一起腺病毒感染院内暴发的流行病学调查

An adenovirus outbreak in hospital: An epidemiology study

目的探讨一起急性呼吸道感染暴发的流行特征、病因及应急处置策略。方法 2014年1月27日我院收治1例由武汉来京探亲的发热患者,1周后与之有密切接触的患者和医护人员均出现不同程度发热。我们对53例密切接触此患者的人群采集咽拭子,分别行甲型流感病毒和腺病毒核酸检测,对检测结果阳性者进行隔离观察或治疗。在隔离初期及解除隔离前,取双份血清标本进行呼吸道9种病原体IgM抗体测定,同时对所有感染病例进行现场调查,记录流行特征、临床症状。依据检测结果制定并实施防控措施。结果 53例密切接触者中,腺病毒核酸检测阳性者17例,发病8例,死亡1例,重症1例,轻症6例,隔离观察9例。发病者均与首发病例有密切接触史,临床以发热、咽痛为主,伴咽部充血、咽后壁淋巴滤泡增生,合并肺炎者均有不同程度胸闷、呼吸困难。CT检查发现肺部炎症3例,肺实变2例,胸腔积液2例。实验室检测均为腺病毒(7型)感染。结论腺病毒感染以呼吸道症状为主,诊断需经核酸检测,隔离可有效控制疫情传播。

Objective To probe the characteristics and pathogenesis of an acute respiratory tract infection and its corresponding emergency control strategy. Methods A visitor from Wuhan with fever was consulted in our emergency department of 309th hospital in January 27th, 2014, one week later all the close contact with the first attacker suffered from different degree of fever. All the fifty-three sufferers with close contact were performed DNA detection of type A influenza virus and adenovirus with PCR by collecting pharyngeal specimen, those patients with positive results were given isolation and treatment. At the beginning of isolation and isolation withdrawing, IgM antibody of nine kinds of pathogens of respiratory tract were measured. Simultaneously, every case of sufferer was investigated by epidemiological questionnaire to describe the epidemiological characteristics and clinical symptoms, and a series of intervention measures were adopted in those patients. Results Of the 53 sufferers with close contact, 17 patients showed adenovirus DNA positive detection, 8 patients with significant clinical symptoms, 1 patient dead, 1 patient with severe clinical manifestation, 6 patients with slight clinical symptoms, and the other nine sufferers with close contact were isolated. All sufferers who had close contact with the first attacker had clinical symptoms mainly including fever, sore throat, pharyngeal hyperemia and hyperplasia of lymphoid follicles in pharynx posterior wall, sever patients with pneumonia showed dyspnea and chest stuffy. CT examination showed pulmonary inflammation in three patients, lung consolidation in two patients and pleural effusion in two cases, which were adenovirus type 7 infection by laboratory examination. Conclusion Adenovirus infection mainly manifests in respiratory symptoms, its diagnosis must be confirmed by DNA detection, and isolation can control its outbreak effectively.