钩端螺旋体病暴发疫情感染危险因素的调查分析

Investigation and analysis on the risk factors of a leptospirosis outbreak

目的调查钩端螺旋体病暴发疫情的可能感染来源和传播途径,为有效控制疫情,防止疫情的再暴发提供科学依据。方法开展病例的流行病学调查、病例对照调查等,以查明疫情的可能感染来源。结果本次疫情为黄疸出血热型,40例病例发病集中于8月21日至9月4日之间,占75.00%;病例多发于魏庄镇、龙亢镇和淝南镇,占60.00%;40-79岁年龄组多发,占85.00%;病例以中等热、高热为主,占85.00%;疲乏无力占95.00%、畏寒占90.00%、全身肌痛占75.00%、腓肠肌痛占62.50%、头痛占40.00%;病例发病前1月可疑疫水暴露史占97.50%;病例对照调查结果显示患病前15d手脚有伤口(χ2=15.74,P<0.01)、患病前15d参加农事活动(χ2=11.08,P<0.01)是罹患钩体病的危险因素。结论沿淮流域存在菌群更迭,南黄北移的现象,加强疫情监测,做好高发地区人群的疫苗接种和健康宣教是降低钩端螺旋体病发病的有效措施。

We aimed to provide scientific evidence for the effective control of the epidemic and to investigate the sources of infection and possible ways of transmission.Epidemiological investigation was carried out to explore the source of infection by using the case-control study.Results showed that the outbreak of the epidemic was hemorrhagic fever,the onset of 40 cases was from August 21 to September 4,accounting for 73.68% of the case number.Cases were cluster in Weizhuang Town,Feinan Town and Longkang Town,accounting for 60.00% of the case number.The cases who aged from 40 to 79 years accounted for 85.00%.The cases with medium and high fever,tiredness,chills,muscle pain,gastrocnemius and headache accounted for 85.00%,95.00%,90.00%,75.00%,62.50% and 40.00%,respectively.The 97.50% cases had exposure history of suspected contaminated water.Case-control study result showed that hands and feet had the wound in 15 days before the onset(χ2=15.74,P<0.01),and farming work in 15 days before the onset(χ2=11.08,P<0.01)were the risk factors of leptospirosis infection.There are the bacteria change and the trend from south to north along the Huaihe River Basin.Strengthen the monitoring work in high-risk areas was the effective measurement to reduce the incidence of leptospirosis.