一起饮水污染导致埃可病毒3O型脑膜炎暴发的调查

陆向东; 崔亮亮; 马焰; 祖荣强; 申涛; 李蒋清; 姚建香; 单军; 谢琪; 施超; 曾光

Abstract

陆向东,崔亮亮,马焰,祖荣强,申涛,李蒋清,姚建香,单军,谢琪,施超,曾光.一起饮水污染导致埃可病毒3O型脑膜炎暴发的调查[J].Chinese journal of Epidemiology,2012,33(10):1067-1071

一起饮水污染导致埃可病毒3O型脑膜炎暴发的调查

A viral meningitis outbreak associated with Ech030 in drinking water

Received:June 25, 2012

DOI：

KeyWord: 埃可病毒30型暴发病例对照研究饮水

English Key Word: Eehovirus 30 Disease outbreaks Case-control studies Dinking-water

FundProject:

Author Name	Affiliation	E-mail
Lu Xiangdong	Jiangyin Center for Disease Control and Prevention, Jiangyin 214434, China
Cui Liangliang	Chinese Field Epidemiology Training Program(CFETP) Jinan Center for Disease Controf and Prevention
Ma Yan	Jiangyin Center for Disease Control and Prevention, Jiangyin 214434, China
Zu Rongqiang	iiangsu Provinciaf Center for Disease Control and Prevention	cdczrq@163.corn
Shen Tao	Chinese Field Epidemiology Training Program(CFETP)
Li Jiangqing	Jiangyin Xuxiake Hospital
Yao Jianxiang	Jiangyin Center for Disease Control and Prevention, Jiangyin 214434, China
Shan Jun	iiangsu Provinciaf Center for Disease Control and Prevention
Xie Qi	Jiangyin Xuxiake Hospital
Shi Chao	Wuxi Center for Disease Control and Prevention
Zeng Guang	Chinese Field Epidemiology Training Program(CFETP)

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Abstract:

目的调查一起学校内多名学生发热伴头晕、头痛，或伴恶心、呕吐的感染原因与影响范围，提出控制措施。方法疑似病例定义为2012年3月1日后L学校师生中?现发热(腋温≥37℃)伴头晕、头痛、恶心、呕吐症状之一者；确诊病例为疑似病例咽拭子或肛拭子肠道通用病毒RT-PCR阳性者。病例搜索通过查阅3月1日后当地4家医院就诊记录和学校师生冈病缺课缺勤记录。采用1：2个体匹配的病例对照研究分析饮水暴露情况。采集27名病例的咽拭子和肛拭子进行肠道通用病毒RT-PCR及序列分析。4月19日采集2份直饮水机温开水样品分析细菌总数和大肠菌群。结果学校学生病例103例，罹患率4.6％(1032255)。77.7％(80／103)病例来自该校综合楼，三年级罹患率最高18.1％(721397)。流行病学曲线为持续同源暴露，饮用直饮水机温开水(OR=18.3，95％CI：2.0～169.5)和饮用生水(OR=15.5，95％CI：1.7～141.8)均是危险冈素。27名病例肠道通用病毒RT-PCR检出率为81.5％(22／27)，其中9例PCR序列分析有7例为埃可病毒卸型(Echo 30)。直饮水机温开水细菌总数和大肠菌群检测结果符合标准。结论该次疫情是由Echo 30导致的一起学校内病毒性脑膜炎暴发，饮水是危险因素，不同于以往的人传人模式，值得关注。

English Abstract:

Objeetive To study the source of infection，the scope of epidemic and controlmeasures in an outbreak involving students having symptoms as fever，dizziness，headache，vomitingand nausea.Methods The suspected-case was defined as fever(armpit temperature≥37 oc)and with one or more of the following symptoms：dizziness，headache，vomiting and nausea，among students and teachers at sch001 from Mar 1.2012.Confirmed-case was among suspected case accompanied by both throat and rectal swabs enterovirus positive by RT-PCR.An the cases werecollected through checking the medical records from 4 hospitals as well as through the absence records of students and teachers.from Mar 1.2012.We conducted a case-control study with ratio of 1：2 anddata on the exposures to water among students and teachers was collected prior to the illness.27 cases’throat and rectal swabs were collected and analyzed bv RT-PCR and PCR sequence methods.2warm-water samples were collected for testing the counts on total bacteria and E eoli.Resultsl 03students’cases were identified in school L.with the attack rate as 4.6％(103／2255).Students fromGrade three had the high attack rate as 18.1％(72／397)and 77.7％(80／103)ofthe cases located in the building with‘multiple-functions’.Epidemic curve of the outbreak showed a paRem with continuouscommon source of infection.It seemed that the exposure to warm-water appeared to be the major risk factor(OR=18.3.95％C，：2.0-169.5)togetherwiththeintake ofan。boiledwater(0尺=15.5，95％CI：1.7-141.8).Specimens from 27 students(81.5％，22／27)were identified enterovirus positive by RTPCR，and 7 of the 9 students were confirmed carrying Echo 30，Bacteria and coli were negative from the 2 warm-water samples.ConclusionThis viral meningitis-outbreak was caused by Echo 30，with drinking water as the major risk factor.

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