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目的对广州市南沙区某中学蜡样芽孢杆菌食物中毒暴发事件进行调查,查找危险因素和传播途径,并提出针对性预防控制措施。方法按照病例定义在全校范围内开展病例搜索,对病例进行描述性分析,采用病例-对照研究方法,对调查对象的就餐地点、食物品种等情况进行调查,分析危险餐次及中毒食物。并对留样食物、部分病例和厨工肛拭子、食堂工具和物品表面拭子等进行4种常见致病菌检测。结果学校共有学生2 670人,教职工212人,共搜索到50例疑似病例,罹患率为1.73%(50/2 882)。病例中男性22例,女性28例,不同性别学生罹患率差异无统计学意义(P>0.05)。50例病例为分布在高中部的15个班里的住校生,其余5个班级无病例发生,有病例发生的各班级罹患率介于5.25%~68.42%之间,各班级间罹患率差异有统计学意义(P<0.01)。首发病例发病时间为5月26日7∶30,末例发病时间为当天19∶00,流行曲线呈单峰点源暴露模式。临床表现主要为腹痛(占63.8%)、恶心(占48.9%)和呕吐(占38.3%)。病例-对照研究结果显示,10名25日在学校食堂宵夜的学生均未发病。50例病例中共有47例进食过学校26日食堂早餐,提示26日学校食堂早餐为可疑餐次,食用炒饭的学生发病风险是未食用炒饭的17.30倍(OR=17.30),其他食物的差异无统计学意义。实验室检测结果显示,在5月26日早餐炒饭样本中检出蜡样芽胞杆菌为1×108CFU/g,血清型为O3∶K6,其他样本没有检出致病菌。结论该起食物中毒系因蜡样芽胞杆菌污染炒饭所导致。建议加强对学校食堂的监督与管理,严格落实各项管理措施和操作规程。
Objective To investigate the outbreak of Bacillus cereus food poisoning in a middle school in Nansha District of Guangzhou City to find out the risk factors and routes of transmission and to put forward targeted prevention and control measures. Methods According to the definition of case, the case search was carried out within the whole school. Descriptive analysis of the cases was carried out. The case-control study was conducted to investigate the dining places and food varieties of the investigated subjects. The dangerous meals and the poisoned foods were analyzed. Four kinds of common pathogenic bacteria were also detected on the remaining samples, some cases and kitchen workers ’anal swabs, canteen tools and articles’ surface swabs. Results A total of 2 670 students and 212 faculty members were included in the school. A total of 50 suspected cases were searched and the attack rate was 1.73% (50/2 882). There were 22 male cases and 28 female cases. There was no significant difference in attack rate among different sexes (P> 0.05). Fifty cases were live-in students in 15 classes in the upper middle school. The remaining five classes had no cases. The attack rates of each class of cases were between 5.25% and 68.42%. There were differences among the classes Statistical significance (P <0.01). The first case onset time at 7:30 on May 26, the last case of onset time of 19:00 the same day, the epidemic curve was single peak point source exposure mode. The main clinical manifestations were abdominal pain (63.8%), nausea (48.9%) and vomiting (38.3%). Case-control study showed that 10 students in the school cafeteria midnight snack on the 25th were not affected. Among 50 cases, 47 cases had eaten breakfast in school on the 26th, suggesting that the school cafeteria breakfast was suspicious on the 26th. The risk of students who consumed fried rice was 17.30 times higher than that of the non-eaten fried rice (OR = 17.30). The differences of other foods Statistical significance. Laboratory tests showed that Bacillus cereus was 1 × 108 CFU / g and O3: K6 was detected in samples of breakfast fried rice on May 26, and no other pathogens were detected in other samples. Conclusion The food poisoning caused by Bacillus cereus pollution caused by fried rice. It is suggested to strengthen the supervision and management of school canteens and strictly implement various management measures and operating procedures.