一起奶牛场职业暴露引起布鲁氏菌病暴发危险因素调查

A brucellosis outbreak and risk factors in a dairy farm

目的对2017年一起奶牛场布鲁氏菌病(布病)暴发原因和感染危险因素进行调查。方法采用自制调查问卷,对该厂所有在职职工进行面对面方式询问,实验室进行试管凝集试验(SAT)。对布病感染危险因素进行分析。结果共调查99人,挤奶人员中布病感染率最高,为25.00%(5/20);12例SAT阳性,其中9例为确诊病例,年龄在23~55岁之间,以关节、肌肉痛和乏力为主,无发热病例;3例隐性感染者,抗体滴度均为1∶100++。接触过流产物(RR=3.73,95%CI:1.07~7.27)、接触过病牛(RR=4.07,95%CI:1.07~7.33)、给牲畜免疫(RR=9.11,95%CI:1.37~21.22)、重复使用手套(RR=5.09,95%CI:1.16~14.63)是布病感染的可能危险因素。结论接触过流产物、给牲畜免疫、重复使用手套是影响从业人员感染布病的主要因素。相关部门应该加强畜间疫情防控,对从事养殖行业的职业人群加强布病相关知识和防护相关培训,尤其是从业过程中的监管。

Objective To understand the causes of a brucellosis outbreak and associated risk factors in a dairy farm in 2017.Methods All the workers in the dairy farm were surveyed by using a self-administrated questionnaire in face to face interviews.For each worker,blood sample was collected for tube agglutination test.Results A total of 99 workers were surveyed.Twelve workers were positive in serological tube agglutination test,and the infection rate in milkers was highest(5/20,25.00%).Nine brucellosis cases were confirmed.The cases were aged between 23 and 55 years,the main clinical symptoms were joint or muscle pain and fatigue without fever;and the antibody titers of 3 latent infection cases were all1∶100++.Risk factors associated with brucellosis were contact with livestock apoblema(RR=3.73,95%CI:1.07–7.27),contact with sick cattle(RR=4.07,95%CI:1.07–7.33),vaccinating livestock(RR=9.11,95%CI:1.37–21.22),repeated use of gloves(RR=5.09,95%CI:1.16–14.63).Conclusion Exposure to livestock apoblema,vaccinating livestock and repeated use of gloves might be main risk factors for brucellosis in the workers.It is necessary to strengthen the prevention and control of animal brucellosis epidemic and health education about brucellosis in occupational groups.Close attention should be paid to the supervision of milk production process.