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目的调查一起小学群体性胃肠炎暴发疫情,查明病原及传播途径,为采取有效控制措施提供依据。方法采用现场流行病学方法对疫情作描述性分析,并对患者及外环境标本进行可疑病原检测。结果该校累计发病104例(临床诊断90例,实验室确诊14例),其中学生102例,罹患率为5.74%。6年级学生罹患率29.00%明显高于1~5年级学生罹患率1.59%(P<0.01)。首例病例为食堂配餐的厨工陈某,在本次暴发的早期病例中,食用由其配餐的6年级学生的罹患率明显高于其他年级学生(RR=44.88,P<0.01)。病例以呕吐发生的比例最高达89.42%,符合诺如病毒感染的临床特征。采集81份样品进行病原检测,其中4份呕吐物及10份肛拭子样本采用RT-PCR法检出诺如病毒核酸阳性。结论本次疫情由受诺如病毒感染厨工污染的食物及餐具引起,继而通过接触、气溶胶传播途径进一步扩散暴发。
Objective To investigate the outbreak of gastroenteritis outbreak in primary school, identify the pathogen and transmission route, and provide basis for effective control measures. Methods Epidemiological methods were used to make descriptive analysis of epidemic situation and to detect suspicious pathogens in patients and external environment specimens. Results The cumulative incidence of the school 104 cases (90 cases of clinical diagnosis, laboratory confirmed 14 cases), of which 102 cases of students, the attack rate was 5.74%. The attack rate of 6th grade students was 29.00%, which was significantly higher than that of 1 ~ 5 students (1.59%, P <0.01). Chen, the first chef in the canteen, was found to have a significantly higher attack rate than the other grade 6 students in the early cases of this outbreak (RR = 44.88, P <0.01). The incidence of vomiting cases up to 89.42%, in line with the clinical features of norovirus infection. 81 samples were collected for pathogen detection, of which 4 vomit samples and 10 samples of anal swabs were detected by Norovirus RT-PCR. Conclusion The outbreak was caused by contaminated food and tableware contaminated by Norovirus virus and further spread through outbreaks of exposure and aerosol transmission.