一起农民家庭屠宰病死羊引发皮肤炭疽疫情的调查和处置

Investigation and disposal of a skin anthrax case caused by a farmer's family slaughter of dead sheep

目的通过对一起家庭屠宰病死羊引发的皮肤炭疽疫情进行流行病学调查,分析其发病原因、病例诊断及报告情况,为炭疽疫情防控提供依据。方法采用现场流行病学的方法对病例进行调查,对疫情发生后采取的措施进行分析,对疫情防控中存在的问题进行研究。结果本次疫情为一起散发性人间皮肤炭疽疫情。病例于8月23日在自己家中没有采取任何防护措施的情况下宰杀病死羊,且在4天前左手大拇指关节处有约1~2 mm的小伤口,炭疽杆菌经过伤口感染发病。暴露后第3天伤口出现黑点,无痛感,黑点逐渐增大,第7天直径增至15 mm,颜色炭黑,第8天黑痂周围出现水肿,有痛感,先后就诊于村诊所和县医院骨外科,第9天(9月1日)就诊于乡镇卫生院并以“手指外伤”收治入院,入院后第3天卫生院院长怀疑炭疽并进行了报告。密切接触者和共同暴露者28人,均未感染。病例焦痂期2份黑痂周围水肿渗出液标本炭疽杆菌PCR检测阳性,病例急性期和恢复期双份血清抗炭疽特异性抗体出现阳转,采集27份外环境标本,进行炭疽杆菌PCR检测,其中7份阳性。结论屠宰羊时应加强个人防护,以防感染;提高广大群众尤其是养殖户等重点人群对病、死畜危害的知晓率。应建立炭疽诊疗知识的定期培训机制,全面提升医务人员对炭疽诊断和及时报告的能力。

Objective To conduct an epidemiological investigation on a case of skin anthrax caused by the slaughter of dead sheep in a family,analyze the causes,case diagnosis and report,and provide the evidence for prevention and control of anthrax.Methods The field epidemiology method was used to investigate the cases,analyze the measures taken after the occurence,and study the problems existing in the prevention and control.Results This case is a sporadic case of human skin anthrax.On August 23,the case killed the dead sheep in his home without any protective measures,and had a small wound of about 1-2 mm at the thumb joint of the left hand four days ago.Anthrax was infected through the wound.On the 3rd day after exposure the black spot appeared on the wound,having no pain,and black spot gradually increased.On the 7th day it increased to 15 mm of the diameter,carbon black.In the 8th day edema appeared around dark scab,having pain.The case saw the doctor successively in the village clinic and county hospital orthopedic surgery.On the 9th day(September 1)saw doctor in the township health center and for the finger wound the case was admitted to the hospital.Three days after admission the case was diagnosed as suspected anthrax and was reported by the hospital director.Close contacts and the persons with co-exposure were not infected.Two samples of edema effusion around black scabs collected in the eschar period were positive for anthrax bacillus with PCR test.The specific anti-anthrax antibody was positive for two serum samples collected in the acute and recovery periods.A total of 27 external environment samples were collected for B.anthracis PCR test,and seven of them were positive.Conclusions The personal protection should be strengthened to prevent infection during sheep slaughter;the awareness rate of the public,especially key groups such as livestock farmers about the hazards of the disease and dead animals needs to improve.A regular training mechanism for anthrax diagnosis and treatment knowledge should be established to comprehensively improve the ability of medical staff to diagnose and timely report anthrax.