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目的查明学校胃肠炎暴发的原因,为今后预防和控制该类事件的发生和处理提供参考。方法制定病例定义,开展病例搜索,采集可疑食物、学生饮用水和病例标本进行实验室检测。同时采用病例对照研究的方法,分析学生饮用水情况。针对水源井污染的原因开展相关卫生学调查。结果共63例病例,临床表现为腹痛(93.7%)、腹泻(88.9%)、发热(76.2%)等症状。病例全部为学生,学生罹患率为9.7%,无班级聚集性。63例病例和27名对照的病例对照研究,病例90.5%饮用生水,对照仅为55.6%(OR=7.6,95%CI=2.4~23.6)。学校水源水、末梢水和病人的粪便中均检出侵袭性致泻大肠埃希氏菌,血清型均为O136∶K78。学校水源井离厕所较近,存在污染可能。5月2日学校开学,停止供应井水后,无新发病例。结论本次暴发可能是由于侵袭性致泻大肠埃希氏菌污染水源井,学生饮用被污染的生水导致。建议加强生活饮用水管理,按照国家要求选择水源地,做好旱厕、化粪池等防渗漏处理,在为学生提供开水的同时,教育学生不要饮用生水。
Objective To identify the causes of gastroenteritis outbreak in schools and provide reference for the prevention and control of the occurrence and treatment of such incidents in the future. Methods To define the case, carry out case search, collect suspicious food, drinking water and case specimens for laboratory testing. At the same time, the method of case-control study was used to analyze the drinking water condition of students. Relevant hygiene investigation is carried out for the reason of water source pollution. Results A total of 63 cases, the clinical manifestations of abdominal pain (93.7%), diarrhea (88.9%), fever (76.2%) and other symptoms. All cases were students, the student attack rate of 9.7%, no class aggregation. A case-control study of 63 patients and 27 controls showed that 90.5% of the patients were drinking raw water, compared with only 55.6% (OR = 7.6, 95% CI = 2.4-23.6). Invasive diarrhea-causing Escherichia coli were detected in school water, peripheral water and patient’s feces. The serotypes were O136: K78. School water wells close to the toilet, there may be pollution. On May 2, when the school started to stop supplying well water, no new cases were found. Conclusion This outbreak may be caused by invasive diarrhea Escherichia coli contaminated water wells and students drinking polluted raw water. Suggestions to strengthen the management of drinking water, water sources in accordance with national requirements, good aquaculture, septic tanks and other anti-seepage treatment, to provide students with boiled water at the same time, educate students not to drink raw water.