本文選題：沙門菌 + 甲型副傷寒　； 參考：《中國(guó)學(xué)校衛(wèi)生》2017年05期

【摘要】：目的了解宣恩縣某初級(jí)中學(xué)2009—2014年間3次甲型副傷寒暴發(fā)疫情的原因,為從源頭減少學(xué)校副傷寒疫情的發(fā)生提供依據(jù)。方法采用病例對(duì)照研究方法,對(duì)病例的活動(dòng)、飲水、飲食和接觸史等開(kāi)展流行病學(xué)調(diào)查,比較宣恩縣副傷寒歷史發(fā)病的流行病學(xué)特點(diǎn)和3次暴發(fā)疫情中病例臨床治療與轉(zhuǎn)歸情況,進(jìn)行實(shí)驗(yàn)室證據(jù)詢證調(diào)查。結(jié)果該校2009,2013,2014年3次暴發(fā)疫情的罹患率分別為2.65%,2.76%,2.25%,無(wú)重癥及死亡病例。監(jiān)測(cè)集中式供水的75份水源水、末梢水及簡(jiǎn)易自流水、井水、桶裝水,僅3份桶裝水符合衛(wèi)生標(biāo)準(zhǔn),其余均顯示細(xì)菌學(xué)超標(biāo),但均未檢出沙門菌、志賀菌、大腸桿菌O157。68份校內(nèi)外環(huán)境及病例家庭外環(huán)境標(biāo)本、學(xué)生食堂1周的食品留樣70份、校內(nèi)外79名食品餐飲從業(yè)人員及21名病例家屬的血培養(yǎng)、肛拭培養(yǎng)均未檢出沙門菌及志賀菌。隨機(jī)抽取健康教師18人、健康學(xué)生117人進(jìn)行監(jiān)測(cè),學(xué)生中有3人血培養(yǎng)檢出甲型副傷寒桿菌,10人血清肥達(dá)試驗(yàn)顯示異常。2014年疫情發(fā)病的有7例系該校2013年暴發(fā)疫情時(shí)發(fā)生的病例,2009,2013年疫情中病例在住院期間抗生素平均治療時(shí)間為8 d,均沒(méi)有達(dá)到規(guī)范治療時(shí)間,且出院時(shí)均未按規(guī)范要求進(jìn)行糞便培養(yǎng)。病例對(duì)照研究顯示,與既往病例同班級(jí)、同桌、同宿舍、為好友等接觸是危險(xiǎn)因素(P值均0.05)。對(duì)2009—2014年分離出的38份甲型副傷寒菌株進(jìn)行溯源分析,顯示高度同源。結(jié)論該校連續(xù)發(fā)生的暴發(fā)疫情主要是既往病人治療不徹底,學(xué)校傳染源發(fā)現(xiàn)不及時(shí),致使傳染源在校內(nèi)積累,在適宜條件下引起疫情暴發(fā)。學(xué)校應(yīng)加強(qiáng)傳染病監(jiān)測(cè)、發(fā)現(xiàn)、報(bào)告與管理機(jī)制,落實(shí)傳染病的監(jiān)測(cè)預(yù)警機(jī)制。
[Abstract]:Objective to understand the causes of three outbreaks of paratyphoid A in a junior middle school in Xuanen County from 2009 to 2014, and to provide a basis for reducing the incidence of paratyphoid fever in schools at the source. Methods A case-control study was conducted to investigate the activities, drinking water, diet and exposure history of the patients. The epidemiological characteristics of paratyphoid fever in Xuanen County and the clinical treatment and outcome of three outbreaks were compared. Results the attack rates of the three outbreaks in 2009 / 2013 and 2014 were 2.65 and 2.76, respectively. There were no severe cases and no death cases. 75 parts of source water, peripheral water and simple self-flowing water, well water, barreled water, only 3 bottled water met the hygienic standard, and the rest showed bacteriology exceeded the standard, but no salmonella and Shigella were detected in all of the 75 parts of source water, end water and simple self-flowing water, well water and barrelled water. Escherichia coli O157.68 samples were collected from school environment and family environment, 70 samples of food samples were collected from students' canteen for one week, 79 food and catering workers and 21 family members of the cases were cultured in blood, and no Salmonella and Shigella were detected in anal swab culture. 18 health teachers and 117 healthy students were randomly selected for monitoring. Three of the students were detected by blood culture and 10 of them were tested for paratyphoid A, the serum Weda test showed abnormal results. In 2014, 7 cases of the disease occurred in the school during the 2013 outbreak, which occurred in 2009, and antibiotics occurred in the hospital in 2013. The average treatment time was 8 days, and none of them reached the standard treatment time. The stool culture was not carried out according to the standard requirement when discharged from hospital. Case-control study showed that contact with the same class, same table, same dormitory and good friend were all the risk factors (P = 0.05). A retrospective analysis of 38 paratyphoid A strains isolated from 2009-2014 showed high homology. Conclusion the main causes of the continuous outbreak in the school are the incomplete treatment of previous patients and the untimely discovery of the source of infection in the school, which leads to the accumulation of the source of infection in the school and the outbreak of the outbreak under suitable conditions. Schools should strengthen infectious disease surveillance, detection, reporting and management mechanism, and implement the monitoring and warning mechanism of infectious diseases.
【作者單位】： 湖北省宣恩縣疾病預(yù)防控制中心;宣恩縣人民醫(yī)院;
【分類號(hào)】：R181.3;R516.3

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