一起野外驻训分队感染性腹泻暴发的调查与分析

Investigation and analysis of an outbreak of infectious diarrhea in field training

目的查明一起野外驻训分队腹泻暴发的原因并及时进行控制。方法走访当地卫健委、疾病预防控制中心,对流行病学相关资料进行调查。采集22名腹泻队员的肛拭子,以实时荧光定量聚合酶链式反应(PCR)检测轮状病毒、诺如病毒、肠道腺病毒、肠道致泻性大肠埃希菌(EPEC)等19种病原体。对发生腹泻的三个分队使用的3眼水井和其驻训地附近另外2眼水井(A水井和B水井)的水质进行检测和评价。结果22名腹泻队员的肛拭子中的21份样本检出致泻性大肠埃希菌,其他18种病原体检测结果均为阴性;有33人发病,发病率18.33%(33/180),主要症状有恶心、呕吐、发热、乏力、腹泻、腹痛、头晕、头痛,3个分队的发病率分别为:第1分队6.00%(6/100)、第2分队42.50%(17/40)、第3分队25.00%(10/40),三者差异有统计学意义(χ^(2)=26.95,P<0.001);第2分队和第3分队发病率差异无统计学意义(χ^(2)=2.73,P=0.142),第2分队和第1分队比较有统计学差异(χ^(2)=27.72,P<0.001);第3分队和第1分队比较有统计学差异(χ^(2)=10.19,P=0.003)。5眼水井水样的33项感官和化学指标均合格;细菌学指标中,第2分队使用的井水有3项指标不合格,其他4眼井的水都是2项细菌指标不合格。结论使用的井水中的致泻性大肠埃希菌可能是本次腹泻疫情的病原,野外军事行动水源水质检验及消毒十分重要。

OBJECTIVE To identify the causes for the outbreak of diarrhea in the field training so as to take control measures.METHODS Relevant epidemiological data were collected by visiting local health commission and disease control center.Anal swabs of 22 diarrhea officers and soldiers were collected for the detection of 19 pathogens such as rotavirus,norovirus,intestinal adenovirus and diarrheogenic Escherichia coli(EPEC)by quantitative real-time fluorescence quantitative PCR assay.Water quality of the three wells used by the three teams with diarrhea and the other two wells(Well A and Well B)near the training site were detected and evaluated.RESULTS Twenty-one anal swabs from 22 diarrhea patients were positive for diarrheogenic E.coli and negative for the other 18 pathogens.Thirty-three patients got the disease,and the incidence was 18.33%(33/180).The main symptoms were nausea,vomiting,fever,fatigue,diarrhea,abdominal pain,dizziness and headache.The incidence in the three teams were 6.00%(6/100)in Unit 1,42.50%(17/40)in Unit 2,25.00%(10/40)in Unit 3,respectively;the difference among them was significant(χ^(2)=26.95,P<0.001);there was no significant difference between Unit 2 and 3(χ^(2)=2.73,P=0.142);there was significant differences between Unit 2 and 1(χ^(2)=27.72,P<0.001)and between Unit 3 and 1(χ^(2)=10.19,P=0.003).Thirty-three sensory and chemical indexes of water samples from 5 wells were all qualified.Three bacteriological indexes of water from the well used by Team 2 was unqualified,and 2 bacteriological indexes of the water from the other 4 wells was unqualified.CONCLUSION The diarrhea-causing E.coli in the well water may be the cause of this diarrhea outbreak.Water detection and disinfect are very important in the field military operations.