probability of CIDT-detected infection increased with age and was greater for White compared with Asian persons. In addition to year, an ill person’s location of residence had a significant impact on odds of infection detection by CIDT versus culture method. Conclusions Improved detection due to increased use of CIDTs has altered our understanding of yersinosis epidemiology. Our findings suggest that yersinosis diagnosis quantitatively varies between demographic groups by diagnostic method and that differential access to CIDTs may still affect our understanding of yersinosis epidemiology.

中文翻译：

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综合症胃肠道诊断测试改变了我们对小肠结肠炎耶尔森菌流行病学的理解——食源性疾病主动监测网络，2010-2021

背景 在美国，小肠结肠炎耶尔森氏菌引起的腹泻病历来与冬季有关，据了解主要发生在黑人或非裔美国婴儿和亚洲儿童中。临床实验室采用独立于培养的诊断测试（CIDT）代替培养方法导致诊断数量显着增加。方法 我们描述了食源性疾病主动监测网络 10 个州卫生部门实验室诊断的由小肠结肠炎耶尔森氏菌引起的感染。使用反事实随机森林模型来识别与检测小肠结肠炎耶尔森氏菌的测试类型相关的个人和社区层面的健康社会决定因素。结果 年报告的小肠结肠炎耶尔森氏菌感染发病率从 2010 年的每 10 万人 0.​​3 例增加到 2021 年的每 10 万人 1.3 例。CIDT 检测到的感染比例从 2012 年的 3% 增加到 2021 年的 89%。几乎所有 (97%) CIDT-通过市售的综合症胃肠道检测检测出阳性感染。报告的 18 岁以上成年人的发病率有所增加，无论种族和民族如何。 2016-2021 年，近一半的感染发生在 5 月至 9 月。 CIDT 检测到的感染概率随着年龄的增长而增加，并且白人的感染概率高于亚洲人。除了年份之外，患者的居住地点对 CIDT 与培养方法检测感染的几率也有显着影响。结论 由于 CIDT 使用的增加而改进的检测改变了我们对耶尔森病流行病学的理解。我们的研究结果表明，根据诊断方法，耶尔森病诊断在不同人口群体之间存在定量差异，并且 CIDT 的获取差异可能仍会影响我们对耶尔森病流行病学的理解。