一起由职业性病损和传染联合作用引起的戊肝突发疫情调查分析

Investigation and Analysis of A Sudden Epidemic of Hepatitis E Caused by Occupational Transmitted Diseases and Infections

目的通过对宁夏某企业突发戊肝疫情的流行病学调查和处置,分析和查找疫情发生的原因,为今后更好的预防控制和规范处置类似疫情提供参考依据。方法通过对疫情企业运行状况、生产工艺、餐饮情况、居住情况、职业体检以及个案资料调查,采用描述流行病学方法对资料进行统计分析。结果本次疫情共报告戊肝病例23例,罹患率为5.79%(23/397),其中男性病例22人,女性病例1人,平均年龄(33.7±11.6)岁。临床表现以恶心、乏力和食欲减退为主,病例分布在9个车间,车间罹患率差异有统计学意义(χ2=23.22,P=0.003),病例中有20例住在公司租赁的两个公租房小区,两个小区的病例罹患率差异无统计学意义(χ2=0.282,P=0.595),生产原料中二甲基乙酰胺和乙二胺可引起职业性肝损伤,职工食堂就餐环境简陋,经常供应不熟透的猪内脏,且餐具消毒不规范。结论该聚集疫情是接触有害物质导致肝功能低下,再由戊肝病毒污染食物而造成的聚集暴发,通过及时隔离救治、关停餐厅供应,未出现新增病例,科学有效地控制了疫情的发展和蔓延。

Objective Through the epidemiological investigation and disposal of the sudden outbreak of hepatitis E in an enterprise in Ningxia,the causes of the outbreak were analyzed and found, which could provide a reference for better prevention,control and standardization of the treatment of similar outbreaks in the future. Methods Through the investigation of the operation status, production process, catering situation, living conditions, occupational physical examination and case data investigation of the epidemic enterprises, the data were statistically analyzed by describing epidemiological methods. Results A total of 23 cases of hepatitis E were reported in this epidemic, with an attack rate of 5.79%(23/397), including 22 male cases and one female case, with an average age of(33.7±11.6) years. The clinical manifestations were mainly nausea, fatigue and loss of appetite. The cases were distributed in 9 workshops. The difference in the prevalence of the workshop was statistically significant(χ2=23.22,P=0.003). In the case, 20 lived in two public rental housing estates leased by the company. There was no significant difference in the incidence of cases between the two districts(χ2=0.282,P=0.595). The production of raw materials in dimethylacetamide and ethylenediamine could cause occupational liver damage, and the dining environment of the staff canteen was poor. Insufficient pig internal organswere often supplied,and tableware was not disinfected. Conclusion Based on the comprehensive epidemiological investigation, clinical symptoms and occupational health examination results, it is concluded that the epidemic situation is caused by workers' exposure to harmful substances, resulting in low liver function of workers, and then the accumulation of outbreaks caused by hepatitis E virus contaminating food. Through timely isolation, treatment and closure of restaurant supply,no new cases have emerged, and the development and spread of the epidemic situation has been scientifically and effectively controlled.