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目的:调查和分析浙江省某中学一起急性胃肠炎暴发疫情的病原和危险因素,为采取针对性的防控措施提供科学依据。方法:制定病例定义,运用描述性和分析性流行病学方法对该起疫情进行流行特征和危险因素分析,采集留样食品、直饮水、桶装水、井水、案板餐具涂抹物和病例肛拭子标本进行诺如病毒核酸检测,直饮水、桶装水、井水和案板餐具涂抹物标本同时进行细菌总数和大肠菌群的卫生学检测。结果该起疫情首发病例发病时间为1月22日,末例病例发病时间为2月10日,累计报告病例233例,罹患率为13.67%(233/1705)。病例对照结果显示,学生食堂用餐每日≥2次(χ~2=12.46,P=0.00)和发病前看到过别人呕吐物(χ~2=13.14,P=0.00)是导致本次疫情的可能危险因素;饭前便后洗手(χ~2=23.57,P=0.00)是导致本次疫情的保护因素。23例患者的肛拭子标本中有10份检测出诺如病毒GⅡ型阳性,标本的卫生学指标均正常。结论:该起事件是由于GⅡ型诺如病毒引起的急性胃肠炎暴发疫情,学生食堂餐具和患者呕吐物的暴露可能是本次暴发疫情的主要危险因素。
Objective: To investigate and analyze the pathogens and risk factors associated with an outbreak of acute gastroenteritis in a middle school in Zhejiang Province, and provide a scientific basis for taking targeted prevention and control measures. Methods: The definition of the case, the use of descriptive and analytical epidemiological methods to epidemic characteristics of epidemic and risk factors analysis, collecting samples of food, drinking water, bottled water, well water, chopsticks spreads and cases anal Swab specimens for Norovirus nucleic acid testing, direct drinking water, bottled water, well water and chopping board smear specimens at the same time the total number of bacteria and coliform bacteria hygiene testing. Results The onset time of onset of this outbreak was January 22, and the last case onset time was February 10, a total of 233 reported cases, the attack rate was 13.67% (233/1705). The results of case-control study showed that students canteens more than 2 times a day (χ ~ 2 = 12.46, P = 0.00), and vomit (χ ~ 2 = 13.14, P = 0.00) Possible risk factors; Wash hands before and after meals (χ ~ 2 = 23.57, P = 0.00) were the protective factors of this epidemic. Twenty-three of the 23 patients with anal swabs tested positive for norovirus G-II, and the hygiene indicators were normal. Conclusion: The incident was caused by the outbreak of acute gastroenteritis caused by norovirus Ⅱ G. The exposure of student canteen utensils and vomit of patients may be the main risk factors of this outbreak.