CAJ | 학술논문

目的对江西省赣县某农村小学甲肝暴发进行调查,查找危险因素和传播途径,并提出针对性预防控制措施.方法调查疑似病例为2008年11月1日至2009年2月14日期间,该校师生中符合下列任何之一者:(1)出现黄疸(尿、巩膜或皮肤黄染)者.(2)丙氨酸氨基转移酶(ALT)出现2倍及以上升高并具有≥2项下列症状者:纳差、厌油、腹痛、恶心、乏力、呕吐.确诊病例为疑似病例并甲肝病毒IgM抗体阳性者.通过查阅乡镇卫生院和村诊所门诊记录、对学校师生开展症状筛查,进行病例搜索.开展病例对照研究,比较病例组和对照组(从同年级无症状、IgM阴性的学生中随机选取)的危险因素暴露情况.结果共搜索到21例甲肝病例,均为小学生,罹患率为3.5％.流行曲线呈现两个高峰,间隔28 d,均为点源暴露模式.病例对照研究显示,饮用B井生水是发病危险因素(0R=4.0,95％CI:1.1～ 15).B井水检测细菌总数600 cfu/ml,大肠菌群23 MPN/100 ml.结论本次甲肝暴发系因饮用被污染的B井生水所导致.建议学校改用经过统一消毒的管网自来水,公共卫生部门应加强学校饮水的卫生监督.
목적 대강서성공현모농촌소학갑간폭발진행조사,사조위험인소화전파도경,병제출침대성예방공제조시.방법 조사의사병례위2008년11월1일지2009년2월14일기간,해교사생중부합하렬임하지일자:(1)출현황달(뇨、공막혹피부황염)자.(2)병안산안기전이매(ALT)출현2배급이상승고병구유≥2항하렬증상자:납차、염유、복통、악심、핍력、구토.학진병례위의사병례병갑간병독IgM항체양성자.통과사열향진위생원화촌진소문진기록、대학교사생개전증상사사,진행병례수색.개전병례대조연구,비교병례조화대조조(종동년급무증상、IgM음성적학생중수궤선취)적위험인소폭로정황.결과 공수색도21례갑간병례,균위소학생,리환솔위3.5％.류행곡선정현량개고봉,간격28 d,균위점원폭로모식.병례대조연구현시,음용B정생수시발병위험인소(0R=4.0,95％CI:1.1～ 15).B정수검측세균총수600 cfu/ml,대장균군23 MPN/100 ml.결론 본차갑간폭발계인음용피오염적B정생수소도치.건의학교개용경과통일소독적관망자래수,공공위생부문응가강학교음수적위생감독.
Objective A hepatitis A outbreak in a primary school was reported by Gan County Center for Disease Control and Province (CDC) and an investigation was conducted to identify the possible source of infection and risk factors for transmission.Methods A probable case was defined as having onset of jaundice (yellow urine,sclera or skin) or a 2-fold increase in Alanine aminotransferase with 2 or more,of the followings symptoms:anorexia,disgust of oil,abdominal pain,nausea,fatigue,vomiting,in students and staff of the primary school between 1 November 2008 and 14 February 2009.A confirmed case was IgM positive for hepatitis A,added on a probable case.We searched for cases through reviewing medical records in the township hospital and village clinics and conducting symptom screening among students or teachers.We also conducted a case-control study to compare the exposure histories of 19 cases and 53 anti-HAV-IgM negative controls randomly selected from those asymptomatic students in the same grade.Results 21 cases from all the students was identified,with the attack rate as 3.5％.The epidemic curve showed the two peaks of the outbreak were 28 days apart,both indicating that they were related to the exposure of the source of origin.74％of the case-students drank the unboiled Well B water,compared to 42％ of control-students (OR=4.0,95％CI:1.1-15).The total bacterial count was 600 cfu/ml and the total coliform was 23 MPN/100 ml in one sample collected from the well water.Conclusion This hepatitis A outbreak was caused by drinking contaminated water in Well B.We recommended that all the schools should use chlorinated municipal pipe water.Public health authorities should strengthen the supervision of quality of water in schools.