2000-2013年我国诺如病毒感染性胃肠炎暴发流行病学特征分析

Epidemiological characteristics of acute gastroenteritis outbreaks caused by norovirus in China,2000-2013

目的了解我国诺如病毒的流行病学特征及变化趋势,为制定有效的防控措施提供依据。方法以"诺如病毒"、"诺瓦克样病毒"以及"暴发"、"调查"为关键词检索,收集整理2000 2013年在CNKI、万方和维普等中文数据库中的文献并进行分析。结果共收集符合要求的文献52篇,涉及诺如病毒暴发疫情72起,累计报道病例11 778例,平均164例/起,疫情持续时间平均8.57 d。报道疫情数居前3位的省份依次是广东省28起(占38.89%),浙江省18起(占25.00%),广西壮族自治区6起(占8.33%)。暴发场所以学校及托幼机构为主,有53起,占73.61%,其中中学25起、小学及幼儿园17起,大学11起;其次是养老/医疗机构10起,占13.89%。传播途径以经水传播为主,有27起,占37.50%,人-人接触传播24起,占33.33%,食源性传播17起,占23.61%。不同场所疫情传播途径差异有统计学意义(χ~2=48.899,P=0.000)。在经水传播的疫情中,由桶装水污染引起的暴发最多,占48.15%。基因组别分布GⅡ24起,占72.73%,GⅠ6起,占18.18%。结论需加强关注我国诺如病毒感染性胃肠炎暴发,特别是学校和幼托机构等人群聚集的场所。建议加强高危场所管理和水质监测,提高菌株检测鉴定水平。

Objective To understand the epidemiological characteristics of acute gastroenteritis outbreaks caused by norovirus in China and provide evidence for the development of effective control measures. Methods A literature retrieval was conducted by using the database of ＂CNKI＂,＂Wan Fang＂,＂VIP＂and others in China. The key words ＂norovirus＂,＂norwalk-like virus＂and＂outbreak＂,＂investigate＂were used. Results A total of 52 papers about 72 norovirus infection outbreaks,involving 11 778 patients,were collected according to the inclusion and exclusion criteria. Averagely 164 cases occurred in each outbreak and the average epidemic duration was 8. 57 days. The first 3 provinces in reporting outbreak number were Guangdong（ 28,38. 89%）,Zhejiang（ 18,25. 00%） and Guangxi（ 6,8. 33%）. The outbreaks occurred mainly in schools and kindergartens,accounting for 73. 61%,including 25 in high schools,17 in kindergartens and primary schools and11 in colleges,followed by old people home / medical institutions,accounting for 13. 89%. The main transmission routes included water drinking（ 27,37. 50%）,close contact（ 24,33. 33%）,food eating（ 17,23. 61%）. The place and transmission route specific differences in the incidence were significant（ χ^2= 48. 899,P = 0. 000）. Barrelled water drinking caused 48. 15% of the water borne outbreaks. Twenty four outbreaks were caused by genotype G Ⅱ,accounting for 72. 73%,6 were caused by genotype GⅠ,accounting for 18. 18%. Conclusion Norovirus outbreak was prone to occur in schools and kindergartens,to which close attention should be paid. It is suggested to strengthen the management of the place at high risk,improve water quality surveillance and increase the pathogen detection level.