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刘颖1,舒红2.某幼儿园一起经气溶胶传播的诺如病毒聚集性疫情调查[J].中国医药科学,2019,(16):183-186        基金项目:
某幼儿园一起经气溶胶传播的诺如病毒聚集性疫情调查
Investigation on cluster epidemics of norovirus transmitted by aerosol in a kindergarten
  
DOI:
中文关键词:  诺如病毒;聚集性疫情;气溶胶传播;胃肠炎;疫情防控
英文关键词:Norovirus;Cluster epidemics;Aerosol transmission;Gastroenteritis;Epidemic prevention and control
作者单位
刘颖1,舒红2 1. 广西壮族自治区桂林市疾病预防控制中心,广西桂林 541001;2. 广西壮族自治区疾病预防控制中心,广西南宁 530021 
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中文摘要:
      [摘要] 目的 通过调查某幼儿园一起诺如病毒感染聚集性疫情,分析疫情发生的原因,探讨如何在托幼机构有效开展诺如病毒等传染病的防控。 方法 制定病例定义并开展病例搜索,通过病例个案调查和现场流行病学调查,分析流行特征和危险因素,采集病例、食堂工作人员、饮用水和食堂留样食品标本等进行实验室检测。 结果 疫情发生时间为 2018 年 4 月 25 日 8:00 ~ 4 月 27 日 13:30,病例集中在一个班,发病 14例,班级罹患率 37.84%(14/37),男女生发病率分别为 33.33%(6/18)、42.11%(8/19),男女生发病率差异无统计学意义(P=0.737)。该幼儿园无外食,供水、供餐均为随机分配。首发病例在教室呕吐后,生活老师未按照“消毒 - 清理 - 消毒”的规范流程进行消毒处理,处置呕吐物时未转移班上儿童。采集 6 例现症病例肛拭子、呕吐物标本,RT-PCR 检测均为诺如病毒 G Ⅱ核酸阳性,采集 4 例食堂员工肛拭子标本、饮用水和食堂留样食品所有检测结果均为阴性。 结论 该疫情为一起诺如病毒感染引起的胃肠炎聚集性疫情,生活老师清扫呕吐物的过程中处理不当,且未进行人员疏散,密闭环境中形成携带病毒的气溶胶,造成局部范围的共同暴露感染,并通过气溶胶 - 人 - 人接触模式进一步传播是主要原因。建议托幼机构加强传染病防病意识,加强对老师的卫生培训、指导,严格执行传染病报告和管理制度,提高消毒等工作的规范性,以预防和控制诺如病毒胃肠炎等疾病在托幼机构中的发生,保证儿童的健康。
英文摘要:
      [Abstract] Objective To analyze the causes of the outbreak and explore how to effectively carry out the prevention and control of norovirus and other infectious diseases in childcare institutions by investigating a cluster epidemics of norovirus infection in a kindergarten. Methods Case definitions were developed and case searches were conducted.The epidemiological characteristics and risk factors were analyzed through case investigation and field epidemiological investigation.Cases,canteen staff,drinking water and canteen food samples were collected for laboratory testing. Results The epidemic disease occurred from 8:00 on April 25,2018 to 13:30 on April 27,2018.The cases were concentrated in one class,with 14 cases,and the attack rate of the class was 37.84% (14/37).The incidence rates of male and female students were 33.33% (6/18) and 42.11% (8/19) respectively.There was no statistically significant difference in the incidence of male and female students (P=0.737).The kindergarten had no food,and the water supply and meals were randomly assigned.After the first case vomited in the classroom,the life teacher did not follow the“disinfection-cleaning-disinfection” standard process for disinfection treatment and did not transfer the children in the class when handling the vomitus.Anal swabs and vomitus samples of 6 current cases were collected,and the RT-PCR assays were all positive for Norovirus GII nucleic acid.Anal swab samples,drinking water and canteen food samples of 4 canteen staff were collected and all tests were negative. Conclusion The epidemic is a gastroenteritis cluster epidemic caused by Norovirus infection.The life teacher handles the vomit improperly in the process of cleaning and he does not evacuate the staff.The aerosol carrying virus forms in the closed environment,resulting in a localized range of common exposure infections.Further transmission through aerosolhuman-human contact patterns is the main reason.It is recommended that child care institutions strengthen awareness of infectious disease prevention,strengthen health training and guidance for teachers,strictly implement reporting and management systems of infectious disease and improve the standardization of disinfection and other work to prevent and control gastroenteritis and other diseases caused by Norovirus in child care institutions in order to ensure the health of children.
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