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目的了解湖南省O139群霍乱的流行特点,分析流行因素,探索快速有效的监测评估方法和预防控制措施,为制定科学的防控策略提供依据。方法采用回顾性队列研究、生态学研究和现场流行病学调查研究湖南省O139霍乱的流行特点和高发区的流行因素;评估农村集体聚餐卫生指导和管理预防控制措施的效果。分别采用膜免疫层析法和常规细菌分离培养法对腹泻病人及霍乱病人的密切接触者粪便标本进行O139霍乱弧菌检测,以后者为金标准,计算膜免疫层析法的灵敏度和特异度。结果湖南省1997-2009年共发生48起O139霍乱疫情,报告病例103例,带菌者119例,死亡2例,病死率为1.94%。在局部地区有集中发生趋势。2002-2009年常规监测腹泻病人阳性率为2.47/万,水产品样阳性率为0.57%,疫点监测检测人群阳性率为1.18%,外环境阳性率为3.44%;非疫点地区水体环境中未检测到霍乱弧菌。48起疫情中暴发16起,散发32起,28起疫情与农村集体聚餐有关。2003年9起暴发疫情中参与聚餐人员的O139霍乱弧菌感染率为5.46%,食用聚餐剩菜人员的感染率为9.23%,未食用聚餐食物人员的感染率为0,病人和带菌者分离到的O139霍乱弧菌和甲鱼中菌株的PFGE图谱相同。高发区农村聚餐中使用甲鱼和食品制作生熟不分的比率、人均甲鱼消耗量、甲鱼中O139霍乱弧菌检出率均高于低发区。高发区采取农村集体聚餐卫生指导和管理措施后,农村厨师和就餐人群的卫生习惯改善,未再发现疫情。膜免疫层析法检测病例粪便标本中灵敏度为100%,特异度为95.20%,45份实验室霍乱弧菌培养阳性的甲鱼和外环境标本经二次增菌培养,试纸条检测结果为阴性。结论湖南省1997-2009年的O139霍乱疫情呈低流行水平;O139霍乱疫情的发生主要跟食用被霍乱弧菌污染的水产品特别是甲鱼有关,以农村集体聚餐卫生指导和管理为主的综合性预防控制措施是预防O139霍乱疫情发生的有效措施;膜免疫层析法可适用于各医疗机构的腹泻病门诊患者的快速筛查和评估。
Objective To understand the epidemiological characteristics of cholera in O139 population in Hunan Province, analyze epidemic factors, explore rapid and effective monitoring and evaluation methods and prevention and control measures, and provide basis for formulating scientific prevention and control strategies. Methods The retrospective cohort study, ecological study and field epidemiological investigation were conducted to study the epidemiological characteristics of cholera O139 in Hunan Province and epidemiological factors of high incidence area. The effectiveness of rural collective meal health guidance and management of prevention and control measures were evaluated. Membrane immunochromatography and routine bacterial isolation and culture methods were used to detect Vibrio cholerae O139 in diarrhea patients and in close contact with cholera patients. The latter was the gold standard, and the sensitivity and specificity of membrane immunochromatography were calculated. Results A total of 48 epidemics of O139 cholera occurred in Hunan Province during 1997-2009. Of the 103 reported cases, 119 were carriers and 2 died, with a mortality rate of 1.94%. In some areas there is a concentrated trend. The positive rate of routine monitoring of diarrhea in 2002-2009 was 2.47 per thousand, the positive rate of aquatic samples was 0.57%, the positive rate of epidemic monitoring and detection was 1.18% and the positive rate of external environment was 3.44%. In non-epidemic areas, Vibrio cholerae was not detected. Outbreak of 48 outbreaks in 16, distributed 32, 28 outbreaks and rural collective dinner. The prevalence of Vibrio cholera O 139 outbreaks among the 9 outbreaks in 2003 was 5.46% for those who engaged in meals, 9.23% for those who consumed food leftovers, 0 for non-food meal users, and for patients and carriers The isolates of V. cholerae O139 and turtle strains had the same PFGE pattern. High incidence of rural dinners in the use of soft-shelled turtle and food production ratio, per capita consumption of soft-shelled turtle, turtle O139 Vibrio cholera detection rate were higher than the low-incidence areas. After the high-risk areas adopted the health guidance and management measures of rural collective dinners, the hygiene habits of rural chefs and dining people improved and no further outbreaks were found. Membrane immunochromatographic detection of cases of stool specimens with a sensitivity of 100%, a specificity of 95.20%, 45 laboratory Vibrio cholerae positive culture turtle and external environment specimens by the second enrichment culture, test strip test results were negative . Conclusions The epidemic situation of O139 cholera was low in 1997-2009 in Hunan Province. The incidence of cholera O139 was mainly related to the consumption of aquatic products polluted by Vibrio cholerae, especially turtle, and the overall guidance and management of rural collective meals Prevention and control measures are effective measures to prevent the outbreak of cholera O139. Membrane immunochromatography can be applied to the rapid screening and assessment of outpatients with diarrheal diseases in various medical institutions.