一起鼠伤寒沙门氏菌引起的食物中毒事件调查

Investigation on a food poisoning caused by Salmonella typhimurium

目的查明一起鼠伤寒沙门氏菌引起的食物中毒事件的感染来源、传播途径和致病因子,防范今后类此事件的发生。方法通过查阅就诊记录和走访医疗机构医务人员、对宾客进行面访或电话调查进行病例搜索。对搜索到的病例开展流行病学调查,调查内容为基本信息、发病及就诊信息、参加满月宴中食用的食物名称和数量、实验室检测信息等。结果调查共发现病例67例,罹患率为84.81%(67/79);病例主要表现为腹泻、腹痛、头痛头晕;回顾性队列研究提示满月宴上食用干锅水鸭、卤牛肉和牛百叶炒韭花3个菜品增加发病风险;食品卫生学调查发现,J酒店厨房砧板未区分生熟食专用,盛装初加工食品的保鲜盒、沥水篮未专物专用;实验室检测结果显示4份病例肛拭子标本检出鼠伤寒沙门氏菌,其中3份标本PFGE同源性100%。结论本事件为一起因厨房用具生熟不分导致交叉污染所引发的鼠伤寒沙门氏菌食物中毒事件。建议加强农村地区餐饮机构的监管和食品安全风险监测,加强酒店厨房工作人员食品卫生安全知识教育及培训,规范食品加工操作,严禁生熟不分,避免交叉污染。

Objective To find the source of infection,route of transmission and the pathogenic factor of the food poisoning,and put forward targeted prevention and control measures. Methods Cases are researched by refering to the medical record of the patients,visiting medical institutions medical staff,and interviewing or making phone calls.. Epidemiological investigations including basic information,onset and treatment information,names and quantities of foods consumed during the full moon feast,and laboratory testing information were conducted on the searched cases. Results A total of 67 cases were found,the incidence rate being 84. 81%（67/79）; the main clinical manifestations of the case were diarrhea,abdominal pain,headache and dizziness; a retrospective cohort study suggested that eating three dishes of dried duck,braised beef,and beef shaved squid on the full moon feast increased the risk; food hygiene investigation found that the kitchen cutting board of J hotel was not differentiate between raw and cooked foods,the fresh-keeping boxes and drain baskets containing freshly-processed foods were not specifically used; the laboratory test results showed that Salmonella typhimurium was detected in 4 cases of anal swab specimens,of which 3 samples had 100% homology of PFGE. Conclusion This incident was due to the kitchen utensils together with the cooked and lead to cross-contamination caused by Salmonella typhimurium food poisoning. It is suggested to strengthen the supervision of food and beverage institutions in rural areas and the monitoring of food safety risks,strengthen the education and training of food hygiene and safety knowledge for hotel kitchen staff,and standardize food processing operations,and strictly prohibit uncooked and uncrossed to avoid cross-contamination.