2015年广东省某县农村1起布鲁氏菌病暴发疫情的调查分析

Investigation and analysis of an outbreak of brucellosis in Guangdong rural areas in 2015

【目的】调查2015年广东省某县1起食源性布鲁氏菌病(布病)暴发疫情,为预防类似事件提供建议。【方法】通过走访个案、医院就诊系统、村卫生站登记资料查询等方式收集病例,对调查对象开展布鲁氏菌感染初筛及确证实验;对结果进行描述与分析。【结果】共发现169例病例,罹患率为2.0‰(169/85000);病例发病时间为2015年1月19日至6月2日,呈现持续同源的暴发模式;病例临床表现为发热(72%)、乏力(40%)、多汗(26%)、睾丸肿大(5.3%)、头痛(2.4%)、肝肿大(1.2%)。此外,还发现54例隐性感染者。患者血清标本中共培养出羊种3型布鲁氏菌13株。对养殖场的所有羊进行采样,血清试管凝集试验阳性16份,阳性率为37%(16/44);经分析,饮用鲜羊奶是发生布病的危险因素(OR=36.25,95%CI:4.68~280.73),且感染与饮奶存在剂量反应关系(χ^(2)=27.00,P<0.05)。【结论】该布病暴发疫情为患者饮用受羊种3型布鲁氏菌污染的未煮沸羊奶所致,建议饮用合格消毒的羊奶,政府部门应加强羊只销售和羊奶生产的监管。

[Objective]To investigate a foodborne brucellosis outbreak in a county in Guangdong Province in 2015,which may provide suggestions for the prevention and control of similar incidents.[Methods]Case search was carried out by visiting cases,accessing the hospital medical record system,and collecting the registration information of rural health stations,and the results were described and analyzed.[Results]A total of 169 cases were found,with an attack rate of 2.0‰(169/85000).The onset time of the cases was from January 19 to June 2,2015,showing a continuous and homogenous outbreak pattern.The clinical manifestations of the cases were fever(72%),fatigue(40%),hyperhidrosis(26%),testicular enlargement(5.3%),headache(2.4%),and hepatomegaly(1.2%).In addition,54 cases of latent infection were found.A total of 13 strains of brucella ovis type 3 were cultured from the patients’serum samples.After all sheep in the farm were sampled,16 samples of serum test tube agglutination test were positive,with a positive rate of 37%(16/44);after analysis,drinking fresh goat milk was a risk factor for brucellosis(OR=36.25,95%CI:4.68-280.73),and there was a dose-response relationship between infection and milk drinking(χ^(2)=27.00,P<0.05).[Conclusion]The brucellosis outbreak was caused by patients who drank unboiled goat milk contaminated with Brucella ovine type 3.People are recommended to drink qualified and sterilized goat milk.Relevant government departments should strengthen the monitoring of goat selling and goat milk production.