一起托幼机构轮状病毒感染性腹泻暴发的调查

Investigation on the outbreak of rotavirus infectious diarrhea in a kindergarten

目的调查一起托幼机构轮状病毒感染性腹泻暴发的原因,为控制疫情蔓延提供建议。方法制定病例定义,开展病例搜索和个案调查,对其进行流行病学特征分析和现场卫生学调查及采样检测。结果共搜索到病例13例,罹患率为24.07%(13/54);所有病例均在A班,平均年龄3岁,临床表现主要为呕吐占92.31%(12/13)、发热占76.92%(10/13)、腹泻占61.54%(8/13);首发病例3月1日发病,发病高峰为3月3日;13例病例中教师1例,其余均为学生。男、女罹患率分别为27.59%(8/29)和20.00%(5/25),差异无统计学意义(χ^(2)=0.42,P>0.05)。采集的肛拭子样本中,13例病例中8例(61.54%)病例样本为轮状病毒A组核酸阳性,其余均为阴性。因试剂数量限制,对7例症状较典型的病例肛拭子样本进行24种腹泻病病原体核酸检测,结果6例为A组轮状病毒核酸阳性,其余均为阴性。结论此次疫情为A组轮状病毒引起的聚集性疫情;主要传播途径为接触首发病例出现人传人或接触呕吐物、排泄物气溶胶引起传播。经对病例采取隔离治疗、通风消毒、停课等措施,疫情很快得到控制。

Objective To investigate the causes of breakout of rotavirus infectious diarrhea in a nursery,and to provide the advice for controlling the spread of epidemic.Methods The case definition was developed,the case search and case investigation were conducted,epidemiologic features and field hygiene survey on cases were analyzed,and the sampling and testing were made.Results Totally 13 cases with the incidence rate of 24.07%(13/54)were found in the epidemic;all cases aged at 3 years old on average were in Class A,the main clinical manifestations involved vomiting with the percent of 92.31%(12/13),fever with the percent of 76.92%(10/13)and diarrhea with the percent of 61.54%(8/13);the first case was attacked on March 1,and the attack peaked on March 3.In the 13 cases,one case was the teacher,and the remaining cases were students.The incidence rate of male and female was 27.59%(8/29)and 20.00%(5/25),respectively,and the difference wasn′t statistically significant(χ^(2)=0.42,P>0.05);the nucleic acid assay of 8 cases(61.54%)case samples out of 13 anal swabs collected in terms of Group A rotavirus was positive,and that of remaining cases was negative.Totally 24 varieties of diarrhea pathogen were subject to nucleic acid testing in anal swabs of 7 cases with typical symptoms.The results showed that 6 cases were found to be positive nucleic acid and the rest pathogens were negative in terms of Group A rotavirus.Conclusion The epidemic is an cluster epidemic caused by Group A rotavirus,and the main transmission route is that the first case is exposed to human transmission or vomit and excreta aerosol.The epidemic is quickly controlled after quarantine treatment,ventilation&disinfection,class suspension and other measures.