一起工厂车间军团菌感染的暴发调查  

An investigation outbreak of legionnaires'disease in a factory

作　　者：何志明 黄福业 钟炜轲 He Zhiming;Huang Fuye;Zhong Weike(Administrative department of Shenzhen Pingshan Center for Disease Control and Prevention,Guangdong Shenzhen 518118,China;Department of Disease Control,Bao'an District Songgang Station for Health Prevention,Guangdong Shenzhen 518118,China)

机构地区：[1]深圳市坪山区疾病预防控制中心行政部,广东深圳518118 [2]深圳市宝安区松岗预防保健所疾控科,广东深圳518106

出　　处：《新发传染病电子杂志》2021年第3期234-237,共4页Electronic Journal of Emerging Infectious Diseases

摘　　要：目的对一起工厂暴发疫情进行调查,确定病原体、传染来源和传播危险因素,为疫情防控提供科学依据。方法2019年11月12日至20日,深圳市宝安区松岗预防保健所按现场流行病学调查步骤,对辖区内某军团菌感染暴发的工厂开展个案调查、职业卫生和环境卫生调查,采集样本进行实验室检测。结果共发病45例,所有病例均为3厂2楼组装车间的工人,年龄18~48岁,平均年龄28岁;其中疑似病例4例,临床病例36人,确诊病例5例,罹患率为10.98%(45/410)。主要临床表现为头痛39例(86.67%)、乏力35例(77.78%)、胸闷33例(73.33%)、头晕32例(71.11%)等。白细胞计数(9.81~30.29)×10^(9)/L,中性粒细胞计数(7.35~28.15)×10^(9)/L。首例病例发病时间为11月15日13:30,末例发病时间为11月15日21:10,符合点源暴露特征。A、B车间工人罹患率高于C车间(χ^(2)=6.37,P<0.05),不同性别工人之间罹患率差异有统计学意义(χ^(2)=34.90,P<0.001)。所有环境和血样均检出乳酸菌属、蜡样芽孢杆菌、脆弱拟杆菌、肠球菌属和草螺菌属等,并有5份血样检出非特异性军团菌基因片段,B车间天花板上空调出风口与患者血样病菌同源性一致。结论这是一起由中央空调和加湿器引起的军团菌庞蒂亚克热暴发疫情,病菌来源为管道式空调系统。Objective To investigate an outbreak in a factory,determine the pathogen,source of infection and risk factors of transmission,and provide scientific basis for epidemic prevention and control.Methods From November 12 to 20,2019,Bao'an District Songgang Station for Health Prevention of Shenzhen city carried out case investigation,occupational health and environmental health investigation on a factory suspected of Legionella disease outbreak according to the onsite epidemiological investigation steps,and collected samples for laboratory testing.Results from November 12 to 20,2019,there were 45 cases,including 4 suspected cases.36 clinical cases and 5 confirmed cases,with an attack rate of 10.98%(45/410).The main symptoms were headache(86.67%),fatigue(77.78%),chest tightness(73.33%),dizziness(71.11%),etc.The white blood cell count was(9.81~30.29)×10^(9)/L,neutrophil count(7.35~28.15)×10^(9)/L.The onset time of the first case was 13:30 on November 15,and that of the last case was 21:10 on November 15,which was consistent with the characteristics of point source exposure.All of them are day workers in the assembly workshop on the second floor of the third factory.Among them,the morbidity rate of workers in workshop A and B was higher than that in workshop C(χ^(2)=37,P<0.05),and there was significant difference between male and female(χ^(2)=34.90,P<0.001).The minimum age of the patients was 18 years old,the maximum age was 48 years old,and the average age was 28 years old.Lactic acid bacteria,Bacillus cereus,Bacteroides fragilis,Enterococcus and Spirillum were detected in all environment and blood samples,and non-specific Legionella gene fragments were detected in some blood samples.The air-conditioning outlet on the ceiling of workshop B had the same homology with the patient's blood samples.Conclusion This is a outbreak of Legionella Pontiaceae fever caused by central air conditioning and humidifier.The source of the outbreak is a pipe air conditioning system.

关 键 词：军团病杆菌属 庞蒂亚克热 暴发 工厂 

分 类 号：R181.8[医药卫生—流行病学] R516[医药卫生—公共卫生与预防医学]