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目的了解2016年山东省菏泽市牡丹区人间布鲁氏菌病(布病)发病数异常升高的原因、感染来源、危险因素,及时采取针对性控制措施。方法通过对医院、重点村庄进行主动搜索,检索医疗机构上报的传染病报告信息管理系统等方式获得该区的人间布病病例,采取重点村庄现场查看,当面访谈或电话调查的方式开展病例个案调查,同时完成病例标本实验室检测。结果 2016年共搜索到170例人间布病病例,58.24%(99/170)的病例集中发生在10 12月。76.47%(130/170)的病例居住在回民聚居地A镇Ⅰ村和B镇Ⅱ村。Ⅰ村和Ⅱ村之间有一个日交易量约1 000只的活羊交易市场,80.00%的羊购自布病高发省份。9月宰牲节期间,两村村民购买的羊数量为平时2倍,其间参与家庭内羊肉处理过程者罹患率和未参与者的罹患率分别是34.82%(122/3 504)和0.02%(1/3 608),差异有统计学意义(χ~2=124.782,P=0.001)。14岁以上村民中,从事与羊接触工作(贩卖、屠宰、皮毛加工、养殖)的村民布病患病率为17.28%(108/625),未从事接触羊工作的14岁以上村民患病率为0.30%(15/5 065)(RR=58.349,95%CI:34.220~99.492)。从事活羊贩卖、屠宰活动、皮毛加工和羊养殖的布病发病风险RR值(95%CI)分别为84.417(45.925~155.172)、80.604(45.209~143.713)、43.414(23.450~80.374)和40.098(20.757~77.459)。在接触羊时,5.13%(8/156)的病例戴口罩,21.15%(33/156)戴毛线手套。结论本次事件可能为一起因活羊交易市场输入染疫羊而接触者缺乏有效防护而引起的人间布病疫情。建议多省份和多部门联防联控,保证羊的输出、输入和交易均在动物卫生检疫指导下进行。此外,需要加强布病防治知识的宣传教育。
Objective To understand the causes of the abnormal increase of brucellosis (brucellosis) in Mudan District, Heze City, Shandong Province in 2016, sources of infection and risk factors, and take targeted control measures in time. Methods The cases of human brucellosis in this area were obtained through the active search of hospitals and key villages, and the retrieval of infectious disease reporting information management system reported by medical institutions. Cases were investigated by field visits, face-to-face interviews or telephone surveys , At the same time to complete the laboratory specimens laboratory tests. Results A total of 170 cases of human brucellosis were searched in 2016, and 58.24% (99/170) cases were concentrated in 10-12 months. 76.47% (130/170) of the cases lived in the villages A and B of the settlements A and B, respectively. There is a live sheep market with a daily trading volume of about 1,000 on the market between Village I and Village II, with 80.00% of the sheep purchased from the high incidence of brucellosis. During the Eid al-Adha in September, the number of sheep purchased by the villagers in the two villages was twice that of the usual sheep. The rates of attack among those involved in the treatment of mutton in the home during the Eid al-Adha incident were 34.82% (122/3 504) and 0.02% (1) respectively / 3 608), the difference was statistically significant (χ ~ 2 = 124.782, P = 0.001). The prevalence of brucellosis among villagers over 14 years old was 17.28% (108/625) who engaged in contact with sheep (selling, slaughtering, fur processing and aquaculture), and the prevalence of villagers aged over 14 not engaged in sheep work Was 0.30% (15/5 065) (RR = 58.349, 95% CI: 34.220-99.492). The RR (95% CI) of the incidence of brucellosis in live sheep trafficking, slaughtering activities, fur processing and sheep breeding were 84.417 (45.925-155.172), 80.604 (45.209-143.713), 43.414 (23.450-80.374) and 40.098 20.757 ~ 77.459). In the contact with sheep, 5.13% (8/156) of the cases wearing masks, 21.15% (33/156) wearing wool gloves. Conclusion This incident may be caused by an outbreak of human brucellosis caused by the lack of effective protection for contacts exposed to imported sheep due to imported live sheep. It is proposed that multiple provinces and multi-sectoral joint prevention and control be provided to ensure that sheep’s output, input and transactions are conducted under the guidance of animal health and quarantine. In addition, there is a need to step up publicity and education on the knowledge of disease control.