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目的探讨新宁县某中学一次甲型肝炎(简称甲肝)暴发流行的流行因素及特征,为甲肝防制提供科学依据。方法采取现况调查方法,对甲肝病例进行个案调查,对全校教职员工、家属、学生及密切接触者进行ALT及抗-HAVIgM检测;采用描述流行病学方法对资料进行分析。结果该中学2008年6月24日-7月17日共发生急性甲肝病例60例,其中学生58例,教职员工1例,家属1例,甲肝罹患率为9.15%。全校12个班都有病例分布,以143班发病人数最多,罹患率为19.44%,发病人数最少的是139班,罹患率为2.00%。发病年龄最小的6岁,最大58岁。男性33例,占55.00%,女性27例,占45.00%,学生58例,占96.7%,教职员工及家属2例,占3.3%。住校生180人,甲肝罹患率为29.44%;走读生400人,甲肝罹患率为1.25%,两者差异有显著统计学意义(χ2=109.64,P<0.01)。病例中出现乏力、茶尿、食欲减退、厌油、腹泻等症状和体征的比例较高,分别占51.72%、48.28%、44.83%、51.72%、51.72%;未出现危重病例。病人ALT检测,异常者24人,最高滴度达1 245 u。抗-HAVIgM检测974人,阳性94人,阳性率为9.65%。生活饮用水水质检测,学校自备井水细菌总数1 290 cfu/ml,大肠菌群>1 600 mpn/100 ml。结论该校自备井水受到污染是此次甲肝暴发流行的直接原因;病例发现晚、疫情报告迟,师生卫生意识差造成了暴发流行时间长,罹患率高。应加强健康教育及人群甲肝疫苗的免疫力度。
Objective To explore the epidemic factors and characteristics of a Hepatitis A (hepatitis A) outbreak in a middle school in Xinning County, and to provide a scientific basis for prevention and control of hepatitis Methods The status quo survey method was used to carry out a case investigation of hepatitis A cases. ALT and anti-HAVIgM were detected in the faculty members, family members, students and close contacts of the whole school. The data were analyzed by descriptive epidemiological method. Results There were 60 cases of acute hepatitis A in the middle school from June 24 to July 17, 2008, including 58 students, 1 faculty member, 1 family member, and an attack rate of 9.15%. The school has 12 cases of class distribution, with the highest incidence of 143 classes, the attack rate was 19.44%, the least number of patients was 139 classes, the attack rate was 2.00%. The youngest age of 6 years old, maximum 58 years old. Male 33 cases, accounting for 55.00%, female 27 cases, accounting for 45.00%, 58 students, accounting for 96.7%, faculty members and their families in 2 cases, accounting for 3.3%. 180 live-in students, the incidence of hepatitis A was 29.44%, 400 were students and the incidence of hepatitis A was 1.25%. The difference was statistically significant (χ2 = 109.64, P <0.01). In the cases, the symptoms such as fatigue, tea loss, loss of appetite, tiredness, diarrhea and other symptoms and signs were high, accounting for 51.72%, 48.28%, 44.83%, 51.72% and 51.72% respectively; no serious cases were found. Patients ALT test, 24 were abnormal, the highest titer of 1 245 u. Anti-HAVIgM test 974 people, 94 were positive, the positive rate was 9.65%. Drinking water quality testing, the school-owned total well water bacteria 1 290 cfu / ml, coliform> 1 600 mpn / 100 ml. Conclusion The pollution of self-provided well water in this school is the direct cause of the outbreak of hepatitis A. The late onset of cases, late reporting of epidemics, poor hygiene awareness between teachers and students led to long outbreaks and high attack rates. Health education and crowd immunity of hepatitis A vaccine should be strengthened.