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目的调查一起学校诺如病毒腹泻暴发疫情的原因,为诺如病毒腹泻防控提供依据。方法采用描述性流行病学方法分析疫情的流行特征;应用病例对照研究发病的危险因素;采集学校自来水和配餐公司留样食品,采用生化鉴定和传统培养方法检测志贺菌等致病菌;采集患者、密切接触者和配餐公司工作人员的粪便、呕吐物、肛拭子标本,采用实时荧光定量PCR检测诺如病毒核酸。结果本次疫情共发病46例,罹患率4.69%(46/948)。临床表现主要以恶心(89.13%)、呕吐(84.78%)、腹痛(47.83%)、腹泻(34.78%)及发热(19.57%)为主,6份患者粪便检测出诺如病毒GⅡ.17型阳性,检出率为54.55%。首发病例于1月3日21时出现症状,发病高峰为1月8日,末例病例出现于1月13日9时10分。单因素分析显示与病例接触(OR=3.667,95%CI:1.688~7.963)是发病的危险因素,餐前便后洗手行为是发病的保护因素(OR=0.401,95%CI:0.194~0.827)。结论该起学校肠道传染病暴发是由诺如病毒GⅡ.17型引起,空气传播与密切接触传播为主要传播途径。经常开窗通风及勤洗手可有效预防和控制学校诺如病毒引起的传染病疫情。
Objective To investigate the causes of outbreaks of Norovirus virus diarrhea in schools and provide basis for prevention and control of Norovirus virus diarrhea. Methods Descriptive epidemiological methods were used to analyze the epidemiological characteristics of epidemic situation. The case-control study was conducted to study the risk factors of the outbreaks. School tap water and food samples from catering companies were collected. Biochemical identification and traditional culture methods were used to detect pathogens such as Shigella. The stool, vomitus and rectal swab specimens of patients, close contacts and catering company staff were tested for real-time PCR for detection of norovirus nucleic acids. Results The total outbreak of the epidemic 46 cases, the attack rate of 4.69% (46/948). The main clinical manifestations were nausea (89.13%), vomiting (84.78%), abdominal pain (47.83%), diarrhea (34.78%) and fever (19.57%). The norovirus GⅡ.17 positive , The detection rate was 54.55%. The first case occurred at 21:00 on January 3 symptoms, the peak incidence on January 8, the last case occurred at 9:10 on January 13. Univariate analysis showed that exposure to the patients (OR = 3.667, 95% CI: 1.688-7.963) was a risk factor for the onset of disease. Pre and post-natal handwashing was the protective factor (OR = 0.401, 95% CI: 0.194-0.827) . Conclusion The school outbreak of intestinal infectious diseases caused by Norovirus G Ⅱ.17 type, air and close contact with the spread of transmission as the main route of transmission. Frequent window ventilation and frequent hand washing can effectively prevent and control the epidemic of infectious diseases caused by norovirus in schools.