广东某市暴发的8起感染性腹泻调查分析

Epidemiological analysis on eight outbreaks of infectious diarrhea in Guangdong

目的通过对2015年1月发生在广东某市的8起感染性腹泻的调查和分析,为学校、工厂等集体单位制定相应的预防控制对策提供科学依据。方法对腹泻疫情进行流行病学分析,并采集食堂可疑食物留样、病例和食堂员工肛拭子等,应用细菌分离培养法和RT-PCR方法分别进行致病菌鉴定和病毒核酸检测。结果这8起疫情在时间上无明显相关性和聚集性,感染人群随机,但都暴发于人口相对集中并且是集中供餐的单位。感染者主要表现为腹泻、呕吐等消化道症状,大部分病情较轻。所有样本均未检出食物中毒常规致病菌,但是检出了诺如病毒和轮状病毒,其中用餐者肛拭子样本诺如病毒检出率为60.3%,厨师肛拭子样本诺如病毒检出率为80.0%,诺如病毒和轮状病毒混合感染检出率为2.4%。综合分析表明,携带病毒的厨师或食物为最大可能的传染源。结论在秋冬季,应提高从业人员腹泻病病原监测频率,加强食品安全监管力度,从而降低腹泻病疫情的暴发频率,保障人民身体健康。

Objective To provide scientific basis for the prevention of infectious diarrhea in schools or factories through the investigation and analysis on eight outbreaks in January, 2015 in Guangdong. Methods Epidemiological analysis was used to reveal the characteristics of these outbreaks. Bacteria culture and nucleic acid tests were conducted on food and/or stool samples（food handlers, students, staff） for the identification of possible pathogens.Results Random infection with no obvious association on the outbreak time point was found. However, all these outbreaks were occurred in schools or factories, where people were crowd and food was centralized provided. Their main symptoms were diarrhea and vomiting, without sever patients observed. No pathogenic bacteria were detected,but norovirus was found in 60.3% and 80% of the students/staff and food handlers, respectively. Norovirus and rotavirus co-infections were observed in two students, with a co-infection rate of 2.4%. Comprehensive analysis indicated that the most possible source of infection may be food handlers with viruses or contaminated food.Conclusion To decrease the outbreak of diarrhea and protect people＇s health, government and relevant departments should increase the frequency of screening tests on diarrhea pathogens among those food handlers and reinforce food safety inspection, especially in Autumn-winter.