文章摘要
王树坤,王志刚,张晓和,阳波,吴强,阚飙,周燕华,杨汝松,闫梅英.云南省元江县2010-2011年一起甲型副伤寒暴发调查与处置[J].中华流行病学杂志,2017,38(2):200-204
云南省元江县2010-2011年一起甲型副伤寒暴发调查与处置
An outbreak of paratyphoid fever in a county of Yunnan province, 2010-2011
收稿日期:2016-07-06  出版日期:2017-02-17
DOI:10.3760/cma.j.issn.0254-6450.2017.02.013
中文关键词: 甲型副伤寒;甲型副伤寒沙门菌;暴发;流行病学调查
英文关键词: Paratyphoid A fever;Salmonella paratyphi A;Outbreak;Epidemiological investigation
基金项目:国家科技重大专项(2012ZX10004215)
作者单位E-mail
王树坤 653100 玉溪市疾病预防控制中心传染病控制科  
王志刚 653300 元江哈尼族彝族傣族自治县疾病预防控制中心传染病控制科  
张晓和 653300 元江哈尼族彝族傣族自治县疾病预防控制中心传染病控制科  
阳波 102206 北京, 中国疾病预防控制中心传染病预防控制所腹泻病室  
吴强 653100 玉溪市疾病预防控制中心传染病控制科  
阚飙 102206 北京, 中国疾病预防控制中心传染病预防控制所腹泻病室  
周燕华 653300 元江哈尼族彝族傣族自治县疾病预防控制中心检验科  
杨汝松 653100 玉溪市疾病预防控制中心传染病控制科  
闫梅英 102206 北京, 中国疾病预防控制中心传染病预防控制所腹泻病室 yanmeiying@icdc.cn 
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中文摘要:
      目的 现场调查一起甲型副伤寒暴发疫情的原因并进行处置。方法 对2010-2011年发生在云南省元江县的一起甲型副伤寒暴发进行流行病学特征描述,采用病例对照研究、环境卫生学检测调查引起暴发的危险因素及污染源,对病例标本进行病原分离及耐药检测,针对流行病学及实验室检测结果采取控制措施。结果 全县10个乡镇均有甲型副伤寒病例发生,2010年4月至2011年8月期间共报告病例600例,各乡镇发病率不同且发病水平随着与城区受污染蔬菜地距离增加呈减弱趋势。病例对照研究结果发现,吃生蔬菜是甲型副伤寒暴发的主要危险因素(OR=65.3,P<0.001)。调查发现病例管理不规范,病例排泄物进入城区污水沟。医院和城区污水中分离到甲型副伤寒沙门菌。采取政府主导的禁售及禁种污染田蔬菜并加强医院污水消毒等措施后,暴发得到有效控制。结论 城区、医院污水用于蔬菜田灌溉和生吃蔬菜区域性习惯共同作用促成污水-蔬菜-人群的传播循环,导致该起大型暴发流行。以政府为主导的干预措施对控制暴发起到了关键作用。
英文摘要:
      Objective To identify the source and to comment on control program regarding an outbreak of paratyphoid A fever in a county, through field studies. Methods Descriptive epidemiological methods were adopted to describe the epidemiological characteristics of the outbreak, which occurred in Yuanjiang county, Yunan province between 2010-2011, China. Case-control study with environmental investigation was performed to identify related risk factors and pathogens while isolation and susceptibility on the suspected pathogens were conducted. Subsequently, intervention and preventive measures were taken for the control of the outbreak. Results A total of 600 cases were diagnosed and reported as paratyphoid fever A which spread over the whole Yuanjiang county, including 10 townships with different incidence rates. The disease was spatially clustered and the prevalence rates in these townships decreased with increasing distances from the polluted fields. Data from the case-control study discovered that consumption of raw vegetables was the main risk factor associated with this outbreak of paratyphoid fever (OR=65.3, P<0.001). Management of patients did not meet the requirements while feces and urine of the outpatients polluted the wastewater system in the city. Salmonella paratyphi A isolates were identified from the improperly disinfected wastewaters in hospitals and city systems, respectively. After the measures as prohibiting the planting of vegetables in contaminated fields and disinfection of hospital wastewater were taken, the outbreak subsided. Conclusions Urban and hospital wastewater used for vegetables irrigation together with the tradition of eating uncooked vegetables seemed responsible for the outbreak of this paratyphoid fever. Intervention programs carried by the local government played a key role in controlling this large outbreak.
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