禽职业暴露人群H5N1禽流感风险评估模型建立与应用

Establishment and application of risk assessment model for avian influenza A (H5N1) virus infection in poultry workers

目的建立禽职业暴露人群H5N1禽流感风险评估模型,筛选高危风险因素,为制定禽流感风险管理措施提供参考依据。方法通过查阅文献梳理出人感染H5N1禽流感风险因素列表,咨询20位专家获得评分与建议后采用层次分析法建立模型并计算权重,并通过查阅档案、现场调查获得浙江省金华市各评估指标实际评分,引入模型计算风险评估得分。结果经过3轮风险识别,专家意见达成一致;建立的模型,其准则层(b)包括"b1家禽高致病性禽流感H5N1流行形势"等9项,指标层(c)包括"c1域内高致病性禽流感H5N1疫情"等30项;各风险矩阵的一致性指数(CI值)和一致性比率(CR值)均<0.10,指标层各指标组合权重显示,c1域内高致病性禽流感H5N1疫情(0.151 3)、c26跨种属(禽-人)间传播能力(0.138 7)、c20最近1周内病死禽暴露率(0.119 3)、c27致病力(0.092 5)和c29特殊暴露者所占比例(0.067 2)为重要指标;金华市禽职业暴露人群2011—2014年风险评估得分分别为0.46、0.47、0.35、0.31分,主要获分项有"b2禽饲养风险"、"b3禽交易风险"、"b6人群暴露状况"、"b7人群防护状况"、"b8新发H5N1禽流感病毒株特征"、"b9暴露人群特征"等6项。结论禽职业暴露人群H5N1禽流感风险评估模型可行、实用;金华市禽职业暴露人群存在一定程度H5N1禽流感感染风险,加强该人群人禽流感风险管理十分必要。

Objective To establish a risk assessment model for avian influenza A （ H5N1 ） virus infection in poultry workers and to provide a basis for developing risk management strategies for avian influenza. Methods The lists of risk factors for human avian influenza A （H5N1） virus infection were made by literature retrieval ;then the factors in the list were scored by 20 experts. Analytical hierarchy process method was used to establish risk assessment model and weights. The risk scores were calculated on the basis of products of weights and actual occurrences resulted from history data or field investigation among poultry workers in Jinhua city of Zhejiang province. Results Through three rounds of risk identification ,the consistency of experts＇ scores was best in the third round consultation. There were a rule and an index layer in the model. The rule layer included highly pathogenic avian influenza HSN1 epidemic situation and other 8 elements （bl to b9）. The index layer included highly pathogenic avian influenza H5N1 epidemic in the local area and other 29 elements （cl to c30）. Each risk matrix had high consistency and satisfaction with the consistency index （CI） and consistency ratio （CR） less than 0. 10 in the model. Five kinds of high risk factors were identified for poultry workers by combined weights,including highly pathogenic avian influenza HSN1 epidemic in the local area （ cl ）, cross species barriers （ poultry to human） transmission capacity （ c26）, rate of exposure to sick or dead birds in last week （ c20）, pathogenicity （ c27 ）, and percentage of special exposure subgroup （ c29 ）, with the weights of 0. 1513,0. 1387,0. 1193, 0. 0925, and 0. 0672, respectively. The risk scores of human avian influenza A （HSN1 ） for poultry workers in Jinhua city from 2011 to 2014 were 0.46,0. 47,0. 35, and 0. 31, respectively. The major risk scores found were exposure （b6） ,protection （ b7 ）, characteristics of the new emerging avian influenza virus strain A （ HSN1 ） （ b8 ）, characteristics of poultry workers （ b9 ）, poultry trade （ b3 ） and poultry farming （ b2 ）. Conclusion The risk assessment model established is reliable and applicable. There is a certain risk of avian influenza A（ HSN1 ） infection among poultry workers in Jinhua city and the management for this risk is necessary.