一起医院内急性出血性结膜炎暴发的现场流行病学调查

Field epidemiological investigation on an outbreak of acute hemorrhagic conjunctivitis in a hospital

目的调查深圳市S医院疑似急性出血性结膜炎暴发的危险传播因素,为及时控制疫情提供科学依据。方法按照病例定义开展病例搜索,描述疾病三间分布,结合现场流行病学调查方法,形成假设,采用病例对照研究,比较病例组与对照组之间使用科室公用厕所、使用公用水龙头洗脸或洗手、揉眼习惯等可能危险因素差异。结果 2011年6月7—15日,S医院共发现急性出血性结膜炎病例11例,所有病例均发生在W科住院部,罹患率为6.01%(11/183)。主要临床表现为眼部结膜充血(100.00%)、刺痛(81.82%)、异物感(72.73%)等。病程中位数为6 d(范围:3～11 d),无并发症发生。住走廊床位的患者罹患率为13.24%(9/68),明显高于住病房内患者的罹患率2.70%(2/74),差异有统计学意义(χ2=5.50,P=0.02)。"使用公用厕所"(OR=12.21,95% CI:1.28～288.33)、"使用公用洗手池"(OR=12.21,95% CI:1.28～288.33)和"揉眼睛"(OR=6.22,95% CI:1.08～39.96)是危险因素;对揉眼睛习惯"经常或有时"、"偶尔"、"从不"进行分析,发现发病风险随揉眼睛频次的增加而升高(Liner trend χ2=5.54,P=0.02)。结论结合病例临床表现和相关流行病学资料提示,这是一起急性出血性结膜炎暴发疫情。在短时间内无法改善硬件设施的情况下,建议S医院加强对公共厕所、水龙头等公共场所物体表面的消毒工作,教育患者不用手直接揉眼睛;同时建议政府进一步加大对医疗卫生机构病床建设的投入。

Objective To investigate the risk factors of transmission of suspected acute hemorrhagic conjunctivitis（AHC） in the S hospital of Shenzhen city,and provide a scientific basis for timely control of the epidemic.Methods Cases were searched according to the definition of AHC,and distribution of space,time and population were described;hypothesis were put forward based on field epidemiological investigation;case-control study was adopted to compare the difference in the possible risk factors between case and control groups.Results From June 7 to June 15,2011,11 AHC cases were found in W inpatient department of the S hospital.The attack rate was 6.01%（11/183）,and the major clinical manifestations were conjunctival congestion（100.00%）,tingling（81.82%）,and foreign body sensation（72.73%）.The median of disease course was 6 days（3-11days）.No complication was found.The attack rate of patients living in corridor beds was significantly higher than that of patients living inside the ward room（13.24% [9 / 68] vs 2.70% [2 / 74],χ^25.50,P=0.02）.Using a public toilet（OR=12.21,95% CI：1.28-288.33）,using a public lavatory（OR=12.21,95% CI：1.28-288.33） and rubbing eyes（OR=6.22,95% CI：1.08-39.96） were risk factors;analysis on habit of rubbing the eyes ＂often or sometimes＂,＂occasionally＂,＂never＂ showed that the risk of developing AHC increased with increasing frequency of rubbing eyes（Liner trend χ^25.54,P=0.02）.Conclusion Clinical manifestations and epidemiological data suggest that this is an outbreak of AHC.S hospital is suggested to strengthen disinfection of the public toilets,faucets and other public places,and patients are suggested not to rub eyes directly by hand;government are suggested to increase investment in the beds construction of medical and health institutions.