一起由B群沙门菌污染聚餐食品所致食物中毒调查分析  

Survey of a food poisoning outbreak caused by Salmonella in serum type B group

作　　者：韦蝶心[1,2] 常利涛 郝林会[1,2] 徐闻[1] 古文鹏 字桂升[3] 马永梅[3] 徐然 WEI Diexin;CHANG Litao;HAO Linhui;XU Wen;GU Wenpeng;ZI Guisheng;MA Yongmei;XU Ran(Center for Disease Control and Prevention of Yunnan Province,Yunnan Kunming 650022,China;Chinese Center for Disease Control and Prevention West of China Field Epidemiology Training Program,Beijing 100050,China;Weishan Prefecture Center for Disease Control and Prevention,Yunnan Weishan 650024,China)

机构地区：[1]云南省疾病预防控制中心,云南昆明650022 [2]中国疾病预防控制中心西部地区现场流行病学培训项目,北京100050 [3]云南省巍山县疾病预防控制中心,云南巍山650024

出　　处：《中国食品卫生杂志》2018年第6期659-662,共4页Chinese Journal of Food Hygiene

摘　　要：目的调查一起农村婚宴聚餐引起食物中毒的致病因子、致病食品及其污染来源,采取有效措施控制事件蔓延,预防今后类似事件的发生。方法开展现场流行病学调查,制定病例定义并主动搜索病例,采用描述流行病学方法分析本次事件病例的流行病学特征。通过个案调查访谈,对参加聚餐的108人开展病例对照研究,分析可能的致病食品。现场勘查和访谈厨师,了解婚宴菜品的制作过程、原料来源和所用水源等,并采集病例肛拭子、婚宴剩余食品、饮用水样进行实验室检测。结果本次食物中毒罹患率为21.6%(138/640),临床表现以腹泻、腹痛、发热为主。单因素分析结果显示94.4%(51/54)的病例和66.7%(36/54)的对照食用过由灌肚、里脊肉片、炸排骨、萝卜丝四种食品组成的凉菜拼盘,食用凉菜拼盘增加发病风险(比值比=8.50, 95%置信区间:2.32～31.02)。叉生分析结果显示同时食用拼盘中两种以上凉菜将增加发病风险(比值比=9.25, 95%置信区间:2.46～34.82)。4份病例肛拭子和1份凉菜拼盘中灌肚均检出B群沙门菌。5株检出的沙门菌脉冲场凝胶电泳(PFGE)指纹图谱为同一带型,提示病例和食品分离株在分子水平具有高度的同源性,为同一暴露源。结论本次事件是一起由B群沙门菌污染聚餐食品导致的食物中毒。凉菜拼盘是主要的致病食品,食品加工卫生环境与制作过程不规范操作是导致本次食物中毒发生的危险因素。当前农村自办宴席仍存在诸多食源性疾病发生的风险环节,应加强监管。Objective To identify the pathogen in the food and the source of infection that might be responsible for a food poisoning outbreak for the banquet in the countryside,and provide evidence for control measures.Methods Case survey,descriptive epidemiological analysis and case study were conducted.A case-control study on 108 people was conducted to identify the foods that might be responsible for this event.Clinical sample from the cases and food processing staff,food and water samples were collected for laboratory detection.Results The attack rate of this event was 21.6%(138/640),and the main clinical symptoms were diarrhea,abdominal pain and fever.94.4%(51/54)of the cases and 66.7%(36/54)of the controls ate the dishes of cold dish-mixed,the risk of eaten cold dish-mixed was increased(OR=8.50,95%CI:2.32-31.02).Data from the crossover analysis result showed that the risk of outbreak increased if more than two ingredient of the cold dish-mixed were eaten(OR=9.25,95%CI:2.46-34.82).Four cases were detected Salmonella in serum type B group from their anus swabs and the same bacteria type was also detected in the guan du ingredient of the cold dish-mixed.The result of pulsed field gel electrophoresis for the 5 strains of Salmonella were highly homologous which indicated that the strains was from the same source of exposure.Conclusion Salmonella in serum type B group was responsible for this outbreak which contaminated the cold dish-mixed during food processing.The risk of foodborne disease outbreak was high in rural area,and the supervision in this situation should be strengthened.

关 键 词：沙门菌 食源性疾病 农村聚餐 暴发调查 潜伏期 脉冲场凝胶电泳 

分 类 号：R155[医药卫生—营养与食品卫生学]