浙江省一起发热伴血小板减少综合征聚集性疫情调查

顾时平; 吴雪; 周斌; 凌锋; 张宏; 黄艺; 胡雪根; 郑昆颖; 叶炜; 刘波; 孙继民

Abstract

顾时平,吴雪,周斌,凌锋,张宏,黄艺,胡雪根,郑昆颖,叶炜,刘波,孙继民.浙江省一起发热伴血小板减少综合征聚集性疫情调查[J].Chinese journal of Epidemiology,2015,36(4):364-367

浙江省一起发热伴血小板减少综合征聚集性疫情调查

Epidemiological investigation on an outbreak of severe fever with thrombocytopenia syndrome in northwest Zhejiang province

Received:September 15, 2014

DOI：10.3760/cma.j.issn.0254-6450.2015.04.015

KeyWord: 发热伴血小板减少综合征聚集性接触传播

English Key Word: Severe fever with thrombocytopenia syndrome Cluster Transmission through contact

FundProject:浙江省科技重大专项(2012C13016-2); 浙江省医药卫生平台计划(2014RCA002)

Author Name	Affiliation	E-mail
Gu Shiping	Anji Center for Disease Control and Prevention, Zhejiang 313300, China
Wu Xue	Anji Center for Disease Control and Prevention, Zhejiang 313300, China
Zhou Bin	Anji Center for Disease Control and Prevention, Zhejiang 313300, China
Ling Feng	Zhejiang Provincial Center for Disease Control and Prevention
Zhang Hong	Anji Center for Disease Control and Prevention, Zhejiang 313300, China
Huang Yi	Anji Center for Disease Control and Prevention, Zhejiang 313300, China
Hu Xuegen	Anji Center for Disease Control and Prevention, Zhejiang 313300, China
Zheng Kunying	Anji Center for Disease Control and Prevention, Zhejiang 313300, China
Ye Wei	Anji Center for Disease Control and Prevention, Zhejiang 313300, China
Liu Bo	Anji Center for Disease Control and Prevention, Zhejiang 313300, China
Sun Jimin	Zhejiang Provincial Center for Disease Control and Prevention	jmsun@cdc.zj.cn

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Abstract:

目的调查2014年5月浙江省西北山区一起发热伴血小板减少综合征(SFTS)暴发疫情的发生原因、传播方式和危险因素。方法制订病例定义并开展病例主动搜索, 现场调查采用统一调查表, 利用回顾性队列研究分析危险因素。采集首发病例污染的血迹涂抹标本和续发病例血液标本, 采用RT-PCR检测新型布尼亚病毒核酸, 同时开展人群和动物血清流行病学调查及生物媒介监测。结果该起疫情共发生13(男性6, 女性7)例。首发病例于4月23日急性起病, 5月1日死亡, 5月10－16日参与丧事的8名亲属、3名邻居及1名同村村民陆续发病, 发病高峰为5月13日, 潜伏期为9～15 d。该13例均急性起病, 临床表现为发热(100%)、畏寒(92%)、乏力(92%)、全身酸痛(92%)、纳差(92%)、头痛(77%)、恶心(69%)等。首发病例病前在居住地采野茶持续1月余, 曾有蜱叮咬史。5月1日首例死亡后, 续发病例中9人直接接触过死者血液, 回顾性队列研究证实直接接触血液是危险因素(RR=43.36, 95%CI:13.66～137.63, P=0.000)。结论该起为家庭内人传人SFTS聚集性疫情, 直接接触血液是疫情暴发的主要危险因素, 但不排除通过气溶胶传播的可能性。

English Abstract:

Objective To investigate the source, transmission route and risk factors of an outbreak of severe fever with thrombocytopenia syndrome(SFTS). Methods Case definition was made and suspected cases were searched. A standardized questionnaire was used to collect information on demographic features (age, gender, occupation, residential address), history of exposure, clinical signs and symptoms etc. Blood samples were collected from 12 suspected cases while index patient’s blood samples were collected from walls of the residence. All samples were detected for SFTS virus using RT-PCR. Sero-prevalence rates of SFTS virus IgG were also conducted among healthy people, host and vectors. Methods A total of 13 cases including 6 male and 7 female were identified during this outbreak in May 2014. Index patient developed illness onset on April 23 and died on May 1. Secondary patients would include 8 family members, 3 neighborhoods, 1 individual who lived in the same village, developing illness onset between May 10 and 16, with a peak on May 13. The incubation period was 9-15 days. Clinical signs and symptoms appeared as fever (100%), chill (92%), anergy (92%), body aches (92%), anorexia (92%), headache (77%), nausea (69%) etc. Neutropenia and thrombocytopenia also appeared. History of the index patient showed that she collected tea leaves in her hometown 1 month before the illness onset. After index patient died on May 1, 9 secondary patients had directly contacted the blood of the deceased. Data from the retrospective cohort study showed that‘direct contact with blood’was an important risk factor(RR=43.36, 95%CI:13.66-137.63, P=0.000). Conclusion Majority of the secondary patients of these clusters contracted the SFTS virus infection through exposure to the blood of the index patient. However, aerosol transmission could not be ruled out, suggesting that precaution should be taken for doctors, nurses and family members when looking after the patients with SFTS virus infection.

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