严重急性呼吸综合征家庭内传播特点及影响因素的研究

Transmission of Severe Acute Respiratory Syndrome in Families

目的了解严重急性呼吸综合征(SARS)在家庭内传播的特点,分析影响其家庭内传播的可能因素,为制定相应的防控策略和措施提供科学依据。方法于2004年在北京市西城区和海淀区进行病例对照调查。以1户有2例或2例以上SARS病例的家庭为病例组,以1户只有1例SARS病例的家庭为对照组,使用自制问卷,比较病例组与对照组的差异,包括病例及其家庭成员的基本情况、病例及其家庭成员之间的关系、接触时间、接触频率、接触方式,接触者发病情况(发病数、发病时间),以及家庭经济状况、卫生习惯、家庭成员易患性等。结果对照组与病例组的家庭人均居住面积差异无统计学意义(t=0.82,P=0.41)。病例组家庭内共同居住人数多于2人和3人的比例(38.89%和35.71%)高于对照组(30.43%和26.09%),但差异均无统计学意义。出现发热症状时,病例组有83.93%的人担心自己得了SARS,而对照组仅有16.07%,差异有统计学意义,但立即去医院就诊的比例2组的差异无统计学意义。对照组中有15.38%的患者认为不需要去医院,显著高于病例组的2.38%(P<0.05)。病例组或对照组的患者均有约90%认为是在医院感染SARS的,病例组中有10.71%的患者认为是在家庭内感染SARS的,显著高于对照组8.51%(P<0.05)。对照组有40.43%、病例组仅有21.82%的患者在发热后对居室进行消毒,对照组中44.68%的患者在发热后不再与家人共用餐具,而病例组中仅25.45%的患者这样做,差异有统计学意义(P<0.05)。本研究未显示避免与他人交往、与他人交谈时戴口罩、不与他人一起进餐3项措施的作用,也未显示中药及一些免疫增强剂对预防家庭内传播有作用。结论同家、同室居住人口少可减少SARS传播的机会,出现发热症状后及时采取隔离、消毒措施,有利于减少SARS家庭内传播。未见中药及一些免疫增强剂对预防家庭内传播有明显作用。

Objective To explore understand the characteristics of transmission of severe acute respiratory syndrome （SARS）, analyze the possible factors of influencing transmission in families and to provide scientific evidence for formulating strategies of SARS prevention and control. Methods A case-control study was conducted in Xicheng District and Haidian District of Beijing in 2004. The case was defined as a household with two or more cases of SARS and control was defined as that with only one case. All the patients were interviewed with an ad hoc questionnaire, to compare the difference of factors that influenced transmission of SARS in families, including demographic data, exposure information（time, frequency and mode）, occurrence of SARS in contacts （number and time of onset）, economic status, hygenic behavior, and so forth. Results There was no significant difference in living space between 56 cases and 47 controls（ t = 0.82, P = 0.41）. Proportion of families with more than three members living together was 35.71% in cases, higher than that in controls（26.09% ）, and proportion of families with more than two members living in a room was 38.89% in cases, also higher than that in controls（30.43% ）, but no statistical significance between the case and control. After onset of fever, 83.93 % of the patients worried about whether they suffered from SARS in cases, significantly higher than that of 16.07% in controls（P〈0.05）. More than 80% of the patients would visit hospital when they had fever. About 90% of the patients thought they infected SARS from hospitals both in cases and controls, and 10.71% of them infected from families in cases and 8.51% in controls（ P 〈 0.05）. Room disinfection was carried out in 40.43 % of the families with the patients after occurrence of fever in cases, but only 21.82% in controls, and tableware were not shared in among family members in 44.68 % of controls, but only 25.45 % in cases（ P 〈 0.05）. No effects of wearing gauze masks while communicating with others, no dining with others together, as well as taking traditional Chinese herbal medicine and immune-enhancing agents on prevention of SARS transmission were found in this study. Concision Less persons living together in a family or in a room can reduce SARS transmission in families. Self-isolation and disinfection are beneficial to reduction of SARS transmission in families after occurrence of fever. No evidence showed that traditional Chinese herbal medicine and some immune-enhancing agents can significantly prevent transmission of SARS in families.