2023年广东省深圳市宝安区一起学校急性出血性结膜炎暴发疫情调查  

Investigation of an outbreak of acute hemorrhagic conjunctivitis in a school in Bao'an district,Shenzhen,Guangdong,2023

作　　者：刘金凤 陈亿雄[1] 李苑[1] 马志锋 陈材 向海山 杨文英 洪烈城 Liu Jinfeng;Chen Yixiong;Li Yuan;Ma Zhifeng;Chen Cai;Xiang Haishan;Yang Wenying;Hong Liecheng(Bao'an District Center for Disease Control and Prevention,Shenzhen 518102,Guangdong,China;Bao′an Field Epidemiology Training Program,Shenzhen 518102,Guangdong,China;Bao'an District Public Health Service Center,Shenzhen 518102,Guangdong,China;Longchuan County Center for Disease Control and Prevention,Heyuan 517300,Guangdong,China)

机构地区：[1]深圳市宝安区疾病预防控制中心,广东深圳518102 [2]深圳市宝安区流行病学培训项目,广东深圳518102 [3]深圳市宝安区公共卫生服务中心,广东深圳518102 [4]河源市龙川县疾病预防控制中心,广东河源517300

出　　处：《疾病监测》2024年第12期1655-1660,共6页Disease Surveillance

摘　　要：目的调查2023年广东省深圳市宝安区一起学校急性出血性结膜炎暴发疫情,分析发病危险因素,提出针对性的防控建议。方法采用现场流行病学方法开展调查,用描述性流行病学方法描述2023年9月广东省深圳市宝安区一起学校急性出血性结膜炎暴发疫情,分析符合病例定义的3种病例的临床症状和三间分布特征,通过回顾性队列研究分析疫情暴发的危险因素。采集病例结膜拭子、环境涂抹样本,采用实时荧光定量反转录–聚合酶链式反应(RT-PCR)方法检测肠道病毒70型(EV-A70)和柯萨奇病毒A组24型(CVA24)。结果共搜索病例123例,均为学生,罹患率为8.27%(123/1487)。病例症状以结膜充血(90.25%)、眼分泌物(74.80%)、眼异物感(51.22%)和眼刺痛(47.76%)为主。病例分布在不同楼层、年级和班级,且组内罹患率总体差异有统计学意义(P<0.001)。首末例病例发病时间分别为9月5日和9月21日,9月15日报告病例数最多(27例),流行曲线显示为人传人模式。17份结膜拭子和1份水龙头把手环境涂抹样本检出CVA24阳性。多因素log-binomial回归分析结果显示,同校兄弟姐妹有充血性结膜炎[相对危险度(RR)=18.59,95%置信区间(CI):3.69~93.80]、与他人手部接触(RR=2.79,95%CI:1.25~6.23)、与充血性结膜炎症状同学玩耍(RR=2.30,95%CI:1.01~5.26)为危险因素,其他危险因素与发病关联差异无统计学意义(P>0.05)。结论该疫情为一起由CVA24变种引起学校急性出血性结膜炎暴发事件,主要通过密切接触传播,特别是与病例的直接玩耍和手部接触,同时家庭内的充血性结膜炎病例也成为部分班级和年级间传播的关键因素。建议学生要避免与充血性结膜炎同学之间的手接触,同时要做好与家中充血性结膜炎兄弟姐妹的相对隔离和个人防护。Objective To investigate an outbreak of acute hemorrhagic conjunctivitis in a school in Bao'an district,Shenzhen of Guangdong province,in 2023,identify associated risk factors,and suggest prevention and control strategies.Methods A field epidemiological investigation was carried out,descriptive epidemiological analysis was done on the clinical symptoms and distribution of three types of cases who met the case definitions and a retrospective cohort study was conducted for risk factor analysis.Conjunctival swabs and environmental smears were collected the detections of enterovirus 70(EVA70)and coxsackievirus A24(CVA24)with real-time fluorescence quantitative reverse transcription-polymerase chain reaction(RT-PCR).Results In 1487 students,123 cases of acute hemorrhagic conjunctivitis were identified with an attack rate of 8.27%.The main symptoms included conjunctival hyperemia(90.25%),secretory ocular discharge(74.80%),foreign body sensation in eye(51.22%),and ocular pruritus(47.76%).The differences in attack rate were significant among students on different floors and in different classes/grades(P<0.001).The outbreak lasted from 5 to 21 in September,and the case count peaked on September 15(27 cases),and the incidence curve suggested person to person transmission.RT-PCR detected CVA24 in 17 conjunctival swabs and 1 tap water handle smear.Multivariate log-binomial regression analysis identified significant risk factors,including having sibling with acute hemorrhagic conjunctivitis at the same school[relative risk(RR)=18.59,95%confidence interval(CI):3.69−93.80],direct hand contact(RR=2.79,95%CI:1.25−6.23),and interaction with symptomatic classmate(RR=2.30,95%CI:1.01−5.26),and the other risk factors were not statistically significantly associated with the onset of the illness(P>0.05).Conclusion This was an outbreak of acute hemorrhagic conjunctivitis caused by CVA24 variant,the disease was mainly transmitted through close contacts with the cases,including direct hand contacts,while the transmission among family

关 键 词：急性出血性结膜炎 学校 暴发 流行病学调查 

分 类 号：R211[医药卫生—中医学] R512.5