一起“腹泻型”新型冠状病毒肺炎家庭聚集性疫情的调查

Epidemiological investigation of a family cluster with'diarrhea type'COVID-19

目的通过对1例新型冠状病毒肺炎确诊患者和其6位家庭成员的流行病学调查,以及其中3例确诊病例主要临床特征进行描述和分析,拟进一步探索新型冠状病毒人际间传播途径,为聚集性暴发疫情防控工作提供理论支持。方法对解放军总医院第五医学中心的1例新型冠状病毒肺炎确诊病例进行个案和聚集性疫情调查,使用Excel 2003软件制作表格、数据录入,SPSS软件进行统计学描述。结果在这起家庭聚集性暴发疫情中,4人感染发病,3人未被感染。2例老年患者有慢性基础疾病。其中3个病例首发症状为消化道症状,2例腹泻,1例恶心;2例有呼吸道症状;3例有发热症状;在感染后,3例潜伏期较短平均5 d;1例潜伏期较长20 d;发病至就诊间隔时间平均12.5 d;平均住院天数<14 d;鼻、咽拭子核酸检测均为阳性,2例粪便核酸检测阳性。未被感染的3名密接者平均年龄16岁,其中2名儿童。结论这起家庭聚集性暴发疫情中,在同一暴露因素下,感染率为50%,进一步证实老年人为易感高危人群;新型冠状病毒存在通过粪口或者吸入气溶胶等方式进入人体并感染;增加粪便或肛拭子核酸检测作为筛查、解除隔离和出院标准之一。

OBJECTIVE To further explore the interpersonal transmission channels of SARS-CoV-2 through an epidemiological survey of one confirmed case of COVID-19 and six close family members and description of major clinical characteristics of 3 confirmed cases so as to provide theoretical basis for prevention and control of cluster outbreaks of the epidemic. METHODS The surveys of individual case and clustered epidemic were conducted for 1 confirmed case of COVID-19 in the Fifth Medical Center of Chinese PLA General Hospital, the forms were made by using Excel 2003, the data were entered, and the statistical description was performed by using SPPS software. RESULTS During the family cluster outbreak, there were 4 persons who were infected and 3 persons who were not infected. 2 elderly patients had chronic underlying diseases. 3 cases had gastrointestinal symptoms which were the initial symptoms, 2 of whom had diarrhea, and 1 had nausea;2 cases had respiratory symptoms;3 cases had fever. The incubation periods of 3 cases were short, with an average period 5 days;the incubation period of 1 case was 20 days. The average interval between onset and consultation was 12.5 days;the average length of hospital stay was more than 14 days. The nasal and throat swab samples of all the patients were positive for nucleic acid tests, the stool samples of 2 cases were positive for the nucleic acid test. The average age of 3 close-contact persons without infection was 16 years old, 2 of whom were children. CONCLUSION During the family cluster outbreak, the infection rate was 50% under the same exposure factor, and it is further confirmed that the elderly people are the population at high risk of infection. SARS-CoV-2 enters the human body and lead to infection through stool or inhaled aerosols. Adding the nucleic acid tests of stool and anal swab samples as one of the criteria for screening, release from quarantine and discharge should be taken into considerations.