河南省一起恙虫病暴发疫情调查分析  

Investigation on an outbreak of tsutsugamushi disease,Henan

作　　者：李孟磊[1] 其木格[1] 王若琳[1] 李懿[1] 苏佳[1] 黄学勇[1] 

机构地区：[1]河南省疾病预防控制中心传染病所,河南郑州450016

出　　处：《现代预防医学》2016年第23期4384-4387,4401,共5页Modern Preventive Medicine

基　　金：2013年度河南省医学科技攻关计划省部共建项目(项目编号:201301016)资助

摘　　要：目的对2015年河南省发生的一起恙虫病暴发疫情进行调查分析,了解其发病特点及流行特征,分析恙虫病感染的影响因素,为制定针对性预防控制措施提供依据。方法采用现场流行病学调查的方法,搜索病例,填写《恙虫病个案调查表》,对病例进行血清学、免疫学以及分子生物学实验。采用病例对照研究的方法,以搜索到的临床诊断病例和确诊病例作为病例组,按1∶2匹配的方式,随机选择与病例所在的同村、年龄相差5岁以内的同性别且无临床症状的村民为对照,收集可疑危险因素。结果本次疫情10月16日至11月20日,共发现病例48例,其中发热≥38.5℃的病例超过83.3%,发现特异性焦痂或溃疡的病例68.7%,有皮疹的病例60.4%,其他临床症状还包括头痛、浅表淋巴结肿大、寒战等。对采集的16份病人标本进行检测,其中血清抗体Ig M阳性15份。外斐氏反应检测OXk血清抗体,抗体滴度>1∶160的13份,最高抗体滴度>1∶640,第二次采集病人恢复期血清有7份抗体呈4倍增高。恙虫病PCR核酸检测,阳性4份。结论本次疫情为一起恙虫病暴发疫情,临床症状上主要表现为发热、特异性焦痂或溃疡、皮疹、头疼等;外斐氏试验可以作为重要诊断依据,PCR核酸检测方法,作为确诊依据之一,具有重要的意义;去参加田间劳动、在屋内堆放柴草或农作物、在家中饲养家禽及在家中饲养宠物为发病的独立影响因素。Objective To investigate and analyze an outbreak of tsutsugamushi disease occurred in Henan Province during 2015,to understand the pathogenesis, epidemiological characteristics and influence factors of tsutsugamushi disease, and to provide the basis for targeted prevention and control measures. Methods We used field epidemiological investigation to search cases and fill the questionnaire of tsutsugamushi disease cases. The serological, immunological and molecular - biological experiments were performed. We adopt case - control study, search clinical diagnosis and confirm cases as the case group, and by matching ratio of 1：2 randomly select the people in the same village,within 5 years age difference, of the same sex and no clinical symptoms as the control group to collect suspicious risk factors. Results This outbreak occurred from October 16th to November 20th in this outbreak. Over 83.3% cases with body temperature of 38.5 ~C or above,68.7% cases had skin eschar or ulcer,and 60. 4% cases had rashes. Headache, superficial lymphadenopathy and chills were also found on some patients. 15 cases were IgM positive,13 cases conducted OXk serum antibody with titer over 1：160 tested by Well Felix reaction, and the highest antibody titer was over 1：640 among the total of 16 detected patient specimens. The antibody titers were 4 times higher in convalescent serum of 7 cases during the second collection. 4 cases were positive detected by PCR Nucleic acid detection. Conclusion This is a typically tsutsugamushi disease outbreak. The main clinical symptoms are specific fever,eschar or ulcer, rash, headache, etc. Weil Felix test can be used as an important basis for diagnosis. PCR detection is of great significance for diagnosing. Working in the fields, stacking firewood or crops indoor, raising poultry or pets in the room are independent factors of the onset of disease.

关 键 词：恙虫病 临床特征 流行特征 危险因素 病例对照研究 

分 类 号：R195[医药卫生—卫生统计学]