一起集中式供水污染引起的诺如病毒感染性腹泻暴发的调查  

Investigation on a Norovirus Infectious Diarrhea Outbreak Through Contaminated Centralized Water Supply System

作　　者：李世娥[1] 孙宇鑫 周浩[1] 杨超[1] 唐道洲[1] 冯茜[1] 郭淑珍[1] 肖凤娟[1] 李旭颖[1] LI Shi’e;SUN Yuxin;ZHOU Hao;YANG Chao;TANG Daozhou;FENG Qian;GUO Shuzhen;XIAO Fengjuan;LI Xuying(Division of InfectiousDiseases Prevention and Control, Harbin Center for Disease Preventionand Control, Harbin Heilongjiang 150056, China)

机构地区：[1]哈尔滨市疾病预防控制中心传染病预防控制所,黑龙江哈尔滨150056

出　　处：《中国卫生标准管理》2018年第9期15-18,共4页China Health Standard Management

摘　　要：目的调查一起感染性腹泻暴发的感染来源,采取措施控制疫情蔓延。方法对病例进行回顾性调查,描述三间分布,调查学校基本情况和可疑因素,采集病例肛拭子标本及水样品进行实验室检查。结果疫情持续7天,累计病例92例,罹患率为6.4%。临床症状以呕吐(59.78%)、腹泻(55.43%)为主,无重症、住院及死亡病例;病例分布在20个班,平均年龄(10.4±1.2)岁;采集病例肛拭子10份,3份诺如病毒GⅡ型阳性,轮状病毒及肠道致病菌未检出;14日该小学及周边居民6份水样大肠菌群检出,其他5份镇内水样未检出;更换管线并清洗消毒供水水箱后,两次采集12份水样检测均符合国家标准;生冷食(OR=3.0,95%CI:1.1~8.4)、手卫生(OR=5.5,95%CI:1.9~16.1)、喝生水(OR=+∞)情况三种暴露因素与发病有关。结论本疫情为自来水分支管线渗漏,学校生活饮用水污染引起的诺如病毒GⅡ型感染性腹泻的暴发疫情。要加强托幼机构、学校等重点场所疫情监测和对供水的监测和管理。Objective To identify the infection source, transmission route and risk factors of an outbreak of infectious diarrhea, and to take measures to control the spread of the disease. Methods The cases were surveyed by retrospective epidemiological investigation. The basic information and suspicious factors of school was surveyed and the distribution characteristic was described. The anus swab samples of patients and the environmental specimens were tested in the laboratory. Results The outbreak lasted for 7 days, and 92 cases were identified, according for 6.4%. Clinical symptoms were mild, mainly involving vomiting （59.78%） and diarrhea （55.43%）, no severe, hospitalized or dead cases. The cases distributed in 20 classed, the average age of the patients was （10.4±1.2）. A total of 10 anus swab samples of patients were collected, and 3 was norovirus G Ⅱ positive. There was no rotavirus or pathogenic bacteria. A total of 23 water samples were collected. The number of coliform group exceeded standard in 6 water samples which were collected in this school and the surrounding resident home, but 5 water samples were well in other place in this towns. After replacing the pipe and cleaning the water tank, all the water samples were conformed to national standards. Eating cold raw （OR=3.0, 95%CI 1.1~8.4）, washing hand （OR=5.5, 95%CI ： 1.9~16.1） and drinking the tap water （OR=＋∞） were signifcantly associated with an increased risk of infection. Conclusion The event was caused by the contamination of community water supply system with norovirus. Surveillance programs on symptoms, disinfection of vomit and stool in places like nurseries and schools should be strengthened. Propose to strengthen of monitoring and management of water supply pipeline, so as to ensure the drinking-water safety.

关 键 词：诺如病毒 集中供水 暴发 感染性腹泻 学校 预防控制 

分 类 号：R181[医药卫生—流行病学]