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目的调查重庆市某幼儿园儿童双下肢紫癜的主要原因,提出防控建议。方法通过随访病例和幼儿园老师,收集园内环境、饮食及饮水等信息,采集病例标本进行实验室检测。采用回顾性队列研究寻找事件原因。结果共搜索到117例儿童病例,罹患率30.8%(117/380)。病例均为该幼儿园儿童。主要临床表现为双下肢皮肤紫癜117例(100%),3例(2.6%)伴鼻衄,2例(1.7%)伴牙龈出血。病例用维生素K治疗有效。有93.3%(14/15)病例的血或尿标本检出抗凝血类杀鼠剂(溴敌隆、溴鼠灵)。卫生学调查采集的食品等标本均未检出抗凝血类杀鼠剂。计算每天在校和缺勤儿童罹患率和相对危险度(RR),提示3月28日可能为共同暴露日期,且暴露地点在学校。结论此事件为一起群体性双下肢紫癜暴发,系一起抗凝血类杀鼠剂(溴鼠灵和溴敌隆)引起的中毒事件。
Objective To investigate the main causes of purpura in both kyphoses in a nursery school in Chongqing and put forward prevention and control suggestions. Methods Follow-up cases and kindergarten teachers collected environmental information, drinking water and other information in the park. Samples were collected for laboratory testing. Retrospective cohort study was used to find the cause of the event. Results A total of 117 cases of children were searched, the attack rate was 30.8% (117/380). The cases were all kindergarten children. The main clinical manifestations were 117 cases (100%) of both lower extremity skin purpura, 3 cases (2.6%) with epistaxis and 2 cases (1.7%) with bleeding gums. Cases treated with vitamin K effective. There were 93.3% (14/15) cases of blood or urine samples detected anticoagulant rodenticides (bromadiolone, bromogalazine). Hygienic survey collected food and other specimens were not detected anticoagulant rodenticides. Calculate the prevalence and relative risk (RR) of daily and absent school children, suggesting that there may be a date of co-exposure on March 28 with exposure to school. Conclusions This event is an outbreak of a group of double-limb purpura, a poisoning event caused by an anticoagulant rodenticide (brodifacoum and bromadiolone).