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目的查明引起暴发的病原、传染来源、传播途径和相关危险因素,为有效防控疫情提供科学依据。方法调查的病例定义为:2012年6月11日以来,某公司职工中出现发热并伴有头痛、乏力、尿频、全身酸痛等症状之一者。通过询问该工厂负责人和周边的医疗机构等方式开展病例搜索,按照病例定义对搜集到的病例逐一核实。采用统一的个案调查表,对病例进行个案调查,包括一般情况、发病及就诊情况、主要临床症状及体征、可疑接触史等,并将病例信息汇总。结果该公司2天内累计出现20例病例,发病时间集中在6月13日19~20时,年龄最大43岁,最小24岁,平均36岁。全部是传感器焊接车间职工,另一半开放式大车间工作人员未发现类似症状病例,传感器焊接车间职工罹患率为100%,全厂罹患率为44%。传感器焊接车间曾于6月13日13时—17时30分使用未清洗的空气加湿器。实验室对5例病例的血液、咽拭子、尿液标本及传感器车间加湿器排污口水标本、进水口水标本、加湿器管道涂抹标本和空调冷凝水表标本、空调出风口和滤网涂抹标本进行检测,其中加湿器排污口水标本PCR方法检测结果显示军团菌属5SrRNA阳性,1份血液标本嗜肺军团菌抗体阳性。结论可能为一起车间内军团菌病暴发,由军团菌感染引起。可能的感染来源为加湿器内被军团菌污染的水,车间内空气密闭,工人工作时未戴口罩及长时间暴露可能是引起此次暴发的危险因素。
Objective To identify the etiological agents, sources of infection, transmission routes and related risk factors that cause the outbreak, and provide a scientific basis for effective prevention and control of the outbreak. Methodological survey of the case is defined as: June 11, 2012, a company workers with fever and accompanied by headache, fatigue, frequent urination, body soreness and other symptoms. By asking the factory manager and the surrounding medical institutions and other ways to carry out case search, according to the case definition of the collected cases verified one by one. Using a single case questionnaire, case-by-case investigations, including general conditions, incidence and treatment, the main clinical symptoms and signs, suspicious exposure history, and the case information summary. Results The company accumulated 20 cases within 2 days, the onset time concentrated on June 13, 19 to 20, the oldest 43 years old, minimum 24 years old, average 36 years old. All the workers in the sensor welding workshop, the other half of the open large workshop staff did not find similar symptoms cases, the sensor welding workshop workers attack rate was 100%, the plant attack rate was 44%. The sensor welding workshop used an unclean air humidifier at 13:00 - 17:30 on June 13. Laboratory samples of 5 cases of blood, throat swabs, urine samples and sensor shop humidifier sewage outfall specimens, water samples, humidifier pipe smear specimens and air conditioning condensate water samples, air conditioning outlet and filter smear specimens Detection, of which humidifier sewage samples stained by PCR test results showed that Legionella 5SrRNA positive, a blood sample of Legionella pneumophila antibody-positive. The conclusion could be that an outbreak of Legionnaires’ disease in a workshop is caused by Legionella infection. Possible source of infection is water contaminated with legionella in the humidifier. The air in the workshop is airtight. Workers who work without a mask and prolonged exposure may be the risk factors for the outbreak.