云南省德宏州某市疑似变形杆菌引起的食物中毒事件调查

A food poisoning incident suspected to be caused by proteus in a city of Dehong Prefecture,Yunnan Province

【目的】调查云南省德宏州某市1起食物中毒事件发生的原因,确定事件波及的范围,以制定有效的预防控制措施。【方法】采用现场流行病学和病例对照研究方法,制定病例定义,开展病例搜索。结合病例临床表现、就餐史等信息查找可疑食物。采集可疑食物、病例和环境等样本进行实验室检测。【结果】共搜索到病例160例,罹患率为26.02%(160/615),主要临床表现以为腹泻、白细胞升高、呕吐、恶心、腹痛为主。发病潜伏期最短2 h,最长28 h,平均(10.89±5.09)h,流行病学曲线提示为点源暴露模式。病例对照研究结果表明,进食青笋拌烧肉是发病的独立危险因素(OR=13.09,95%CI:3.26~52.54)。16份样品经当地疾病预防控制中心实验室检测,2份患者肛拭子检出奇异变形杆菌,另一患者肛拭子检出潘氏变形杆菌和奇异变形杆菌。烧肉中检出潘氏变形杆菌,其余样品致病菌均未检出。【结论】根据现场流行病学调查和实验室检测结果可判断本次事件为疑似变形杆菌引起的食物中毒。建议市场监管部门应加强当地食品卫生的监管,明确医疗机构收治食源性疾病患者时的采样权责任,确保及时查明原因,采取有效防控措施,避免类似食物中毒事件发生。

[Objective] To Investigate the cause of a food poisoning incident in a city in Dehong Prefecture,determine the scope of the incident,and to formulate effective prevention and control measures.[Methods]Field epidemiology and case-control study methods were used to formulate case definition;carry out case search;find suspicious food combined with clinical manifestations,dining history and other information;and collect samples from the suspicious food,cases and environment for laboratory testing.[Results]A total of 160 cases were found and the incidence rate was 26.02%(160/615). The main clinical manifestations were diarrhea,leukocytosis,vomiting,nausea and abdominal pain. The average incubation period was 10.89±5.09 h,with 2 h as the shortest and 28 h as the longest. The epidemiological curve suggested the point source exposure mode. The results of case-control study showed that eating roast pork with green shoots was an independent risk factor(OR=13.09,95%CI:3.26-52.54).16 samples were tested by the local CDC laboratory. Proteus mirabilis was detected in two the anal swabs of two patients He and Chen. Both proteus pani and proteus mirabilis were detected in anal swab of patient Zhou and Proteus pani was detected in roast meat. There was no detection of pathogenic bacteria in other samples.[Conclusion]Based on the field epidemiological investigation and laboratory test results,we conclude that the food poisoning incident is caused by suspected proteus bacteria. We suggest that the market supervision department should strengthen the supervision of local food hygiene;clarify the sampling rights,responsibilities and technical procedures when medical institutions treat patients with foodborne diseases;ensure finding the causes in time;and take effective prevention and control measures to avoid similar food poisoning events.