华南预防医学 ›› 2015, Vol. 41 ›› Issue (1): 11-15.doi: 10.13217/j.scjpm.2015.0011

• 论著 • 上一篇    下一篇

一起新型诺如病毒感染性腹泻暴发的现场流行病学调查

张振1,2,陈兵3,廖玉学1,2,陈亿雄3,吴泰顺3   

  1. 1.深圳市疾病预防控制中心,广东 深圳 518055;2.深圳市现场流行病学培训项目;3.深圳市宝安区疾病预防控制中心
  • 出版日期:2015-02-20 发布日期:2015-03-30
  • 通讯作者: 吴泰顺 E-mail:wuweibk@163.com
  • 作者简介:张振(1981—),男,硕士研究生,主管医师,主要从事肠道传染病防控工作

Epidemiological investigation of an outbreak of infectious diarrhea caused by new Norovirus

ZHANG Zhen1,2, CHEN Bing3, LIAO Yu-xue1,2, CHEN Yi-xiong3, WU Tai-shun3   

  1. 1.Center for Disease Control and Prevention of Shenzhen City, Shenzhen 518055, China. 2.Shenzhen Field Epidemiology Training Program.3.Baoan Center for Disease Control and Preventive of Shenzhen
  • Online:2015-02-20 Published:2015-03-30

摘要: 目的了解某工厂1起感染性腹泻暴发疫情的流行特点和危险因素,为制定防制策略提供依据。方法按照病例定义开展病例搜索,采用描述性流行病学方法分析疾病的流行特征并提供病因线索,利用回顾性队列研究和病例对照研究分析危险因素;采集患者和厨师肛拭子以及食品和外环境样本,用实时荧光定量逆转录聚合酶链反应(RT-PCR)进行病毒核酸检测,对PCR扩增产物进行测序以确定病毒基因型别。结果2013年1月17日至21日共搜索到病例76例,罹患率为18.12%(76/414),普通员工罹患率为26.28%(72/274),中层人员为2.96%(4/135),高管人员未发现患者(0/5),差异有统计学意义(P<0.01)。回顾性队列研究显示,到普通员工处用餐的中层人员罹患率为11.43%(4/35),不去普通员工处用餐的则没有发病(0/75),差异有统计学意义(P<0.01)。病例对照研究显示,病例组在1月15日中餐和晚餐食用第1批员工餐的青菜的比例分别为64.00%(32/50)和70.83%(34/48),对照组比例分别为41.67%(35/84)和50.00%(40/80),病例组均高于对照组,OR分别为2.489(95%CI:1.209~5.125)和2.429(95%CI:1.134~5.199),提示该天中餐和晚餐第1批员工餐的青菜暴露可能是危险因素。采集患者肛拭子、呕吐物、粪便、厨师肛拭子、手拭子以及食物、调料、厨具、水样本共64份,其中致病菌检测56份,均为阴性;诺如病毒核酸检测51份,其中13份患者肛拭、2份厨师肛拭、2份患者粪便、1份患者呕吐物样本为阳性,全部为GⅡ4.Sydney 2012新型诺如病毒毒株。结论该起疫情可能是1起食物污染引起的新型诺如病毒感染性腹泻暴发疫情,建议加强食品从业人员健康教育,继续做好感染性腹泻病原学监测工作。

Abstract: Objective To investigate the epidemiological characteristics and analyze the risk factors of an infectious diarrhea outbreak in a factory in Shenzhen City, so as to provide scientific evidence for decision-making in the prevention and control of diarrhea outbreaks. Methods All cases were screened according to the case definition. The epidemiologic characteristics were described to facilitate proposing etiological hypothesis, followed by retrospective cohort study and case-control analyses to determine the risk factors. Anal swabs of patients and cooks, and samples of the outer environment were collected for pathogenic detection. The real time fluorescent quantitative RT-PCR was used for detection of virus nucleic acid and the PCR amplified products were sequenced to identify the virus genotyping. Results A total of 76 cases were found from 17 to 21 January 2013, with an attack rate of 18.12%(76/414). The attack rates in general staff, middle-level staff, and senior staff were 26.28% (72/274), 2.96% (4/135), and 0.00%(0/5), respectively(P<0.01). The retrospective cohort study analysis showed that the attack rate in middle-level staff who ate meals serving for the general staff was 11.43%(4/35), while there was no case in middle-level staff who didn’t (0/75)(P<0.01). Case-control study showed that on January 15th, the proportions of cases who ate the first round vegetables for lunch and dinner were 64.00%(32/50)and 70.83%(34/48)respectively in the case group, and those were 41.67%(35/84)and 50.00% (40/80) in the control group, and the ORs were 2.489(95%CI: 1.209-5.125)and 2.429(95%CI: 1.134-5.199), respectively, indicating the exposure to the first round vegetables of the lunch and dinner was a risk factor for the outbreak. Sixty-four samples of rectal swabs of patients and cooks,vomit, feces,hand swabs, food, spices, kitchen utensils, and water were collected. Pathogenic bacteria were negative in 56 samples detected. Among the 51 samples for detection of norovirus nucleic acid, 13 rectal swabs of patients, 2 rectal swabs of cooks, 2 feces of patients and 1 patient vomit were positive for the norovirus nucleic acid and all were identified as the GII-4 norovirus Sydney 2012 strain. Conclusion This infectious diarrhea outbreak may be caused by vegetables contaminated with the new GII-4 norovirus Sydney 2012 strain. Health education should be strengthened among food-processing workers.

中图分类号: 

  • R183.4