论文部分内容阅读
目的调查上海市浦东新区某中学多名学生出现急性胃肠炎症状事件的影响因素。方法制定病例定义,现场病例搜索,设计调查问卷进行现场调查,重点询问病例的饮食、饮水史和日常生活习惯,选择流行高峰期发病的病例开展1∶2病例对照研究,数据采用COX比例风险分层回归模型进行拟合。现场采集病例、环节和饮用水标本,进行细菌培养和实时荧光聚合酶链式反应(real-time polymerase chain reaction,real-time PCR)检测。结果该校学生罹患率为5.57%(93/1 671),教职员工罹患率为0.60%(1/168)。病例症状以腹痛、呕吐和腹泻为主。直饮水与厕所距离较近,部分学生有用手或嘴直接接触直饮水龙头饮水的习惯。水样和环节样本病原学检测结果均为阴性。79.63%的病例和38.89%的对照曾经饮用过学校楼道内的直饮水(Ⅹ2=22.51,P<0.001,OR=6.75)。结论结合现场调查和病例对照研究结果,怀疑本次事件可能是一起与直饮水行为有关的杯状病毒胃肠炎暴发,病原体可能通过接触传播。建议学校加强健康教育和监督,改造直饮水装置,定期进行水质检测。
Objective To investigate the influencing factors of acute gastroenteritis in more than one student in a middle school in Pudong New Area, Shanghai. Methods A case-definition, field case search and design questionnaire were conducted to investigate the case-based diet, history of drinking water and daily life habit. The case-control study was conducted to select the patients with peak incidence of epidemic disease. The data were analyzed by COX proportional hazard score Layer regression model to fit. The cases, links and samples of drinking water were collected on the spot for bacterial culture and real-time PCR (real-time PCR). The results of the school attack rate was 5.57% (93/1 671), staff incidence of 0.60% (1/168). Case symptoms are abdominal pain, vomiting and diarrhea. Direct drinking water and toilets close, some students have hands or mouth direct contact with drinking water faucet drinking habits. The etiological test results of water samples and sample samples were negative. 79.63% of cases and 38.89% of controls had consumed drinking water in the school corridor (Ⅹ 2 = 22.51, P <0.001, OR = 6.75). Conclusion Based on the results of field investigation and case control study, we suspect that this incident may be an outbreak of cup virus gastroenteritis associated with drinking water behavior. The pathogens may spread through contact. It is suggested that schools should strengthen health education and supervision, reform direct drinking water installations and regularly conduct water quality testing.