某初级中学2009-2014年甲型副伤寒疫情流行病学调查

发布时间：2018-05-04 12:37

本文选题：沙门菌 + 甲型副伤寒　；参考：《中国学校卫生》2017年05期

【摘要】：目的了解宣恩县某初级中学2009—2014年间3次甲型副伤寒暴发疫情的原因,为从源头减少学校副伤寒疫情的发生提供依据。方法采用病例对照研究方法,对病例的活动、饮水、饮食和接触史等开展流行病学调查,比较宣恩县副伤寒历史发病的流行病学特点和3次暴发疫情中病例临床治疗与转归情况,进行实验室证据询证调查。结果该校2009,2013,2014年3次暴发疫情的罹患率分别为2.65%,2.76%,2.25%,无重症及死亡病例。监测集中式供水的75份水源水、末梢水及简易自流水、井水、桶装水,仅3份桶装水符合卫生标准,其余均显示细菌学超标,但均未检出沙门菌、志贺菌、大肠杆菌O157。68份校内外环境及病例家庭外环境标本、学生食堂1周的食品留样70份、校内外79名食品餐饮从业人员及21名病例家属的血培养、肛拭培养均未检出沙门菌及志贺菌。随机抽取健康教师18人、健康学生117人进行监测,学生中有3人血培养检出甲型副伤寒杆菌,10人血清肥达试验显示异常。2014年疫情发病的有7例系该校2013年暴发疫情时发生的病例,2009,2013年疫情中病例在住院期间抗生素平均治疗时间为8 d,均没有达到规范治疗时间,且出院时均未按规范要求进行粪便培养。病例对照研究显示,与既往病例同班级、同桌、同宿舍、为好友等接触是危险因素(P值均0.05)。对2009—2014年分离出的38份甲型副伤寒菌株进行溯源分析,显示高度同源。结论该校连续发生的暴发疫情主要是既往病人治疗不彻底,学校传染源发现不及时,致使传染源在校内积累,在适宜条件下引起疫情暴发。学校应加强传染病监测、发现、报告与管理机制,落实传染病的监测预警机制。
[Abstract]:Objective to understand the causes of three outbreaks of paratyphoid A in a junior middle school in Xuanen County from 2009 to 2014, and to provide a basis for reducing the incidence of paratyphoid fever in schools at the source. Methods A case-control study was conducted to investigate the activities, drinking water, diet and exposure history of the patients. The epidemiological characteristics of paratyphoid fever in Xuanen County and the clinical treatment and outcome of three outbreaks were compared. Results the attack rates of the three outbreaks in 2009 / 2013 and 2014 were 2.65 and 2.76, respectively. There were no severe cases and no death cases. 75 parts of source water, peripheral water and simple self-flowing water, well water, barreled water, only 3 bottled water met the hygienic standard, and the rest showed bacteriology exceeded the standard, but no salmonella and Shigella were detected in all of the 75 parts of source water, end water and simple self-flowing water, well water and barrelled water. Escherichia coli O157.68 samples were collected from school environment and family environment, 70 samples of food samples were collected from students' canteen for one week, 79 food and catering workers and 21 family members of the cases were cultured in blood, and no Salmonella and Shigella were detected in anal swab culture. 18 health teachers and 117 healthy students were randomly selected for monitoring. Three of the students were detected by blood culture and 10 of them were tested for paratyphoid A, the serum Weda test showed abnormal results. In 2014, 7 cases of the disease occurred in the school during the 2013 outbreak, which occurred in 2009, and antibiotics occurred in the hospital in 2013. The average treatment time was 8 days, and none of them reached the standard treatment time. The stool culture was not carried out according to the standard requirement when discharged from hospital. Case-control study showed that contact with the same class, same table, same dormitory and good friend were all the risk factors (P = 0.05). A retrospective analysis of 38 paratyphoid A strains isolated from 2009-2014 showed high homology. Conclusion the main causes of the continuous outbreak in the school are the incomplete treatment of previous patients and the untimely discovery of the source of infection in the school, which leads to the accumulation of the source of infection in the school and the outbreak of the outbreak under suitable conditions. Schools should strengthen infectious disease surveillance, detection, reporting and management mechanism, and implement the monitoring and warning mechanism of infectious diseases.
【作者单位】：湖北省宣恩县疾病预防控制中心;宣恩县人民医院;
【分类号】：R181.3;R516.3

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