论文部分内容阅读
目的:查明一起农村学校胃肠炎暴发疫情的病因和危险因子,提出针对性的防控措施。方法:建立病例定义,主动搜索符合病例定义的患者进行调查,采用描述流行病学方法,描述该次暴发疫情的流行病学特征;采用病例对照研究,分析本次暴发疫情的危险因子;采集病例、食堂员工、留样食品、直饮水、餐具和砧板物表等标本开展病原学检测。结果:该次暴发疫情的罹患率为8.96%(43/480),75%(9/12)的班级有病例发生;病例对照研究显示,3月9日凉拌黄瓜与患病存在统计学关联[χ2值=18.5,P值=0.00,OR值(OR值95%CI)=11.37(2.93,51.57)],凉拌黄瓜的食用剂量和患病存在剂量反应关系(trendχ2值=11.51,P=0.00);有10份标本(8份学生、厨师和老师各1份)病毒核酸结果为诺如病毒Ⅱ型阳性。结论:该次暴发疫情的可疑食品为隐性感染的厨师制作的凉拌黄瓜,同时存在学生间密切接触或者患者呕吐物和排泄物形成气溶胶等传播方式引起疫情的拖尾现象,疫情的病原学因子确认为诺如病毒Ⅱ型,采取厨师调离工作岗位,病例及其呕吐物或排泄物的科学管理和环境消毒等针对性措施后,疫情很快终止。
Objective: To identify the etiology and risk factors of outbreaks of gastroenteritis in rural schools and put forward targeted prevention and control measures. Methods: To establish the definition of the case, to actively search for the patients who meet the definition of the case to conduct the investigation, to describe the epidemiological characteristics of the outbreak by using the description of epidemiological methods, to analyze the risk factors of this outbreak by case-control study, to collect the cases , Canteens staff, leave samples of food, drinking water, tableware and chopping board specimens and other specimens for etiological testing. Results: The attack rate of the outbreak was 8.96% (43/480) and 75% (9/12) of the cases were found. Case-control studies showed that there was a statistical correlation between cold cucumber and illness on March 9 [ (χ2 = 18.5, P = 0.00, OR = 95% CI = 11.37 (2.93,51.57)]. There was dose-response relationship between food consumption and illness in cucumber (trendχ2 = 11.51, P = 0.00) ; 10 samples (8 copies of students, 1 chef and teacher) The results of the virus nucleic acid Norovirus type Ⅱ positive. Conclusions: The suspicious food in this outbreak was cold cucumber made by the chef with hidden infection. At the same time, there was smear phenomenon caused by close contact among students or aerosol spread of vomit and excrement in patients. The epidemic etiology The factor was confirmed as Norovirus type II, and the outbreak was quickly terminated after taking targeted measures such as the chef’s removal of jobs, scientific management of cases and their vomitus or excrement, and environmental disinfection.