一起饮水污染导致埃可病毒30型脑膜炎暴发的调查  

A viral meningitis outbreak associated with Echo30 in drinking water

作　　者：陆向东[1] 崔亮亮[2,6] 马焰[1] 祖荣强[3] 申涛 李蒋清 姚建香[1] 单军[3] 谢琪 施超[5] 曾光 

机构地区：[1]江苏省江阴市疾病预防控制中心,214434 [2]中国现场流行病学培训项目 [3]江苏省疾病预防控制中心 [4]江苏省江阴市徐霞客医院 [5]江苏省无锡市疾病预防控制中心 [6]山东省济南市疾病预防控制中心

出　　处：《中华流行病学杂志》2012年第10期1067-1071,共5页Chinese Journal of Epidemiology

摘　　要：目的调查一起学校内多名学生发热伴头晕、头痛，或伴恶心、呕吐的感染原因与影响范围，提出控制措施。方法疑似病例定义为2012年3月1日后L学校师生中出现发热（腋温≥37℃）伴头晕、头痛、恶心、呕吐症状之一者；确诊病例为疑似病例咽拭子或肛拭子肠道通用病毒RT-PCR阳性者。病例搜索通过查阅3月1日后当地4家医院就诊记录和学校师生因病缺课缺勤记录。采用1：2个体匹配的病例对照研究分析饮水暴露情况。采集27名病例的咽拭子和肛拭子进行肠道通用病毒RT-PCR及序列分析。4月19日采集2份直饮水机温开水样品分析细菌总数和大肠菌群。结果L学校学生病例103例，罹患率4．6％（103／2255）。77．7％（80／103）病例来自该校综合楼，三年级罹患率最高18．1％（72／397）。流行病学曲线为持续同源暴露，饮用直饮水机温开水（OR=18．3，95％CI：2．0～169．5）和饮用生水（OR=15．5，95％CI：1．7～141．8）均是危险因素。27名病例肠道通用病毒RT-PCR检出率为81．5％（22／27），其中9例PCR序列分析有7例为埃可病毒30型（Echo30）。直饮水机温开水细菌总数和大肠菌群检测结果符合标准。结论该次疫情是由Echo30导致的一起学校内病毒性脑膜炎暴发，饮水是危险因素，不同于以往的人传人模式，值得关注。Objective To study the source of infection, the scope of epidemic and control measures in an outbreak involving students having symptoms as fever, dizziness, headache, vomiting and nausea. Methods The suspected-case was defined as fever （armpit temperature ≥37℃ ） and with one or more of the following symptoms： dizziness, headache, vomiting and nausea, among students and teachers at school from Mar 1, 2012. Confirmed-case was among suspected case accompanied by both throat and rectal swabs enterovirus positive by RT-PCR. All the cases were collected through checking the medical records from 4 hospitals as well as through the absence records of students and teachers, from Mar 1,2012. We conducted a case-control study with ratio of 1 ： 2 and data on the exposures to water among students and teachers was collected prior to the illness. 27 cases＇ throat and rectal swabs were collected and analyzed by RT-PCR and PCR sequence methods. 2 warm-water samples were collected for testing the counts on total bacteria and E. coll. Results 103 students＇ cases were identified in school L, with the attack rate as 4.6% （103/2255）. Students from Grade three had the high attack rate as 18.1% （72/397） and 77.7% （80/103 ） of the cases located in the building with ＇ multiple-functions＇. Epidemic curve of the outbreak showed a pattern with continuous common source of infection. It seemed that the exposure to warm-water appeared to be the major risk factor （OR= 18.3,95%CI： 2.0-169.5） together with the intake of un-boiled water （OR= 15.5,95%CI：1.7-141.8）. Specimens from 27 students （81.5%, 22/27） were identified enterovirus positive by RT- PCR, and 7 of the 9 students were confirmed carrying Echo 30. Bacteria and coli were negative from the 2 warm-water samples. Conclusion This viral meningitis-outbreak was caused by Echo 30, with drinking water as the major risk factor.

关 键 词：埃可病毒30型 暴发 病例对照研究 饮水 

分 类 号：R51[医药卫生—内科学] R1[医药卫生—临床医学]