医院内诺如病毒性急性胃肠炎暴发的流行病学与临床特点分析

Epidemiological and clinical characteristics of norovirus gastroenteritis in hospital

目的通过对我院急性胃肠炎聚集病例的调查，了解诺如病毒性急性胃肠炎流行及临床特点。方法调查与分析我院2006年冬季（2006年11月28日-2006年12月24日）聚集发生的急性胃肠炎的临床表现和流行特点，采用PCR法检测患者便标本诺如病毒核酸和免疫印迹法查血清抗体。结果本次流行的急性胃肠炎患者共87例，中老年人发病占大多数，主要临床特点为腹泻、呕吐、腹痛等，大便细菌培养阴性。用PCR法检测20例患者大便标本，其中12例诺如病毒呈阳性。检测24例患者血标本，19例诺如病毒抗体阳性。结论 证实2006年我院发生的急性胃肠炎是诺如病毒性急性胃肠炎医院感染的暴发流行，潜伏期24—48h，多表现为腹泻、呕吐等非细菌性胃肠炎．在医院中该病传染性极强，冬季好发，中老年人易感，饮食、接触污染物表面及人与人密切接触等是主要的传播方式。提高对该病的认识、及时识别对治疗与控制具有萤要意义。

Objective To study the epidemiological and clinical characteristics of norovirus gastroenteritis outbreak in hospital by investigating cases of norovirus gastrocnteritis in our hospital. Methods Epidemiological and clinical characteristics of the cases of acute gastroenteritis in our hospital from November 28 to December 24, 2006 were investigated and analyzed. Faecal specimens were examined for norovirus by polymerase chain reaction-reverse transcription （RT-PCR） and blood by western-blot. Results Among 87 patients with norovirus gastroenteritis in our hospital, the elderly inpatients were susceptible population. The most frequently observed clinical symptoms were diarrhea （ 100% ）, vomiting （ 35.6% ） , fever （ 11.5% ） , abdominal pain （ 23.0% ） , and headache （ 10.3% ） . Bacterial cultures were negative in faecal samples, but 12 （60%） of 20 stool specimens were positive by RT-PCR for norovirus, 19 were positive for norovirus by western-blot in 24 blood samples. Conclusions The acute gastroenteritis outbreak has been confirmed as a nosocomial norovirus gastroenteritis one in hospital, which has an incubation period of 24 to 48 hours, and the symptoms of acute nonbacterial gastroenteritis such as diarrhea and vomiting. With a high infectivity in hospital, it is most likely to occur in the middle-aged and the elderly in winter, and is transmitted by food, the touch of the surfaces of infected articles and person-to-person contact. Therefore, it is a must to improve the knowledge of this disease and to differentiate it timely in the treatment and control.